Polio Cases Research Articles

Floods in Pakistan: a public health crisis

Background In August 2010, Pakistan experienced floods that affected 20 million people in 78 districts, killed 1800, damaged or destroyed about 2 million homes, 514 health facilities and inundated a land mass the size of England. (1) Prior to this current crisis, Pakistan already had about four million internally displaced people and refugees due to the war along the Afghan border and the 2005 earthquake in Khyber-Pakhtunkhwa (formerly North-West Frontier Province). Health indicators in Pakistan were dismal even before the floods, with maternal mortality at 230 (190-280) per 100 000 live births and under-5 mortality at 89 per 1000 live births. (2) Most of the flooded populations comprise the lowest socioeconomic quintiles that were already facing neglect. This crisis has worsened their plight. Relief agencies Relief operations were mainly carried out by the Pakistani government, the army and international agencies such as the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), Medecins Sans Frontieres and the United States Agency for International Development (USAID). (3) In addition, civilian volunteers, independent teams of physicians, nongovernmental organizations and various other groups with little experience in disaster relief were also working in the field. The Pakistan army provided the most visible rescue operations but was overextended with massive rescue efforts, shoring up and breaching dykes, as well as fighting the war in the tribal areas. The National Disaster Management Authority was established after the earthquake in 2005. However, it does not have a dedicated post for an individual overseeing the public health aspect of the disaster. Widespread mistrust of governmental agencies, primarily stemming from perceived corruption and mismanagement, has hindered donors and citizens from cooperating with governmental initiatives. We strongly recommend that the government take the lead in coordinating the public health response and allocate personnel and resources to that effect. Infectious diseases Between August and September 2010, 6.2 million consultations for gastroenteritis, respiratory infections, malaria and dermatologic conditions were reported to WHO from 50 of 64 affected districts, with countless more predicted to fall sick in the period that followed. (1) Using surveillance data from flood-affected districts, WHO reported mounting cases of Crimean-Congo haemorrhagic fever, dengue fever, cholera, falciparum malaria, measles and polio. (3) A nationwide diphtheria outbreak was also unfolding at the time of writing this paper. An oral cholera vaccine is available and recommended for use in humanitarian emergencies by WHO (4) yet it has not been recommended for use in flood-affected areas due to perceived logistic difficulties in delivery, e.g. two-dose regimen, vaccine production capacity. While such obstacles were overcome for delivery of the H1N1 pandemic flu vaccine, mass cholera vaccination was not given priority in Pakistan. With the manufacture and potential availability of a cheap and effective cholera vaccine from India, mass vaccination may have been a consideration for the affected populations in Pakistan. Adverse impact on polio eradication has been significant. Pakistan is one of only four countries where polio remains endemic. Eradication remains a challenge due to the complex situation exacerbated by the war in Afghanistan, insurgency in Pakistan and the resulting mass movement of people. By 9 November 2010, Pakistan accounted for about 62% (111 cases) of all 180 polio cases from endemic countries, (5) and most new cases were from flood-affected areas. (3) However, WHO increased efforts at delivering vaccination services in 45 flood-affected districts and, due to enhanced cooperation between the Pakistan Expanded Program on Immunization (EPI), WHO and UNICEF, national immunization days went ahead as planned. …

