KUALA LUMPUR, March 10 — Malaysia has recorded its fourth case of disabling and life-threatening polio, health officials announced today.
The case involves a three-year-old boy in Sandakan, Sabah, who is not a Malaysian.
“He has not received polio vaccination since birth,” Health director-general Dr Noor Hisham Abdullah said.
In a statement, Dr Noor Hisham said the boy experienced weakness in his left leg on February 18 this year and sought treatment at a hospital. He is currently in stable condition.
“The case was confirmed to be positive for polio by the World Health Organization’s (WHO) Regional Polio Reference Laboratory in Australia on March 5, 2020.”
Malaysia earlier recorded three cases of polio, all from Sabah: a three-year-old child from Tuaran, an eight-year-old from Sandakan, and an 11-year-old from Kinabatangan.
Two of these three cases are not Malaysian and have never received polio vaccination in their lives.
Only the three-year-old child from Tuaran is still in hospital. Dr Noor Hisham said the patient is in stable condition but still needs breathing aid.
Polio, which mainly affects children below five years of age, invades the nervous system and can cause total paralysis in hours.
The virus is transmitted mainly through the faecal-oral route, which means it enters the body through the mouth and spreads to others through faecal-contaminated food and water.
There is no cure for polio, but it can be prevented through vaccination.
Malaysia’s polio outbreak comes 27 years after the country’s last case in 1992, and 19 years after Malaysia was declared polio-free in 2000.
Dr Noor Hisham, meanwhile, said that polio containment efforts have since identified a two-year-old girl, not local, in Semporna with acute flaccid paralysis or AFP. She had fever, followed by weakness in her legs, to the point that she could not walk normally.
The case has since been classified as “polio compatible”, which means that she has symptoms that are similar to what polio patients experience.
Dr Noor Hisham said a healthy non-local three-year-old, also in Semporna, had traces of polio in their stool. But this case was not classified as a polio case as global polio eradication guidelines stipulate that the patient must also be symptomatic.
“Nevertheless, the child is being observed from time to time and given oral polio vaccine (OPV) to build their immunity system against polio spread,” he said.
A spokesman for the WHO noted that these findings indicate the need for intensified efforts in implementing Malaysia’s existing outbreak response plan — which is already in place — to vaccinate all children under 13 years of age in Sabah.
“When the population is fully immunised, this kind of transmission cannot take place,” said Dr Cory Couillard, WHO Malaysia country office risk communication consultant.
Dr Couillard also told CodeBlue that using both polio vaccines — monovalent oral polio vaccine type 2 (mOPV2) and bivalent oral polio vaccines (bOPV) — “should be adequate” in containing the polio outbreak.
But this is only if more than 95 per cent of the children under 13 are vaccinated, he said.
“(The) Ministry of Health and the Sabah state government must ensure that children that enter Sabah in the post-campaign period must be vaccinated against polio to ensure high vaccination coverage to prevent recurrence,” he said.
“The best and most important public health measure is to ensure all children under 13 years of age in Sabah be vaccinated against the disease.”
As part of efforts to curb polio spread, Malaysia received 2.5 million vaccines of mOPV2 last month from the WHO’s vaccines stockpile — which is overseen by the WHO’s sister agency Unicef.
The vaccines are additional vaccines to the bOPV that Malaysian health officials are currently administering in Sabah for both Malaysian and foreign children below five years as part of an ongoing statewide immunisation campaign.
It remains to be seen if Malaysia will make vaccination compulsory, however. The Ministry of Health last year said so long as the national immunisation programme is underway, there is no need to do this, but was reported to be mulling the matter all the same.
Dr Couillard noted that the oral polio vaccine is “very safe’. Malaysia stopped using the oral polio vaccine since 2008 and replaced it with the inactivated polio vaccine (IPV), which is administered through injections and is cheaper.
“And thanks to its unique ability to stop person-to-person spread of the virus, it has been most utilised in the global effort to eradicate polio,” he added.
He also spoke of other measures to prevent and combat polio, such as maintaining AFP surveillance and environmental surveillance.
Dr Noor Hisham today said that 13 samples of untreated water in Sabah have tested positive for the polio virus so far.
Identification of such sources are being carried out in all Sabahan districts and in every Malaysian state, he said, so that containment efforts can be done.