Indonesia, once declared polio-free by the World Health Organization (WHO), is now grappling with a resurgence of the disease. The outbreak, primarily centered in the East Java province, has raised concerns among health authorities and experts. According to Infectious diseases specialist Professor Robert Booy, the situation is more alarming than initially reported, with an estimated 200 cases of polio in the region. This unexpected resurgence is attributed to a mutated strain of the polio vaccine circulating in the community, posing a heightened risk to human health.
Recent reports indicate cases of acute flaccid paralysis (AFP) caused by Polio Virus Type 2 in East Java and Central Java. Three children have been confirmed to have AFP, and lab results from the surrounding area have revealed nine other children testing positive for the virus. Two of these children are currently in intensive care. These cases are believed to be linked to the circulating vaccine-derived poliovirus type 2 (cVDPV2).
The mutation of the polio vaccine used in the affected regions is identified as a significant factor contributing to the outbreak. This mutated vaccine has taken on a more dangerous form, leading to increased transmission and the emergence of symptomatic cases. Additionally, sub-optimal vaccination coverage in various districts has heightened the risk of further transmission and its impact on human health.
Vaccine hesitancy rooted in sociocultural barriers, particularly within the Madura community in East Java, has posed challenges to vaccination efforts. Fear of adverse effects, multiple injections, and religious reasons have hindered the immunization drive. The complex sociocultural landscape has played a role in the resurgence of a disease that was once thought to be eradicated.
Polio is a highly infectious disease that primarily affects children under the age of five, potentially causing permanent paralysis or death. The virus spreads through the fecal-oral route, contaminated water, or food. Oftentimes, the disease goes unrecognized as up to 90% of infected individuals either show no symptoms or experience mild ones. Vaccine-derived poliovirus, resulting from the mutation of the oral polio vaccine (OPV), can circulate in communities with low vaccination coverage.
In response to the outbreak, extensive public health measures are being implemented. Case investigations, risk assessments, and active case finding in affected households are currently underway. It is crucial to coordinate with the global polio eradication initiative, and efforts are being made to enhance routine immunizations, particularly with the inactivated polio vaccine (IPV). The release of a novel oral polio vaccine type 2 (nOPV2) has been approved to conduct supplementary immunization activities (SIAs) aimed at curbing the outbreak.
The World Health Organization (WHO) has assessed the overall risk as high at the national level while acknowledging Indonesia’s strong response capacity. However, susceptibility to type 2 polioviruses raises concerns due to the switch from trivalent OPV to bivalent OPV and sub-optimal IPV vaccination coverage. The international risk is deemed moderate, emphasizing the need for heightened surveillance and cooperation across borders.
To prevent further spread, the government has declared an Extraordinary Event (KLB) status in East Java. National Immunization Weeks (PIN) have been initiated in several provinces to vaccinate children aged 0-7 years. Maintaining high vaccination coverage and addressing public awareness and hesitancy are crucial in containing the outbreak.
The low coverage of polio vaccines, worsened by the COVID-19 pandemic, is a critical concern. Misinformation and the belief that polio has been eradicated contribute to hesitancy. Collaborative efforts between health workers, community leaders, the media, and the government are essential to educate the public, improve hygiene practices, and address the current outbreak.
The unexpected resurgence of polio in Indonesia, despite being declared polio-free, highlights the importance of robust vaccination programs, surveillance, and public awareness. Urgent measures are needed to contain the outbreak, including enhanced vaccination efforts, addressing sociocultural barriers, and international cooperation. The global community must remain vigilant and support Indonesia in its fight against this resurgent public health threat.