Update on Polio outbreak in European region - no time for complacency regarding polio immunisation
In April 2010 the WHO European Region experienced the first importation of wild poliovirus since it was certified polio free in 2002. The WHO European office has issued an update on the polio situation in the region. Please click here to access the report.
As of 30 September 2010, polio has been reported in three European countries and cases are under investigation in an additional 3 countries; • Tajikistan (458 laboratory‐confirmed cases of wild poliovirus type 1, including 26 deaths) • The Russian Federation (12 cases) • Turkmenistan (3 polio cases) • Kyrgyzstan (50 cases investigated, laboratory results pending on 13) • Uzbekistan(99 cases under investigation) • Kazakhstan(54 cases under investigation)
Polio vaccination is part of the routine immunization programme in Ireland.
HPSC recommendations
1. Vaccination to protect against polio is included in the 6-in-1 vaccine given to infants at 2, 4, 6 months of age. An additional booster dose is given at 4-5 years of age (as part of the 4-in-1 vaccine). 2. All individuals, of all ages, regardless of whether they intend to travel, should ensure that they have completed appropriate immunisation against polio. 3. Travellers of any age to areas where polio is epidemic or endemic should ensure that they are appropriately immunised.
Note for clinicians: 4. All cases of acute flaccid paralysis (AFP)*, particularly in children < 15 years of age, should be investigated and 2 stool samples should be sent to the National Virus Reference Laboratory (NVRL) for testing indicating reason for investigation†.
*Acute flaccid paralysis has been defined as any case of new onset of hypotonic weakness in a child aged less than 15 years of age. This includes possible illness due to Guillain-Barré Syndrome, transverse myelitis, traumatic neuritis, viral infections such as Enterovirus 71, Echovirus, Coxsackie virus, toxins and tumours. All these causes of acute flaccid paralysis should be investigated. The non-Polio acute flaccid paralysis rate should be at least 1 per 100,000 children under 15. *Isolated facial paralysis is not included in the case definition of acute flaccid paralysis and does not require to be reported.
†It is strongly recommended to contact the National Virus Reference Laboratory in UCD for advice regarding the transfer of appropriate specimens immediately on admission of any child with acute flaccid paralysis, regardless of the cause of the AFP. Non-infectious causes of AFP are included in the surveillance required by the WHO.
In all cases of acute flaccid paralysis it is essential that two specimens of stool are collected taken 24 hours apart and within 14 days of the on set of paralysis. These stool specimens must be sent to the National Virus Reference Laboratory.
Polio outbreak in the south-west of Tajikistan
A polio outbreak in the south-west of Tajikistan, in the area bordering Afghanistan and Uzbekistan.
As of 22 April, 128 AFP cases have been reported and 10 children have died. All cases are in the south-west of the country, in an area bordering Afghanistan and Uzbekistan. Poliovirus has been isolated in diagnostic specimens from seven of these cases. Genetic sequencing of the virus is being done to further characterize the virus. Uzbekistan has also reported three AFP cases, which are under investigation.
Poliovirus travels long distances easily and polio-free regions will continue to be at risk until poliovirus transmission is stopped in the remaining endemic countries. The WHO European Region was certified polio-free in 2002, following over three years without transmission of indigenous wild poliovirus in the presence of certification-standard surveillance. The outbreak in Tajikistan has no immediate implications for the European Region’s certification.
This outbreak, however, demonstrates the need to maintain high population immunity until transmission of polio has been interrupted worldwide. The outbreak coincides with the annual European Immunization Week campaign which begins on 24 April 2010 to raise awareness of vaccine-preventable diseases and the importance of immunization.
Polio outbreak in Nigeria- spreading to other African countries
The World Health Organization has issued an alert regarding the ongoing polio outbreak in northern Nigeria.
The outbreak which is concentrated in Northern Nigeria has spread internationally to nearby countries in west Africa (Benin, Burkina Faso, Ghana, Mali, Niger and Togo). In 2008, Nigeria accounted for 80% of type 1 polio cases in the world. The Nigerian health authorities are undertaking immunisation activities to provide oral polio vaccine (OPV) to children to prevent further spread of the disease.
From 2003 to 2007, type 1 polio originating in northern Nigeria spread to cause outbreaks in 20 previously polio-free countries, including across west Africa, the Horn of Africa, and as far away as Indonesia and Yemen. The outbreaks in these 20 countries resulted in 1,517 cases, and more than 500 million dollars (US) in international emergency outbreak response costs Please click here for most recent map on polio cases from WHO.
