Exploding polio epidemic in South Africa is fueling a strain of disease that is now resistant to the vaccine

At least 65 new cases of the disease have been reported in the Capetown area, bringing the total in South Africa since June 5 to roughly 370. Experts are running out of treatments.

Trying to catch a break

At a distribution center in a tidy parking lot, numerous green, cardboard shipping boxes of polio vaccine were ready for distribution to early childhood education centers and preschools in South Africa, the continent’s largest economy and commercial hub.

These centers – and the clinics, kindergartens and other public health facilities across South Africa – are rushing to meet a burgeoning demand for polio vaccine.

So far, they’ve been able to successfully prevent any infections through immunizing every child with the vaccine. It’s the main method of protection against polio that has been devised in the last decade. But it hasn’t been enough.

It’s impossible to verify, but the sudden growth in South Africa appears to be driven by poor sanitation practices. During a massive nationwide immunization campaign that started in July 2017, 21 confirmed cases of a strain of the polio virus identified as type 2, a dangerous strain of the virus, were recorded, according to a report released on Tuesday by The World Health Organization. Many more children were still at risk because the strain was not being detected.

But in a quick-moving new outbreak this year, that type 2 strain has resulted in more than 60 new cases of polio-like illnesses and six fatalities in South Africa, according to the WHO report. Scientists found the polio strain at two major events – blood collection demonstrations for a kidney dialysis center in one hospital and a conference held at a college on the outskirts of Cape Town – that “set the stage for the outbreak to appear in July,” the report said.

The World Health Organization called this sequence of events “unusual.”

“You would normally expect to see it before a larger outbreak of these polio strains,” said Matt Ryan, the WHO South Africa representative.

It’s impossible to confirm, but many health experts believe the more than 450 cases that have been reported in South Africa may be an early “end point” in the spread of the polio strain. Since the summer 2017 round of immunizations, the strain mutated again and spread to Angola and Nigeria, where it has killed dozens.

Tomaz Kolakci, an epidemiologist with the United Nations children’s fund, UNICEF, said that South Africa’s largest public health facility was overwhelmed in recent weeks by cases of rubella, a disease that has become resistant to most vaccine-preventable vaccines in the world.

“Our hospitals cannot cope with the patients coming from all over the country, and each hospital has become its own clinic,” Kolakci said in a statement.

Most hospitals and clinics in South Africa are experiencing similar strains of a severe shortage of beds and medicine, adding to their problems.

Those running the centers distributing polio vaccine said immunization this year has been more difficult to reach than in past years, due to a lack of refrigeration capacity for the drops and a lack of money from national coffers. It also takes longer to reach children because transportation distances are longer in the northern provinces and less accessible because of lack of power.

“The fact is that we have this outbreak and we need to stop it,” said Crinabelo Kooyong, chief executive of the Royal Hospital for Sick Children in Pretoria, South Africa’s largest city. “It’s costing us money and we need to address it. We are trying as hard as we can, but the supply chain needs to be improved.”

Still, nearly 800 children have been immunized every day this month in South Africa, according to the South African National Primary Health Care Reference Laboratory.

And even with tough conditions, some primary health care facilities, such as those run by the Van der Merwe Foundation – an international public health organization that supports HIV care, health promotion and hepatitis treatment – have been able to help.

“We have been busy at any minute,” said Elisabet du Toit, a nurse in the facility, as she went through immunization of a child and explained why vaccination is so important. “It’s due to this outbreak that we are having so many people now come in, and we don’t have enough staff. We would like to have more than we do have now.”

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