Polio spreads from Nigeria to Indonesia and other Islamic countries

Donald G. McNeil Jr:

A case of polio has been detected in Indonesia, World Health Organization officials said today, indicating that an outbreak spreading from northern Nigeria since 2003 had crossed an ocean and reached the world's fourth-most-populous country.

The virus, found in a village in Java, is most closely related to a strain that was found in Saudi Arabia in December, they said, and the most likely explanation is that it was brought back either by an Indonesian working there or by a pilgrim who went to Mecca in January.

Indonesia's last case was in 1995, and it is now the 16th country to be re-infected by a strain of the virus that broke out of northern Nigeria when vaccinations stopped there, then crossed Africa and the Red Sea.

Officials recommended that Indonesia immediately vaccinate five million children on the western end of Java, including the capital, Jakarta, to control the virus. The country began planning such a drive last week, they said.

Indonesia has more Muslims than any other nation, and polio is now found almost exclusively in Muslim countries or regions.

Many people from northern Nigeria to the Pakistan frontier have resisted getting polio vaccines because of persistent rumors that it is a Western plot to render Muslim girls infertile or to spread AIDS. (Paradoxically, after several states in Muslim northern Nigeria halted vaccinations in 2003, it was purchases of Indonesian vaccine that finally convinced wary imams and politicians to drop their opposition, because it came from a Muslim country.)

With each new case, the W.H.O.'s goal of eradicating polio by the end of this year slips farther away. Its emergency response fund is virtually depleted and the agency has begun pleading with donors for help controlling new outbreaks in Ethiopia, Yemen and other very poor countries.

At the disease's low point, in early 2003, it was endemic in only six countries: Nigeria, Niger, Egypt, Pakistan, Afghanistan and India.

The current case was found in an 18-month-old boy in a village in Sukabhumi province in West Java who became paralyzed in mid-March, said Dr. Bruce Aylward, coordinator of the polio eradication campaign for the W.H.O.

Genetic typing, just completed in Bombay, India, clearly shows that the original source of the strain was northern Nigeria, said Dr. David L. Heymann, the W.H.O. director general's representative for polio eradication.

Comparison to databases at the Centers for Disease Control and Prevention in Atlanta shows that is about 99.2 percent similar to a strain circulating in Saudi Arabia and 99.1 percent similar to a strain in Sudan, suggesting that it came from Saudi Arabia, "but they're so close that it's a hard call," Dr. Aylward said.

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