POLIOMYELITIS - WORLDWIDE (22): PAKISTAN
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In this update:
[1] Pakistan: newswire
[2] Worldwide weekly case count update: Polio eradication website
******
[1] Pakistan: newswire
Date: Tue 19 Oct 2010
Source: SOS Children's Villages Canada [edited]
<http://www.soschildrensvillages.ca/News ... e-431.aspx>
The number of detected cases of polio among children in Pakistan rose
2 percent in relation to last year [2009]. Expanding vaccination
campaigns is constrained by the remoteness of some regions in
Pakistan, the aftermath of the floods and violence.
The United Nations Children's Fund (UNICEF) has recorded an increased
number of cases of polio among children in Pakistan in recent months.
The news is disheartening considering that it comes despite massive
vaccination campaigns undertaken this year [2010] that have been
estimated to have reached 9 million children.
The Global Polio Eradication Initiative describes polio, or
poliomyelitis, as a highly infectious disease caused by a virus. The
virus, coming in through the mouth, attacks the body's nervous system
leading to paralysis in 1/200 cases. The disease affects children
under 5 years old the most, with roughly 50 percent of cases
occurring in children under 3 years old. In [5-10 percent] of cases,
the paralysis will be fatal, owing to the eventual paralysis of
breathing muscles. The vaccine prevents the virus from being able to
replicate and attack the body [presumably taken from
<http://www.polioeradication.org/disease.asp>]
As of 14 Oct 2010, there were 78 cases of polio recorded,
representing a 2 percent increase from 2009. Of these cases, 57 were
recorded in Pakistan's Federally Administered Tribal Areas (FATA).
These remote areas are home to many children who were missed by
vaccination campaigns. Part of the reason behind the neglect of the
FATA is that the region is prone to more violence, making it
difficult for international aid agencies to reach. Only on Sunday
[?17 Oct 2010], for instance, Pakistani authorities reported the
bombing of 3 schools in the Mohmand Agency, a district of the FATA.
One boys' school and 2 girls' schools suffered damage, but no child
or adult was injured.
Along with Afghanistan, India, and Nigeria, Pakistan is one of the
few countries left in the world where polio remains endemic. All
these countries except Pakistan have made significant progress in
reducing the number of polio cases, as well as in containing the
spread of the most deadly strains of the virus.
Pakistan, however, has been severely affected by the derailing impact
of natural disaster on health and development priorities. Pakistan
still lacks adequate funding to deal with the destruction caused by
the devastating floods that hit the summer [2010]. According to the
UN Office for the Coordination of Humanitarian Affairs, there are
more than 20 million people affected by the floods and about 14
million in need of emergency relief services.
UN Secretary-General Ban Ki-Moon last week [week of 11 Oct 2010]
called on the international community to inject an additional USD 2
billion into Pakistan relief projects.
--
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******
[2] Worldwide weekly case count update: Polio eradication website
Date: Tue 19 Oct 2010
Source: Global Polio Eradication Initiative [edited]
<http://www.polioeradication.org/casecount.asp>
Total cases: Year-to-date 2010 / Year-to-date 2009
Globally: 732 / 1198
- in endemic countries: 153 / 930
- in non-endemic countries: 579 / 268
Case breakdown by country
Country: Year-to-date 2010 / Year-to-date 2009 / Total in 2009 / Date
of onset most recent case
Pakistan: 88 / 62 / 89 / 1 Oct 2010
Russian Federation: 14 / 0 / 0 / 25 Sep 2010
India: 39 / 464 / 741 / 16 Sep 2010
DRC: 28 / 3 / 3 / 6 Sep 2010
Afghanistan: 18 / 23 / 38 / 4 Sep 2010
Nepal: 6 / 0 / 0 / 30 Aug 2010
Nigeria: 8 / 381 / 388 / 27 Aug 2010
Angola: 25 / 26 / 29 / 20 Aug 2010
Kazakhstan: 1 / 0 / 0 / 12 Aug 2010
Tajikistan: 458 / 0 / 0 / 4 Jul 2010
Turkmenistan: 3 / 0 / 0 / 28 Jun 2010
Chad: 14 / 24 / 64 / 10 May 2010
Mali: 3 / 9 / 2 / 1 May 2010
Senegal: 18 / 0 / 0 / 30 Apr 2010
Mauritania: 5 / 0 / 13 / 28 Apr 2010
Niger: 2 / 15 / 15 / 1 Apr 2010
Liberia: 1 / 10 / 11 / 3 Mar 2010
Sierra Leone: 1 / 2 / 11 / 28 Feb 2010
Guinea: 0 / 24 / 42 / 3 Nov 2009
Burkina Faso: 0 / 13 / 15 / 25 Oct 2009
Cameroon: 0 / 2 / 3 / 15 Oct 2009
Burundi: 0 / 2 / 2 / 12 Sep 2009
CAR: 0 / 14 / 14 / 9 Aug 2009
Cote d'Ivoire: 0 / 27 / 26 / 6 Aug 2009
Kenya: 0 / 18 / 19 / 30 Jul 2009
Sudan: 0 / 45 / 45 / 27 Jun 2009
Uganda: 0 / 8 / 8 / 10 May 2009
Benin: 0 / 20 / 20 / 19 Apr 2009
Togo: 0 / 6 / 6 / 28 Mar 2009
--
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[A review of the newswire alerts over the past few days reveals that
this coming Sunday [24 Oct 2010] will be World Polio Day (see
<http://www.eptrail.com/ci_16398109>). What is impressive is that
during 2010, the overwhelming majority of polio cases reported
through the official reporting systems have been associated with
transmission of the wild poliovirus (WPV) in Pakistan, and those
associated with the outbreak in Tajikistan (with spread to the
Russian Federation, Turkmenistan, and Kazakhstan) -- the former
representing 12 percent of reported cases to date this year (2010),
and the latter representing 65 percent of reported cases to date this
year (2010).
In the weekly summaries found on the polio eradication case count
weekly update page (available at
<http://www.polioeradication.org/casecount.asp>) there are the
following important highlights related to WPV activity in Pakistan:
- 10 new cases were reported this week [?week of 11 Oct 2010] (9 WPV1
and one WPV3), located in Khyber Pakhtunkhwa (KP -- formerly NWFP)
and Sindh.
- The total number of cases for this year [2010] is 88 (67 WPV1 and
21 WPV3), compared with 62 cases at this time last year [2009] (40
WPV1, 21 WPV3, and one WPV1/3 mixture). The most recent case (WPV1
case in Sindh) had onset of paralysis on [1 Oct 2010].
- The 2nd phase of NIDs [national immunization days] was carried out
in the 45 worst flood-affected districts from 11-13 Oct 2010. NIDs
are planned from [8-10 Nov 2010], using trivalent oral polio vaccine
(tOPV), with SNIDs [supplemental national immunization days] planned
for high-risk districts from [13-15 Dec 2010], using bOPV [bivalent
OPV].
For a map of Pakistan with provinces with accompanying descriptions
of the administrative units, see
<http://en.wikipedia.org/wiki/Administra ... f_Pakistan>.
For the interactive HealthMap/ProMED map of Pakistan, see
<http://healthmap.org/r/00tj>. - Mod.MPP]
Kinderlähmung - Poliomyelitis
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Re: Kinderlähmung - Poliomyelitis
Africa seizes chance against polio
More than 72 million children to be immunized across 15 countries to tackle remaining risks
26.10.2010 - WHO
DAKAR | BRAZZAVILLE | GENEVA -- This week, Africa seizes an unprecedented chance to drive out polio when 15 countries across the continent launch a synchronized mass immunization campaign to reach 72 million children, capitalizing on gains made this year. A total of some 290 000 vaccinators have been mobilized to go door-to-door to deliver two drops of oral polio vaccine (OPV) to every child under five in areas considered at "highest risk" of polio transmission.
Unprecedented cooperation
Africa's leaders demonstrated unprecedented cooperation and commitment to carry out a series of synchronized immunization activities in 2009 and in March and April, 2010, following the spread of the disease from Nigeria which came to infect 24 countries across west and central Africa and in the Horn of Africa. As a direct result of these immunization campaigns, the polio outbreaks have slowed to a trickle. Across west Africa, only Liberia and Mali have recorded any cases in the past five months, while Nigeria – the only country in Africa never to have stopped polio transmission – has slashed polio by 98% in the past year.
Risks of not completing eradication
However, recent weeks have shown the very real risks of not completing eradication, with a September case in Liberia confirming residual transmission, a new importation of type 3 wild poliovirus into Mali (the first since 2001), and a case in Uganda, which had been polio-free for more than a year. In all countries, rapid assessments are being conducted to formulate an emergency response plan in which two additional mop-up rounds will be held. All countries in the West Africa sub-region will again conduct two full campaigns in February and March, 2011, but high-quality immunization campaigns must be complemented by enhanced routine immunization and strong disease surveillance.
With the outbreak in Angola (25 cases) having spilled over the border into neighboring provinces of the Democratic Republic of the Congo (28 cases) - these two countries now represent the greatest threat to polio in Africa, having recorded 48 of Africa's 58 cases in the past six months. However, the virus in DR Congo remains geographically restricted and in Angola, steps by the Federal Government to close vaccination coverage gaps in the most recent campaign – which started on 1 October – saw the percentage of missed children in the key reservoir of Luanda fall from nearly 30% to 13%, while nationally, the percentage of missed children fell from 15% to 8%.
WHO's Regional Director for Africa, Dr Luis G. Sambo, acknowledged the recent steps taken by Angola and DR Congo to close vaccination coverage gaps, with the Angolan Minister of Health personally vaccinating children on the streets of Luanda during the October campaign. "In Africa," Dr Sambo said, "we are seeing the essential government support that can make the difference between success and failure. But much more remains to be done to fill the gaps if we are to protect the stunning gains made this year."
"We are on the cusp of an exciting possibility here," said Dr Gianfranco Rotigliano, UNICEF’s Regional Director for West and Central Africa. "Political leaders across Africa answered the challenge posed by this dreadful disease and the results are before us. It shows what can be done when there is leadership and dynamic partnership with donor support around such an important health issue. We need to continue efforts to vaccinate and to put the needs of children in Africa first."
Many volunteer vaccinators in these vaccination campaigns will be Rotarians, who have themselves given almost US$ 1 billion to the polio eradication effort since 1985. Mr Ambroise Tshimbalanga Kasongo, chair of Rotary's African PolioPlus Committee, called on international donors to stay the course to finish the job by filling the US$ 810 million funding gap in the Global Polio Eradication Initiative Strategic Plan that aims to eradicate polio globally by 2013.
"Rotary's catch phrase is 'End Polio Now'," he said. "In Africa, the end of polio is in sight, but we are not there yet. To think we could not reach the finishing line because of lack of financial resources is unacceptable."
The 15-country synchronized activities will cost approximately US$ 42.6 million, and are funded by the Bill & Melinda Gates Foundation, the US Centers for Disease Control and Prevention (CDC), USAID, Rotary International, UNICEF and the Governments of Germany and Japan.
Immunization activities
DR Congo and Angola will launch immunization activities from 28 October and 29 October, respectively, while the 10-country synchronized campaigns are being launched from today (26 October) in Cote d'Ivoire, from 28 October in Benin, Burkina Faso, Gambia, Guinea, Mali, Mauritania, Senegal and Sierra Leone, and from 29 October in Liberia. Chad and Sudan will launch immunization activities on 1 November, while last week (from 23 October), Nigeria immunized more than 29 million children in 20 high-risk northern states.
The Global Polio Eradication Initiative (GPEI) is spearheaded by national governments, WHO, Rotary International, the CDC and UNICEF.
Since the launch of the GPEI in 1988, the incidence of polio has been reduced by more than 99%. In 1988, more than 350 000 children were paralyzed each year in more than 125 endemic countries. Only four countries remain endemic: Nigeria, India, Pakistan and Afghanistan.
More than 72 million children to be immunized across 15 countries to tackle remaining risks
26.10.2010 - WHO
DAKAR | BRAZZAVILLE | GENEVA -- This week, Africa seizes an unprecedented chance to drive out polio when 15 countries across the continent launch a synchronized mass immunization campaign to reach 72 million children, capitalizing on gains made this year. A total of some 290 000 vaccinators have been mobilized to go door-to-door to deliver two drops of oral polio vaccine (OPV) to every child under five in areas considered at "highest risk" of polio transmission.
Unprecedented cooperation
Africa's leaders demonstrated unprecedented cooperation and commitment to carry out a series of synchronized immunization activities in 2009 and in March and April, 2010, following the spread of the disease from Nigeria which came to infect 24 countries across west and central Africa and in the Horn of Africa. As a direct result of these immunization campaigns, the polio outbreaks have slowed to a trickle. Across west Africa, only Liberia and Mali have recorded any cases in the past five months, while Nigeria – the only country in Africa never to have stopped polio transmission – has slashed polio by 98% in the past year.
Risks of not completing eradication
However, recent weeks have shown the very real risks of not completing eradication, with a September case in Liberia confirming residual transmission, a new importation of type 3 wild poliovirus into Mali (the first since 2001), and a case in Uganda, which had been polio-free for more than a year. In all countries, rapid assessments are being conducted to formulate an emergency response plan in which two additional mop-up rounds will be held. All countries in the West Africa sub-region will again conduct two full campaigns in February and March, 2011, but high-quality immunization campaigns must be complemented by enhanced routine immunization and strong disease surveillance.
With the outbreak in Angola (25 cases) having spilled over the border into neighboring provinces of the Democratic Republic of the Congo (28 cases) - these two countries now represent the greatest threat to polio in Africa, having recorded 48 of Africa's 58 cases in the past six months. However, the virus in DR Congo remains geographically restricted and in Angola, steps by the Federal Government to close vaccination coverage gaps in the most recent campaign – which started on 1 October – saw the percentage of missed children in the key reservoir of Luanda fall from nearly 30% to 13%, while nationally, the percentage of missed children fell from 15% to 8%.
WHO's Regional Director for Africa, Dr Luis G. Sambo, acknowledged the recent steps taken by Angola and DR Congo to close vaccination coverage gaps, with the Angolan Minister of Health personally vaccinating children on the streets of Luanda during the October campaign. "In Africa," Dr Sambo said, "we are seeing the essential government support that can make the difference between success and failure. But much more remains to be done to fill the gaps if we are to protect the stunning gains made this year."
"We are on the cusp of an exciting possibility here," said Dr Gianfranco Rotigliano, UNICEF’s Regional Director for West and Central Africa. "Political leaders across Africa answered the challenge posed by this dreadful disease and the results are before us. It shows what can be done when there is leadership and dynamic partnership with donor support around such an important health issue. We need to continue efforts to vaccinate and to put the needs of children in Africa first."
Many volunteer vaccinators in these vaccination campaigns will be Rotarians, who have themselves given almost US$ 1 billion to the polio eradication effort since 1985. Mr Ambroise Tshimbalanga Kasongo, chair of Rotary's African PolioPlus Committee, called on international donors to stay the course to finish the job by filling the US$ 810 million funding gap in the Global Polio Eradication Initiative Strategic Plan that aims to eradicate polio globally by 2013.
"Rotary's catch phrase is 'End Polio Now'," he said. "In Africa, the end of polio is in sight, but we are not there yet. To think we could not reach the finishing line because of lack of financial resources is unacceptable."
The 15-country synchronized activities will cost approximately US$ 42.6 million, and are funded by the Bill & Melinda Gates Foundation, the US Centers for Disease Control and Prevention (CDC), USAID, Rotary International, UNICEF and the Governments of Germany and Japan.
Immunization activities
DR Congo and Angola will launch immunization activities from 28 October and 29 October, respectively, while the 10-country synchronized campaigns are being launched from today (26 October) in Cote d'Ivoire, from 28 October in Benin, Burkina Faso, Gambia, Guinea, Mali, Mauritania, Senegal and Sierra Leone, and from 29 October in Liberia. Chad and Sudan will launch immunization activities on 1 November, while last week (from 23 October), Nigeria immunized more than 29 million children in 20 high-risk northern states.
The Global Polio Eradication Initiative (GPEI) is spearheaded by national governments, WHO, Rotary International, the CDC and UNICEF.
Since the launch of the GPEI in 1988, the incidence of polio has been reduced by more than 99%. In 1988, more than 350 000 children were paralyzed each year in more than 125 endemic countries. Only four countries remain endemic: Nigeria, India, Pakistan and Afghanistan.
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Kinderlähmung Uganda
POLIOMYELITIS - WORLDWIDE (23): UGANDA
*****************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
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<http://www.isid.org>
[1]
Date: Tue 26 Oct 2010
Source: The New Vision Uganda [edited]
<http://www.newvision.co.ug/D/8/13/736215>
Polio is back in Uganda barely a year after the World Health
Organization (WHO) declared the country free of the disease.
The health ministry and WHO yesterday [25 Oct 2010] announced that
cases of the disease have been identified in Bugiri district where
one of the victims has developed paralysis.
Tests of samples done in South Africa found the virus to have been
imported from the Turkana area in North West Kenya.
As a result, the ministry and WHO have announced a 3-phase
supplementary vaccination exercise for 2 million children in 48
districts of eastern, northeastern, and northern Uganda.
Children aged of up to 5 years will be immunized in a house-to-house
exercise whose 1st phase will be carried out on 20 and 21 Nov 2010,
according to health minister Dr Stephen Mallinga.
"Every home will be visited and revisited if the children are away,"
Mallinga told journalists at the Media Centre in Kampala yesterday
[25 Oct 2010]. He jointly addressed the journalists with the WHO
country director, Dr Joaquim Saweka.
Poliomyelitis is a contagious viral disease that can lead to death.
However, about 95 percent of those infected with the virus show no
symptoms of the virus. Of these, 4 percent to 8 percent show
symptoms, according to medical reports.
The disease is said to appear in 3 forms. The mild form or abortive
polio is where one may fail to suspect they have polio because it
presents flu-like symptoms, mild respiratory infection, diarrhoea,
fever, and a sore throat.
The 2nd more serious form associated with aseptic meningitis, is
non-paralytic polio. It affects about 1-5 percent of those infected
with the virus. These show neurological symptoms like sensitivity to
light and stiffness in the neck.
The 3rd and severe type is debilitating and occurs in 1-2 percent of
those infected. This type known as paralytic polio causes paralysis
and [can lead to] death. The virus attacks nerves that control the
muscles in the limbs and those necessary for breathing. Here, it
causes respiratory difficulty and paralysis of arms and legs.
Immunisation offers protection against the disease.
Mallinga said it is suspected that the 2-year-old, who 1st fell
victim, was not immunized, though the mother claimed that she was.
The mother, according to the minister, could not produce an
immunisation card to prove her claim.
The 2nd round, he added, will be done on 11 and 12 Dec 2010 and the
3rd on 16 and 17 Jan 2011.
The exercise is expected to cost about sh 11 billion [approx USD 5
million], according to Mallinga. The money will be contributed by the
Government, WHO and the United Nations Children's Fund (UNICEF).
