Epidemiologic Notes and Reports Poliomyelitis -- United States, Canada

As part of its continuing commemoration of CDC's 50th anniversary in July 1996, MMWR is reprinting selected MMWR articles of historical interest to public health, accompanied by current editorial notes. Reprinted below are the reports published May 25 and July 27, 1979, which are two of the seven reports in MMWR describing the last oubreak of poliomyelitis in the United States.

{From the May 25, 1979, MMWR}

As of May 22, an additional case of polio caused by type 1 poliovirus has been reported in Pennsylvania, bringing to 4 the total number of such cases this year. Two other states have reported suspected cases. Three of the confirmed and both suspected cases are in Amish residents (1,2). In addition, Ontario, Canada, has confirmed a case of paralytic poliomyelitis (type 1 virus) in an Amish woman.

United States: The Pennsylvania Department of Health's most recent report is of a case of non-paralytic polio (aseptic meningitis) in a 36-year-old, non-Amish woman whose vaccination history is unclear. The woman became ill on April 30. She was hospitalized with apparent aseptic meningitis on May 8. The State Laboratory confirmed a poliovirus type 1 isolate from her stool on May 14. The patient is from Mifflin County, where 2 cases of paralytic polio were recently identified in an Amish community (2). Although this woman's husband has had regular contact with Amish farmers in the county, the patient, herself, has had no direct contact with this community. She is the first non-Amish ill person identified in 1979 with confirmed poliovirus type 1.

In addition, Iowa and Wisconsin are each currently evaluating a case of acute paralytic illness in a previously unvaccinated Amish person. These 2 patients became ill on April 30 and May 5, respectively. In Wisconsin at least 8 of 20 stool specimens from the patient's unvaccinated family members showed early growth of probable enterovirus.

Canada: Ontario has reported a case of paralytic poliomyeltis in a previously unvaccinated, 25-year-old Amish woman, hospitalized on May 13 with right lower extremity weakness. Her brother was hospitalized the same day with a similar acute paralytic disorder. Poliovirus type 1 has been confirmed from stool specimens of the woman and from her asymptomatic mother and sister. The female patient had attended an Amish wedding in the United States on April 5; Amish persons from various areas, including Pennsylvania, attended the wedding.

Reported by S Acres, MD, Dept of National Health and Welfare, Ottawa; J Joshua, MD, Ontario Ministry of Health, Toronto; R Gens, MD, WE Parkin, DVM, DrPH, State Epidemiologist, Pennsylvania Dept of Health; LA Wintermeyer, MD, State Epidemiologist, Iowa State Dept of Health; JP Davis, MD, State Epidemiologist, Wisconsin State Dept of Health and Social Services; Bur of State Services, Viral Diseases Div, Bur of Epidemiology, CDC.

Editorial Note

Editorial Note: There have now been 5 confirmed and 3 suspected cases of type 1 polio reported in the United States and Canada in 1979. These cases, from geographically distinct areas, are further evidence of the spread of the type 1 -- presumably wild-type -- poliovirus. The virus appears to have spread from 1 unvaccinated Amish group to another, with transmission enhanced by the extensive travel and large social gatherings characteristic of this population. It is unlikely that the wild poliovirus will spread significantly among the general population, even to areas adjacent to Amish groups, because routine immunization practices have led to a high level of community protection.

Because dissemination of poliovirus is occurring among unvaccinated Amish populations, and because of the possibility for increased (often inapparent) transmission throughout the upcoming summer months, CDC considers the entire American Amish population at risk of infection and recommends vaccination of all unvaccinated Amish persons (including adults) with a full series of trivalent oral poliovirus vaccine (TOPV). TOPV is also recommended for unimmunized persons who are in daily contact with an unvaccinated community from which a wild-type poliovirus is isolated. Immunization levels of children in areas near Amish communities should be reviewed to assure that routine immunizations are up-to-date.

CDC has notified all 21 states known to have Amish residents of the new cases and of current recommendations. These states include Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Michigan, Minnesota, Missouri, Montana, New Jersey, New York, Ohio, Oklahoma, Pennsylvania, Tennessee, Virginia, and Wisconsin. Particularly in these states, physicians should include polio in the differential diagnosis of aseptic meningitis and acute paralytic disease.

References

1. MMWR 28:49, 1979

2. MMWR 28:207, 1979

   
   

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