Polio has broken out in Ivory Coast, with three children confirmed as having the crippling disease, the World Health Organization (WHO) said on Thursday.

The U.N. agency warned that the virus may spread within Ivory Coast, where disease surveillance is poor after months of post-election violence, and to other parts of West Africa.

“The outbreak response may be constrained by the current security situation in Cote d’Ivoire,” the WHO said.

Immunization rounds are planned in 15 West African countries from next week, but the dates for Ivory Coast will depend on the security situation, WHO spokesman Oliver Rosenbauer said.

Vaccinations had not taken place as planned in Ivory Coast last month due to the fighting and the WHO could not rule out that the virus was continuing to circulate undetected there.

Ivory Coast forces attacked formerly allied ‘Invisible Commando’ fighters in Abidjan on Wednesday in the most serious escalation of violence since former leader Laurent Gbagbo was toppled by the new President Alassane Ouattara.

A polio outbreak struck 27 children in Ivory Coast between 2008-2009 but was caused by a different strain known as type 1. The current strain, wild poliovirus type 3, had not been detected in the country since 2000, according to the WHO.

The three new cases were all among children in Soubre district of the southwest province of Bas Sassandra, whose symptoms began in January and February, Rosenbauer said.

The virus was linked to one detected in northern Nigeria in 2008, he said. “It was imported but then locally transmitted (in Ivory Coast),” he said.

Nigeria is one of four countries where the virus is still endemic, the others being Afghanistan, India and Pakistan.

A global campaign began more than 20 years ago to wipe out polio, which normally strikes children under five years of age and for which there is no cure, only preventative vaccines.

Travelers to Ivory Coast who have previously received three or more doses of oral polio vaccine should take another dose before departure, the Geneva-based agency said. Those not previously vaccinated should have a complete course.

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(Reuters)