During April 17-September 16, 1996, an ongoing outbreak of
paralytic
poliomyelitis in Albania resulted in 66 cases of acute flaccid
paralysis
(AFP), including seven (11%) deaths. Wild poliovirus type 1 was
isolated
from seven cases.
The first case-patient, a 12-month-old child, had onset of
paralysis on
April 17; ages of AFP patients ranged from 4 months to 46 years
(median
age: 20-24 years). Of the reported AFP cases, 46 (70%) occurred
among
persons aged 10-30 years, and 13 (20%) occurred among persons aged
greater
than or equal to 30 years. Seven cases occurred among children aged
0-9
years; five (8%) were among children aged less than 5 years. Cases
have
been reported from 18 of 37 districts, primarily in the northern
and
central parts of the country; no cases have been reported from the
southernmost districts.
National Immunization Days (NIDs) were successfully completed
on April
8 and May 17, during which reported coverage with oral poliovirus
vaccine
(OPV) was greater than 97% among children aged less than 5 years,
the
targeted age group. Albania's Ministry of Health is organizing a
mass
vaccination campaign with OPV for children and adults (aged 0-50
years) to
control the outbreak.
Reported by: A Sallabanda, MD, L Diamante, MD, A Ylli, MD,
Institute of
Public Health, Ministry of Health, Albania. National Institute of
Health,
Rome, Italy. Regional Office for Europe, World Health Organization,
Copenhagen, Denmark; Global Program on Vaccines and Immunization,
World
Health Organization, Geneva, Switzerland. Respiratory and
Enterovirus Br,
Div of Viral and Rickettsial Diseases, National Center for
Infectious
Diseases; Polio Eradication Activity, National Immunization
Program, CDC.
Editorial Note
Editorial Note: Preliminary results of the outbreak investigation
suggest
that factors contributing to this outbreak include 1) problems with
the
delivery of routine vaccination services before 1993, 2) an
increase in
contacts with persons from polio-endemic countries since 1991, and
3)
sanitation problems resulting from recent large-scale movement of
segments
of the Albanian population to urban areas. The relatively low
incidence
among children aged less than 5 years may be a result of the recent
NIDs
and improvements in the cold chain for routine vaccination services
since
1993. The high case-fatality rate may be due to the high proportion
of
cases among older children and adults -- who are known to be at
higher risk
for bulbar paralysis -- and may be aggravated by delays in seeking
medical
care.
Travelers to Albania who have received a primary series of
polio
vaccine should receive a booster dose before departure. Travelers
who are
inadequately vaccinated against polio or whose past vaccination
history is
uncertain should contact their physician to discuss polio
vaccination
options before leaving for Albania.
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