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Due to wartime, which leads to an increase in food and water contamination, Syria is facing its first polio outbreak in over a decade. With the lack of healthcare professionals, fewer children were being vaccinated against the poliovirus as well. Now, after the World Health Organization (WHO) confirmed cases of polio, the Syrian Health Ministry has been working hard to vaccinate vulnerable children. Despite their efforts, a new study conducted by two German doctors is reporting that the outbreak could become a major threat to Europe.

"The WHO wants to get rid of polio completely and had got pretty close until recent outbreaks. The fact that most of those infected do not display symptoms but can still spread the disease makes it a very hard virus to get rid of as it is like fighting an invisible enemy," Professor Martin Eichner from the University of Tubingen said.

The research team made up of Eichner and Stefan Brockmann from Reutlingen Regional Public Health Office reasoned that since people can carry the virus without being detected and diagnosed, silent transmissions could occur before a massive outbreak. The team stated that around one in 200 people infected with the virus develops paralysis. The rest of the infected people could live and transmit the virus before any symptoms show up, making a potential outbreak relatively hard to control.  

The researchers also stated that in many European nations, governments use the inactivated polio vaccine (IPV) as opposed to the live oral polio vaccine (OPV). Even though IPV is effective, it does not protect as well as the oral option. Therefore, in some nations where vaccination coverage is relatively low, such as Austria and Ukraine, the risk of a polio outbreak is high.

"The Syrian outbreak puts Europe at risk because of the way we give vaccines. In parts of the world where it is still possible to catch a wild strain of poliovirus, children are usually vaccinated with a live but genetically weakened poliovirus which gives excellent protection but has a tiny risk of changing back to the more dangerous form," Dr. Benjamin Neuman said according to BBC News. Neuman is a virologist at the University of Reading. "However, in parts of the world where polio has been eradicated, like the UK, children are usually given a killed vaccine. It doesn't protect quite as well but it cannot mutate, so it protects reasonably well while preventing polio from being accidentally reintroduced to a country.

So far, Syria has 22 confirmed cases of polio with 10 of them identified as the wild poliovirus type. The majority of the cases occurred in children under two-years-old who were not vaccinated or did not receive the full course of vaccinations. In 2013, there have been 322 cases of wild poliovirus with half of them from Somalia.

The study was published in The Lancet.