Public Health Dispatch: Outbreak of Poliomyelitis --- Dominican
Republic and Haiti, 2000--2001
During July 12, 2000--February 8, 2001, 12 laboratory-confirmed
poliomyelitis cases attributed to vaccine-derived poliovirus type 1 were identified in the
Dominican Republic (1). Of these, 11 (92%) case-patients were aged
<6 years (range: 9 months--14 years), and the date of paralysis onset of the last case was January 2, 2001.
All case-patients were inadequately vaccinated or unvaccinated. In Haiti, one
confirmed polio case attributed to vaccine-derived type 1 poliovirus was reported in
an unvaccinated child aged 2 years with paralysis onset on August 30, 2000. As
of February 21, 33 acute flaccid paralysis (AFP) cases from the Dominican Republic
and three AFP cases from Haiti were pending final classification.
Extensive control efforts are under way. The Dominican Republic held
nationwide mass vaccination campaigns with oral poliovirus vaccine (OPV) in December 2000
and February 2001, with a third round planned for April 2001. All children aged <5
years are being targeted, with approximately 1.2 million OPV doses given in the
first campaign. AFP surveillance has been strengthened with intensification of active
case-finding and weekly reporting. Haiti has initiated regional OPV campaigns to
be conducted approximately every 2 months.
Travelers to the Dominican Republic and Haiti who are not vaccinated
adequately are at risk for polio. All travelers should be vaccinated against polio according
to national vaccination policies (2)*.
Reported by: Ministry of Health, Pan American Health Organization, Santo
Domingo, Dominican Republic. Ministry of Health, Pan American Health Organization,
Port-au-Prince, Haiti. Caribbean Epidemiology Center Laboratory, Pan American Health
Organization, Trinidad and Tobago. Div of Vaccines and Immunization, Pan American Health
Organization, Washington, DC. Respiratory and Enteric Viruses Br, Div of Viral and Rickettsial
Diseases, National Center for Infectious Diseases; Vaccine Preventable Disease Eradication
Div, National Immunization Program, CDC.
* Recommendations for children in the United States include a 4-dose vaccination
series with inactivated poliovirus vaccine (IPV) at ages 2, 4, 6--18 months, and 4--6 years.
Unvaccinated adults should receive three doses of IPV, the first two doses at intervals
of 4--8 weeks and the third dose 6--12 months after the second. If three doses cannot
be administered within the recommended intervals before protection is needed,
alternative schedules are proposed. For incompletely vaccinated persons, additional IPV doses
are recommended to complete a series. Booster doses of IPV may be considered for
persons
who previously have completed a primary series of polio vaccination and who may
be traveling to areas where polio is endemic.
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