An update on the African polio outbreak

Poliovirus invades the nervous system, resulting in paralysis and occasionally death. In 1988, a global initiative was launched by the WHO and partners to eradicate the virus by mass immunization. The effort was largely successful; the number of polio cases fell by 99%, and today the virus remains endemic to just four countries: India, Pakistan, Afghanistan, and Nigeria (1). However, in November and December of last year, hundreds of polio victims were identified in the Congo, and an estimated 40% of those cases were fatal. The JCI recently spoke to Vincent Racaniello, selfdescribed “virus guy” and polio expert at Columbia University, about the outbreak. JCI: Is the poliovirus currently circulating in Africa different from that seen in the rest of the world? Racaniello: There is no evidence that the poliovirus circulating in Africa (specifically in the Congo) has changed in any way. The Congo strain appears to have come from India via Angola, possibly spread by migrant workers. It is a wild-type 1 strain, not a vaccine-derived strain that has caused outbreaks in other countries. JCI: Most of the victims in the Congo are teenagers and young adults, and the fatality rate is high; does that signal that the virus has changed in some way? Racaniello: The high prevalence of infection among teenagers and young adults is likely related to gaps in immunization. The last case of polio in the Congo was in 2000; hence immunization has lagged. When polio is acquired at a later age, the disease tends to be more severe. JCI: How far do you think this latest outbreak is likely to spread? Racaniello: Mass immunizations will probably restrict the outbreak to the Congo. However, consider that only 1% of poliovirus infections are paralytic. That means in the current outbreak, where 476 cases of paralytic disease have been recorded, there have been a total of 47,600 infections, 99% of which have gone unnoticed. Therefore the potential for spreading the infection to neighboring countries is high — unless those countries maintain high levels of immunization. Migrant worker travel can also cause distant spread of infection. In 2004, there was an outbreak of polio in Nigeria; the virus spread to other countries in Africa and then to Indonesia. JCI: How should vaccination policy change to prevent future outbreaks? Racaniello: All countries need to maintain high levels of immunization coverage until the disease has been eradicated. In the US and other developed countries, this is done by routine immunization at birth. In underdeveloped countries, this is difficult due to poor health care systems, unstable political situations, and armed conflict. Hence, mass immunizations are used to improve coverage. As long as countries such as the Congo allow immunizations to lag, there will be outbreaks.

Pakistan's fight against poliomyelitis: introducing innovative strategies to address challenges and attain the goal of eradication

Pakistan, with Nigeria, India and Afghanistan, is one of the four remaining polio endemic countries in the world. Since the start of polio eradication initiative in 1994, the country has succeeded in reducing the number of polio cases from an estimated 20,000 annually to 89 in 2009. Furthermore, persistent transmission is largely localized to three transmission zones in which ten of the fifteen highest risk areas are situated. Insecurity, operational issues, governance lapses, low routineimmunization coverage, inadequate trickle-down of the political commitment existing at the national level to sub-national level and extensive population movement are the main barriers to the process. A robust strategic plan was developed for 2010-2012 encompassing district-specific plans and focused strategy on securitycompromised areas, performance-based payment, independent monitoring, attention to migratory populations, social mobilization, and strategic cooperation with Afghanistan. This will provide Pakistan a strong and imminent opportunity to interrupt polio virus circulation.

Challenges faced by the global polio eradication initiative

After the World Health Assembly resolved in 1988 to eradicate wild poliovirus (WPV) transmission globally by 2000, dramatic progress in reducing polio cases and increasing the number of countries t...

Folic Acid–Preventable Spina Bifida: A Good Start but Much to Be Done

Nearly 20 years ago, a randomized trial unequivocally showed that folic acid prevents spina bifida and anencephaly. 1 MRC Vitamin Study Research GroupPrevention of neural tube defects: results of the Medical Research Council Vitamin Study. Lancet. 1991; 338: 131-137 Abstract PubMed Scopus (3481) Google Scholar This publication provided the scientific basis that should have led to the rapid, global disappearance of folic acid–preventable spina bifida and anencephaly. Although these preventable birth defects should be as scarce as polio, globally we continue to have about as many cases as there were cases of polio in 1988 when WHO began the polio eradication program. There are now fewer than 1000 cases of polio each year in the world, while there remain more than 200,000 cases of folic acid–preventable spina bifida and anencephaly. This failure of modern-day preventive medicine is primarily the failure to create the political will to eliminate these diseases. 2 Oakley Jr, G.P. Brent R.L. Birth defects prevention: “The fierce urgency of now.”. Birth Defects Res A Clin Mol Teratol. 2008; 82: 745-747 Crossref PubMed Scopus (6) Google Scholar The CDC has been the institution that provided the inspiration and early funding for the global eradication of smallpox and polio, but it has yet to receive funding to mobilize sufficiently the global elimination of spina bifida and anencephaly. The current annual budget of the CDC for polio eradication is about $200 million, while the budget for global prevention of folic acid–preventable spina bifida is less than $5 million. In the meantime, tens of thousands of children each year continue to be born with these preventable birth defects that contribute to infant mortality and life-long paralysis and disability.

