Brote de poliomielitis en Haiti y la Republica Dominicana debido a un virus derivado de la vacuna antipoliomielitica oral / Poliomyelitis outbreak caused by vaccine-derived virus in Haiti and the Dominican Republic

In October 2000, the Ministries of Helth of the Dominican Republic and Haiti notified two cases of acute flaccid paralyis (AFP) in rural areas, one of them in a 9-month-old female, and the other in a 2-year-old female, respectively. Stool samples that were obtained from these cases, which occured in July and August 2000, after a 9-year interruption of wild poliovirus circulation in the Western Hemisphere, revealed the presence of type 1 poliovirus. Genetic sequencing, which was later performed at the CEnters for Disease Control and Prevention, in Atlanta, Georgia, United States of America, revealed an atypical descendant of the virus used in the manufacture of the oral polio vaccine (OPV), but with 3 percent genetic divergence with respect to the parent strain. Normally, viral isolates that derive from vaccine components show 99.5 percent genetic agreement with the parent strain; in wild polioviruses, on the other hand, this agreement is usually less than 82.0 percent. Thus, the 3 percent genetic divergence detected in this study suggests that, in areas with low vaccine coverage, the virus used in the vaccine remained in circulation for at least two years, during which it recovered the neurovirulence and communicability of wild poliovirus type 1. This report describes the characteristics and results of the active search for cases of AFP that was sparked by the detection of the two index cases. It also looks at the public health implications of this outbreak for the entire Region of the Americas (AU)

Importation of wild polio virus from Europe

Canada has recently isolated wild poliovirus type 3 from members of a church community in Alberta that refuses immunization. The members of this community frequently travel back an forth to visit the religious community in the Netherlands which recently had a large poliovirus outbreak. The viruses isolated in Alberta have identical genomic sequences to those isolated in the Netherlands. There are no cases of paralytic poliomyelitis thus far in Canada. This is the first detected importation of wild poliovirus into the Americas since the interruption of indigenous transmission in 1991 (AU)

Summary report on the ninth meeting of Caribbean EPI managers, held in the Department of Guadeloupe, France November 9-13, 1992

Besides the various topics that will be discussed in the subsequent sections of this report, it is important to state from the onset the tremendous progress made by every country towards the organization and implementation of surveillance system for detection of suspected measles cases. In one year, the countries of the English-speaking Caribbean and Suriname went from a phase in which little active surveillance was occuring to what now may be one of the most sophisticated systems in the world (AU)

Expanded programme on immunization: a parish-level evaluation of the surveillance system

To achieve the goal of measles elimination in the Caribbean subregion by 1995, a 3-part strategy has been developed. This plan of action consists of: strengthening the ongoing Expanded Programme on Immunization (EPI) in each country; mass immunization campaigns to stop transmission; and improved and expanded surveillance systems to identify and respond to suspected cases. Poliomyelitis eradication also requires heightened surveillance. In the case of poliomyelitis this surveillance seeks to identify and investigate all cases of acute flacid paralysis. As poliomyelitis eradication in the Americas nears, and measles elimination moves beyond the stage of mass immunization campaigns, the improvement of surveillance systems is becoming a central priority for the Caribbean (AU)

Amyotrophic lateral sclerosis and antecedent poliomyelitis

Motor neurone disease may occur in patients with antecedent, sometimes remote, paralytic poliomyelitis. A Jamaican patient with this sequence is described. Research exploring the relationship between the two diseases is giving a new insight into the aetiology of motor neurone disease. (AU)

Coverage survey, an evaluation of the immunization programme for infants - abstract

The objective of this study was to obtain information on the coverage rate for DPT, poliomyelitis and MMR/measles and rubella among children in Curacao. A cluster sampling technique was used to select 211 children, aged 15 to 26 months, whose immunization status was evaluated. Data were obtained from the immunization card and by interviewing the parent. The coverage rate ranged from 99.1 percent (first DPT) to 70.6 percent(MMR); 67.8 percent of children were fully immunized. Two children (0.9 percent were not immunized at all. Less than 10 percent of all immunization doses was administered outside the Well Baby Clinics. Some of the recorded doses were given too early (invalid)according to the WHO criteria. Accurate registration was recommended as a possible way to decrease the number of invalid doses. It was found that many of the 3 doses of poliomyelitis vaccine were administered too late and it is recommended that the 3rd oral polio dose should be given earlier. Reasons why children were not fully immunized could be divided into: obstacles to participation in the programme (55.9 percent), lack of motivation (10.3 percent) and lack of information (33.8 percent). Illness of the child was the main obstacle (AU)

Eight meeting of Caribbean EPI managers expanded program on immunization

The three main objectives of the meeting were to review the progress of EPI in the countries of the English-speaking Caribbean, to National Work Plans for 1992, and to explore all venues for further collaboration between the Ministries of Health and the NGOs to strengthen EPI and ensure achievement of the goals of measles elimination and polio eradication. All countries have produced a National Work Plan for 1992. These plans were discussed during the Working Group Sessions, in which there was the participation from all the collaborating agencies and NGOs. The plans cover several program components such as: biologicals and logistics, cold chain, training, supervision, surveillance, research, social communication, evaluation and operational costs (AU)

