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Public Health Dispatch: Poliomyelitis --- Madagascar, 2002
Surveillance for acute flaccid paralysis (AFP) in Madagascar has detected a cluster of four cases of paralytic
poliomyelitis from which type-2 vaccine-derived polioviruses have been isolated. Preliminary data indicate that these patients, residing
in the Tolagnaro district of Toliara province in southeastern Madagascar, had onset of paralysis during March 20--April
12, 2002. None of the children affected was vaccinated fully. During March--April 2002, provincial authorities conducted
a small-scale house-to-house vaccination response. Genetic sequencing studies of these vaccine-derived viruses
indicate substantial genetic drift and recombination with nonpolio enteroviruses. These findings are compatible with an outbreak
of paralytic polio associated with a circulating vaccine-derived poliovirus (cVDPV); however, further investigation is required.
The three outbreaks of cVDPV described previously occurred in areas where routine oral polio vaccine (OPV) coverage
is low, AFP surveillance is suboptimal, and supplementary vaccination activities have not been conducted for years
(1,2). Vaccination coverage data suggest that during 1999, 37% of children aged <1 year had received 3 doses of OPV. In 2001,
the nonpolio AFP rate of 0.3 case per 100,000 population aged <15 years was below the target level of 1.0.
A joint mission by the Ministry of Health of Madagascar, the Pasteur Institute of Madagascar, the World
Health Organization, and United Nations Children's Fund (UNICEF) is ongoing to 1) conduct a field investigation of the cases
to verify early reports, 2) review health facility records for any missed cases, 3) enhance the quality of AFP
surveillance nationwide, and 4) plan for a nationwide house-to-house polio vaccination response. The work of this mission is
being complemented by laboratory work in Madagascar, South Africa, France, and the United States.
Reported by: Ministry of Health; Pasteur Institute, Madagascar. National Institute for Communicable Diseases, South Africa. Pasteur
Institute, Paris, France. World Health Organization Regional Office for Africa, Harare, Zimbabwe. Vaccines and Biologicals Dept, World
Health Organization, Geneva, Switzerland. Div of Viral and Rickettsial Diseases, National Center for Infectious Diseases; Global Immunization
Div, National Immunization Program, CDC.
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