Evaluation of Tanzania National Measles Surveillance System with laboratory component, for 2006 and 2007

Background: Measles is among the seven vaccine preventable diseases of priority under the Expanded Program on Immunization in Tanzania. The objectives of the measles surveillance system which was established in 1975 are to establish disease early detection, prevention, control of its outbreak, monitor disease pattern and integrate enhanced surveillance for polio and measles cases. The objective of this evaluation was to determine whether the surveillance system is achieving its objectives, purposes and to asses its attributes. Methods: Used the Centres for Disease Control and Prevention (CDC) guideline document, discussions and interviews with different stakeholders, reviewing National measles data for 2006 and 2007 with reference to WHO indicators of quality measles surveillance system. Results: There was a total of 7656 suspected measles cases with 2871 (37.5%) of cases confirmed by IgM laboratory testing which is above WHO target of 10%. The system is highly sensitive with low Predictive Value Positive, flexible and acceptable. Not simple as it requires laboratory confirmation. Quality of data in terms of completeness and timeliness is good with description of age and vaccination status. There is poor data feedback communication with low levels and between Expanded Programme in Immunization headquarters and Epidemiology Section. Conclusion: The System mainly achieves its objectives and purposes, but should strengthen the timely distribution of feedback to lower levels, and strengthens data communication with Epidemiology section, for better preparedness in case of any outbreak. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive

Public Health Response to Influenza A(H1N1) as an Opportunity to Build Public Trust

IN JUNE 2009, THE WORLD HEALTH ORGANIZATION (WHO) declared the 2009 influenza A(H1N1) pandemic and in October 2009, President Obama declared it a national emergency. The influenza A(H1N1) virus is being monitored around the world for changes in virulence or epidemiology. There has been a push to have vaccines ready, yet vaccine supply may be insufficient in some areas. The public wants to be assured that there is enough vaccine, but at the same time, some are questioning the safety and effectiveness of the vaccine. It is a time of uncertainty both for the public health community and for the public. Times of uncertainty and risk are times when public trust is most needed. But trust is built long before the time that trust matters most. As the public weighs the perceived risks of the A(H1N1) virus against the perceived risks of vaccination, they are taking into account multiple, often conflicting, sources of current and historic information, as well as their own personal experiences. Questioning the safety of A(H1N1) vaccines is for some influenced by memories of the 1976 US swine flu alert, of the follow-up swine flu vaccination campaign and the ensuing cases of GuillainBarre syndrome (GBS), and of a swine flu pandemic that never materialized. For others, questioning may come from memories of severe acute respiratory syndrome (SARS), which had severe but rapidly contained health effects; for others, questions may arise from warnings about avian influenza A(H5N1) and its continued pandemic threat. Perception of risk about A(H1N1) vaccination is also influenced by a broader environment of distrust and vocal antivaccine groups. Questioning and mistrust of the measles-mumpsrubella (MMR) vaccine in the United Kingdom that began during the late 1990s was prompted by the claimed association between the MMR vaccine, bowel disease, and autism. This claim came shortly after a loss of public trust around the government’s lack of transparency and understating of the risks of bovine spongiform encephalopathy. Even after clear evidence emerged that these claims about autism being related to vaccines were unfounded, historic levels of distrust, compounded by massive media coverage that amplified the unproven links between the MMR vaccine and bowel disease, played a role in contributing to lower vaccine coverage and consequent disease outbreaks. In France, public trust in hepatitis B vaccine plummeted after the government’s precautionary decision to stop the school vaccination program because of suspected, but not proven, links with multiple sclerosis, despite recommendations by WHO and French pediatricians to continue the program. This followed concerns over the French government’s management of the human immunodeficiency virus (HIV)–contaminated blood crisis in the mid-1980s, and public opposition and rumors associating hepatitis B vaccines with not only multiple sclerosis but also autism and leukemia led to low levels of hepatitis B vaccination. In Nigeria, the mistrust and 2003-2004 boycott of the polio vaccination program by predominantly Muslim states in Northern Nigeria emerged at a time when false rumors of the safety of polio vaccine—linked to HIV, hormonal contamination, or both—weakened trust in global initiatives such as polio eradication. This followed a 1996 drug trial of an antibiotic for meningitis in Nigeria in which children died. Adding to the mistrust, repeated door-to-door polio vaccination campaigns are thought to have increased levels of suspicion in historically marginalized states. In these states, health services are inadequate, immunization coverage is lower than in the rest of the country, and communities questioned why other diseases, perceived by them to be more important, continued to be neglected. The loss of public confidence and vaccination boycott led to a resurgence of polio cases in Nigeria. The Nigerian virus spread to more than 12 neighboring countries that had been certified as poliofree and polio caused by the Nigerian strain was traced as far as Indonesia. Significant efforts have since been made at the community level in Northern Nigeria to build public

