No Polio in Venezuela, But Challenges Remain: Public Health Watch

These days, public health specialists and clinicians working on the ground in Venezuela follow one simple rule: Assume the worst.

At least that seems to be the case after reports surfaced last week that a 3-year-old child from the Warao indigenous community in the rural northeastern part of the country presented to a clinic with symptoms of paralysis consistent with polio. Officials notified the Pan-American Health Organization (PAHO), and headlines trumpeted that the troubled South American country was facing yet another public health crisis.

In 2018 alone, Venezuela has already confronted outbreaks of HIV, as reported by Contagion^®, and measles. The latter has resulted in 70 deaths and now threatens communities in neighboring Colombia and Brazil.

“There are significant gaps in community protection through vaccination in [Venezuela],” Edwin J. Asturias, MD, Jules Amer Chair, Community Pediatrics, Children’s Hospital Colorado and associate professor, Pediatrics and Epidemiology, University of Colorado School of Medicine told Contagion^®. Dr. Asturias has written extensively about health challenges in general, and vaccination specifically, in South America.

“These communities are also at risk of measles, diphtheria, and other infections that have already reemerged in the country and could be well prevented by a strong vaccination program,” he continued. “In Venezuela, the low vaccine coverage is being driven by the erosion of the health system due to the economic and political crisis. Every time a country dips into economic or political struggle, we see these diseases reemerging.”

It turns out, though, that at least with regard to polio, health officials had sounded a false alarm—this time. Within 1 day of the news that the country had its first documented case of the deadly disease since 1961, PAHO and the World Health Organization (WHO) issued a clarification: The child’s acute flaccid paralysis was not caused by polio; and, the child had, in fact, been vaccinated against the disease. As of this writing, the cause of the child’s symptoms remains unknown.

To be clear, this is not a criticism of health officials and providers in Venezuela. The country has been on the brink of collapse since the death of former president Hugo Chavez in 2013, though some would argue it was in trouble when the leader was still alive and in charge. As a result, the health infrastructure is in dire straits, hampered by medication shortages and crumbling facilities. Given the recent history of disease outbreaks and other crises, even in the most cosmopolitan regions of the country, a diagnosis of polio in a child from a poor, rural area where vaccine coverage is likely limited is hardly far-fetched.

Indeed, it’s important here to not accuse those working on the frontlines in Venezuela of “crying wolf.” Rather, the polio misdiagnosis should be considered a dodged bullet—for now.

“The main reason for these infections coming back is the lack of population immunity, meaning not enough people are protected with these life-saving vaccines,” Dr. Asturias said. “Polio easily transmits in communities when vaccine coverage is below 50%. The main challenge ahead is for organizations like the PAHO and other partners to be allowed to coordinate with the Venezuelan government to launch a massive campaign to rapidly provide immunity to children and those at risk in these areas of vulnerability.”

And if that doesn’t happen soon, clinicians working in the region are expecting the worst. In other words, sadly, it may only be a matter of time before a deadly diagnosis in Venezuela isn’t a misdiagnosis but a harbinger of things to come.

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous health care-related publications. He is the former editor of Infectious Disease Special Edition.