The 1st phase will cost sh 4 billion [approx USD 1.8 million], the
2nd sh 3.6 billion [approx USD 1.58 million], while the 3rd will cost
sh 3.7 billion [approx USD 1.62 million]. The Government will
contribute sh 1.2 billion [approx USD 525 000] for social mobilization
Mallinga said next year [2011], there will be a national
supplementary vaccination exercise targeting 6 million children aged
5 years and below.
He said there had been a drop in vaccination coverage from 83 percent
to 76 percent this financial year [2009/2010] due to inadequate
resources in the health ministry.
Mallinga also attributed lack of immunisation to unwillingness of
parents to cooperate with health officials and blocking access to children.
Uganda was declared polio-free in December last year [2009] after the
absence of the disease for 13 years. The latest cases were reported
in Nawamboga village, Bulesa sub-county in Bugiri district.
The disease is spread through consumption of food contaminated with
faecal matter from an infected person.
[Byline: Anne Mugisa]
--
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******
[2]
Date: 27 Oct 2010
Source: Xinhua Net [edited]
<http://news.xinhuanet.com/english2010/h ... 6909_2.htm>
The Ugandan health ministry announced on Tuesday [26 Oct 2010] that
the country has been struck by a polio outbreak, the 2nd year in a
row after the World Health Organization (WHO) declared the country
polio free in 2006.
A 2-year-old girl in the eastern Ugandan district of Bugiri fell
victim after laboratory tests both in Uganda and South Africa showed
that she had Wild Polio Virus Type 1 [WPCV-1].
"This 2-year-old child was well until [20 Sep 2010] when she
developed a fever. On [25-26 Sep 2010], she was taken to a health
center where she was treated for malaria. On [29 Sep 2010], she
failed to stand without support and became unable to walk using the
right leg," minister of health Stephen Mallinga narrated the girl's
ordeal to reporters here.
Experts say that the polio virus the child has is linked to the one
isolated in the Turkana region of Kenya on [3 Feb 2009], indicating
that the virus has been spreading up to the districts bordering
Kenya, Uganda's neighbor to the east.
The ministry of health now fears that 48 districts bordering with
Kenya are at risk or at worst, there may be already unreported cases
especially in the northeastern part of the country which borders the
Turkana region.
The polio virus is transmitted by drinking water or eating food
contaminated with fecal material containing the virus.
A child infected with the virus presents with acute fever followed by
weakness in the limbs.
Health experts say that out of 100 children infected with the virus,
only one develops the acute state of the disease which presents with
weakness of limbs.
Most of the polio outbreaks in Uganda are imported from neighboring
countries. In February 2009, a sample from a 16-month-old baby boy in
the northern Ugandan district of Amuru tested positive for the polio virus.
The virus is reported to have been imported from neighboring southern
Sudan where there was an outbreak.
The eastern Democratic Republic of Congo which had also reported
polio cases in 2009 continues to be a risk to Uganda as some
Congolese flee to the country when there are political upheavals back home.
"Uganda had been declared polio free, but in some of our neighboring
countries, the health situation there is not as well as it should
be," said Mallinga.
The polio situation in Uganda is likely to worsen as the country's
ministry of health is reporting that it is facing financial shortages
to help carry out polio immunization.
Mallinga said that until last year [2009], the ministry has been
depending entirely on donor funds to carry out the immunization programs.
According to observers, the financial crisis that has affected most
of the donor countries is likely to worsen the funding as they cut
back on spending.
Currently, the country needs about 11 billion shillings [USD 5
million] to carryout a mass immunization exercise in 48 districts,
but the ministry can only raise 1.3 billion shillings [USD 600 000].
Joaquim Saweka, WHO representative to Uganda said that there is need
for urgent mobilization of funds from both government and donor
agencies in order to fight polio, which not only poses a threat to
the country but the region and the world.
"We need immediate response to this outbreak; otherwise we will put
our children and the children of neighboring countries and the entire
world again at the risk of polio that was almost eradicated, " he said.
Despite the financial shortages, the ministry said that starting this
month [October 2010] until January next year [2011], a mass
immunization exercise is going to be carried out in 48 districts in
northern, northeastern and eastern parts of the country.
Malinga said that a house to house strategy will be used to ensure
that all targeted children are immunized.
Apart from this exercise, Mallinga said all the children in the
country below the age of 5 will be immunized against the crippling
disease during the country's routine immunizations exercises that are
held in April and October of every year.
He urged the public to take children below the age of 5 for
immunization at the nearest health facility.
Globally, polio is a diminishing disease, occurring more on the
Indian subcontinent and parts of west and central Africa.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[Uganda has once again reported a new laboratory confirmed case of
polio virus, wild type, a disease that is subject to global
eradication. This comes 10 months after Uganda was declared polio
free following an earlier outbreak that started February 2009. The
wild polio virus [WPV] isolated in Bugiri, Eastern Uganda is
genetically linked to the one isolated in Turkana region, North West
Kenya on 3 Feb 2009. This implies that the virus has been circulating
in North East and Eastern Uganda for the last 21 months. Uganda
implemented a modified house-to-house polio immunisation campaign in
response to the February 2009 outbreak. This seems not to have
effectively prevented cross-border transmission of WPV from
North-West Kenya. This time round however, the country has opted for
a "house-to-house" strategy to ensure that all the targeted children
are reached. The strategy involves vaccinators going to every house
and dwelling place in an assigned geographical area and re-visiting h!
ouseholds where children are away at the time of the visit. The
strategy will be used during all the 3 rounds of Polio Supplemental
Immunization in 48 high risk districts in North East, East and Northern Uganda.
The HealthMap/ProMED-mail interactive map of Uganda is available at
<http://healthmap.org/r/00Zn>. An administrative map of the country
can be seen at
<http://www.coetzee-uganda.com/index_fil ... Uganda.htm>.
- Mod.JFW]
[The occurrence of this new case of WPV-1 (wild poliovirus type 1)
associated polio serves as a reminder of the challenges facing the
polio eradication activities, vis a vis "below the radar"
transmission of WPVs in areas with presumed high levels of
vaccination coverages. Uganda and Kenya were countries with early
successes in interrupting transmission of WPV within their countries.
Uganda had interrupted transmission in 1996, and Kenya in 1989.
Limited transmission of WPV was identified in both countries in 2009
with a total of 8 cases reported in Uganda and 18 cases reported in Kenya.
The identification of a WPV-1 isolate genetically similar to the
virus circulating in north-west Kenya in February 2009 suggests that
while the vaccination activities conducted in both Kenya and Uganda
during 2009 significantly reduced the number of susceptibles, there
were still persistent pockets of susceptibles to sustain transmission
of the WPV. The estimates are that for every WPV infection that
results in a case of paralytic disease, there are between 50 and 1000
individuals infected with the WPV without paralytic disease, the
average being cited as one per 200 infected. The non-paralytic
infections are associated with continuing the chain of transmission
of the WPV, which remains below the radar of routine surveillance
activities (that are aimed at identified acute flaccid paralysis
[AFP] cases). These non-paralytic cases require laboratory
surveillance which could include screening of healthy individuals and
individuals presenting with mild "viral illnesses" to identify their
presence, or environmental sampling to identify the WPV in the
environment (water and sanitation), very costly and labor intensive exercises.
A question that arises here is whether the circulation of this WPV-1
has been restricted to Uganda or if it is continuing "under the
radar" in Kenya as well. - Mod.MPP]
*****************************************
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<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
[1]
Date: Tue 26 Oct 2010
Source: The New Vision Uganda [edited]
<http://www.newvision.co.ug/D/8/13/736215>
Polio is back in Uganda barely a year after the World Health
Organization (WHO) declared the country free of the disease.
The health ministry and WHO yesterday [25 Oct 2010] announced that
cases of the disease have been identified in Bugiri district where
one of the victims has developed paralysis.
Tests of samples done in South Africa found the virus to have been
imported from the Turkana area in North West Kenya.
As a result, the ministry and WHO have announced a 3-phase
supplementary vaccination exercise for 2 million children in 48
districts of eastern, northeastern, and northern Uganda.
Children aged of up to 5 years will be immunized in a house-to-house
exercise whose 1st phase will be carried out on 20 and 21 Nov 2010,
according to health minister Dr Stephen Mallinga.
"Every home will be visited and revisited if the children are away,"
Mallinga told journalists at the Media Centre in Kampala yesterday
[25 Oct 2010]. He jointly addressed the journalists with the WHO
country director, Dr Joaquim Saweka.
Poliomyelitis is a contagious viral disease that can lead to death.
However, about 95 percent of those infected with the virus show no
symptoms of the virus. Of these, 4 percent to 8 percent show
symptoms, according to medical reports.
The disease is said to appear in 3 forms. The mild form or abortive
polio is where one may fail to suspect they have polio because it
presents flu-like symptoms, mild respiratory infection, diarrhoea,
fever, and a sore throat.
The 2nd more serious form associated with aseptic meningitis, is
non-paralytic polio. It affects about 1-5 percent of those infected
with the virus. These show neurological symptoms like sensitivity to
light and stiffness in the neck.
The 3rd and severe type is debilitating and occurs in 1-2 percent of
those infected. This type known as paralytic polio causes paralysis
and [can lead to] death. The virus attacks nerves that control the
muscles in the limbs and those necessary for breathing. Here, it
causes respiratory difficulty and paralysis of arms and legs.
Immunisation offers protection against the disease.
Mallinga said it is suspected that the 2-year-old, who 1st fell
victim, was not immunized, though the mother claimed that she was.
The mother, according to the minister, could not produce an
immunisation card to prove her claim.
The 2nd round, he added, will be done on 11 and 12 Dec 2010 and the
3rd on 16 and 17 Jan 2011.
The exercise is expected to cost about sh 11 billion [approx USD 5
million], according to Mallinga. The money will be contributed by the
Government, WHO and the United Nations Children's Fund (UNICEF).
The 1st phase will cost sh 4 billion [approx USD 1.8 million], the
2nd sh 3.6 billion [approx USD 1.58 million], while the 3rd will cost
sh 3.7 billion [approx USD 1.62 million]. The Government will
contribute sh 1.2 billion [approx USD 525 000] for social mobilization
Mallinga said next year [2011], there will be a national
supplementary vaccination exercise targeting 6 million children aged
5 years and below.
He said there had been a drop in vaccination coverage from 83 percent
to 76 percent this financial year [2009/2010] due to inadequate
resources in the health ministry.
Mallinga also attributed lack of immunisation to unwillingness of
parents to cooperate with health officials and blocking access to children.
Uganda was declared polio-free in December last year [2009] after the
absence of the disease for 13 years. The latest cases were reported
in Nawamboga village, Bulesa sub-county in Bugiri district.
The disease is spread through consumption of food contaminated with
faecal matter from an infected person.
[Byline: Anne Mugisa]
--
Communicated by:
ProMED-EAFR
<promed-eafr@promedmail.org>
******
[2]
Date: 27 Oct 2010
Source: Xinhua Net [edited]
<http://news.xinhuanet.com/english2010/h ... 6909_2.htm>
The Ugandan health ministry announced on Tuesday [26 Oct 2010] that
the country has been struck by a polio outbreak, the 2nd year in a
row after the World Health Organization (WHO) declared the country
polio free in 2006.
A 2-year-old girl in the eastern Ugandan district of Bugiri fell
victim after laboratory tests both in Uganda and South Africa showed
that she had Wild Polio Virus Type 1 [WPCV-1].
"This 2-year-old child was well until [20 Sep 2010] when she
developed a fever. On [25-26 Sep 2010], she was taken to a health
center where she was treated for malaria. On [29 Sep 2010], she
failed to stand without support and became unable to walk using the
right leg," minister of health Stephen Mallinga narrated the girl's
ordeal to reporters here.
Experts say that the polio virus the child has is linked to the one
isolated in the Turkana region of Kenya on [3 Feb 2009], indicating
that the virus has been spreading up to the districts bordering
Kenya, Uganda's neighbor to the east.
The ministry of health now fears that 48 districts bordering with
Kenya are at risk or at worst, there may be already unreported cases
especially in the northeastern part of the country which borders the
Turkana region.
The polio virus is transmitted by drinking water or eating food
contaminated with fecal material containing the virus.
A child infected with the virus presents with acute fever followed by
weakness in the limbs.
Health experts say that out of 100 children infected with the virus,
only one develops the acute state of the disease which presents with
weakness of limbs.
Most of the polio outbreaks in Uganda are imported from neighboring
countries. In February 2009, a sample from a 16-month-old baby boy in
the northern Ugandan district of Amuru tested positive for the polio virus.
The virus is reported to have been imported from neighboring southern
Sudan where there was an outbreak.
The eastern Democratic Republic of Congo which had also reported
polio cases in 2009 continues to be a risk to Uganda as some
Congolese flee to the country when there are political upheavals back home.
"Uganda had been declared polio free, but in some of our neighboring
countries, the health situation there is not as well as it should
be," said Mallinga.
The polio situation in Uganda is likely to worsen as the country's
ministry of health is reporting that it is facing financial shortages
to help carry out polio immunization.
Mallinga said that until last year [2009], the ministry has been
depending entirely on donor funds to carry out the immunization programs.
According to observers, the financial crisis that has affected most
of the donor countries is likely to worsen the funding as they cut
back on spending.
Currently, the country needs about 11 billion shillings [USD 5
million] to carryout a mass immunization exercise in 48 districts,
but the ministry can only raise 1.3 billion shillings [USD 600 000].
Joaquim Saweka, WHO representative to Uganda said that there is need
for urgent mobilization of funds from both government and donor
agencies in order to fight polio, which not only poses a threat to
the country but the region and the world.
"We need immediate response to this outbreak; otherwise we will put
our children and the children of neighboring countries and the entire
world again at the risk of polio that was almost eradicated, " he said.
Despite the financial shortages, the ministry said that starting this
month [October 2010] until January next year [2011], a mass
immunization exercise is going to be carried out in 48 districts in
northern, northeastern and eastern parts of the country.
Malinga said that a house to house strategy will be used to ensure
that all targeted children are immunized.
Apart from this exercise, Mallinga said all the children in the
country below the age of 5 will be immunized against the crippling
disease during the country's routine immunizations exercises that are
held in April and October of every year.
He urged the public to take children below the age of 5 for
immunization at the nearest health facility.
Globally, polio is a diminishing disease, occurring more on the
Indian subcontinent and parts of west and central Africa.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[Uganda has once again reported a new laboratory confirmed case of
polio virus, wild type, a disease that is subject to global
eradication. This comes 10 months after Uganda was declared polio
free following an earlier outbreak that started February 2009. The
wild polio virus [WPV] isolated in Bugiri, Eastern Uganda is
genetically linked to the one isolated in Turkana region, North West
Kenya on 3 Feb 2009. This implies that the virus has been circulating
in North East and Eastern Uganda for the last 21 months. Uganda
implemented a modified house-to-house polio immunisation campaign in
response to the February 2009 outbreak. This seems not to have
effectively prevented cross-border transmission of WPV from
North-West Kenya. This time round however, the country has opted for
a "house-to-house" strategy to ensure that all the targeted children
are reached. The strategy involves vaccinators going to every house
and dwelling place in an assigned geographical area and re-visiting h!
ouseholds where children are away at the time of the visit. The
strategy will be used during all the 3 rounds of Polio Supplemental
Immunization in 48 high risk districts in North East, East and Northern Uganda.
The HealthMap/ProMED-mail interactive map of Uganda is available at
<http://healthmap.org/r/00Zn>. An administrative map of the country
can be seen at
<http://www.coetzee-uganda.com/index_fil ... Uganda.htm>.
- Mod.JFW]
[The occurrence of this new case of WPV-1 (wild poliovirus type 1)
associated polio serves as a reminder of the challenges facing the
polio eradication activities, vis a vis "below the radar"
transmission of WPVs in areas with presumed high levels of
vaccination coverages. Uganda and Kenya were countries with early
successes in interrupting transmission of WPV within their countries.
Uganda had interrupted transmission in 1996, and Kenya in 1989.
Limited transmission of WPV was identified in both countries in 2009
with a total of 8 cases reported in Uganda and 18 cases reported in Kenya.
The identification of a WPV-1 isolate genetically similar to the
virus circulating in north-west Kenya in February 2009 suggests that
while the vaccination activities conducted in both Kenya and Uganda
during 2009 significantly reduced the number of susceptibles, there
were still persistent pockets of susceptibles to sustain transmission
of the WPV. The estimates are that for every WPV infection that
results in a case of paralytic disease, there are between 50 and 1000
individuals infected with the WPV without paralytic disease, the
average being cited as one per 200 infected. The non-paralytic
infections are associated with continuing the chain of transmission
of the WPV, which remains below the radar of routine surveillance
activities (that are aimed at identified acute flaccid paralysis
[AFP] cases). These non-paralytic cases require laboratory
surveillance which could include screening of healthy individuals and
individuals presenting with mild "viral illnesses" to identify their
presence, or environmental sampling to identify the WPV in the
environment (water and sanitation), very costly and labor intensive exercises.
A question that arises here is whether the circulation of this WPV-1
has been restricted to Uganda or if it is continuing "under the
radar" in Kenya as well. - Mod.MPP]
-
Birgitt
- Moderator
- Beiträge: 35237
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- Kontaktdaten:
Re: Kinderlähmung - Poliomyelitis
POLIOMYELITIS - WORLDWIDE (24): AFRICA
***************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
******
Nigeria (Kano, Sokoto, Katsina): suspected
Date: Sat 30 Oct 2010
Source: Leadership Editors [edited]
<http://www.leadershipeditors.com/ns/ind ... e&id=18313>
Fresh polio fear hits Kano, Sokoto, Katsina
-------------------------------------------
As Nigeria and the international community continue to celebrate the
success recorded in the fight against the dreaded poliomyelitis
scourge, there are fears of a possible resurgence of cases in 3
states in northwestern Nigeria.
One case each of the wild poliovirus (WPV3) has been suspected to
have occurred in Kano, Sokoto, and Katsina States.
[The Leadership] correspondent gathered exclusively that as at
yesterday [29 Oct 2010], health officials in the federal and state
governments were making frantic efforts to investigate the case
suspected to have occurred in Dambatta, Dambatta local government
area of Kano State.
Similarly, cases are also being investigated in Wurno in Sokoto
State, as well as in an undisclosed area in Katsina State.
To recount, in recent times, Federal and foreign donor agencies have
been popping champagne to celebrate what their statistics put at 98
percent success attained in the sustained combat to eradicate the
dreaded ailment.
Efforts to reach the North West zonal coordinator of the National
Primary Health Care Development Agency (NPHCDA), Dr Abdullahi Bulama
Garba proved abortive as officials in his office told our
correspondent he went out on a crucial field assignment.
Also, none of the officials was ready to either deny or confirm the
veracity of the cases suspected to have occurred in these states' as
they revealed they are not in a position to speak on the issue.
