Tajikistan hit by deadly polio outbreak: WHO

[Shiloh]

Source: http://www.thenews.com.pk/updates.asp?id=103496

Tajikistan hit by deadly polio outbreak: WHO
Updated at: 1435 PST, Friday, April 23, 2010

GENEVA: The World Health Organisation said Friday that it was investigating a confirmed polio outbreak in Tajikistan which has killed 10 children and marked renewed spread of the disease in central Asia.

A team of WHO experts was sent to the country after local authorities alerted the UN health agency about cases of acute flaccid paralysis detected early this month in southwestern Tajikistan, in an area bordering Afghanistan and Uzbekistan.

"Laboratory tests by the WHO Collaborating Centre in Moscow confirmed polio virus as the cause of the outbreak," the WHO said in a statement.

"WHO immediately alerted all other countries of this new public health risk in Eastern Central Asia, as required under the International Health Regulations."

By April 22, 128 cases of paralysis were reported and 10 of the infected children had died, the agency added.

[alert]

Re: Tajikistan hit by deadly polio outbreak: WHO

I don't understand the red text. Shouldn't children who got the vaccine be immune to the virus?

http://www.who.int/csr/don/2010_04_23/en/index.html

Polio in Tajikistan, first importation since Europe certified polio-free
23 April 2010 -- Poliovirus type 1 has been detected in diagnostic samples from cases of Acute Flaccid Paralysis (AFP) from Tajikistan. This represents the first importation of poliovirus in the WHO European Region since it was certified polio-free in 2002.

As of 21 April 2010, 120 cases of acute flaccid paralysis had been reported from Tajikistan. The majority of these have onset of paralysis within the past 2 weeks, prompting the Government to notify WHO of an outbreak. Ten of the children have died. The vast majority of the cases are children < five years of age. Preliminary data suggests >45% had four or more doses of oral polio vaccine.

To date, poliovirus type 1 has been isolated in diagnostic specimens from 7 of these cases. All cases are in the south-west of the country, in an area bordering Afghanistan and Uzbekistan. Afghanistan is one of the four remaining polio-endemic countries. No cases have been reported in the areas of Afghanistan bordering Tajikistan.

The Government of Tajikistan has requested technical guidance and support from WHO. Vaccine for three outbreak response rounds is being pre-positioned by UNICEF Supply Division for Tajikistan.

Tajikistan's last case of clinically confirmed polio was in 1997; the last case of polio confirmed by virological testing was in 1991. Reported OPV3 coverage nationwide was 87% in 2008, the last year for which complete data are available under the WHO/UNICEF joint reporting process. AFP surveillance indicators in Tajikistan meet certification standards at the national level. In 2009, Tajikistan reported 35 cases of acute flaccid paralysis, of which none were caused by wild poliovirus. Globally, more than 90,000 cases of acute flaccid paralysis were reported in 2009, of which 1606 were caused by wild poliovirus.

Three cases of acute flaccid paralysis have been reported in Uzbekistan on the Tajikistan border; poliovirus has not been isolated yet in laboratory testing. In addition, a child from Tajikistan travelled from Dushanbe to Tashkent for medical treatment shortly after onset of paralysis. The Government of Uzbekistan is planning one nationwide round of vaccination; the Government of Kyrgyzstan, is immunizing children <5 years over the course of European Immunization Week (26-30 April).

WHO is communicating with countries in the Region about the outbreak. It is important that neighboring countries strengthen surveillance for cases of acute flaccid paralysis, in order to rapidly detect any new poliovirus importations and facilitate a rapid response. Countries should also analyze routine immunization coverage data to identify any sub-national gaps in population immunity to guide catch-up immunization activities and thereby minimize the consequences of any new virus introduction. Priority should be given to areas at high-risk of importations and where OPV3/DPT3 coverage is <80%.

This outbreak demonstrates the need to maintain high population immunity until transmission of polio has been interrupted worldwide.

Public health measures such as enhanced surveillance and immunization may be put in place at the borders by Tajik health authorities and their counterparts. It is important that international travellers to and from polio affected areas are adequately immunized against polio as recommended in Chapter 6 of International Travel and Health (see link below).

WHO does not recommend the imposition of restrictions to the international movement of persons as a control measure at this time.