International task force for disease eradication

The eradication of smallpox from the world in 1977 proved the feasibility of infectious disease eradication. The International Task Force for Disease Eradication (ITFDE) is assessing the potential for global eradication of other infectious diseases. This report summarizes the ITFDE's findings on the potential to eradicate eight diseases based on draft versions of criteria under development (AU)

Immunize now : polio, the crippler can be prevented

Pamphlet explaining the disease poliomyelitis, its symptoms and the nethods of prevention

The study of serological immunity to poliomyelitis in children and adolescents in Jamaica (1985) - abstract

A survey of the immunization status and serological immunity to poliomyelitis was carried out in 5 parishes in Jamaica in 1985. A sample of 2,506 children and adolescents, aged 1 - 19 years, was chosen by selecting clusters of children in 20 enumeration districts in each parish (25 in Kingston & St. Andrew) from the 1980 Census. Immunization status was verified by examining immunization records. Serological assay for anti-bodies to Polio Types I, II and III was done at the Caribbean Epidemiology Centre. A positive neutralization test at a dilution of 1:8 was taken as immunity to the polio virus. Of the 1,819 children whose immunization status was confirmed, coverage with 3 or more doses of oral Polio vaccine was highest in the 1-4 year age group (79.7 percent) and lowest in the 15-19 year age group (37.4 percent); 5-9 year (67.8 percent) and 10-14 year age group (59.6 percent) were intermediate. Coverage was highest in St. James (74.5 percent) and lowest in Clarendon (59.9 percent). Of the 2,506 children, 81.4 percent, 94.7 percent and 72.3 percent were sero-positive for Polio Types I, II and III respectively. Sero-positivity was lowst in Clarendon in the 1-4 year age group and tended to increase with age. No urban/rural or gender differences were noted. Seven persons in the sample were reported to have had paralytic poliomyelitis. The study indicated a much higher level of immunization status than previous surveys and a high level of serological immunity to polio (AU)

The Public Health (Immunization) Regulations, 1986. Dated 7 August 1986 (The Jamaican Gazettel Supplement, Proclamations; Rules and Regulations, Vol 109, no 61, 18 August 1098, pp 285-289)

The Jamaica Public health administration passed regulations concerning child immunization and immunization requirements for entering school in August 1986. The regulations define the terms child, immunization, parent, public immunization officer and school. Immunization refers to diphtheria, pertussis, polio, tetanus, tuberculosis and measles. Parents are required to have children immunized within 1 year of birth or soon after, and reimmunized as required. Exceptions may be granted by seeking an official certificate if immunization is contraindicated. Certificates of immunization are issued by immunization officers and physicians. Children are not permitted to attend school without certificate of immunization with a current expiry date. (AU)

Thyroid function in dengue fever, meningitis, encephalitis, poliomyelitis and other febrile conditions

Thyroid function was studied by estimating serum thyroxine (T4), triodothyronine (T3) and thyrotropin (TSH) in 52 patients suffering from dengue fever, bacterial meningitis, viral encephalitis, paralytic poliomyelitis and other febrile illnesses. Mean serum concentrations of total T4 and T3 were significantly lower in all patients except those suffering from poliomyelitis. Serum TSH was significantly low in dengue fever and pyrexia of unknown origin (PUO). Though the TSH levels were also low in patients with bacterial meningitis and encephalitis, the differences were not statistically significant. Decreases in serum T4, T3 and FT1 in severe illnesses as compared to normal subjects may signify a state of secondary hypothyroidism of a functional type. It will be erroneous to say that decreases in T4 and T3 in systemic illnesses is entirely an adaptive or protective process to maintain metabolic rate. The possible value of thyroid hormone replacement therapy in these illnesses needs further investigations. (AU)

Poliomyelitis in Jamaica: immunization policies and socioeconomic implications

An analysis of the social and economic costs of the 1982 poliomyelitis epidemic in Jamaica shows that on both counts prevention by immunization is preferable to crisis management (Summary)

Immunization of the premature newborn - abstract

The human immune system is not fully competent at the time of birth and is even more immature with earlier gestational age at delivery. Nothing is known about the ability of the immune system of the premature newborn to respond to immunization. We are studying the immune response of prematures at Mt. Hope Maternity Hospital, Trinidad to determine the optimal time of immunization. Neonates are divided into four groups based on birth weight. Each group is further subdivided into two subgroups, one immunized 6-8 weeks after birth and the other at 6-8 weeks after calculated full term. Immunization includes diphtheria, pertussis, tetanus and polio. Immune response is measured by tetanus toxoid antibody and cellular reponses. To date, 50 neonates have been entered into the study. Thirty-nine have completed the primary series of three immuniations and 27 have had at least one follow-up sample. Twelve of the neonate were less than 1500/gm at birth. Eleven of the 12 have had appropriate antibody responses. The baby who did not respond had a high titre of passive maternal antibody at birth (4.2 i.u./ml) and the absence of reponse may be related to this. No differences in reponses habe been observed with early and late immunization. Cellular responses to tetanus toxoid were variable. Forty-two per cent of babies showed in-vitro reativity to tetanus at birth. However, only 30 per cent were reactive following the primary immunization series. Responses to streptococcal antigens fluctuated with the tetanus reponses, suggesting no specificity in the blastogenic response in these neonates (AU)