Specifically, the Rotary International had rolled out the carpet to
toast to the success some weeks back.
Only Nigeria, India, and Pakistan are reported not to have fully
stemmed the scourge worldwide.
[Byline: Salihu Othman Isah]
--
Communicated by:
ProMED-EAFR
<promed-eafr@promedmail.org>
[While the newswire above refers to the cases as "suspected", the
mention that each of the 3 suspected cases is due to infection with
wild poliovirus type 3 (WPV3) suggests there is laboratory
identification of the WPV3 from specimens from these cases. We await
further confirmation on these cases.
According to the most recent case count available on the polio
eradication website, as of 26 Oct 2010, there have been 8 cases of
WPV associated polio in Nigeria -- 4 attributable to infection with
WPV1 and 4 to infection with WPV3 (see
<http://www.polioeradication.org/Dataand ... sweek.aspx>).
The date of onset of the most recent case was 27 Aug 2010. Of note,
of 747 cases of polio with WPV isolated this year (2010), 163 were in
endemic countries, and 584 were in non-endemic countries. The
outbreak in Tajikistan involved 458 cases, with another 14 identified
in the Russian Federation, 3 identified in Turkmenistan, and one
identified in Kazakhstan.
For a map of Nigeria with states, see
<http://www.un.org/Depts/Cartographic/ma ... igeria.pdf>. All 3
states mentioned (Kano, Katsina, and Sokoto) are in the north and
border with Niger. For the interactive HealthMap/ProMED-mail map of
Nigeria, see <http://healthmap.org/r/007*>. - Mod.MPP]
***************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
******
Nigeria (Kano, Sokoto, Katsina): suspected
Date: Sat 30 Oct 2010
Source: Leadership Editors [edited]
<http://www.leadershipeditors.com/ns/ind ... e&id=18313>
Fresh polio fear hits Kano, Sokoto, Katsina
-------------------------------------------
As Nigeria and the international community continue to celebrate the
success recorded in the fight against the dreaded poliomyelitis
scourge, there are fears of a possible resurgence of cases in 3
states in northwestern Nigeria.
One case each of the wild poliovirus (WPV3) has been suspected to
have occurred in Kano, Sokoto, and Katsina States.
[The Leadership] correspondent gathered exclusively that as at
yesterday [29 Oct 2010], health officials in the federal and state
governments were making frantic efforts to investigate the case
suspected to have occurred in Dambatta, Dambatta local government
area of Kano State.
Similarly, cases are also being investigated in Wurno in Sokoto
State, as well as in an undisclosed area in Katsina State.
To recount, in recent times, Federal and foreign donor agencies have
been popping champagne to celebrate what their statistics put at 98
percent success attained in the sustained combat to eradicate the
dreaded ailment.
Efforts to reach the North West zonal coordinator of the National
Primary Health Care Development Agency (NPHCDA), Dr Abdullahi Bulama
Garba proved abortive as officials in his office told our
correspondent he went out on a crucial field assignment.
Also, none of the officials was ready to either deny or confirm the
veracity of the cases suspected to have occurred in these states' as
they revealed they are not in a position to speak on the issue.
Specifically, the Rotary International had rolled out the carpet to
toast to the success some weeks back.
Only Nigeria, India, and Pakistan are reported not to have fully
stemmed the scourge worldwide.
[Byline: Salihu Othman Isah]
--
Communicated by:
ProMED-EAFR
<promed-eafr@promedmail.org>
[While the newswire above refers to the cases as "suspected", the
mention that each of the 3 suspected cases is due to infection with
wild poliovirus type 3 (WPV3) suggests there is laboratory
identification of the WPV3 from specimens from these cases. We await
further confirmation on these cases.
According to the most recent case count available on the polio
eradication website, as of 26 Oct 2010, there have been 8 cases of
WPV associated polio in Nigeria -- 4 attributable to infection with
WPV1 and 4 to infection with WPV3 (see
<http://www.polioeradication.org/Dataand ... sweek.aspx>).
The date of onset of the most recent case was 27 Aug 2010. Of note,
of 747 cases of polio with WPV isolated this year (2010), 163 were in
endemic countries, and 584 were in non-endemic countries. The
outbreak in Tajikistan involved 458 cases, with another 14 identified
in the Russian Federation, 3 identified in Turkmenistan, and one
identified in Kazakhstan.
For a map of Nigeria with states, see
<http://www.un.org/Depts/Cartographic/ma ... igeria.pdf>. All 3
states mentioned (Kano, Katsina, and Sokoto) are in the north and
border with Niger. For the interactive HealthMap/ProMED-mail map of
Nigeria, see <http://healthmap.org/r/007*>. - Mod.MPP]
-
Birgitt
- Moderator
- Beiträge: 35237
- Registriert: Di 2. Aug 2005, 22:52
- Wohnort: NRW / Südl. Rheinland
- Kontaktdaten:
Re: Kinderlähmung - Poliomyelitis
POLIOMYELITIS - WORLDWIDE (25): IMPORTATION RELATED
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: 4 Nov 2010
Source: Morbidity and Mortality Weekly Report (MMWR), 5 Nov 2010 /
59(43);1393-1399 [edited]
<http://www.cdc.gov/mmwr/preview/mmwrhtm ... mm5943a1_e>
Outbreaks Following Wild Poliovirus Importations --- Europe, Africa,
and Asia, January 2009-September 2010
----------------------------------
The Global Polio Eradication Initiative (GPEI) began in 1988. By
2006, indigenous transmission of wild poliovirus (WPV) had been
interrupted in all but 4 countries (Afghanistan, India, Nigeria, and
Pakistan) (1). However, outbreaks following WPV importations into
previously polio-free countries remain an ongoing risk until polio is
eradicated (1--3). The GPEI Strategic Plan for 2010--2012 (4) set the
following 2 goals for outbreak control: 1) end outbreaks occurring in
2009 by mid-2010 and 2) end outbreaks occurring during 2010 to
mid-2012 within 6 months of confirmation. This report describes new
outbreaks that have occurred in the World Health Organization (WHO)
European Region and updates previous reports on the status of
outbreaks in Africa and Asia (3).
In 2010, the 1st WPV importation into the European Region since the
region was declared polio-free in 2002 resulted in 476 confirmed
cases: 458 in Tajikistan, 14 in Russia, 3 in Turkmenistan, and one in
Kazakhstan. In Africa and Asia, 11 new importations into 6 countries
were observed in 2010; 30 WPV importations that occurred during
2008--2009 resulted in 215 cases in 15 African countries during
2009--2010. An outbreak is considered interrupted if 6 months have
elapsed since the latest confirmed case and surveillance performance
indicators meet WHO standards. All 2009 outbreaks in Africa appear to
have been interrupted, and 2010 outbreaks in 3 countries appear to
have been interrupted. Maintaining high routine vaccination coverage
and sensitive surveillance at all times and rapidly instituting
additional immunization programs to control outbreaks are key to
limiting and stopping the spread of WPV.
European Region Importations, 2010
On [13 Apr 2010], Tajikistan notified WHO of a sharp increase in
reported acute flaccid paralysis (AFP) cases. On [20 Apr 2010], the
designated WHO regional reference laboratory in Moscow, Russia,
identified WPV type 1 (WPV1) in stool specimens from persons with AFP
cases; the WPV1 was genetically most closely related to WPV1 isolated
in Uttar Pradesh, India, in August 2009. As of [1 Nov 2010],
Tajikistan had reported 458 laboratory-confirmed WPV1 cases from 35
of 61 administrative territories, with paralysis onset dates
occurring [1 Feb--4 Jul 2010] (Figure 1 [available at above given URL
link). 90 (20 percent) patients were aged less than 1 year, 208 (45
percent) were aged 1--4 years, 107 (23 percent) were aged 5--14
years, and 53 (12 percent) were aged greater than or equal to 15
years. Early in the outbreak, the majority of cases were in children
aged less than 5 years; after week 20, 78 percent of cases were in
persons aged greater than or equal to 5 years (Figure 1). 26 (5.7
percent) patients died; 15 were aged less than 5 years, 8 were aged
5--14 years, and 3 were aged greater than or equal to 15 years.
The outbreak spread to 3 other polio-free countries,* where 18 cases
were confirmed, bringing to 476 the total number of cases in the
European Region (Figure 2 [available at above given URL link). Russia
reported 14 cases following at least 5 independent importations, with
onsets during [4 May 4--25 Sep 2010] (confirmed [31 May 2010]).
Turkmenistan reported 3 cases in June (confirmed [27 Jun 2010]), and
Kazakhstan reported one case in August (confirmed [5 Oct 2010])
(Table 1 see table excerpt below). Nine of these 18 patients were
aged less than 5 years.
Efforts to control the outbreak in Tajikistan began [4 May 2010] with
the 1st of 4 rounds of national supplementary immunization activities
(SIAs),***** 2 weeks apart, using monovalent type 1 oral poliovirus
vaccine (mOPV1) (Table 2 [available at above given URL link]). The
1st 2 SIAs targeted children aged less than 6 years, and the 3rd and
4th SIAs targeted children aged less than 15 years. Mop-up SIAs with
mOPV1 were conducted in 34 districts in September [2010]; one
national SIA using trivalent OPV was conducted in early October
[2010], and another is planned for November [2010], each targeting
children aged less than 15 years (Table 2). Reported vaccination
coverage for each SIA was greater than or equal to 98 percent of the
target (Table 2 [available at above given URL link]).
In early May 2010, the risk for importation was assessed for 12
countries*** in the European Region to identify high-risk subnational
areas for WPV transmission. National authorities were advised to
strengthen surveillance**** through enhanced active case finding and
weekly reporting and to implement SIAs as needed. Kazakhstan,
Kyrgyzstan, Turkmenistan, and Uzbekistan conducted national SIAs to
limit further spread; Russia conducted focal mop-up SIAs and catch-up
immunizations (Table 2).
Importations in Africa and Asia, 2009--2010
19 importations of WPV1 and 11 of WPV type 3 (WPV3) that occurred
during 2008--2009 (9 in 2008 and 21 in 2009) resulted in 208 polio
cases in 15 countries in 2009 and 7 additional cases in 2010 (Table 1
[see excerpted Table 1 below). As of [1 Nov 2010], no other 2009
outbreak-related cases had been detected during the 6 months since
the latest case in Mauritania ([28 Apr 2010]). In outbreaks with the
1st case occurring in 2010, 7 importations of WPV1 and 2 of WPV3
resulted in 26 polio cases in 4 African countries, and WPV1
importation into one Asian country resulted in 6 cases to date (Table
1 [see excerpted Table 1 below]).
West Central Africa.** In 2009, outbreaks related to increased
circulation of WPV1 and WPV3 in Nigeria during 2008--2009 occurred in
12 countries****** (Table 1). Outbreaks in Mali, Mauritania, and
Sierra Leone continued into 2010.
In 2010, Senegal had 3 importations (1st confirmed [18 Jan 2010]).
New importations with no or limited subsequent transmission also
occurred in Liberia (confirmed [14 Apr 2010), Mali (WPV1 confirmed [8
Apr 2010] and WPV3 confirmed [15 Oct 2010]) and Niger (confirmed [22
Apr 2010]) (Table 1). The most recent case among 2010 outbreaks
occurred on [8 Sep 2010] in Liberia.
Horn of Africa. Outbreaks occurred in Kenya and Uganda in 2009 (the
latest cases on [30 Jul 2010 and 10 May 2009], respectively) (Table
1). These represented 2 distinct importations from south Sudan, where
WPV1 genetically related to viruses from the importation-related
outbreak during 2004--2005 in Sudan was again confirmed from polio
cases during June 2008--June 2009.******* A new 2010 importation case
occurred in Uganda on [28 Sep 2010] (confirmed [18 Oct 2010]),
genetically related to virus last isolated in Kenya in 2009.
South Central Africa. Two cases occurred in Burundi in 2009, most
recently on [12 Sep 2009] (Table 1). This outbreak spread from the
Democratic Republic of the Congo (DRC) as a result of WPV1
importation from India into Angola in 2005 and subsequently into DRC (3).
Nepal. Two WPV1 importations from India caused 6 confirmed WPV1 cases
in Nepal in 2010. The 1st case occurred on [19 Feb 2010] (confirmed
on [19 Mar 2010]), and the most recent occurred on [30 Aug 2010].
Reported by: Vaccine Preventable Diseases and Immunization, World
Health Organization Regional Office for Europe, Copenhagen, Denmark;
Polio Eradication Dept, World Health Organization, Geneva,
Switzerland. Div of Viral Diseases, Global Immunization Div, National
Center for Immunization and Respiratory Diseases, CDC.
MMWR Editorial Note
-------------------
The large 2010 WPV1 outbreak in the WHO European Region, certified as
polio-free since 2002, highlights the risk for WPV reintroduction for
all countries posed by international travel and migration. Factors
contributing to the scale of the outbreak in Tajikistan included a
health system with limited resources, accumulation of susceptible
persons in areas of low OPV coverage (5), and delays in recognizing
and testing the initial cluster of AFP cases, as also occurred during
the 2005 outbreak in Yemen (2). In June 2009, the European Regional
Commission for the Certification of Poliomyelitis Eradication
highlighted a high risk for transmission in Tajikistan if WPV was
introduced (6), but funds were not available to conduct preventive
SIAs. Additional SIAs are planned in the Central Asian republics and
Russia to end the outbreaks and prevent spread to other countries in
the region known to have pockets of low vaccination coverage (e.g.,
Bulgaria, Georgia, and Ukraine). All countries in the region must
ensure full political commitment to undertake the actions recommended
by WHO to detect WPV importations and limit spread.
The GPEI Strategic Plan milestone of ending 2009 importation-related
outbreaks by mid-2010 appears to have been met, with one possible
exception: WPV1 circulation related to the 2009 outbreak in Kenya, as
suggested by the [18 Sep 2010] case in Uganda. Whether WPV1
circulating in Kenya in 2009 continued to circulate without detection
in Uganda, in Kenya, or in both countries is uncertain and requires
further observation and investigation. Many outbreaks occurring in
2010 have ended or are on track to end within 6 months of
confirmation, including the outbreak in Tajikistan. However, concern
exists that ongoing transmission within the northern Caucasus area of
Russia and in Nepal could spread further, unless high-quality SIAs
are implemented. In Africa, some countries that had outbreaks have
not met AFP surveillance performance criteria fully, so caution is
needed when interpreting the length of time after the latest
confirmed cases as a sign that an outbreak has ended, particularly
when surveillance is suboptimal in neighboring countries.
During 2009--2010, WPV was imported into polio-free countries from
both polio-endemic countries (India and Nigeria) and previously
polio-free countries with reestablished transmission (Chad and Sudan)
(3), with importations occurring more frequently in countries
adjacent to countries with ongoing WPV transmission. The risk for WPV
importations in 2010 appears to have decreased as a result of 1) a
greater than or equal to 90 percent decrease in confirmed cases in
Nigeria and northern India compared with the same period in 2009, 2)
a prolonged period without confirmed WPV cases in Sudan, and 3)
greater than 4 months without confirmed cases in Chad. However, WPV
importations from reservoir countries into polio-free areas will
continue to occur until transmission is interrupted everywhere.
Transmission after WPV importation can be prevented by ensuring high
levels of poliovirus immunity in the population. Early recognition
and response to WPV transmission limit the geographic extent and
enable more rapid control of an outbreak (8,9). All polio-free
countries are advised to maintain high levels of immunity against
polioviruses at all times through strong routine vaccination
programs, adding SIAs when necessary. Maintaining sensitive,
efficient, nationwide AFP surveillance systems with timely
investigation and testing of specimens in accredited laboratories is
critical to promptly identifying importations. National authorities
should maintain updated preparedness plans for timely, large-scale,
high-quality response SIAs if WPV importations occur (9).
References
-------------
1. CDC. Progress toward interruption of wild poliovirus
transmission---worldwide, 2009. MMWR 2010;59:545--50. [available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5918a1.htm>]
2. CDC. Resurgence of wild poliovirus type 1 transmission and
consequences of importation---21 countries, 2002--2005. MMWR
2006;55:145--50. [available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5506a1.htm>]
3. CDC. Wild poliovirus type 1 and type 3 importations---15
countries, Africa, 2008--2009. MMWR 2009;58:357--62. [available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5814a1.htm>]
4. World Health Organization. Global Polio Eradication Initiative:
strategic plan 2010--2012. Geneva, Switzerland: World Health
Organization; 2010. Available at
<http://www.polioeradication.org/content ... y.2010.pdf>
Adobe PDF fileExternal Web Site Icon. Accessed 29 Oct 2010.
5. Tajikistan State Committee for Statistics, UNICEF. Tajikistan
living standards measurement survey, 2007. Available at
<http://www.tojikinfo.tj/en/index.php?news=362External> Web Site
Icon. Accessed 1 Nov 2010.
6. World Health Organization Regional Office for Europe. Report of
the 22nd meeting of the European Regional Certification Commission
for Poliomyelitis Eradication. Copenhagen, Denmark: World Health
Organization; 2010. Available at
<http://www.euro.who.int/__data/assets/p ... E93603.pdf>
Adobe PDF fileExternal Web Site Icon. Accessed 29 Oct 2010.
7. Global Polio Eradication Initiative. Wild poliovirus cases by
type, 2009--2010, year to date comparison Geneva, Switzerland: World
Health Organization; 2010. Available at
<http://www.polioeradication.org/casecount.asp> External Web Site
Icon. Accessed 29 Oct 2010.
8. Thompson KM, Duintjer Tebbens RJ, Pallansch MA. Evaluation of
response scenarios to potential polio outbreaks using mathematical
models. Risk Anal 2006;26:1541--56.
9. World Health Organization. Advisory Committee on Polio
Eradication: standing recommendations for responding to circulating
polioviruses in polio-free areas. Wkly Epidemiol Rec 2005;80:330--1.
[available at <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5814a1.htm>]
* Countries with no evidence of indigenous WPV transmission for
greater than or equal to 1 years and subsequent cases determined to
be of external origin by genomic sequencing analysis.
** Mass campaigns conducted for a brief period (days to weeks),
during which 1 dose of OPV typically is administered to all children
aged less than 5 years (although the target age group can vary),
regardless of vaccination history. Campaigns can be conducted
nationally or in portions of the country, and the approach to SIA
implementation varies widely by country.
*** Armenia, Azerbaijan, Bosnia and Herzegovina, Georgia, Kyrgyzstan,
Kazakhstan, Russia, Tajikistan, Turkey, Turkmenistan, Ukraine, and Uzbekistan.
**** AFP surveillance quality is monitored by performance indicators
that suggest the ease by which any WPV transmission will be detected.