世界ポリオ根絶の失われた10年とポリオ根絶計画のこれから

The Global Polio Eradication Initiative was aimed to eradicate poliomyelitis by the year 2000, however, polio eradication is still not in sight even in 2010, over 10 years after the initial target date. In 2010, indigenous transmission of wild polioviruses has been interrupted throughout the world except four countries, Afghanistan, Pakistan, India, and Nigeria. Despite the intense use of monovalent oral polio vaccines, type 1 and type 3 wild polioviruses still circulate in the four remaining polio-endemic countries, and multiple importations of wild polioviruses have also occurred extensively from Nigeria and India to a number of previously polio-free countries in Africa, Asia, and Europe. Furthermore, the emergence of type 2 vaccine-derived polioviruses has raised concerns about low level of immunity against type 2 poliovirus in some polio-endemic areas like Nigeria and India. On the other hand, operational improvements in 2009 were reported in high-risk states in northern Nigeria and transmission of type 1 and type 3 polioviruses in Nigeria is markedly declining from 2009 to 2010. Moreover, bivalent oral polio vaccine containing Sabin 1 and Sabin 3 strains has been introduced in 2010 as a promising tool to improve and simplify the supplemental immunization activities in high-risk areas. Although there was no apparent decline in the annual number of polio cases in 2000-2009 globally, it would be critical to review our experience during "the lost decade of global polio eradication" to move forward into the final stage of global polio eradication.

Pakistan, politics and polio

Pakistan, politics and polio

The Assessment of Effectiveness of Immunization in the Control of Infectious Childhood Diseases in Nigeria

Childhood immunization remains an important strategy in the reduction of morbidity and mortality from common vaccine preventable diseases. Nigeria’s immunization coverage rates are among the lowest in the world. This low coverage rate can be attributed to challenges encountered by the programme. A quick turn around came in December 2005 when the World Health Organisation – Nigeria Expanded programme on immunization team supported a Government of Nigeria consultative process to strengthen routine immunization using a 4 – point strategy. This strong partnership resulted in the increase of routine immunization coverage of Diptheria-Pertussis-Tetanus 3 from 37.5% in December 2005 to 72% by end of December 2006. There was a decline in the transmission of wild polio virus type 1. Only 22% of the 1129 polio cases confirmed in 2006 occurred during the second half of 2006; the number of children never vaccinated with OPV also declined from 50% to 20%. Enhanced surveillance for measles has demonstrated the dramatic reduction in measles morbidity and mortality rate from 144,068 cases in 2005 with a case fatality rate of >4% to 16,629 cases in 2006 with a case fatalityrate of 1.8%. Also, 26 million (83%) children under age five were also vaccinated for measles during the integrated measles campaign in 17 southern states in October 2006. The challenges encountered by the Nigerian’s immunization programme include inadequate vaccination supplies, collapse of primary healthcare services, poor acceptance ofimmunization particularly in northern Nigeria, civil unrest, wars, natural disasters and others.