[sharon sanders]

Re: Tajikistan hit by deadly polio outbreak: WHO



Sending emails out......

[alert]

Re: Tajikistan hit by deadly polio outbreak: WHO

http://www.promedmail.org/pls/otn/f?p=2400:1001:2361903480729125::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,82388

Archive Number 20100423.1314
Published Date 23-APR-2010
Subject PRO/EDR> Poliomyelitis - Worldwide (03): Tajikistan, RFI


POLIOMYELITIS - WORLDWIDE (03): TAJIKISTAN, REQUEST FOR INFORMATION
************************************************** *****************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this posting:
[1] Subscriber query
[2] Russian language newswire

******
[1] Subscriber query
Date: Thu 22 Apr 2010
From: Mick Mulders <mick.mulders@gmail.com>


Subject: Polio outbreak in Tajikistan
-------------------------------------
Any news about this outbreak? First time since 1998 in polio-free declared
WHO European Region.

--
Dr Mick Mulders
<mick.mulders@gmail.com>

******
[2] Russian language newswire
Date: Thu 22 Apr 2010
Source: RIA (Russian News & Information Agency) Novosti [in Russian,
machine trans., edited]
<http://www.rian.ru/society/20100422/225589803.html>


Russia is ready to help Tajikistan in the fight against the polio outbreak
--------------------------------------------------------------------------
In response to an outbreak of polio reported in Tajikistan, Russia is ready
to help neighbors in the CIS and, if necessary, take protective measures,
the state chief sanitary inspector Dr Gennady Onishchenko told RIA Novosti
on Thursday [22 Apr 2010].

"Today we learned from the World Health Organization (WHO), that there were
more than 100 cases of polio in Tajikistan, including one death. In
addition, they are not localized to one place, but have occurred in several
cities -- for example, in Dushanbe and Leninskiye -- Onishchenko said.

According to Onishchenko, the 1st cases were registered in Tajikistan in
December 2009, and the Russian Polio Institute helped process specimens
taken from patients. Recently, however, the outbreak has become more
dynamic. [The laboratory testing] has confirmed that the cases are due to
wild poliovirus, not the same strain contained in the polio vaccine, said
Onishchenko.

"The [occurrence of an] outbreak suggests that the collective ["herd"]
immunity is faltering. Most likely, there were shortcomings in vaccination
[decreases in vaccination coverage]. We now make the [offer of assistance]
directly to Tajikistan and the CIS and, depending on the outcome, we will
take possible measures to help," he said. According to Onishchenko, Russian
scientists who had experience with outbreaks of polio in India, have
already traveled to Tajikistan.

"Let us understand what to do in our country. Some quarantine measures
introduced do not have much meaning, but, depending on how events will
unfold, we will take action on its territory," said Onishchenko. "We will
give guidance to our services on the ground that they [should be]
particularly careful when handling citizens of Tajikistan, especially
children," he added.

The head of Rospotrebnadzor [Federal Service for Consumer Affairs and Human
Welfare] was concerned about the situation of poliomyelitis in Tajikistan.
"There has been a breach in the defense, which has practically been formed.
There have been polio outbreaks associated with African countries and
Afghanistan. Now Tajikistan has been added to the list," said Onishchenko.

Poliomyelitis -- an acute infectious disease, children's spinal paralysis,
caused by a lesion of the gray matter of the spinal cord is characterized
mainly by disorders of the nervous system. Introduction of vaccines that
prevent polio, led to rapid reductions in morbidity, and in many areas, the
complete elimination of the disease. For example, Russia since 2002, is a
country free of the virus.

[byline: Alexei Nikolsky]

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[As of Tue 20 Apr 2010, the above mentioned outbreak of polio has not been
reported on the polio eradication website (see
<http://www.polioeradication.org/casecount.asp>). In 2010 to date a total
of 71 cases of polio have been confirmed in the world of which 42 were in
endemic countries [India (19), Pakistan (13), Afghanistan (8), and Nigeria
(2)] and 29 were in non-endemic countries [Senegal (13), Chad (7),
Mauritania (4), Liberia (1), Sierra Leone (1), Angola (1), and Nepal (1)].

