Table 1.

Summary of three major re-emerging vaccine-preventable diseases in the Eastern Mediterranean Region.

Human disease	Infectious agent	Mode of transmission	Symptoms	Treatment	Available vaccine	Re-emerging EMR countries
Poliomyelitisa	Polio virus	Fecal–oral	Asymptomatic, may affect the CNS and cause paralysis	Supportive	Salk Vaccine—IPV: inactivated polio vaccine Sabin Vaccine—OPV: oral polio vaccine	Syria, Iraq
Measlesb	Measles virus	Direct contact with infectious droplet or by airborne spread	Maculopapular rash, fever, cough, coryza, conjunctivitis, koplik spots	Supportive	Either alone or as part of a combination (e.g., MMR, MMRV)	Iraq, South Sudan, Syria, Yemen
Cholerac	Vibrio cholerae bacteria	Fecal–oral through contaminated food and water	Profuse watery diarrhea (“rice-water” diarrhea), symptoms of dehydration	Rehydration therapy, antibiotics for severe illness	Two oral killed vaccines: Dukoral and Shanchol (Shantha Biotechnics-Sanofi Pasteur)	South Sudan, Yemen

^aMehndiratta et al. (76).

^bNaim (77).

^cHarris et al. (78).