Controlling polio outbreak due to imported wild poliovirus in Indonesia: A success story

Background As a WHO member state, Indonesia is committed toGlobal Polio Eradication. The last indigenous polio case was found in 1995. However, we faced a big challenge with the occurrence of polio outbreak, beginning with a polio case caused by imported wild poliovirus (WPV) type 1 in Sukabumi in 2005. The virus was originated from Sudan and imported to Indonesia through Saudi Arabia. The outbreak ended with totally 305 cases throughout the country. The last one occurred on 20 February 2006 in Aceh Tenggara District, Nanggroe Aceh Darussalam Province. In addition and separated from the WPV type 1 outbreak, in August 2005, four Acute Flaccid Paralysis (AFP) cases with type 1 Vaccine Derived Poliovirus (VDPV) in stool samples were identified in Madura, East Java Province. The first case was on 9 June 2005 and ended with 45 cases in Madura and another case in Probolinggo District, East Jawa.Objective To report a success of controlling outbreak of importedWPV in Indonesia.Methods Outbreak Response Immunization (ORI) and mopup immunization were conducted immediately. To completelystop the transmission, three rounds of National ImmunizationDays (NIDs) were conducted in 2005 (August, September, andNovember). Some more Supplementary Immunization Activities(SIAs) were conducted in 2006 (mop up in January, NIDs inFebruary and early April, mop ups in June and August 2006).For the VDPV outbreak, ORI of 18,880 children in 83 villagestook place during the first week of August, beside three roundsofNIDs in 2005.Results All activities resulted in satisfactorily coverage, whereeach round always exceeded 95%.Conclusions Those activities were conducted successfully andproven to be effective to stop the outbreak. Then again, Indonesia can be a polio free country in the coming years.

Non‐polio enteroviruses in acute flaccid paralysis children of India: Vital assessment before polio eradication

This study is an overview of non-polio enterovirus (NPEV) circulating in North India studied from the perspective of poliomyelitis eradication. Wild polio cases declined because of intensive oral polio vaccine immunization. As we approach global eradication of poliovirus (PV), NPEV causing acute flaccid paralysis (AFP) are equal cause of concern. A total of 46 653 AFP samples (World Health Organization) and apparently 1000 healthy contacts living in the same geographical area were studied (2004-2007). Serological identification of NPEV was done using RIVM-specific pools (The Netherlands). Untyped (UT)-NPEVs were sequenced directly from reverse transcription-polymerase chain reaction using pan-enterovirus (Pan-EV) primer (CDC, Atlanta, GA) targeting highly conserved 5'un-translated regions of the enterovirus. In this study, 12 513 NPEVs were isolated from the collected stool samples. Seroneutralization had identified 67% of NPEV isolates, whereas 32.6% remained as UT- NPEV. Of the typed NPEVs, Coxsackie-B accounted for 32.3%; followed by echoviruses-11, 12, 13, 7 between 8 and 28%. In sequencing few UT-NPEVs, some were identified also as echovirus-30, 11 and 18 which were probably present in mixtures as they remained UT-NPEV in ENT. Newly classified human enterovirus virus-86 (HEV) (EU079026), HEV-97(EU071767) and HEV-B isolate (EU071768) were isolated in AFP samples. This study provided definitive information about circulation, prevalence and new emerging NPEV in the polio-endemic region of India, hence they should be considered in AFP surveillance. This would help in adopting and planning new strategies in post-PV eradication era in the country. This is the right time to prepare for the future tasks while we head towards a polio-free region.