The current WHO targets are a nonpolio AFP detection rate of greater
than 2 cases per 100 000 population aged less than 15 years and
adequate stool specimen collection from greater than 80 percent of
AFP cases, in which 2 specimens are collected greater than or equal
to 24 hours apart, both within 14 days of paralysis onset, and
shipped on ice or frozen ice packs to a WHO-accredited laboratory,
arriving in good condition. National data might mask surveillance
system weaknesses at subnational levels.
***** Regions are based on GPEI epidemiologic and programmatic
considerations and do not necessarily coincide with traditional
geographic divisions.
****** Benin, Burkina Faso, Cameroon, Central African Republic, Cote
d'Ivoire, Guinea, Liberia, Mali, Mauritania, Niger, Sierra Leone, and Togo.
******* The latest patient in south Sudan had onset [27 Jun 2009];
however, surveillance quality has not met performance standards for
greater than 12 months.
Figure 1. Laboratory-confirmed wild poliovirus type 1 cases (N =
458), by week of paralysis onset and age group --- Tajikistan, 2010
--The figure is a histogram showing laboratory-confirmed wild
poliovirus type 1 cases (N = 458), by week of paralysis onset and age
group in Tajikistan in 2010. As of [1 Nov 2010], Tajikistan had
reported 458 laboratory-confirmed WPV1 cases from 35 of 61
administrative territories, with paralysis onset dates occurring [1
Feb-4 Jul 2010].
Figure 2. Distribution of laboratory-confirmed wild poliovirus type 1
cases (N = 476) --- World Health Organization European Region, 2010
-- The figure shows the distribution of laboratory-confirmed wild
poliovirus type 1 cases (N = 476) in 4 countries in the World Health
Organization European Region in 2010: 458 in Tajikistan, 14 in
Russia, 3 in Turkmenistan, and one in Kazakhstan.
Table 1. Summary information regarding importations of wild
poliovirus (WPV) types 1 and 3 into previously polio-free* countries
and subsequent outbreaks --- Africa, Europe, and Asia, January
2009--September 2010 [see URL link above for full table, information
on vaccination campaigns and coverages available there].
Region/Country: No. Importations**by WPV type / Onset date 1st conf.
case / Onset date most recent case / WPV origin by sequencing / No.
cases confirmed to date***
2009 outbreaks
--------------
West Central Africa****
Benin: 1 WPV1 / 3 Nov 2008 / 19 Apr 2009 / Nigeria / 20
Burkina Faso: 3 WPV1 / 4 Nov 2008 / 25 Oct 2009 / Togo, Cote
d'Ivoire, Benin / 15
Cameroon: 2 WPV3 / 29 Jul 2009 / 15 Oct 2009 / Nigeria, Chad / 3
CAR: 1 WPV3 / 2 Apr 2009 / 3 Aug 2009 / Chad / 14
Cote d'Ivoire: 2 WPV1 / 24 Dec 2008 / 6 Aug 2009 / Burkina Faso / 27
Guinea: 1 WPV1 / 9 Apr 2009 / 3 Nov 2009 / Cote d'Ivoire / 42
Liberia: 1 WPV1 / 29 Apr 2009 / 26 Oct 2009 / Cote d'Ivoire / 11
Mali: 2 WPV1 / 30 Aug 2008 / 30 Mar 2010 / Burkina Faso, Guinea / 3***
Mauritania: 1 WPV1 / 7 Oct 2009 / 28 Apr 2010 / Cote d'Ivoire / 18***
Niger: 8 WPV3 / 6 Dec 2008 / 28 May 2009 / Nigeria, Chad / 15
1 WPV1 / 28 May 2009 / --- / Nigeria / 1
Sierra Leone: 1 WPV1 / 15 Jul 2009 / 28 Feb 2010 / Guinea / 12***
Togo: 3 WPV1 / 16 Oct 2008 / 28 Mar 2009 / Burkina Faso, Ghana / 6
Horn of Africa
------------
Kenya: 1 WPV1 / 3 Feb 2009 / 30 Jul 2009 / Sudan / 18
Uganda: 1 WPV1 / 28 Jan 2009 / 10 May 2009 / Sudan / 8
South Central Africa
----------------
Burundi: 1 WPV1 / 8 Sep 2009 / 12 Sep 2009 / DRC / 2
2010 outbreaks
West Central Africa
----------------
Liberia: 1 WPV1 / 3 Mar 2010 / 8 Sep 2010 / Guinea / 2
Mali: 2 WPV1 / 6 Mar 2010 / 1 May 2010 / Mauritania, Burkina Faso / 2
1 WPV3 / 17 Sep 2010 / --- / TBD / 1
Niger: 1 WPV3 / 8 Mar 2010 / 1 Apr 2010 / Nigeria / 2
Senegal: 3 WPV1 / 5 Jan 2010 / 30 Apr 2010 / Mauritania, Guinea / 18
Horn of Africa
-----------
Uganda: 1 WPV1 / 28 Sep 2010 / --- / Kenya / 1
Europe/Asia
----------
Kazakhstan: 1 WPV1 / 12 Aug 2010 / --- / TBD / 1
Nepal: 2 WPV1 / 19 Feb 2010 / 30 Aug 2010 / India / 6
Russia: 5 WPV1 / 4 May 2010 / 25 Sep 2010 / Tajikistan, TBD / 14
Tajikistan: 1 WPV1 / 1 Feb 2010 / 4 Jul 2010 / India / 458
Turkmenistan: 2 WPV1 / 20 Jun 2010 / 28 Jun 2010 / Tajikistan / 3
Abbreviations: CAR = Central African Republic; DRC = Democratic
Republic of the Congo; OPV3 = 3 doses of live, attenuated oral polio
virus vaccine; SIAs = supplementary immunization activities; TBD = to
be determined.
* Countries with no evidence of indigenous WPV transmission for
greater than or equal to 1 years and subsequent cases determined to
be of external origin by genomic sequencing analysis. Importations
also occurred into Chad and DRC, which in 2009 also experienced
reestablished persistent transmission of WPV (greater than or equal
to 12 months) after importation. Data as of [1 Nov 2010].
**Detection of one or more polio cases in a country from WPV that
genetic analysis showed to be originating from another country. For
some outbreaks occurring in 2009, the related importation occurred in
2008 and transmission continued into 2009: Benin (one importation),
Burkina Faso (two), Cote d'Ivoire (1), Mali (1), Niger (3), and Togo
(1). Data as of [1 Nov 2010].
*** Number of polio cases in a country from WPV importations
resulting in outbreaks in that year. For some outbreaks occurring in
2009, additional cases occurred in 2010 that are reflected in the
totals for 2009 outbreaks: Mali (1 case), Mauritania (5), and Sierra Leone (1).
**** Regions are based on Global Polio Eradication Initiative
epidemiologic and programmatic considerations and do not necessarily
coincide with traditional geographic divisions.
--
Communicated by:
ProMED-mail <promed@promedmail.org>
[The above report is an excellent review of the current challenges
posed by reintroduction of WPV into countries that had interrupted
transmission of the WPV. The report does demonstrate the challenges
countries face in maintaining high coverages with 3 or more doses of
OPV after they have interrupted transmission of the WPV.
Another challenge confronting the surveillance efforts once
transmission of the WPV has been interrupted in a country is
identifying newly introduced cases when clinicians in the country
automatically assume that these can't be polio. When the polio
eradication efforts 1st began in the Americas region in 1985, Brazil
had had 5 years of intensive polio control activities (since 1980)
ongoing that included the use of national immunization days (NIDs).
As a result of those activities, reported high coverages of the
population with OPV and the marked reduction in paralytic cases,
clinicians often did not entertain the diagnosis of polio when seeing
cases of acute flaccid paralysis (AFP). The result of this was that a
large outbreak of polio that was ongoing in the northeastern states
of the country had been "missed" through routine surveillance
activities, and was identified later in the course of the outbreak
than would have occurred before the NIDs had begun. The outbreak in
Tajikistan was very reminiscent of this, and one suspects that
similar events were ongoing within the country, where clinicians saw
cases of AFP, and assumed they couldn't be due to WPV infection,
since it had been years since WPV had circulated in the country, and
NIDs had "eliminated" the problem of large groups of susceptibles.
For a map of current WPV associated cases of polio as of 26 Oct 2010,
see <http://www.polioeradication.org/Dataandmonitoring.aspx>. - Mod.MPP]
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: 4 Nov 2010
Source: Morbidity and Mortality Weekly Report (MMWR), 5 Nov 2010 /
59(43);1393-1399 [edited]
<http://www.cdc.gov/mmwr/preview/mmwrhtm ... mm5943a1_e>
Outbreaks Following Wild Poliovirus Importations --- Europe, Africa,
and Asia, January 2009-September 2010
----------------------------------
The Global Polio Eradication Initiative (GPEI) began in 1988. By
2006, indigenous transmission of wild poliovirus (WPV) had been
interrupted in all but 4 countries (Afghanistan, India, Nigeria, and
Pakistan) (1). However, outbreaks following WPV importations into
previously polio-free countries remain an ongoing risk until polio is
eradicated (1--3). The GPEI Strategic Plan for 2010--2012 (4) set the
following 2 goals for outbreak control: 1) end outbreaks occurring in
2009 by mid-2010 and 2) end outbreaks occurring during 2010 to
mid-2012 within 6 months of confirmation. This report describes new
outbreaks that have occurred in the World Health Organization (WHO)
European Region and updates previous reports on the status of
outbreaks in Africa and Asia (3).
In 2010, the 1st WPV importation into the European Region since the
region was declared polio-free in 2002 resulted in 476 confirmed
cases: 458 in Tajikistan, 14 in Russia, 3 in Turkmenistan, and one in
Kazakhstan. In Africa and Asia, 11 new importations into 6 countries
were observed in 2010; 30 WPV importations that occurred during
2008--2009 resulted in 215 cases in 15 African countries during
2009--2010. An outbreak is considered interrupted if 6 months have
elapsed since the latest confirmed case and surveillance performance
indicators meet WHO standards. All 2009 outbreaks in Africa appear to
have been interrupted, and 2010 outbreaks in 3 countries appear to
have been interrupted. Maintaining high routine vaccination coverage
and sensitive surveillance at all times and rapidly instituting
additional immunization programs to control outbreaks are key to
limiting and stopping the spread of WPV.
European Region Importations, 2010
On [13 Apr 2010], Tajikistan notified WHO of a sharp increase in
reported acute flaccid paralysis (AFP) cases. On [20 Apr 2010], the
designated WHO regional reference laboratory in Moscow, Russia,
identified WPV type 1 (WPV1) in stool specimens from persons with AFP
cases; the WPV1 was genetically most closely related to WPV1 isolated
in Uttar Pradesh, India, in August 2009. As of [1 Nov 2010],
Tajikistan had reported 458 laboratory-confirmed WPV1 cases from 35
of 61 administrative territories, with paralysis onset dates
occurring [1 Feb--4 Jul 2010] (Figure 1 [available at above given URL
link). 90 (20 percent) patients were aged less than 1 year, 208 (45
percent) were aged 1--4 years, 107 (23 percent) were aged 5--14
years, and 53 (12 percent) were aged greater than or equal to 15
years. Early in the outbreak, the majority of cases were in children
aged less than 5 years; after week 20, 78 percent of cases were in
persons aged greater than or equal to 5 years (Figure 1). 26 (5.7
percent) patients died; 15 were aged less than 5 years, 8 were aged
5--14 years, and 3 were aged greater than or equal to 15 years.
The outbreak spread to 3 other polio-free countries,* where 18 cases
were confirmed, bringing to 476 the total number of cases in the
European Region (Figure 2 [available at above given URL link). Russia
reported 14 cases following at least 5 independent importations, with
onsets during [4 May 4--25 Sep 2010] (confirmed [31 May 2010]).
Turkmenistan reported 3 cases in June (confirmed [27 Jun 2010]), and
Kazakhstan reported one case in August (confirmed [5 Oct 2010])
(Table 1 see table excerpt below). Nine of these 18 patients were
aged less than 5 years.
Efforts to control the outbreak in Tajikistan began [4 May 2010] with
the 1st of 4 rounds of national supplementary immunization activities
(SIAs),***** 2 weeks apart, using monovalent type 1 oral poliovirus
vaccine (mOPV1) (Table 2 [available at above given URL link]). The
1st 2 SIAs targeted children aged less than 6 years, and the 3rd and
4th SIAs targeted children aged less than 15 years. Mop-up SIAs with
mOPV1 were conducted in 34 districts in September [2010]; one
national SIA using trivalent OPV was conducted in early October
[2010], and another is planned for November [2010], each targeting
children aged less than 15 years (Table 2). Reported vaccination
coverage for each SIA was greater than or equal to 98 percent of the
target (Table 2 [available at above given URL link]).
In early May 2010, the risk for importation was assessed for 12
countries*** in the European Region to identify high-risk subnational
areas for WPV transmission. National authorities were advised to
strengthen surveillance**** through enhanced active case finding and
weekly reporting and to implement SIAs as needed. Kazakhstan,
Kyrgyzstan, Turkmenistan, and Uzbekistan conducted national SIAs to
limit further spread; Russia conducted focal mop-up SIAs and catch-up
immunizations (Table 2).
Importations in Africa and Asia, 2009--2010
19 importations of WPV1 and 11 of WPV type 3 (WPV3) that occurred
during 2008--2009 (9 in 2008 and 21 in 2009) resulted in 208 polio
cases in 15 countries in 2009 and 7 additional cases in 2010 (Table 1
[see excerpted Table 1 below). As of [1 Nov 2010], no other 2009
outbreak-related cases had been detected during the 6 months since
the latest case in Mauritania ([28 Apr 2010]). In outbreaks with the
1st case occurring in 2010, 7 importations of WPV1 and 2 of WPV3
resulted in 26 polio cases in 4 African countries, and WPV1
importation into one Asian country resulted in 6 cases to date (Table
1 [see excerpted Table 1 below]).
West Central Africa.** In 2009, outbreaks related to increased
circulation of WPV1 and WPV3 in Nigeria during 2008--2009 occurred in
12 countries****** (Table 1). Outbreaks in Mali, Mauritania, and
Sierra Leone continued into 2010.
In 2010, Senegal had 3 importations (1st confirmed [18 Jan 2010]).
New importations with no or limited subsequent transmission also
occurred in Liberia (confirmed [14 Apr 2010), Mali (WPV1 confirmed [8
Apr 2010] and WPV3 confirmed [15 Oct 2010]) and Niger (confirmed [22
Apr 2010]) (Table 1). The most recent case among 2010 outbreaks
occurred on [8 Sep 2010] in Liberia.
Horn of Africa. Outbreaks occurred in Kenya and Uganda in 2009 (the
latest cases on [30 Jul 2010 and 10 May 2009], respectively) (Table
1). These represented 2 distinct importations from south Sudan, where
WPV1 genetically related to viruses from the importation-related
outbreak during 2004--2005 in Sudan was again confirmed from polio
cases during June 2008--June 2009.******* A new 2010 importation case
occurred in Uganda on [28 Sep 2010] (confirmed [18 Oct 2010]),
genetically related to virus last isolated in Kenya in 2009.
South Central Africa. Two cases occurred in Burundi in 2009, most
recently on [12 Sep 2009] (Table 1). This outbreak spread from the
Democratic Republic of the Congo (DRC) as a result of WPV1
importation from India into Angola in 2005 and subsequently into DRC (3).
Nepal. Two WPV1 importations from India caused 6 confirmed WPV1 cases
in Nepal in 2010. The 1st case occurred on [19 Feb 2010] (confirmed
on [19 Mar 2010]), and the most recent occurred on [30 Aug 2010].
Reported by: Vaccine Preventable Diseases and Immunization, World
Health Organization Regional Office for Europe, Copenhagen, Denmark;
Polio Eradication Dept, World Health Organization, Geneva,
Switzerland. Div of Viral Diseases, Global Immunization Div, National
Center for Immunization and Respiratory Diseases, CDC.
MMWR Editorial Note
-------------------
The large 2010 WPV1 outbreak in the WHO European Region, certified as
polio-free since 2002, highlights the risk for WPV reintroduction for
all countries posed by international travel and migration. Factors
contributing to the scale of the outbreak in Tajikistan included a
health system with limited resources, accumulation of susceptible
persons in areas of low OPV coverage (5), and delays in recognizing
and testing the initial cluster of AFP cases, as also occurred during
the 2005 outbreak in Yemen (2). In June 2009, the European Regional
Commission for the Certification of Poliomyelitis Eradication
highlighted a high risk for transmission in Tajikistan if WPV was
introduced (6), but funds were not available to conduct preventive
SIAs. Additional SIAs are planned in the Central Asian republics and
Russia to end the outbreaks and prevent spread to other countries in
the region known to have pockets of low vaccination coverage (e.g.,
Bulgaria, Georgia, and Ukraine). All countries in the region must
ensure full political commitment to undertake the actions recommended
by WHO to detect WPV importations and limit spread.
The GPEI Strategic Plan milestone of ending 2009 importation-related
outbreaks by mid-2010 appears to have been met, with one possible
exception: WPV1 circulation related to the 2009 outbreak in Kenya, as
suggested by the [18 Sep 2010] case in Uganda. Whether WPV1
circulating in Kenya in 2009 continued to circulate without detection
in Uganda, in Kenya, or in both countries is uncertain and requires
further observation and investigation. Many outbreaks occurring in
2010 have ended or are on track to end within 6 months of
confirmation, including the outbreak in Tajikistan. However, concern
exists that ongoing transmission within the northern Caucasus area of
Russia and in Nepal could spread further, unless high-quality SIAs
are implemented. In Africa, some countries that had outbreaks have
not met AFP surveillance performance criteria fully, so caution is
needed when interpreting the length of time after the latest
confirmed cases as a sign that an outbreak has ended, particularly
when surveillance is suboptimal in neighboring countries.
During 2009--2010, WPV was imported into polio-free countries from
both polio-endemic countries (India and Nigeria) and previously
polio-free countries with reestablished transmission (Chad and Sudan)
(3), with importations occurring more frequently in countries
adjacent to countries with ongoing WPV transmission. The risk for WPV
importations in 2010 appears to have decreased as a result of 1) a
greater than or equal to 90 percent decrease in confirmed cases in
Nigeria and northern India compared with the same period in 2009, 2)
a prolonged period without confirmed WPV cases in Sudan, and 3)
greater than 4 months without confirmed cases in Chad. However, WPV
importations from reservoir countries into polio-free areas will
continue to occur until transmission is interrupted everywhere.
Transmission after WPV importation can be prevented by ensuring high
levels of poliovirus immunity in the population. Early recognition
and response to WPV transmission limit the geographic extent and
enable more rapid control of an outbreak (8,9). All polio-free
countries are advised to maintain high levels of immunity against
polioviruses at all times through strong routine vaccination
programs, adding SIAs when necessary. Maintaining sensitive,
efficient, nationwide AFP surveillance systems with timely
investigation and testing of specimens in accredited laboratories is
critical to promptly identifying importations. National authorities
should maintain updated preparedness plans for timely, large-scale,
high-quality response SIAs if WPV importations occur (9).