From the newswire above, it appears as though there has been significant
wild poliovirus (WPV) transmission in Tajikistan since sometime in December
2009, with the stated "more than 100 cases". (For every paralytic case
identified, there are between 50 and 1000 infected individuals without
paralytic disease, which allows for a somewhat "silent" transmission of the
virus over significant geographic areas).

If the report above is true and not exaggerated, this represents a
significant setback for polio eradication activities in Asia. According to
the WHO website, the last confirmed case of polio in Tajikistan was in
1997, but it was apparently due to a vaccine virus, as there have been no
WPVs confirmed in Tajikistan since 1996 (see
<http://www.who.int/immunization_monitoring/en/diseases/poliomyelitis/afpextract.cfm>).

For a the interactive HealthMap/ProMED map of Tajikistan, see
<http://healthmap.org/r/01dJ>. Tajikistan shares a southern border with
Afghanistan, of which one area is a very narrow strip that separates
Tajikistan from Pakistan -- 2 of the 4 remaining polio endemic countries in
the world. (see <http://www.polioeradication.org>).

ProMED-mail would greatly appreciate more information from knowledgeable
sources on the number of confirmed and probable cases of polio in
Tajikistan, results of genetic testing of the virus identified (wild vs
vaccine derived, type 1, 2, or 3), and genetically confirmed geographic
origin of the virus. - Mod.MPP]

[alert]

Re: Tajikistan hit by deadly polio outbreak: WHO

The red text below might be part of the problem; apparently a monovalent polio vaccine may have been used. Perhaps it wasn't the right strain. The standard vaccine used in much of the world is trivalent (http://www.brown.edu/Courses/Bio_160...polio/vac.html). That link also indicates that the standard trivalent polio vaccine should protect against type 1 poliovirus.

http://translate.googleusercontent.com/translate_c?hl=en&ie=UTF-8&sl=ru&tl=en&u=http://www.rbc.ru/rbcfreenews/20100423173726.shtml&prev=_t&rurl=translate.google.com&usg=ALkJrhhYnZxJzYhImWZUi_zvLoHo3eX_Pw

Rospotrebnadzor control of the situation with the possibility of introduction of paralytic polio from Tajikistan.

23.04.2010, Москва 17:37:26 Федеральная служба по надзору в сфере защиты прав потребителей и благополучия человека РФ (Роспотребнадзор) контролирует ситуацию с возможностью заноса паралитического полиомиелита из Таджикистана. 23.04.2010, Moscow 17:37:26 The Federal Service for Supervision of Consumer Rights Protection and Human Welfare Federation (Federal Service) control the situation with the possibility of introduction of paralytic polio from Tajikistan. Об этом сообщили в пресс-службе ведомства. This was reported in the press-service agencies.

По данным Министерства здравоохранения Республики Таджикистан, в период с 26 января 2009г. According to the Ministry of Health, in the period from 26 January 2009. по 20 апреля 2010г. April 20, 2010. на территории страны было зарегистрировано 120 случаев острых вялых параличей среди детей в возрасте до 16-ти лет, из них 108 случаев - среди детей в возрасте до 5 лет, 10 случаев заболеваний закончились летальным исходом. in the country recorded 120 cases of acute flaccid paralysis among children under the age of 16 years, of which 108 cases - among children under 5 years, 10 cases resulted in death. Заболевания регистрируются в центральной и юго-западной частях республики. Diseases recorded in the central and southwestern parts of the country. В эпидемический процесс вовлечены 20 территорий страны. The epidemic involved 20 areas of the country.

В Таджикистан выехала группа экспертов для оказания организационно-методической и практической помощи. In Tajikistan has left a group of experts to provide organizational, methodological and practical assistance. Решается вопрос о поставке в страну моновалентной полиовакцины. Solve the question of supply in the country of monovalent polio vaccine.

Роспотребнадзор направил письмо в субъекты РФ о ситуации и принятии первоочередных мер в целях недопущения формирования эпидемических очагов полиомиелита на территории страны. Federal Service sent a letter to the federation's about the situation and taking immediate measures to prevent the emergence of epidemic foci of polio in the country. Также направлено письмо в органы, осуществляющие государственный санитарно-эпидемиологический надзор Таджикистана, о предоставлении информации, связанной с заболеваемостью полиомиелитом и предложением по оказанию практической и методической помощи. Also sent a letter to the authorities exercising state sanitary-epidemiological supervision of Tajikistan, to provide information related to the incidence of polio and the proposal to provide practical and methodological assistance.