Religious Opposition to Polio Vaccination

To the Editor: In 1988, the Global Polio Eradication Initiative was formed, with the aim of reducing infection with poliomyelitis virus. Two decades later in 2008, a total of 1,625 children contracted acute flaccid paralysis caused by poliovirus infection (1). This finding represented a 150% increase over the number of cases in 2007 (1) and resulted in the reemergence of polio as one of the world’s deadliest infections. As of 2009, polio remains endemic to 4 countries (India, Nigeria, Pakistan, and Afghanistan); in 2008, cases were also detected in 14 other countries. Religious opposition by Muslim fundamentalists is a major factor in the failure of immunization programs against polio in Nigeria (2), Pakistan (3) and Afghanistan (4). This religious conflict in the tribal areas of Pakistan is one of the biggest hindrances to effective polio vaccination. Epidemiologists have detected transmission of wild poliovirus from polio-endemic districts in Afghanistan, most of which are located in the southern region of this country bordering Pakistan, to tribal areas of Pakistan (4). This transmission has resulted in new cases of polio in previously polio-free districts. The local Taliban have issued fatwas denouncing vaccination as an American ploy to sterilize Muslim populations. Another common superstition spread by extremists is that vaccination is an attempt to avert the will of Allah. The Taliban have assassinated vaccination officials, including Abdul Ghani Marwat, who was the head of the government’s vaccination campaign in Bajaur Agency in the Pakistani tribal areas, on his way back from meeting a religious cleric (5). Over the past year, several kidnappings and beatings of vaccinators have been reported. Vaccination campaigns in Nigeria and Afghanistan have also been hampered by Islamic extremists, especially in the Nigerian province of Kano in 2003, which has resulted in the infection returning to 8 previously polio-free countries in Africa (2). Before the Global Polio Eradication Initiative in 1988, a total of 1,000 persons/day were infected with a virus that would cripple them for the rest of their lives (6). To eradicate the disease, 1 major factor will be to gain support of those susceptible to fundamentalist propaganda. Islam is a progressive religion, and religious leaders should be asked to support polio eradication programs. The Imam of the Ka’aba and other influential religious figures should be asked to highlight the plight of children with polio. Vaccinators operating in conflict-ridden areas should be provided protection so that they are better able to perform their duties. Not only will children in these areas be safer, but the disease will not be exported to areas where wild polio transmission has been interrupted by vaccination. Further study of the attitudes of Muslim populations toward vaccination is needed.

Leaping Tall Buildings--The Science-to-Service Gap in Schizophrenia Treatment

Leaping Tall Buildings--The Science-to-Service Gap in Schizophrenia Treatment

Why polio has not been eradicated in India despite many remedial interventions?

Oral polio vaccine has reduced the incidence of polio in India and many states have been polio free for a long time while occasional polio cases are occurring in some states. On the other hand more than 96% of polio cases being reported in India are occurring in Uttar Pradesh and Bihar. The current polio scenario indicates that oral polio vaccines cannot eradicate polio from Uttar Pradesh and Bihar because some children from these two states show poor response to OPV. There is an urgent need for re-appraisal of polio eradication strategy.

Oral polio vaccines and their role in polio eradication in India

Although the oral polio vaccine has reduced the incidence of polio in India, the current polio scenario indicates that oral polio vaccine cannot eradicate polio from Uttar Pradesh and Bihar, two states that have approximately 32% of the total Indian population and report more than 96% of polio cases that occur in India. Poor response to oral polio vaccine by some children from these two states could be due to genetic factors. Thus, for polio eradication in India, inactivated polio vaccine is needed.

Biographical truths and their clinical consequences: Understanding ‘embodied memories’ in a third psychoanalysis with a traumatized patient recovered from severe poliomyelitis

The relationship between ‘narrative’ and ‘historical–biographical truth’ in psychoanalytic treatment has become the subject of many controversial debates in recent years. Findings of contemporary memory research have lead to great scepticism as to whether therapists are able objectively and reliably to reconstruct biographical events on the basis of their observations in the therapeutic situation. Some authors even claim that psychoanalysts should concentrate exclusively on observing the here and now of the patient′s behaviour within the transference relationship to the analyst. In this paper it will be discussed whether the baby has been thrown out with the bathwater in this debate. Centred around the insights from a third psychoanalysis with a patient who suffered from a severe case of childhood polio, the hypothesis will be discussed that working through the traumatic experience in the transference with the analyst, as well as the reconstruction of the biographical–historical reality of the trauma suffered, prove to be indispensable for a lasting structural change.Integration of the trauma into one′s own personal history and identity is and remains one of the main aims of a psychoanalytic treatment with severely traumatized patients. The reconstruction of the original trauma is indispensable in helping the patient to understand the ‘language of the body’ and to connect it with visualizations, images and verbalizations. The irreversable wounds and vulnerability of his body as the ‘signs of his specific traumatic history’ have to be recognized, emotionally accepted and understood in order to live with them and not deny them any longer. Another important aspect in psychoanalysis is to develop the capability to mentalize, in other words, to understand the intentions of central (primary) objects related to the trauma.The concept of ‘embodied memory’ might be helpful in understanding precisely in what way ‘early trauma is remembered by the body’. Observing in detail the sensory‐motor coordinations in the analytic relationship enables one to decode the inappropriate intensity of affects and fantasies which match the original traumatic interaction and are revealed as inappropriate reactions in the present, new relationship to the analyst.