References
-------------
1. CDC. Progress toward interruption of wild poliovirus
transmission---worldwide, 2009. MMWR 2010;59:545--50. [available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5918a1.htm>]
2. CDC. Resurgence of wild poliovirus type 1 transmission and
consequences of importation---21 countries, 2002--2005. MMWR
2006;55:145--50. [available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5506a1.htm>]
3. CDC. Wild poliovirus type 1 and type 3 importations---15
countries, Africa, 2008--2009. MMWR 2009;58:357--62. [available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5814a1.htm>]
4. World Health Organization. Global Polio Eradication Initiative:
strategic plan 2010--2012. Geneva, Switzerland: World Health
Organization; 2010. Available at
<http://www.polioeradication.org/content ... y.2010.pdf>
Adobe PDF fileExternal Web Site Icon. Accessed 29 Oct 2010.
5. Tajikistan State Committee for Statistics, UNICEF. Tajikistan
living standards measurement survey, 2007. Available at
<http://www.tojikinfo.tj/en/index.php?news=362External> Web Site
Icon. Accessed 1 Nov 2010.
6. World Health Organization Regional Office for Europe. Report of
the 22nd meeting of the European Regional Certification Commission
for Poliomyelitis Eradication. Copenhagen, Denmark: World Health
Organization; 2010. Available at
<http://www.euro.who.int/__data/assets/p ... E93603.pdf>
Adobe PDF fileExternal Web Site Icon. Accessed 29 Oct 2010.
7. Global Polio Eradication Initiative. Wild poliovirus cases by
type, 2009--2010, year to date comparison Geneva, Switzerland: World
Health Organization; 2010. Available at
<http://www.polioeradication.org/casecount.asp> External Web Site
Icon. Accessed 29 Oct 2010.
8. Thompson KM, Duintjer Tebbens RJ, Pallansch MA. Evaluation of
response scenarios to potential polio outbreaks using mathematical
models. Risk Anal 2006;26:1541--56.
9. World Health Organization. Advisory Committee on Polio
Eradication: standing recommendations for responding to circulating
polioviruses in polio-free areas. Wkly Epidemiol Rec 2005;80:330--1.
[available at <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5814a1.htm>]
* Countries with no evidence of indigenous WPV transmission for
greater than or equal to 1 years and subsequent cases determined to
be of external origin by genomic sequencing analysis.
** Mass campaigns conducted for a brief period (days to weeks),
during which 1 dose of OPV typically is administered to all children
aged less than 5 years (although the target age group can vary),
regardless of vaccination history. Campaigns can be conducted
nationally or in portions of the country, and the approach to SIA
implementation varies widely by country.
*** Armenia, Azerbaijan, Bosnia and Herzegovina, Georgia, Kyrgyzstan,
Kazakhstan, Russia, Tajikistan, Turkey, Turkmenistan, Ukraine, and Uzbekistan.
**** AFP surveillance quality is monitored by performance indicators
that suggest the ease by which any WPV transmission will be detected.
The current WHO targets are a nonpolio AFP detection rate of greater
than 2 cases per 100 000 population aged less than 15 years and
adequate stool specimen collection from greater than 80 percent of
AFP cases, in which 2 specimens are collected greater than or equal
to 24 hours apart, both within 14 days of paralysis onset, and
shipped on ice or frozen ice packs to a WHO-accredited laboratory,
arriving in good condition. National data might mask surveillance
system weaknesses at subnational levels.
***** Regions are based on GPEI epidemiologic and programmatic
considerations and do not necessarily coincide with traditional
geographic divisions.
****** Benin, Burkina Faso, Cameroon, Central African Republic, Cote
d'Ivoire, Guinea, Liberia, Mali, Mauritania, Niger, Sierra Leone, and Togo.
******* The latest patient in south Sudan had onset [27 Jun 2009];
however, surveillance quality has not met performance standards for
greater than 12 months.
Figure 1. Laboratory-confirmed wild poliovirus type 1 cases (N =
458), by week of paralysis onset and age group --- Tajikistan, 2010
--The figure is a histogram showing laboratory-confirmed wild
poliovirus type 1 cases (N = 458), by week of paralysis onset and age
group in Tajikistan in 2010. As of [1 Nov 2010], Tajikistan had
reported 458 laboratory-confirmed WPV1 cases from 35 of 61
administrative territories, with paralysis onset dates occurring [1
Feb-4 Jul 2010].
Figure 2. Distribution of laboratory-confirmed wild poliovirus type 1
cases (N = 476) --- World Health Organization European Region, 2010
-- The figure shows the distribution of laboratory-confirmed wild
poliovirus type 1 cases (N = 476) in 4 countries in the World Health
Organization European Region in 2010: 458 in Tajikistan, 14 in
Russia, 3 in Turkmenistan, and one in Kazakhstan.
Table 1. Summary information regarding importations of wild
poliovirus (WPV) types 1 and 3 into previously polio-free* countries
and subsequent outbreaks --- Africa, Europe, and Asia, January
2009--September 2010 [see URL link above for full table, information
on vaccination campaigns and coverages available there].
Region/Country: No. Importations**by WPV type / Onset date 1st conf.
case / Onset date most recent case / WPV origin by sequencing / No.
cases confirmed to date***
2009 outbreaks
--------------
West Central Africa****
Benin: 1 WPV1 / 3 Nov 2008 / 19 Apr 2009 / Nigeria / 20
Burkina Faso: 3 WPV1 / 4 Nov 2008 / 25 Oct 2009 / Togo, Cote
d'Ivoire, Benin / 15
Cameroon: 2 WPV3 / 29 Jul 2009 / 15 Oct 2009 / Nigeria, Chad / 3
CAR: 1 WPV3 / 2 Apr 2009 / 3 Aug 2009 / Chad / 14
Cote d'Ivoire: 2 WPV1 / 24 Dec 2008 / 6 Aug 2009 / Burkina Faso / 27
Guinea: 1 WPV1 / 9 Apr 2009 / 3 Nov 2009 / Cote d'Ivoire / 42
Liberia: 1 WPV1 / 29 Apr 2009 / 26 Oct 2009 / Cote d'Ivoire / 11
Mali: 2 WPV1 / 30 Aug 2008 / 30 Mar 2010 / Burkina Faso, Guinea / 3***
Mauritania: 1 WPV1 / 7 Oct 2009 / 28 Apr 2010 / Cote d'Ivoire / 18***
Niger: 8 WPV3 / 6 Dec 2008 / 28 May 2009 / Nigeria, Chad / 15
1 WPV1 / 28 May 2009 / --- / Nigeria / 1
Sierra Leone: 1 WPV1 / 15 Jul 2009 / 28 Feb 2010 / Guinea / 12***
Togo: 3 WPV1 / 16 Oct 2008 / 28 Mar 2009 / Burkina Faso, Ghana / 6
Horn of Africa
------------
Kenya: 1 WPV1 / 3 Feb 2009 / 30 Jul 2009 / Sudan / 18
Uganda: 1 WPV1 / 28 Jan 2009 / 10 May 2009 / Sudan / 8
South Central Africa
----------------
Burundi: 1 WPV1 / 8 Sep 2009 / 12 Sep 2009 / DRC / 2
2010 outbreaks
West Central Africa
----------------
Liberia: 1 WPV1 / 3 Mar 2010 / 8 Sep 2010 / Guinea / 2
Mali: 2 WPV1 / 6 Mar 2010 / 1 May 2010 / Mauritania, Burkina Faso / 2
1 WPV3 / 17 Sep 2010 / --- / TBD / 1
Niger: 1 WPV3 / 8 Mar 2010 / 1 Apr 2010 / Nigeria / 2
Senegal: 3 WPV1 / 5 Jan 2010 / 30 Apr 2010 / Mauritania, Guinea / 18
Horn of Africa
-----------
Uganda: 1 WPV1 / 28 Sep 2010 / --- / Kenya / 1
Europe/Asia
----------
Kazakhstan: 1 WPV1 / 12 Aug 2010 / --- / TBD / 1
Nepal: 2 WPV1 / 19 Feb 2010 / 30 Aug 2010 / India / 6
Russia: 5 WPV1 / 4 May 2010 / 25 Sep 2010 / Tajikistan, TBD / 14
Tajikistan: 1 WPV1 / 1 Feb 2010 / 4 Jul 2010 / India / 458
Turkmenistan: 2 WPV1 / 20 Jun 2010 / 28 Jun 2010 / Tajikistan / 3
Abbreviations: CAR = Central African Republic; DRC = Democratic
Republic of the Congo; OPV3 = 3 doses of live, attenuated oral polio
virus vaccine; SIAs = supplementary immunization activities; TBD = to
be determined.
* Countries with no evidence of indigenous WPV transmission for
greater than or equal to 1 years and subsequent cases determined to
be of external origin by genomic sequencing analysis. Importations
also occurred into Chad and DRC, which in 2009 also experienced
reestablished persistent transmission of WPV (greater than or equal
to 12 months) after importation. Data as of [1 Nov 2010].
**Detection of one or more polio cases in a country from WPV that
genetic analysis showed to be originating from another country. For
some outbreaks occurring in 2009, the related importation occurred in
2008 and transmission continued into 2009: Benin (one importation),
Burkina Faso (two), Cote d'Ivoire (1), Mali (1), Niger (3), and Togo
(1). Data as of [1 Nov 2010].
*** Number of polio cases in a country from WPV importations
resulting in outbreaks in that year. For some outbreaks occurring in
2009, additional cases occurred in 2010 that are reflected in the
totals for 2009 outbreaks: Mali (1 case), Mauritania (5), and Sierra Leone (1).
**** Regions are based on Global Polio Eradication Initiative
epidemiologic and programmatic considerations and do not necessarily
coincide with traditional geographic divisions.
--
Communicated by:
ProMED-mail <promed@promedmail.org>
[The above report is an excellent review of the current challenges
posed by reintroduction of WPV into countries that had interrupted
transmission of the WPV. The report does demonstrate the challenges
countries face in maintaining high coverages with 3 or more doses of
OPV after they have interrupted transmission of the WPV.
Another challenge confronting the surveillance efforts once
transmission of the WPV has been interrupted in a country is
identifying newly introduced cases when clinicians in the country
automatically assume that these can't be polio. When the polio
eradication efforts 1st began in the Americas region in 1985, Brazil
had had 5 years of intensive polio control activities (since 1980)
ongoing that included the use of national immunization days (NIDs).
As a result of those activities, reported high coverages of the
population with OPV and the marked reduction in paralytic cases,
clinicians often did not entertain the diagnosis of polio when seeing
cases of acute flaccid paralysis (AFP). The result of this was that a
large outbreak of polio that was ongoing in the northeastern states
of the country had been "missed" through routine surveillance
activities, and was identified later in the course of the outbreak
than would have occurred before the NIDs had begun. The outbreak in
Tajikistan was very reminiscent of this, and one suspects that
similar events were ongoing within the country, where clinicians saw
cases of AFP, and assumed they couldn't be due to WPV infection,
since it had been years since WPV had circulated in the country, and
NIDs had "eliminated" the problem of large groups of susceptibles.
For a map of current WPV associated cases of polio as of 26 Oct 2010,
see <http://www.polioeradication.org/Dataandmonitoring.aspx>. - Mod.MPP]
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Kinderlähmung Republik Kongo
Polio in Congo
04.11.2010 - WHO
An acute outbreak of poliomyelitis is occurring in the Republic of Congo, with 120 cases of acute flaccid paralysis and 58 deaths. Half the cases have been reported in the past ten days, with the first case occurring in early October. Two cases have been confirmed to have been caused by wild poliovirus type 1 and laboratory testing continues.
Most cases are in young adults: among those cases for which age data is available (43) at this time, 33 are between the ages of 15-25 years. Only one is under five years old, three are between 7 and 13 and five are between 26 and 58.
The outbreak is due to imported poliovirus. Congo had recorded its last case of indigenous polio in 2000. Investigations are ongoing to determine definitively the origins of the virus.
Nearly all cases have been reported from the port city of Pointe Noire, with cases also reported from Dolisie (2), Kayes, Bouenza, Brazzaville, and Mvouiti (one each).
The Government of Congo has alerted the public to the outbreak and launched an emergency response plan, with support from key partners, including WHO, UNICEF and the US CDC. At least three nationwide vaccination campaigns are expected, using monovalent oral polio vaccine and targeting the entire population. The number, geographic extent and target age groups of further campaigns will be determined by the Government based on the evolving epidemiology. It is anticipated that a multi-country campaign will be required to cover bordering at-risk areas. New cases continue to be reported every day.
It is important that countries across central Africa and the Horn of Africa strengthen AFP surveillance, in order to rapidly detect any poliovirus importations and facilitate a rapid response. Countries should also strengthen population immunity levels to minimise the consequences of any virus introduction. As per recommendations outlined in WHO's International Travel and Health, guidance travellers to and from Angola and DR Congo should be fully protected by vaccination.
Given the recent progress achieved in Nigeria (98% reduction in cases this year compared to the same period in 2009), very high priority is being given to rapidly controlling persistent transmission such as in Angola and stopping new outbreaks such as Congo.
04.11.2010 - WHO
An acute outbreak of poliomyelitis is occurring in the Republic of Congo, with 120 cases of acute flaccid paralysis and 58 deaths. Half the cases have been reported in the past ten days, with the first case occurring in early October. Two cases have been confirmed to have been caused by wild poliovirus type 1 and laboratory testing continues.
Most cases are in young adults: among those cases for which age data is available (43) at this time, 33 are between the ages of 15-25 years. Only one is under five years old, three are between 7 and 13 and five are between 26 and 58.
The outbreak is due to imported poliovirus. Congo had recorded its last case of indigenous polio in 2000. Investigations are ongoing to determine definitively the origins of the virus.
Nearly all cases have been reported from the port city of Pointe Noire, with cases also reported from Dolisie (2), Kayes, Bouenza, Brazzaville, and Mvouiti (one each).
The Government of Congo has alerted the public to the outbreak and launched an emergency response plan, with support from key partners, including WHO, UNICEF and the US CDC. At least three nationwide vaccination campaigns are expected, using monovalent oral polio vaccine and targeting the entire population. The number, geographic extent and target age groups of further campaigns will be determined by the Government based on the evolving epidemiology. It is anticipated that a multi-country campaign will be required to cover bordering at-risk areas. New cases continue to be reported every day.
It is important that countries across central Africa and the Horn of Africa strengthen AFP surveillance, in order to rapidly detect any poliovirus importations and facilitate a rapid response. Countries should also strengthen population immunity levels to minimise the consequences of any virus introduction. As per recommendations outlined in WHO's International Travel and Health, guidance travellers to and from Angola and DR Congo should be fully protected by vaccination.
Given the recent progress achieved in Nigeria (98% reduction in cases this year compared to the same period in 2009), very high priority is being given to rapidly controlling persistent transmission such as in Angola and stopping new outbreaks such as Congo.
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Re: Kinderlähmung - Poliomyelitis
Polio in Congo - update
09.11.2010 - WHO
184 cases of acute flaccid paralysis and 85 deaths have been reported from the site of the acute poliomyelitis outbreak centred in Pointe Noire, Republic of Congo. Four cases have been confirmed to have been caused by wild poliovirus type 1 and laboratory testing continues. The majority of the reported cases and deaths have occurred in the population aged over 15 years.
Genetic sequencing has determined that the cases are caused by a poliovirus most closely related to that circulating in neighbouring Angola. Congo had recorded its last case of indigenous polio in 2000.
Nearly all cases have been reported from the port city of Pointe Noire, with cases also reported from Niari (5), Bouenza (2), Brazzaville (1), and Kouilou (2).
The Government of Congo has alerted the public to the outbreak and launched an emergency response plan, with support from key partners, including WHO, UNICEF and the US CDC. The first vaccination response, using monovalent oral polio vaccine type 1 (mOPV1), will start on Friday, 12 November, to cover the whole population of Porte Noire and Kouilou, in conjunction with the neighbouring province of Cabinda in Angola. The rest of Congo will be vaccinated starting 18 November using mOPV1. Two additional nationwide rounds are planned. The number, geographic extent and target age groups of further campaigns will be determined by the Government based on the evolving epidemiology. The multi-country campaign may be further expanded to cover additional bordering at-risk areas. New cases continue to be reported.
Countries across central Africa should strengthen surveillance for cases of acute flaccid paralysis (AFP) to rapidly detect any poliovirus importations and facilitate a rapid response. Countries should also address any gaps in polio immunization coverage to minimise the consequences of a poliovirus introduction. As per the recommendations in the WHO publication International Travel and Health, travellers to and from all countries where polio is circulating, including the Republic of Congo and Angola, should be fully protected by vaccination.
Given the recent progress towards polio eradication in Nigeria (98% reduction in cases in 2010 compared to the same period in 2009), rapidly stopping the persistent poliovirus transmission in central Africa (i.e. Angola, DR Congo) and stopping new polio outbreaks such as in Congo, are top international disease control priorities.
09.11.2010 - WHO
184 cases of acute flaccid paralysis and 85 deaths have been reported from the site of the acute poliomyelitis outbreak centred in Pointe Noire, Republic of Congo. Four cases have been confirmed to have been caused by wild poliovirus type 1 and laboratory testing continues. The majority of the reported cases and deaths have occurred in the population aged over 15 years.
Genetic sequencing has determined that the cases are caused by a poliovirus most closely related to that circulating in neighbouring Angola. Congo had recorded its last case of indigenous polio in 2000.
Nearly all cases have been reported from the port city of Pointe Noire, with cases also reported from Niari (5), Bouenza (2), Brazzaville (1), and Kouilou (2).
The Government of Congo has alerted the public to the outbreak and launched an emergency response plan, with support from key partners, including WHO, UNICEF and the US CDC. The first vaccination response, using monovalent oral polio vaccine type 1 (mOPV1), will start on Friday, 12 November, to cover the whole population of Porte Noire and Kouilou, in conjunction with the neighbouring province of Cabinda in Angola. The rest of Congo will be vaccinated starting 18 November using mOPV1. Two additional nationwide rounds are planned. The number, geographic extent and target age groups of further campaigns will be determined by the Government based on the evolving epidemiology. The multi-country campaign may be further expanded to cover additional bordering at-risk areas. New cases continue to be reported.
Countries across central Africa should strengthen surveillance for cases of acute flaccid paralysis (AFP) to rapidly detect any poliovirus importations and facilitate a rapid response. Countries should also address any gaps in polio immunization coverage to minimise the consequences of a poliovirus introduction. As per the recommendations in the WHO publication International Travel and Health, travellers to and from all countries where polio is circulating, including the Republic of Congo and Angola, should be fully protected by vaccination.
Given the recent progress towards polio eradication in Nigeria (98% reduction in cases in 2010 compared to the same period in 2009), rapidly stopping the persistent poliovirus transmission in central Africa (i.e. Angola, DR Congo) and stopping new polio outbreaks such as in Congo, are top international disease control priorities.