HPSC recommendations for Ireland
All cases of acute flaccid paralysis (AFP)*, particularly in children < 15 years of age, should be investigated and 2 stool samples should be sent to the National Virus Reference Laboratory (NVRL) for testing†.
Travellers to areas where polio is epidemic or endemic should ensure that they are appropriately immunised.
Polio vaccination is part of the routine immunization programme in Ireland. All individuals, regardless of whether they intend to travel should ensure that they have completed appropriate immunisation against polio.
*Acute flaccid paralysis has been defined as any case of new onset of hypotonic weakness in a child aged less than 15 years of age. This includes possible illness due to Guillain-Barre Syndrome, transverse myelitis, traumatic neuritis, viral infections such as Enterovirus 71, Echovirus, Coxsackie virus, toxins and tumours. All these causes of acute flaccid paralysis should be investigated. The non-Polio acute flaccid paralysis rate should be at least 1 per 100,000 children under 15. *Isolated facial paralysis is not included in the case definition of acute flaccid paralysis and does not require to be reported.
†It is strongly recommended to contact the National Virus Reference Laboratory in UCD for advice regarding the transfer of appropriate specimens immediately on admission of any child with acute flaccid paralysis, regardless of the cause of the AFP. Non-infectious causes of AFP are included in the surveillance required by the WHO.
In all cases of acute flaccid paralysis it is essential that two specimens of stool are collected taken 24 hours apart and within 14 days of the on set of paralysis. These stool specimens must be sent to the National Virus Reference Laboratory under reverse cold chain conditions to enable appropriate virological examination.
Australia reports first polio case since 1986
On July 13 2007 Australian Health Authorities reported a case of polio in a 22-year-old male who recently returned by plane to Australia from Pakistan. Click here for further details.
The last case of wild type poliovirus infection in Australia occurred in 1986 and the Western Pacific Region, including Australia, was certified as polio free in 2000. Any case of polio is a significant public health concern.
The Australian Health Protection Committee are implementing a national action to contact trace all passengers who travelled with the infected passenger and to isolate his Australian home contacts. The patient, who has recovered from his initial paralysis, will remain in hospital in isolation until he is diagnosed polio free
Passengers on Thai Airlines flight TG999 from Bangkok arriving in Melbourne on 2nd July 2007 were asked to contact the National (Australian) Public Health Info Line on 1800 004 599 for further information.
HPSC is not aware of any Irish residents who may have been on this flight. However, if any individual in Ireland was on this flight they are encouraged to contact their local HSE Department of Public Health.
Polio is a highly infectious disease that can be prevented through immunisation. All Irish children should receive four doses of polio vaccine as part of the childhood immunisation programme. However, any individuals (child or adult) who are unsure of their immunisation status, particularly if they are travelling abroad to countries where polio is still reported (Nigeria, Pakistan, India, Afghanistan, Niger, Somalia, Angola, DR Congo, Chad, Myanmar) should inform their doctor and receive polio vaccine as necessary.
Ireland, together with the WHO European region was certified polio free in 2002. The last case of polio was reported in Ireland in 1984.
More information on polio can be found on the HPSC website by clicking here.
Polio cases in Nigeria double
As of 30th August, the Global Polio Eradication Initiative reports 746 polio cases have occurred in Nigeria in 2006, compared to 349 cases for the same period in 2005. Most polio cases in the world are occurring in Nigeria. WHO estimates that in the five northern states of Nigeria (Bauchi, Jigawa, Kaduna, Kano and Katsina) which have the highest rates of polio, 40% of children are non-immune.
Nigeria, India, Pakistan and Afghanistan are the only four countries in the world which are still polio-endemic. This is an all-time low. In addition to the endemic countries, nine countries have reported polio cases in 2006 due to importations - Somalia, Yemen, Indonesia, Bangladesh, Ethiopia, Namibia, Niger, Nepal and DR Congo.
According to the Global Polio Eradication Initiative the five remaining challenges to a polio-free world are:
- Curbing the intense transmission in the high-priority states in Northern Nigeria and western Uttar Pradesh, India - Sustaining campaigns to break the final polio chains in the other two endemic countries - Rapidly stopping polio outbreaks in previously polio-free countries - Addressing the low routine immunisation rates and surveillance gaps in polio-free areas - Maintaining funding and political committment.
For more information on the Global Polio Eradication Initiative click here.