Polio Outbreak Response in Ethiopia

Ethiopia had been polio-free for almost four years until December 2004. However, between December 2004 and February 2006, 24 children were paralysed as a result of infection with wild poliovirus imported from the neighbouring country of Sudan. In response, the country has attempted to document the impact of various response measures on the containment of wild poliovirus transmission. This study aims at systematic and epidemiological assessment of the extent of the outbreak, its determinants, and the lessons learned as well as the implications for future control strategies to interrupt wild poliovirus transmission. A cross-sectional study design with qualitative and quantitative data collection approaches was used to conduct the epidemiologic assessment. All confirmed wild poliovirus cases, and reported acute flaccid paralysis cases in close proximity to the confirmed polio cases were the study subjects. Child caretakers and health service providers were interviewed as part of the investigation. Between December 2004 and February 2006, eight children from Tigray Regional State, nine children from Amhara Regional State and seven children from Oromia Regional State were paralysed as a result of infection with wild poliovirus type 1. Genetic sequencing demonstrated two separate importations to Ethiopia. Risk factors that may have facilitated spread of the outbreak within the country included gaps in vaccination coverage and interruption of the cold chain system, gaps in acute flaccid paralysis surveillance performance, high population mobility, poor environmental sanitation, crowded living conditions and unsafe drinking water. In response to the outbreak, Ethiopia conducted detailed outbreak investigations within two days of confirmation of the index cases. Large-scale, house-to-house vaccination campaigns were also implemented. As a result, the three regions interrupted the wild poliovirus transmission within the regions within one year of confirmation of the index case. Outbreak response activities were successful in interrupting the imported wild poliovirus transmission in Tigray, Amhara and Oromia Regional States of Ethiopia within a one-year period of time. In Ethiopia, programme strategies should be intensified to contain further spread and prevent future importation of wild poliovirus. Large-scale immunisation campaigns should reach every child, including those isolated by geography, poverty and security.

2005 Poliovirus eradication: poliovirus presence in Cyprus 2 years after

The last case of polio in Cyprus caused by a wild-type poliovirus occurred in 1995. Since then Cyprus belongs to the countries considered poliovirus-free by the WHO. The aim of this study was to confirm the absence of any circulating wild-type polioviruses and to monitor vaccine-derived polioviruses in Cyprus by analysis of sewages. During the course of this study no wild-type polioviruses were identified, although the identification of viable oral poliovirus vaccine isolates confirmed the presence and circulation of poliovirus vaccine strains in sewage in Cyprus.

Uncertainty and Sensitivity Analyses of a Decision Analytic Model for Posteradication Polio Risk Management

Decision analytic modeling of polio risk management policies after eradication may help inform decisionmakers about the quantitative tradeoffs implied by various options. Given the significant dynamic complexity and uncertainty involving posteradication decisions, this article aims to clarify the structure of a decision analytic model developed to help characterize the risks, costs, and benefits of various options for polio risk management after eradication of wild polioviruses and analyze the implications of different sources of uncertainty. We provide an influence diagram of the model with a description of each component, explore the impact of different assumptions about model inputs, and present probability distributions of model outputs. The results show that choices made about surveillance, response, and containment for different income groups and immunization policies play a major role in the expected final costs and polio cases. While the overall policy implications of the model remain robust to the variations of assumptions and input uncertainty we considered, the analyses suggest the need for policymakers to carefully consider tradeoffs and for further studies to address the most important knowledge gaps.