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Re: Kinderlähmung - Poliomyelitis
Kongo-Brazzaville
Viele Tote nach Polio-Ausbruch
11.11.2010 - Zeit
In Kongo-Brazzaville sind seit der vergangenen Woche fast 100 Menschen an den Folgen von Kinderlähmung gestorben. Unicef und WHO wollen eine Massenimpfung starten ... mehr
Gruß
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Viele Tote nach Polio-Ausbruch
11.11.2010 - Zeit
In Kongo-Brazzaville sind seit der vergangenen Woche fast 100 Menschen an den Folgen von Kinderlähmung gestorben. Unicef und WHO wollen eine Massenimpfung starten ... mehr
Gruß
Birgitt
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Re: Kinderlähmung - Poliomyelitis
Polio in Central Asia and the North Caucasus Federal Region of the Russian Federation
13.11.2010 - WHO
The risk of further international spread of the ongoing polio outbreak in Central Asia and the North Caucasus Federal Region in Russia continues to be high.
In Central Asia, genetic sequencing of the poliovirus isolated from a child paralyzed in Kazakhstan on 12 August 2010 has confirmed ongoing circulation of the virus which caused the Tajikistan outbreak and subsequently spread to the Russian Federation, Turkmenistan and possibly Uzbekistan. In the Russian Federation, the detection of an additional case of polio with onset on 25 September in the Republic of Dagestan confirms ongoing poliovirus transmission in the North Caucasus Federal Region.
In Tajikistan, the epicenter of the Central Asian outbreak (458 WPV1 cases, at 3 November), no new polio cases have been reported since 4 July 2010 following five mass immunization campaigns with oral poliovirus vaccine (OPV), with a sixth and final round planned for 8-12 November. In Turkmenistan (three WPV1 cases), no new cases have been reported since 28 June 2010, and four mass OPV immunization campaigns have been completed. In Kazakhstan, the seven-year-old boy from Saryagach in the Southern Kazakhstan Oblast (SKO) who was paralyzed on 12 August 2010, represents the only case in the country; a second large-scale OPV mop-up round is being conducted in the first week of November.
The Russian Federation's 14th case, the child paralyzed on 25 September, brings the total number of cases in the North Caucasus Federal Region to six, three each from Dagestan and Chechnya. Genetic sequencing of this virus is consistent with ongoing transmission in the North Caucasus Federal Region since the detection of the index cases on 15 July 2010 in Dagestan and 4 August 2010 in Chechnya following two separate importations from Tajikistan. The other eight cases in Russia represent sporadic importations associated with individual cases, the last of which occurred on 2 July 2010; none of these cases has been associated with ongoing circulation following local catch-up immunization activities with OPV. In response to the continued transmission in the North Caucasus Federal Region, the Russian Federation initiated a 1st round of mass OPV immunization in the area on 1 November, with a 2nd round planned for late November; both rounds will target all children aged six months to 15 years.
Although Uzbekistan has not confirmed a polio case during the current outbreak in Central Asia, it is not possible to rule out ongoing, undetected transmission in the country because stool samples from acute flaccid paralysis (AFP) cases are not currently being tested in a WHO-accredited laboratory; the bordering areas of Turkmenistan, Kazakhstan and Tajikistan have all reported cases; and, at least one Uzbek national became paralyzed shortly after arrival in Russia which, given the incubation period for paralytic poliomyelitis, suggests infection may have occurred prior to leaving Uzbekistan. Recognizing the risk of a poliovirus importation and outbreak, Uzbekistan has conducted 4 nationwide OPV campaigns, the last one from 25-31 October.
Countries at risk of poliovirus importation from Central Asia or the North Caucasus Federal Region of the Russian Federation should continue to strengthen surveillance for AFP cases, ensure processing of all specimens at a WHO-accredited poliovirus laboratory, maintain high routine immunization coverage against polio, and conduct supplementary OPV immunization activities as needed to close gaps in population immunity.
As per recommendations in the WHO's International Travel and Health guidelines, travelers to and from polio-affected countries should be fully protected by vaccination. Travelers who have in the past received three or more doses of OPV should be offered another dose of polio vaccine before departure. Any unimmunized individuals intending to travel to a polio-infected area should have a complete course of polio vaccination. Travelers from polio-affected areas should have a full course of vaccination against polio before leaving, with a minimum one dose of OPV before departure.
WHO's European Regional Office has alerted all Member States to the public health risk posed by the ongoing polio outbreak in Central Asia and the North Caucasus Federal Region of the Russian Federation, as required under the International Health Regulations.
WHO continues to update the European Member States and partners through letters to Ministers, Chief Medical Officers and partners; postings on its European Region website [http://www.euro.who.int/en/what-we-do/h ... -responses and the www.polioeradication.org website; and through situation reports covering the epidemiology, response actions, and risk assessment.
13.11.2010 - WHO
The risk of further international spread of the ongoing polio outbreak in Central Asia and the North Caucasus Federal Region in Russia continues to be high.
In Central Asia, genetic sequencing of the poliovirus isolated from a child paralyzed in Kazakhstan on 12 August 2010 has confirmed ongoing circulation of the virus which caused the Tajikistan outbreak and subsequently spread to the Russian Federation, Turkmenistan and possibly Uzbekistan. In the Russian Federation, the detection of an additional case of polio with onset on 25 September in the Republic of Dagestan confirms ongoing poliovirus transmission in the North Caucasus Federal Region.
In Tajikistan, the epicenter of the Central Asian outbreak (458 WPV1 cases, at 3 November), no new polio cases have been reported since 4 July 2010 following five mass immunization campaigns with oral poliovirus vaccine (OPV), with a sixth and final round planned for 8-12 November. In Turkmenistan (three WPV1 cases), no new cases have been reported since 28 June 2010, and four mass OPV immunization campaigns have been completed. In Kazakhstan, the seven-year-old boy from Saryagach in the Southern Kazakhstan Oblast (SKO) who was paralyzed on 12 August 2010, represents the only case in the country; a second large-scale OPV mop-up round is being conducted in the first week of November.
The Russian Federation's 14th case, the child paralyzed on 25 September, brings the total number of cases in the North Caucasus Federal Region to six, three each from Dagestan and Chechnya. Genetic sequencing of this virus is consistent with ongoing transmission in the North Caucasus Federal Region since the detection of the index cases on 15 July 2010 in Dagestan and 4 August 2010 in Chechnya following two separate importations from Tajikistan. The other eight cases in Russia represent sporadic importations associated with individual cases, the last of which occurred on 2 July 2010; none of these cases has been associated with ongoing circulation following local catch-up immunization activities with OPV. In response to the continued transmission in the North Caucasus Federal Region, the Russian Federation initiated a 1st round of mass OPV immunization in the area on 1 November, with a 2nd round planned for late November; both rounds will target all children aged six months to 15 years.
Although Uzbekistan has not confirmed a polio case during the current outbreak in Central Asia, it is not possible to rule out ongoing, undetected transmission in the country because stool samples from acute flaccid paralysis (AFP) cases are not currently being tested in a WHO-accredited laboratory; the bordering areas of Turkmenistan, Kazakhstan and Tajikistan have all reported cases; and, at least one Uzbek national became paralyzed shortly after arrival in Russia which, given the incubation period for paralytic poliomyelitis, suggests infection may have occurred prior to leaving Uzbekistan. Recognizing the risk of a poliovirus importation and outbreak, Uzbekistan has conducted 4 nationwide OPV campaigns, the last one from 25-31 October.
Countries at risk of poliovirus importation from Central Asia or the North Caucasus Federal Region of the Russian Federation should continue to strengthen surveillance for AFP cases, ensure processing of all specimens at a WHO-accredited poliovirus laboratory, maintain high routine immunization coverage against polio, and conduct supplementary OPV immunization activities as needed to close gaps in population immunity.
As per recommendations in the WHO's International Travel and Health guidelines, travelers to and from polio-affected countries should be fully protected by vaccination. Travelers who have in the past received three or more doses of OPV should be offered another dose of polio vaccine before departure. Any unimmunized individuals intending to travel to a polio-infected area should have a complete course of polio vaccination. Travelers from polio-affected areas should have a full course of vaccination against polio before leaving, with a minimum one dose of OPV before departure.
WHO's European Regional Office has alerted all Member States to the public health risk posed by the ongoing polio outbreak in Central Asia and the North Caucasus Federal Region of the Russian Federation, as required under the International Health Regulations.
WHO continues to update the European Member States and partners through letters to Ministers, Chief Medical Officers and partners; postings on its European Region website [http://www.euro.who.int/en/what-we-do/h ... -responses and the www.polioeradication.org website; and through situation reports covering the epidemiology, response actions, and risk assessment.
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Re: Kinderlähmung - Poliomyelitis
POLIOMYELITIS - WORLDWIDE (28 ): REPUBLIC OF CONGO
***************************************************************
A ProMED-mail post
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Eurosurveillance: WPV1 and putative enterovirus 109
Date: Thu 25 Nov 2010
Source: Eurosurveillance edition 2010; 15(47)
<http://www.eurosurveillance.org/ViewArt ... leId=19723 >
Type 1 wild poliovirus and putative enterovirus 109 in an outbreak of acute
flaccid paralysis in Congo, Oct-Nov 2010
------------------------------------------------------------------
[Grard G, Drexler JF, Lekana-Douki S, Caron M, et al: Type 1 wild
poliovirus and putative enterovirus 109 in an outbreak of acute flaccid
paralysis in Congo, October-November 2010. Euro Surveill. 2010; 15(47):
pii=19723]
An outbreak of flaccid paralysis syndrome in adults is ongoing in Congo.
Molecular analysis of faecal, throat, and cerebrospinal samples identified
wild type 1 poliovirus and an additional enterovirus C strain related to
enterovirus 109 as the cause. As of [22 Nov 2010], the cumulative number of
cases was 409, of which 169 (41.3 per cent) were fatal. This is one of the
largest wild type 1 poliovirus (WPV1) outbreaks ever described associated
with an unusually high case fatality rate.
Background
----------
Following mass vaccination campaigns organised through the Global Polio
Eradication Initiative, the World Health Organization (WHO) declared that
poliomyelitis had been eradicated from many regions of the world. However,
although transmission of wild poliovirus type 2 (WPV2) has been
interrupted, isolated human cases and outbreaks of WPV1 and WPV3 are still
being reported in many countries (1). Epidemiological investigations showed
that all these clinical cases during the last decade were due to
importation of WPV from one of the 4 countries where indigenous WPV
transmission is still ongoing, namely Afghanistan, India, Nigeria, and
Pakistan (1).
In the past decade, several outbreaks and isolated clinical cases resulting
from WPV1 and/or WPV3 importation from Nigeria or India were reported in 15
polio-free countries in Africa. 2 small WPV1 outbreaks occurred recently,
in Namibia in 2006 and Angola in 2010, after importation of WPV1 of Indian
origin (2). In order to prevent these episodic cases of imported and
indigenous WPV transmission, polio immunisation campaigns were conducted
that targeted some 72 million children in 15 countries across western and
central Africa.
Outbreak description
--------------------
Congo had recorded its last official case of indigenous polio in 2000 (3).
On 5 Nov 2010 the Ministry of Health of Congo declared an outbreak of
poliovirus centred in the 2nd largest town, Pointe-Noire. The outbreak
presumably started in mid-October 2010, with an unusual accumulation of
cases of acute flaccid paralysis (AFP) syndrome in patients between 15 and
72 years old. Most cases occurred in Pointe-Noire and some in Cabinda
province. Cases exported from Pointe-Noire were then reported in several
towns and villages of Congo. As of [22 Nov 2010] the cumulative number of
cases was 409, of which 169 (41.3 per cent) were fatal. Direct contact
between cases was rare, and there was no apparent spatial pattern.
Likewise, there was no evidence of a common source such as food or water.
In most hospitalised patients the disease started with influenza-like
symptoms 4 to 7 days before the onset of AFP of the legs. AFP then ascended
rapidly (within a day), frequently leading to death from cardiac and/or
respiratory failure. The large number of severe cases and the high case
fatality rate contrast sharply with previous WPV outbreaks and point to a
role of unknown viral/host features or to the existence of massive numbers
of mild and therefore unreported additional cases.
Laboratory investigations
-------------------------
The Centre International de Recherches Medicales de Franceville (CIRMF),
Gabon, received 3 plasma samples for aetiologic investigation on [29 Oct
2010]. Real-time and conventional reverse transcription (RT)-PCR testing
was negative for neurologic, enteric, and respiratory viral pathogens,
namely the genera _Enterovirus_, _Flavivirus_, _Alphavirus_, _Phlebovirus_,
human mastadenoviruses, the family Paramyxoviridae (mumps virus, measles
virus, parainfluenza viruses 1-4, respiratory syncytial virus, human
metapneumovirus) and the subfamily _Coronavirinae_ (human coronavirus Nl63,
HKU1, OC43, and 229E.
Also negative were species-specific real-time RT-PCR tests for West Nile
virus, tick-borne encephalitis virus, cytomegalovirus, human herpesvirus
type 6, herpes simplex virus type 1, varicella zoster virus, rotavirus
serogroup A, norovirus genogroups 1 and 2, sapovirus, astrovirus, influenza
viruses A and B, and rhinovirus.
CIRMF then received 15 rectal swabs, 14 throat swabs, and 5 cerebrospinal
fluid (CSF) samples on [2 Nov 2010] of which 13 rectal swab specimens (86.7
per cent), 5 throat specimens (35.7 per cent) and one CSF specimen (20.0
per cent) were positive for enterovirus in a real-time RT-PCR targeting the
5'-noncoding region (4). The faecal and throat samples had threshold cycles
ranging from 24 to 38 in real-time RT-PCR, indicating medium to high virus
concentrations, while the concentration in the positive CSF sample was low
(cycle threshold (CT) 38 ). The genome was studied by the Institute of
Virology at the University of Bonn Medical Centre in Germany, based on
partial VP1 sequencing (5), 3D sequencing (unpublished in-house assay) and
5'-UTR sequencing (6).
Poliovirus type 1 was identified in one sample (100 per cent amino acid
identity to recent poliovirus strains of Indian genotype in 'typing' VP1
PCR). The amplified 327 nt sequence of this sample (corresponding to genome
positions 2631 to 2957 in WPV1 strain Brunhilde) shared 94.8-96.3 per cent
identity with poliovirus type 1 sampled in Africa (Angola and Democratic
Republic of the Congo) in 2006 and 2007 (isolates ANG-LUA-KIL-07-003 and
RDC-BCG-SEK-06-004) and 95.1 per cent identity with a strain recovered
during a polio outbreak in Tajikistan in 2010 (GenBank accession number
HQ317702).
A more sensitive strain-specific nested PCR assay amplifying a 201 bp VP1
fragment was developed from the initial sequencing data, and all but 2 of
the 19 samples positive in the enterovirus real-time RT-PCR were typed as
wild type 1 polio virus. Partial sequences of the 3D genomic region
encoding the viral polymerase (181 nt corresponding to genome positions
6869-7049 in WPV1 strain Brunhilde) were retrieved from 5 samples. The
maximum nucleotide identity of all these samples was 96.1 per cent with 2
poliovirus type 1 strains recovered in Russia and the Philippines after the
year 2000 (isolates P1W/Bar65, and Mindanao-01-1, respectively).
Partial 5'-UTR sequencing yielded positive results for all the specimens
tested. The 115 nt thus obtained (corresponding to genome positions 466 to
580 in WPV1 strain Brunhilde) were 96.5 per cent identical to recent WPV1
strains from China (isolate CHN-Hainan/93-2). Therefore, all analysed
genomic regions were identified as WPV1, indicating absence of putative
intra- or interspecies recombination.
An additional enterovirus C strain distantly related to enterovirus 109
(EV109) in the VP1 region was retrieved from a rectal swab of a deceased
patient. In the 322 nt VP1 sequence fragment that could be retrieved, the
virus showed 75 to 77 per cent nt sequence identity with the 5 EV109
sequences available in GenBank, and 90.5 per cent nt identity in the 3D
genome region with EV109 isolate NICA08-4327 recovered in Nicaragua in 2010
(7).
Of note, the corresponding sample contained one of the highest enterovirus
RNA copy numbers (CT value 24). Polio virus was not detected in this sample
with the broad-range typing assays described above, nor with
strain-specific VP1 nested and 3D real-time PCR assays. No other sample was
positive for the EV109-related virus in a strain-specific 3D real-time PCR
assay.
The presence of other enteric viruses (adenovirus, astrovirus, enterovirus,
rotavirus A, sapovirus, and norovirus genogroups 1 and 2) was ruled out in
all the faecal samples except for one WPV-positive sample which also
contained norovirus RNA. Genome sequencing and further typing of samples
containing poliovirus and enterovirus, targeting the complete VP1 genomic
region, are ongoing. Additional samples have been sent to CIRMF for analysis.
Conclusions
-----------
The preliminary sequencing data and clinical picture are compatible with a
wild type poliovirus outbreak. Further epidemiological and serological
studies are required to explain the unusually high case fatality rate and
the patients' relatively advanced age. One possible explanation is that
only severe cases may be reported. Alternatively, the population may be
immunologically naive and highly susceptible, although this is unlikely
given the claimed success of vaccination campaigns. Epidemiological
investigations have just begun. At this time, no direct contact between
cases has been observed, and no apparent spatial pattern was identified,
with neither domestic dissemination nor within the same subdivisions.
Together, these observations suggest a diffuse source of contamination,
such as, from water drawn from wells in the poor neighbourhoods of the
city. Involvement of a more virulent virus, or potentially other viruses,
is another possibility. More information on non-hospitalised patients and
mild cases is needed. Information on predisposing conditions of the fatal
cases as well as full-length sequencing of VP1 and the full genome are
currently ongoing.
The WHO Country Office, Regional Office, and Headquarters are supporting
the Ministry of Health in Pointe-Noire, and the WHO Country Office is
supporting the operational costs of the investigation and response teams.
At least 1.1 million people are to be vaccinated in the epicentre of the
outbreak (Pointe-Noire region), and further 600 000 people will be
vaccinated simultaneously in the neighbouring regions of Congo near Angola,
where the last cases of WPV1 occurred in 2010.
Acknowledgements
----------------
We thank Global Viral Forecasting, and the USAID Emerging and Pandemic
Threats PREDICT Cooperative Agreement for financial support. We also thank
P Yaba, P Engandja, and G Maganga from Centre International de Recherches
de Franceville, Gabon, as well as S Bruenink and T Bleicker from the
Institute of Virology, University of Bonn Medical Center, for technical
assistance during this work. SeqLab GmbH, Goettingen, provided prompt
sequencing. The work in Bonn was funded by the European Union DG Research
(contract 223498, EMPERIE).
