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* Genetic sequencing shows strain is of Pakistani origin

* Virus also found in Egypt, Israel, West Bank and Gaza

* WHO warns of further spread in Middle East

By Stephanie Nebehay

GENEVA, Nov 11 (Reuters) – Polio that has crippled at least

13 children in Syria has been confirmed as being caused by a

strain of the virus that originated in Pakistan and is spreading

across the Middle East, the World Health Organisation said.

Genetic sequencing shows the strain found in Syrian children

in Deir al-Zor, where an outbreak was detected last month, is

linked to the strain of Pakistani origin found in sewage in

Egypt, Israel and Palestinian territories in the past year.

“Genetic sequencing indicates that the isolated viruses are

most closely linked to virus detected in environmental samples

in Egypt in December 2012 (which in turn had been linked to wild

poliovirus circulating in Pakistan),” the United Nations agency

said in a statement on Monday.

Closely-related strains of the wild poliovirus of Pakistani

origin have also been detected in sewage samples in Israel, the

West Bank and Gaza Strip since February 2013, it said.

Polio virus has been confirmed in 13 of 22 children who

became paralysed in the northern Syrian province of Deir al-Zor.

Investigations continue into the other 9 cases. It is Syria’s

first polio outbreak since 1999.

No children in Egypt, Israel or the Palestinian territories

have been hit by polio thanks to high immunisation rates and a

strong response to the alert, WHO spokeswoman Sona Bari said.

Polio virus is endemic in Pakistan, Afghanistan and Nigeria

despite a 25-year-old campaign to eradicate the disease, which

can paralyse a child in hours.

IMMUNISATION RATES

Islamist fighters from countries including Pakistan are

among groups battling to oust President Bashar al-Assad, leading

to speculation that they brought the virus into the country.

The WHO says it is unlikely that adults, who generally have

higher immunity, carried the virus into Syria and that its mode

of transmission will probably never be known.

Syria’s immunisation rates have plummeted from more than 90

percent before the conflict to around 68 percent. Polio mainly

affects children under five and cannot be cured, only prevented.

“All the children (paralysed) are under two years old, so

they were all born after immunisation services fell apart,” Bari

told Reuters. “No doubt the outbreak will be large.”

Children living in unsanitary conditions are especially

vulnerable to the virus, which spreads via faecal-oral

transmission and contaminated food and water.

More than 20 million children, including 1.6 million in

Syria, are to be vaccinated in Syria and neighbouring countries

over the next six months, U.N. agencies said last week.

(Reporting by Stephanie Nebehay; editing by Andrew Roche)