В РФ в 2009г. In Russia in 2009. не было зарегистрировано ни одного случая полиомиелита, в том числе вакциноассоциированного. there was no recorded case of polio, including vaktsinoassotsiirovannogo. Это стало возможным благодаря использованию для первичного вакцинального комплекса детям с 3 месяцев только инактивированной полиомиелитной вакцины, пояснили в Роспотребнадзоре. This was made possible through the use of vaccine for the primary set for children from 3 months only inactivated polio vaccine, explained in Rospotrebnadzor.

[Treyfish]

Re: Tajikistan hit by deadly polio outbreak: WHO

Russian doctors say an outbreak of poliomyelitis in Tajikistan and ready to help

04/23/2010 16:24

Author: Asia-Plus


Dushanbe. April 23. "Asia-Plus - Russian authorities to help Tajikistan in combating an outbreak of polio. This, as RIA Novosti reports, chief sanitary doctor Gennady Onishchenko.

According to Onishchenko, cases of infection recorded in several cities of Tajikistan, including in Dushanbe Rudaki. Chapter Rospotrebnadzor noted that the disease is caused by strain of poliovirus, other than that used for the manufacture of vaccines.

The cause of outbreaks of polio in the south-east of Tajikistan Onishchenko called disadvantages of vaccination. "The outbreak suggests that after all collective immunity is faltering", - he explained.

Onishchenko said that Tajikistan had already departed the Russian doctors had previously been involved in the elimination of outbreaks of polio in India. He also noted that Russia has not yet planned to conduct quarantine measures. "Depending on how events will unfold, we will take action on its territory", - added the head of Rospotrebnadzor.

As reported by Russian news agency, a sharp increase in the number of cases of acute flaccid paralysis were reported in Tajikistan in April 2010. As of April 22, the disease was diagnosed in 128 children, 10 of whom died. Seven cases of laboratory confirmed diagnosis of polio. In addition, three cases of acute flaccid paralysis were reported in Uzbekistan.

Meanwhile, as reported by "AP" in the Ministry of Health of Tajikistan on April 22, with the beginning of the year in the country were registered 120 cases of acute flaccid paralysis (AFP). The disease can be caused by poliovirus, but the results of laboratory studies yet.

In the Ministry of Health also noted that to find out why in Tajikistan arrived adviser to WHO. It is expected that upon the recommendation of WHO in the country will be a campaign for polio immunization in conjunction with neighboring countries to prevent the emergence of this disease.

Polio - a disease caused by a virus invades the nervous system, and within a few hours can cause total paralysis. Initial symptoms are fever, fatigue, headache, nausea, stiff neck and pain in the limbs. One in 200 infections leads to irreversible paralysis. The most at risk of contracting the disease are children aged under five years. http://www.asiaplus.tj/news/43/64714.html

[Treyfish]

Re: Tajikistan hit by deadly polio outbreak: WHO

RUSSIA help Tajikistan
Dushanbe, April 23. / NIAT "Howar". - According to the World Health Organization, in Tajikistan, an outbreak of polio. Russia stands ready to assist your partner in the CIS and, if necessary, take protective measures. Told the chief sanitary doctor, Gennady Onishchenko, Russia, AFP reported.

"Today we learned that in Tajikistan with more than 100 polio cases, including death. Moreover, they are not fixed in one place, and in several cities. For example, in Dushanbe and in Rudaki", - said G. Onishchenko.