References
----------
1. Centers for Disease Control and prevention (CDC). Wild poliovirus type 1
and type 3 importations - 14 countries, Africa, 2008-2009. MMWR Morb Mortal
Wkly Rep. 2009; 58(14): 357-62 [available from
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5814a1.htm>].
2. Outbreak of type-1 wild poliovirus in adults, Namibia, 2006. Wkly
Epidemiol Rec. 2006; 81(45): 425-32 [available from
<http://www.who.int/wer/2006/wer8145/en/index.html>].
3. Polio in Congo - update. Geneva: World Health Organisation; 9 Nov 2010.
Available from <http://www.who.int/csr/don/2010_11_09/en/index.html>
4. Dierssen U, Rehren F, Henke-Gendo C, et al: Rapid routine detection of
enterovirus RNA in cerebrospinal fluid by a one-step real-time RT-PCR
assay. J Clin Virol. 2008; 42(1):58-64 [abstract available at
<http://www.ncbi.nlm.nih.gov/pubmed/18164234>].
5. Oberste MS, Nix WA, Maher K, Pallansch MA: Improved molecular
identification of enteroviruses by RT-PCR and amplicon sequencing. J Clin
Virol. 2003; 26(3): 375-7.
6. Nix WA, Berger MM, Oberste MS, et al: Failure to detect enterovirus in
the spinal cord of ALS patients using a sensitive RT-PCR method. Neurology.
2004; 62(8 ): 1250-1 [abstract available from
<http://www.neurology.org/content/62/8/1372.abstract>].
7. Yozwiak NL, Skewes-Cox P, Gordon A, et al: Human enterovirus 109: a
novel interspecies recombinant enterovirus isolated from a case of acute
pediatric respiratory illness in Nicaragua. J Virol. 2010; 84(18 ): 9047-58
[available from <http://jvi.asm.org/cgi/content/full/84/18/9047>].
--
communicated by:
ProMED-mail
<promed@promedmail.org>
[The authors of this Rapid Communication report the detection of 2 viruses
in some clinical samples obtained from patients during an ongoing outbreak
of flaccid paralysis in the Republic of Congo. This outbreak has been
characterised by a higher than usual case fatality ratio for outbreaks of
poliomyelitis. Curiously, any direct contact between cases was rare and
there is no evidence of a common source of infection. Molecular analyses
identified the presence of 2 enteroviruses -- wild poliovirus type 1, and a
2nd enterovirus identified as human enterovirus 109. The wild poliovirus
type 1 exhibited 100 per cent amino acid identity with the wild poliovirus
type 1 currently prevalent in India.
The human enterovirus 109 isolate is closely related to the novel
recombinant enterovirus previously associated with a case of acute
pediatric respiratory illness in Nicaragua. Similar molecular analyses
(real-time and conventional reverse transcription (RT)-PCR testing) were
negative for an impressively wide range of potential human neurologic,
enteric and respiratory viral pathogens. However, so far the analysis of
the outbreak lacks any element of quantitation that would allow assessment
of the relative roles of these 2 viruses in the causation of flaccid
paralysis. It is unclear whether enterovirus 109 alone or in combination
with wild poliovirus type 1 is a determining factor responsible for the
high case fatality ratio observed in this outbreak. This question must
await further analysis. - Mod.CP
In Table 5 of Nathanson N, Kew OM. From emergence to eradication: the
epidemiology of poliomyelitis deconstructed. Am J Epidemiol. 2010; 172(11):
1213-29 (available at
<http://aje.oxfordjournals.org/content/e ... wq320.full >),
the authors present data from Olin G (The epidemiologic pattern of
poliomyelitis in Sweden from 1905 to 1950. In: Fishbein M, editor.
Poliomyelitis: papers and discussions presented at the second international
poliomyelitis conference. Philadelphia, PA: Lippincott; 1952. p. 367-75)
from a review of polio in Sweden 1925-1944 demonstrating an increasing case
fatality rate (CFR) by increasing age, going from 4.5 per cent in the
population under 3 years of age to 23.5 per cent for those over 25 years of
age. This same increase in CFR with increased age has been observed by
other descriptive epidemiologic presentations in earlier years. Nielsena
NM, Aabya P, Wohlfahrta J, et al. The polio model. Does it apply to polio?
Int J Epidemiol. 2002; 31(1): 181-6. (available at
<http://ije.oxfordjournals.org/content/31/1/181.long>, mentions that
Weinstein L (Influence of age and sex on susceptibility and clinical
manifestations in poliomyelitis. N Engl J Med. 1957; 257:47-52),
demonstrates that there is an increase in respiratory paralysis with
increasing age, which by the nature of the involvement is more serious and
results in a higher CFR. Hence, the observation that the majority of the
reported cases have been in older age groups might well support the
observation of a higher CFR in the outbreak in the Congo than usually seen
in recent outbreaks of polio elsewhere in Africa and Asia, that have
predominantly involved unvaccinated younger age groups.
That being said, the reported CFR of 41.3 per cent in this current outbreak
in the Congo is much higher than usually reported and one can't help but
wonder if there isn't significant under reporting of milder cases to
explain this observation. One also questions whether there might not have
been a problem with vaccine potency in earlier years, leading to a larger
than expected susceptible population presently at older ages, having been
vaccinated in earlier years with non-potent vaccine, hence further
explaining the unusual epidemiology of this outbreak.
We await further information as results of active case finding and
additional laboratory studies become available.
For a map of the Republic of Congo showing Pointe-Noire, see
<http://www.ecoi.net/file_upload/dh935_01460con.gif>. For the interactive
HealthMap/ProMED map of the Republic of the Congo, see
<http://healthmap.org/r/0f0G>. - Mod.MPP]
***************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
******
Eurosurveillance: WPV1 and putative enterovirus 109
Date: Thu 25 Nov 2010
Source: Eurosurveillance edition 2010; 15(47)
<http://www.eurosurveillance.org/ViewArt ... leId=19723 >
Type 1 wild poliovirus and putative enterovirus 109 in an outbreak of acute
flaccid paralysis in Congo, Oct-Nov 2010
------------------------------------------------------------------
[Grard G, Drexler JF, Lekana-Douki S, Caron M, et al: Type 1 wild
poliovirus and putative enterovirus 109 in an outbreak of acute flaccid
paralysis in Congo, October-November 2010. Euro Surveill. 2010; 15(47):
pii=19723]
An outbreak of flaccid paralysis syndrome in adults is ongoing in Congo.
Molecular analysis of faecal, throat, and cerebrospinal samples identified
wild type 1 poliovirus and an additional enterovirus C strain related to
enterovirus 109 as the cause. As of [22 Nov 2010], the cumulative number of
cases was 409, of which 169 (41.3 per cent) were fatal. This is one of the
largest wild type 1 poliovirus (WPV1) outbreaks ever described associated
with an unusually high case fatality rate.
Background
----------
Following mass vaccination campaigns organised through the Global Polio
Eradication Initiative, the World Health Organization (WHO) declared that
poliomyelitis had been eradicated from many regions of the world. However,
although transmission of wild poliovirus type 2 (WPV2) has been
interrupted, isolated human cases and outbreaks of WPV1 and WPV3 are still
being reported in many countries (1). Epidemiological investigations showed
that all these clinical cases during the last decade were due to
importation of WPV from one of the 4 countries where indigenous WPV
transmission is still ongoing, namely Afghanistan, India, Nigeria, and
Pakistan (1).
In the past decade, several outbreaks and isolated clinical cases resulting
from WPV1 and/or WPV3 importation from Nigeria or India were reported in 15
polio-free countries in Africa. 2 small WPV1 outbreaks occurred recently,
in Namibia in 2006 and Angola in 2010, after importation of WPV1 of Indian
origin (2). In order to prevent these episodic cases of imported and
indigenous WPV transmission, polio immunisation campaigns were conducted
that targeted some 72 million children in 15 countries across western and
central Africa.
Outbreak description
--------------------
Congo had recorded its last official case of indigenous polio in 2000 (3).
On 5 Nov 2010 the Ministry of Health of Congo declared an outbreak of
poliovirus centred in the 2nd largest town, Pointe-Noire. The outbreak
presumably started in mid-October 2010, with an unusual accumulation of
cases of acute flaccid paralysis (AFP) syndrome in patients between 15 and
72 years old. Most cases occurred in Pointe-Noire and some in Cabinda
province. Cases exported from Pointe-Noire were then reported in several
towns and villages of Congo. As of [22 Nov 2010] the cumulative number of
cases was 409, of which 169 (41.3 per cent) were fatal. Direct contact
between cases was rare, and there was no apparent spatial pattern.
Likewise, there was no evidence of a common source such as food or water.
In most hospitalised patients the disease started with influenza-like
symptoms 4 to 7 days before the onset of AFP of the legs. AFP then ascended
rapidly (within a day), frequently leading to death from cardiac and/or
respiratory failure. The large number of severe cases and the high case
fatality rate contrast sharply with previous WPV outbreaks and point to a
role of unknown viral/host features or to the existence of massive numbers
of mild and therefore unreported additional cases.
Laboratory investigations
-------------------------
The Centre International de Recherches Medicales de Franceville (CIRMF),
Gabon, received 3 plasma samples for aetiologic investigation on [29 Oct
2010]. Real-time and conventional reverse transcription (RT)-PCR testing
was negative for neurologic, enteric, and respiratory viral pathogens,
namely the genera _Enterovirus_, _Flavivirus_, _Alphavirus_, _Phlebovirus_,
human mastadenoviruses, the family Paramyxoviridae (mumps virus, measles
virus, parainfluenza viruses 1-4, respiratory syncytial virus, human
metapneumovirus) and the subfamily _Coronavirinae_ (human coronavirus Nl63,
HKU1, OC43, and 229E.
Also negative were species-specific real-time RT-PCR tests for West Nile
virus, tick-borne encephalitis virus, cytomegalovirus, human herpesvirus
type 6, herpes simplex virus type 1, varicella zoster virus, rotavirus
serogroup A, norovirus genogroups 1 and 2, sapovirus, astrovirus, influenza
viruses A and B, and rhinovirus.
CIRMF then received 15 rectal swabs, 14 throat swabs, and 5 cerebrospinal
fluid (CSF) samples on [2 Nov 2010] of which 13 rectal swab specimens (86.7
per cent), 5 throat specimens (35.7 per cent) and one CSF specimen (20.0
per cent) were positive for enterovirus in a real-time RT-PCR targeting the
5'-noncoding region (4). The faecal and throat samples had threshold cycles
ranging from 24 to 38 in real-time RT-PCR, indicating medium to high virus
concentrations, while the concentration in the positive CSF sample was low
(cycle threshold (CT) 38 ). The genome was studied by the Institute of
Virology at the University of Bonn Medical Centre in Germany, based on
partial VP1 sequencing (5), 3D sequencing (unpublished in-house assay) and
5'-UTR sequencing (6).
Poliovirus type 1 was identified in one sample (100 per cent amino acid
identity to recent poliovirus strains of Indian genotype in 'typing' VP1
PCR). The amplified 327 nt sequence of this sample (corresponding to genome
positions 2631 to 2957 in WPV1 strain Brunhilde) shared 94.8-96.3 per cent
identity with poliovirus type 1 sampled in Africa (Angola and Democratic
Republic of the Congo) in 2006 and 2007 (isolates ANG-LUA-KIL-07-003 and
RDC-BCG-SEK-06-004) and 95.1 per cent identity with a strain recovered
during a polio outbreak in Tajikistan in 2010 (GenBank accession number
HQ317702).
A more sensitive strain-specific nested PCR assay amplifying a 201 bp VP1
fragment was developed from the initial sequencing data, and all but 2 of
the 19 samples positive in the enterovirus real-time RT-PCR were typed as
wild type 1 polio virus. Partial sequences of the 3D genomic region
encoding the viral polymerase (181 nt corresponding to genome positions
6869-7049 in WPV1 strain Brunhilde) were retrieved from 5 samples. The
maximum nucleotide identity of all these samples was 96.1 per cent with 2
poliovirus type 1 strains recovered in Russia and the Philippines after the
year 2000 (isolates P1W/Bar65, and Mindanao-01-1, respectively).
Partial 5'-UTR sequencing yielded positive results for all the specimens
tested. The 115 nt thus obtained (corresponding to genome positions 466 to
580 in WPV1 strain Brunhilde) were 96.5 per cent identical to recent WPV1
strains from China (isolate CHN-Hainan/93-2). Therefore, all analysed
genomic regions were identified as WPV1, indicating absence of putative
intra- or interspecies recombination.
An additional enterovirus C strain distantly related to enterovirus 109
(EV109) in the VP1 region was retrieved from a rectal swab of a deceased
patient. In the 322 nt VP1 sequence fragment that could be retrieved, the
virus showed 75 to 77 per cent nt sequence identity with the 5 EV109
sequences available in GenBank, and 90.5 per cent nt identity in the 3D
genome region with EV109 isolate NICA08-4327 recovered in Nicaragua in 2010
(7).
Of note, the corresponding sample contained one of the highest enterovirus
RNA copy numbers (CT value 24). Polio virus was not detected in this sample
with the broad-range typing assays described above, nor with
strain-specific VP1 nested and 3D real-time PCR assays. No other sample was
positive for the EV109-related virus in a strain-specific 3D real-time PCR
assay.
The presence of other enteric viruses (adenovirus, astrovirus, enterovirus,
rotavirus A, sapovirus, and norovirus genogroups 1 and 2) was ruled out in
all the faecal samples except for one WPV-positive sample which also
contained norovirus RNA. Genome sequencing and further typing of samples
containing poliovirus and enterovirus, targeting the complete VP1 genomic
region, are ongoing. Additional samples have been sent to CIRMF for analysis.
Conclusions
-----------
The preliminary sequencing data and clinical picture are compatible with a
wild type poliovirus outbreak. Further epidemiological and serological
studies are required to explain the unusually high case fatality rate and
the patients' relatively advanced age. One possible explanation is that
only severe cases may be reported. Alternatively, the population may be
immunologically naive and highly susceptible, although this is unlikely
given the claimed success of vaccination campaigns. Epidemiological
investigations have just begun. At this time, no direct contact between
cases has been observed, and no apparent spatial pattern was identified,
with neither domestic dissemination nor within the same subdivisions.
Together, these observations suggest a diffuse source of contamination,
such as, from water drawn from wells in the poor neighbourhoods of the
city. Involvement of a more virulent virus, or potentially other viruses,
is another possibility. More information on non-hospitalised patients and
mild cases is needed. Information on predisposing conditions of the fatal
cases as well as full-length sequencing of VP1 and the full genome are
currently ongoing.
The WHO Country Office, Regional Office, and Headquarters are supporting
the Ministry of Health in Pointe-Noire, and the WHO Country Office is
supporting the operational costs of the investigation and response teams.
At least 1.1 million people are to be vaccinated in the epicentre of the
outbreak (Pointe-Noire region), and further 600 000 people will be
vaccinated simultaneously in the neighbouring regions of Congo near Angola,
where the last cases of WPV1 occurred in 2010.
Acknowledgements
----------------
We thank Global Viral Forecasting, and the USAID Emerging and Pandemic
Threats PREDICT Cooperative Agreement for financial support. We also thank
P Yaba, P Engandja, and G Maganga from Centre International de Recherches
de Franceville, Gabon, as well as S Bruenink and T Bleicker from the
Institute of Virology, University of Bonn Medical Center, for technical
assistance during this work. SeqLab GmbH, Goettingen, provided prompt
sequencing. The work in Bonn was funded by the European Union DG Research
(contract 223498, EMPERIE).
References
----------
1. Centers for Disease Control and prevention (CDC). Wild poliovirus type 1
and type 3 importations - 14 countries, Africa, 2008-2009. MMWR Morb Mortal
Wkly Rep. 2009; 58(14): 357-62 [available from
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5814a1.htm>].
2. Outbreak of type-1 wild poliovirus in adults, Namibia, 2006. Wkly
Epidemiol Rec. 2006; 81(45): 425-32 [available from
<http://www.who.int/wer/2006/wer8145/en/index.html>].
3. Polio in Congo - update. Geneva: World Health Organisation; 9 Nov 2010.
Available from <http://www.who.int/csr/don/2010_11_09/en/index.html>
4. Dierssen U, Rehren F, Henke-Gendo C, et al: Rapid routine detection of
enterovirus RNA in cerebrospinal fluid by a one-step real-time RT-PCR
assay. J Clin Virol. 2008; 42(1):58-64 [abstract available at
<http://www.ncbi.nlm.nih.gov/pubmed/18164234>].
5. Oberste MS, Nix WA, Maher K, Pallansch MA: Improved molecular
identification of enteroviruses by RT-PCR and amplicon sequencing. J Clin
Virol. 2003; 26(3): 375-7.
6. Nix WA, Berger MM, Oberste MS, et al: Failure to detect enterovirus in
the spinal cord of ALS patients using a sensitive RT-PCR method. Neurology.
2004; 62(8 ): 1250-1 [abstract available from
<http://www.neurology.org/content/62/8/1372.abstract>].
7. Yozwiak NL, Skewes-Cox P, Gordon A, et al: Human enterovirus 109: a
novel interspecies recombinant enterovirus isolated from a case of acute
pediatric respiratory illness in Nicaragua. J Virol. 2010; 84(18 ): 9047-58
[available from <http://jvi.asm.org/cgi/content/full/84/18/9047>].
--
communicated by:
ProMED-mail
<promed@promedmail.org>
[The authors of this Rapid Communication report the detection of 2 viruses
in some clinical samples obtained from patients during an ongoing outbreak
of flaccid paralysis in the Republic of Congo. This outbreak has been
characterised by a higher than usual case fatality ratio for outbreaks of
poliomyelitis. Curiously, any direct contact between cases was rare and
there is no evidence of a common source of infection. Molecular analyses
identified the presence of 2 enteroviruses -- wild poliovirus type 1, and a
2nd enterovirus identified as human enterovirus 109. The wild poliovirus
type 1 exhibited 100 per cent amino acid identity with the wild poliovirus
type 1 currently prevalent in India.
The human enterovirus 109 isolate is closely related to the novel
recombinant enterovirus previously associated with a case of acute
pediatric respiratory illness in Nicaragua. Similar molecular analyses
(real-time and conventional reverse transcription (RT)-PCR testing) were
negative for an impressively wide range of potential human neurologic,
enteric and respiratory viral pathogens. However, so far the analysis of
the outbreak lacks any element of quantitation that would allow assessment
of the relative roles of these 2 viruses in the causation of flaccid
paralysis. It is unclear whether enterovirus 109 alone or in combination
with wild poliovirus type 1 is a determining factor responsible for the
high case fatality ratio observed in this outbreak. This question must
await further analysis. - Mod.CP
In Table 5 of Nathanson N, Kew OM. From emergence to eradication: the
epidemiology of poliomyelitis deconstructed. Am J Epidemiol. 2010; 172(11):
1213-29 (available at
<http://aje.oxfordjournals.org/content/e ... wq320.full >),
the authors present data from Olin G (The epidemiologic pattern of
poliomyelitis in Sweden from 1905 to 1950. In: Fishbein M, editor.
Poliomyelitis: papers and discussions presented at the second international
poliomyelitis conference. Philadelphia, PA: Lippincott; 1952. p. 367-75)
from a review of polio in Sweden 1925-1944 demonstrating an increasing case
fatality rate (CFR) by increasing age, going from 4.5 per cent in the
population under 3 years of age to 23.5 per cent for those over 25 years of
age. This same increase in CFR with increased age has been observed by
other descriptive epidemiologic presentations in earlier years. Nielsena
NM, Aabya P, Wohlfahrta J, et al. The polio model. Does it apply to polio?
Int J Epidemiol. 2002; 31(1): 181-6. (available at
<http://ije.oxfordjournals.org/content/31/1/181.long>, mentions that
Weinstein L (Influence of age and sex on susceptibility and clinical
manifestations in poliomyelitis. N Engl J Med. 1957; 257:47-52),
demonstrates that there is an increase in respiratory paralysis with
increasing age, which by the nature of the involvement is more serious and
results in a higher CFR. Hence, the observation that the majority of the
reported cases have been in older age groups might well support the
observation of a higher CFR in the outbreak in the Congo than usually seen
in recent outbreaks of polio elsewhere in Africa and Asia, that have
predominantly involved unvaccinated younger age groups.
That being said, the reported CFR of 41.3 per cent in this current outbreak
in the Congo is much higher than usually reported and one can't help but
wonder if there isn't significant under reporting of milder cases to
explain this observation. One also questions whether there might not have
been a problem with vaccine potency in earlier years, leading to a larger
than expected susceptible population presently at older ages, having been
vaccinated in earlier years with non-potent vaccine, hence further
explaining the unusual epidemiology of this outbreak.
We await further information as results of active case finding and
additional laboratory studies become available.
For a map of the Republic of Congo showing Pointe-Noire, see
<http://www.ecoi.net/file_upload/dh935_01460con.gif>. For the interactive
HealthMap/ProMED map of the Republic of the Congo, see
<http://healthmap.org/r/0f0G>. - Mod.MPP]
-
Birgitt
- Moderator
- Beiträge: 35237
- Registriert: Di 2. Aug 2005, 22:52
- Wohnort: NRW / Südl. Rheinland
- Kontaktdaten:
Re: Kinderlähmung - Poliomyelitis
Kongo, Republik - Polio
29.11.2010
Anfang November wurde ein Ausbruch gemeldet, der inzwischen zu mindestens 400 Erkrankungen und fast 170 Todesfällen geführt hat. Angesichts dieser hohen Sterberate ist von einem starken Underreporting auszugehen. Auffällig ist weiterhin, dass es sich bei den Betroffenen zum großen Teil um Personen über 15 Jahre und kaum um kleine Kinder handelt. Es sind große Impfaktionen geplant, bei denen alle Bürger einen monovalenten oralen Impfstoff erhalten sollen. Das Virus wurde wahrscheinlich aus Angola importiert. / Quelle: crm
29.11.2010
Anfang November wurde ein Ausbruch gemeldet, der inzwischen zu mindestens 400 Erkrankungen und fast 170 Todesfällen geführt hat. Angesichts dieser hohen Sterberate ist von einem starken Underreporting auszugehen. Auffällig ist weiterhin, dass es sich bei den Betroffenen zum großen Teil um Personen über 15 Jahre und kaum um kleine Kinder handelt. Es sind große Impfaktionen geplant, bei denen alle Bürger einen monovalenten oralen Impfstoff erhalten sollen. Das Virus wurde wahrscheinlich aus Angola importiert. / Quelle: crm
-
Alexander
- Administrator
- Beiträge: 24253
- Registriert: Sa 30. Jul 2005, 19:12
- Wohnort: Dubai/Vereinigte Arabische Emirate
- Kontaktdaten:
Re: Kinderlähmung - Poliomyelitis
Über 200 Polio-Tote in Kongo
Ein Polio-Ausbruch hat in der Republik Kongo nach Angaben von UNICEF mehr als 200 Menschen das Leben gekostet. Erkrankt sind vor allem junge Männer zwischen 15 und 24 Jahren. mehr...
Grüsse
Alexander
Ein Polio-Ausbruch hat in der Republik Kongo nach Angaben von UNICEF mehr als 200 Menschen das Leben gekostet. Erkrankt sind vor allem junge Männer zwischen 15 und 24 Jahren. mehr...
Grüsse
Alexander
The one who follows the crowd will usually go no further than the crowd. Those who walk alone are likely to find themselves in places no one has ever been before.
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Birgitt
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- Kontaktdaten:
Re: Kinderlähmung - Poliomyelitis
POLIOMYELITIS - WORLDWIDE (30): DEMOCRATIC REPUBLIC OF CONGO, REQUEST
FOR INFORMATION
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: 9 Dec 2010
Source: MINSA (Missionary International Service News Agency) [edited]
<http://www.misna.org/news.asp?a=1&IDLingua=1&id=285438>
A serious polio epidemic was declared in the town of Kikwit, in the
south-west of the Democratic Republic of Congo, along the border with
Angola.
In a statement released yesterday [8 Dec 2010], the mayor of the town
formalised the concerns regarding the health sector after the rapid
increase of polio cases in the area, where 90 percent of cases on a
national level were registered. Based on the latest update by the
mayor, 36 cases were registered just in Kikwit and the outskirts, 15
of which were fatal. The mayor also announced a sensitisation
campaign and urgent mass vaccinations.
In the neighbouring Republic of Congo, a serious polio epidemic
killed over 200 people in just over a month, paralysing some 409,
based on estimates of the World Health Organisation. Also, in the
cases registered in DR-Congo, polio is mainly affecting adult men,
while it normally affects children under the age of 5. Polio was
considered eradicated from DR-Congo when no cases were registered
between 2001 and 2005.
--
Communicated by:
ProMED-mail <promed@promedmail.org>
[According to the Polio Eradication Initiative website, circulation
of the wild poliovirus (WPV) has persisted for over 12 months
following the reintroduction of WPV into the country in 2006, and the
country has been classified as having re-established transmission.
Prior to 2006, the last reported WPV associated case was in 2000.
Since the reintroduction, there were 13 cases reported in 2006, 41
cases in 2007, 5 cases in 2008, 3 cases in 2009, and to date in 2010,
there have been 69 cases reported (the date of onset of the most
recent WPV1 virus isolate was 11 Nov 2010
<http://www.polioeradication.org/Dataand ... slist.aspx>).
The summary on the polio eradication website of the past week's
reports in the DRC is presented below:
- 9 new cases were reported in the past week (WPV1s), bringing the
total number of cases for 2010 to 69 (all WPV1s). The most recent
case had onset of paralysis on 11 Nov 2010 (from Bas-Congo).
- The majority of cases are reported from Kasai Occidental and
Bandundu provinces.
- A SNID was held from 23 Nov 2010 using a combination of bivalent
OPV, mOPV1 and trivalent OPV throughout most of the country.
The above newswire mentions that the epidemiology of these cases in
Kikwit is similar to that seen in the Republic of the Congo: adult
males, a curious observation. The vaccination coverages in the DRC
were less than optimal for many years (this moderator had been
involved in vaccination program activity evaluation in the former
Zaire back in the late 80s and early 90s). If this moderator
remembers correctly from the days of the Ebola outbreak in Kikwit,
the area is one of those areas with a high coverage of the
population's health services provided through missionary health
facilities and thereby may well have been a pocket of high
vaccination coverages, which would possibly explain an earlier
interruption of circulating WPV in the area with resultant pockets of
unvaccinated adults.
All of this is speculation in the absence of solid data from the
affected area. ProMED would greatly appreciate more information from
knowledgeable sources in the region.
For a map of the DRC with provinces, see
<http://www.usaid.gov/our_work/cross-cut ... arged2.jpg>.
Kikwit is located in Bandundu province in the southwest of the DRC.
For the HealthMap/ProMED map of Kikwit, see
<http://healthmap.org/r/0iwM>. - Mod.MPP]
FOR INFORMATION
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: 9 Dec 2010
Source: MINSA (Missionary International Service News Agency) [edited]
<http://www.misna.org/news.asp?a=1&IDLingua=1&id=285438>
A serious polio epidemic was declared in the town of Kikwit, in the
south-west of the Democratic Republic of Congo, along the border with
Angola.
In a statement released yesterday [8 Dec 2010], the mayor of the town
formalised the concerns regarding the health sector after the rapid
increase of polio cases in the area, where 90 percent of cases on a
national level were registered. Based on the latest update by the
mayor, 36 cases were registered just in Kikwit and the outskirts, 15
of which were fatal. The mayor also announced a sensitisation
campaign and urgent mass vaccinations.
In the neighbouring Republic of Congo, a serious polio epidemic
killed over 200 people in just over a month, paralysing some 409,
based on estimates of the World Health Organisation. Also, in the
cases registered in DR-Congo, polio is mainly affecting adult men,
while it normally affects children under the age of 5. Polio was
considered eradicated from DR-Congo when no cases were registered
between 2001 and 2005.
--
Communicated by:
ProMED-mail <promed@promedmail.org>
[According to the Polio Eradication Initiative website, circulation
of the wild poliovirus (WPV) has persisted for over 12 months
following the reintroduction of WPV into the country in 2006, and the
country has been classified as having re-established transmission.
Prior to 2006, the last reported WPV associated case was in 2000.
Since the reintroduction, there were 13 cases reported in 2006, 41
cases in 2007, 5 cases in 2008, 3 cases in 2009, and to date in 2010,
there have been 69 cases reported (the date of onset of the most
recent WPV1 virus isolate was 11 Nov 2010
<http://www.polioeradication.org/Dataand ... slist.aspx>).
The summary on the polio eradication website of the past week's
reports in the DRC is presented below:
- 9 new cases were reported in the past week (WPV1s), bringing the
total number of cases for 2010 to 69 (all WPV1s). The most recent
case had onset of paralysis on 11 Nov 2010 (from Bas-Congo).
- The majority of cases are reported from Kasai Occidental and
Bandundu provinces.
- A SNID was held from 23 Nov 2010 using a combination of bivalent
OPV, mOPV1 and trivalent OPV throughout most of the country.
The above newswire mentions that the epidemiology of these cases in
Kikwit is similar to that seen in the Republic of the Congo: adult
males, a curious observation. The vaccination coverages in the DRC
were less than optimal for many years (this moderator had been
involved in vaccination program activity evaluation in the former
Zaire back in the late 80s and early 90s). If this moderator
remembers correctly from the days of the Ebola outbreak in Kikwit,
the area is one of those areas with a high coverage of the
population's health services provided through missionary health
facilities and thereby may well have been a pocket of high
vaccination coverages, which would possibly explain an earlier
interruption of circulating WPV in the area with resultant pockets of
unvaccinated adults.
All of this is speculation in the absence of solid data from the
affected area. ProMED would greatly appreciate more information from
knowledgeable sources in the region.
For a map of the DRC with provinces, see
<http://www.usaid.gov/our_work/cross-cut ... arged2.jpg>.
Kikwit is located in Bandundu province in the southwest of the DRC.
For the HealthMap/ProMED map of Kikwit, see
<http://healthmap.org/r/0iwM>. - Mod.MPP]
-
Birgitt
- Moderator
- Beiträge: 35237
- Registriert: Di 2. Aug 2005, 22:52
- Wohnort: NRW / Südl. Rheinland
- Kontaktdaten:
Re: Kinderlähmung - Poliomyelitis
POLIOMYELITIS - WORLDWIDE (31): DEMOCRATIC REPUBLIC OF THE CONGO
****************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Sat 25 Dec 2010
From: Pol Jansegers
<pol.jansegers@gmail.com>
Subject: Polio epidemic in Kwilu district, RDC
----------------------------------------------
Hello,
I am a retired physician from Belgium, who has worked in Kikwit, DR
Congo, during the years 1970-80.
I was in Kikwit recently, and was told about several suspected cases
of polio-virus [infection] there.
In a mail dated [9 Dec 2010], Dr Matthieu Bikoko, a local
[physician], working for a Belgian NGO, Memisa, reported:
*"Yesterday, I participated in an epidemiological surveillance
meeting, during which the mayor of the city of Kikwit [Dr Cyrille
Kiyungu], accompanied by local WHO staff and a team of the provincial
health division of Bandundu, reported the epidemiological situation
of the province (more particularly the Kwilu district):
For the moment, the status of the polio virus epidemic (l'Epidemie de
poliovirus sauvage) is as follows:
in the city of Kikwit (with its 2 health zones Kikwit North and
Kikwit South), there are 42 suspected cases, of which 3 cases were
confirmed, and 15 died. One of the 3 confirmed cases is a young lady
of 20 years old, who is still alive.*
** Health zone Ipamu: 10 cases*
** Health zone Kimputu: 1 case."*
Yesterday, 24 Dec 2010, the mayor, Dr Kiyungu, sent me a mail
mentioning: "We have now 60 cases of wild polio virus in Kikwit, and
20 fatalities.
--
Dr Pol Jansegers
<pol.jansegers@gmail.com>
[ProMED-mail is grateful to Dr. Jansegers for providing us with an
update on the polio situation in Kikwit Democratic Republic of the
Congo (DR Congo). In the ProMED-mail posting of 9 Dec 2010, there was
a report of 36 cases and 15 deaths attributable to wild poliovirus
(WPV) infection in Kikwit (see Poliomyelitis - worldwide (30): DR
Congo, RFI 20101209.4395).
According to the most recent weekly report available on the polio
eradication initiative website, as of 22 Dec 2010, there have been 79
cases of WPV infection confirmed to date in the DR Congo. In the
preceding week, there were 5 new cases reported (3 WPV1s from Kasai
Occidental, one WPV1 from Kasai Oriental and one WPV1 from
Bas-Congo). The most recent confirmed case had a date of onset of
paralysis of 18 Nov 2010 -- a WPV1 in Bas Congo.
Kikwit is located in the province of Bandundu (see the map links
provided below). One suspects that the cases referred to in the above
message from Dr. Jansegers may be pending laboratory confirmation,
and will be added to the official case count as laboratory results
become available.
For a map of the DRC with provinces, see
<http://www.usaid.gov/our_work/cross-cut ... arged2.jpg>.
Kikwit is located in Bandundu province in the southwest of the DRC.
For the HealthMap/ProMED map of Kikwit, see
<http://healthmap.org/r/0iwM>. - Mod.MPP]
****************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Sat 25 Dec 2010
From: Pol Jansegers
<pol.jansegers@gmail.com>
Subject: Polio epidemic in Kwilu district, RDC
----------------------------------------------
Hello,
I am a retired physician from Belgium, who has worked in Kikwit, DR
Congo, during the years 1970-80.
I was in Kikwit recently, and was told about several suspected cases
of polio-virus [infection] there.
In a mail dated [9 Dec 2010], Dr Matthieu Bikoko, a local
[physician], working for a Belgian NGO, Memisa, reported:
*"Yesterday, I participated in an epidemiological surveillance
meeting, during which the mayor of the city of Kikwit [Dr Cyrille
Kiyungu], accompanied by local WHO staff and a team of the provincial
health division of Bandundu, reported the epidemiological situation
of the province (more particularly the Kwilu district):
For the moment, the status of the polio virus epidemic (l'Epidemie de
poliovirus sauvage) is as follows:
in the city of Kikwit (with its 2 health zones Kikwit North and
Kikwit South), there are 42 suspected cases, of which 3 cases were
confirmed, and 15 died. One of the 3 confirmed cases is a young lady
of 20 years old, who is still alive.*
** Health zone Ipamu: 10 cases*
** Health zone Kimputu: 1 case."*
Yesterday, 24 Dec 2010, the mayor, Dr Kiyungu, sent me a mail
mentioning: "We have now 60 cases of wild polio virus in Kikwit, and
20 fatalities.
--
Dr Pol Jansegers
<pol.jansegers@gmail.com>
[ProMED-mail is grateful to Dr. Jansegers for providing us with an
update on the polio situation in Kikwit Democratic Republic of the
Congo (DR Congo). In the ProMED-mail posting of 9 Dec 2010, there was
a report of 36 cases and 15 deaths attributable to wild poliovirus
(WPV) infection in Kikwit (see Poliomyelitis - worldwide (30): DR
Congo, RFI 20101209.4395).
According to the most recent weekly report available on the polio
eradication initiative website, as of 22 Dec 2010, there have been 79
cases of WPV infection confirmed to date in the DR Congo. In the
preceding week, there were 5 new cases reported (3 WPV1s from Kasai
Occidental, one WPV1 from Kasai Oriental and one WPV1 from
Bas-Congo). The most recent confirmed case had a date of onset of
paralysis of 18 Nov 2010 -- a WPV1 in Bas Congo.
Kikwit is located in the province of Bandundu (see the map links
provided below). One suspects that the cases referred to in the above
message from Dr. Jansegers may be pending laboratory confirmation,
and will be added to the official case count as laboratory results
become available.
For a map of the DRC with provinces, see
<http://www.usaid.gov/our_work/cross-cut ... arged2.jpg>.
Kikwit is located in Bandundu province in the southwest of the DRC.
For the HealthMap/ProMED map of Kikwit, see
<http://healthmap.org/r/0iwM>. - Mod.MPP]
-
Birgitt
- Moderator
- Beiträge: 35237
- Registriert: Di 2. Aug 2005, 22:52
- Wohnort: NRW / Südl. Rheinland
- Kontaktdaten:
Re: Kinderlähmung - Poliomyelitis
Mass polio immunisation on in north, eastern Uganda
16.01.2011 - New Vision
THE Health ministry has embarked on a two-day massive door-to-door polio immunisation campaign for children below five years in five regions in the country. The regions, where the activity commenced on Friday, are Teso, Acholi, Karamoja, Bugisu and Lango. This is the third phase of immunisation carried out by the ministry since the disease was discovered in February last year. James Kakooza, the state minister for Primary healthcare, said the exercise, which ends today, is intended to protect children, especially those in northern Uganda, against polio. “The people in the north missed the previous immunisations due to the insurgency. This time, we have them on board and we shall leave no stone unturned,” Kakooza said ... mehr
Gruß
Birgitt
16.01.2011 - New Vision
THE Health ministry has embarked on a two-day massive door-to-door polio immunisation campaign for children below five years in five regions in the country. The regions, where the activity commenced on Friday, are Teso, Acholi, Karamoja, Bugisu and Lango. This is the third phase of immunisation carried out by the ministry since the disease was discovered in February last year. James Kakooza, the state minister for Primary healthcare, said the exercise, which ends today, is intended to protect children, especially those in northern Uganda, against polio. “The people in the north missed the previous immunisations due to the insurgency. This time, we have them on board and we shall leave no stone unturned,” Kakooza said ... mehr
Gruß
Birgitt