According to Chief State sanvracha Russia, the first cases were registered in Tajikistan in December last year, and the Russian Institute of polio helped decipher the selected samples from patients. Recently, an outbreak has become more dynamic in nature and for its localization requires urgent action.

http://www.khovar.tj/index.php?option=com_content&task=view&id=20620

[alert]

Re: Tajikistan hit by deadly polio outbreak: WHO

http://en.wikipedia.org/wiki/Polio_vaccine

[snip]

OPV is usually provided in vials containing 10-20 doses of vaccine. A single dose of oral polio vaccine (usually two drops) contains 1,000,000 infectious units of Sabin 1 (effective against PV1), 100,000 infectious units of the Sabin 2 strain, and 600,000 infectious units of Sabin 3. The vaccine contains small traces of antibiotics— neomycin and streptomycin—but does not contain preservatives.[33] One dose of OPV produces immunity to all three poliovirus serotypes in approximately 50&#37; of recipients.[15] Three doses of live-attenuated OPV produce protective antibody to all three poliovirus types in more than 95% of recipients

[snip]

A major concern about the oral polio vaccine (OPV) is its known ability to revert to a form that can achieve neurological infection and cause paralysis.[34] Clinical disease, including paralysis, caused by vaccine-derived poliovirus (VDPV) is indistinguishable from that caused by wild polioviruses.[35] This is believed to be a rare event, but outbreaks of vaccine-associated paralytic poliomyelitis (VAPP) have been reported, and tend to occur in areas of low coverage by OPV, presumably because the OPV is itself protective against the related outbreak strain.[36][37]

[sharon sanders]

Re: Tajikistan hit by deadly polio outbreak: WHO

I have heard back from WHO. They are still investigating the situation and have not made any conclusions about what is going on.

Thanks everyone.

[alert]

Re: Tajikistan hit by deadly polio outbreak: WHO

http://www.khabrein.info/news/WHO_deploys_experts_to_face_polio_in_Tajikistan_1272034327/

WHO deploys experts to face polio in Tajikistan

23 April, 2010

GENEVA, April 23 (KUNA) -- The World Health Organization (WHO) said Friday that it has deployed a team of experts to investigate a polio outbreak in the south-west of Tajikistan, in the area bordering Afghanistan and Uzbekistan. Together with its partners at the Global Polio Eradication Initiative, WHO will also support the Tajik Ministry of Health in conducting a mass immunization campaign.




WHO spokesperson Sona Bari said a sharp increase in early April of acute flaccid paralysis cases (AFP) prompted Tajikistan's government to contact WHO about a possible polio outbreak.

She added that as part of a joint investigation by the Tajik national health authorities and WHO, laboratory tests by the WHO Collaborating Centre in Moscow confirmed polio virus as the cause of the outbreak.

Bari added that WHO immediately alerted all other countries of this new public health risk in Eastern Central Asia, as required under the International Health Regulations. and added that this is the first imported polio outbreak in the WHO European Region since the Region was certified polio-free in 2002.

As of 22 April, 128 AFP cases have been reported and 10 of the infected children have died. All cases are in the south-west of the country, in an area bordering Afghanistan and Uzbekistan. Polio virus has been isolated in diagnostic specimens from seven of these cases. Genetic sequencing of the virus is ongoing to further characterize the virus. Uzbekistan has also reported three AFP cases which are under investigation.

Afghanistan, Pakistan, India and Nigeria are the four remaining polio-endemic countries in the world but recent outbreaks were registered in several countries in Africa due to importation. Tajikistan's last case of clinically confirmed polio was in 1997. Reported vaccination coverage nationwide was 87 percent in 2008, which is the last year for which complete data are available to WHO.

This outbreak, however, demonstrates the need to maintain high population immunity until transmission of polio has been interrupted worldwide.

The outbreak coincides with the annual European Immunization Week campaign which begins on 24 April 2010 to raise awareness of vaccine-preventable diseases and the importance of immunization.

[sharon sanders]

Re: Tajikistan hit by deadly polio outbreak: WHO

http://en.wikipedia.org/wiki/Polio_vaccine

[snip]

OPV is usually provided in vials containing 10-20 doses of vaccine. A single dose of oral polio vaccine (usually two drops) contains 1,000,000 infectious units of Sabin 1 (effective against PV1), 100,000 infectious units of the Sabin 2 strain, and 600,000 infectious units of Sabin 3. The vaccine contains small traces of antibiotics? neomycin and streptomycin?but does not contain preservatives.[33] One dose of OPV produces immunity to all three poliovirus serotypes in approximately 50% of recipients.[15] Three doses of live-attenuated OPV produce protective antibody to all three poliovirus types in more than 95% of recipients

[snip]

A major concern about the oral polio vaccine (OPV) is its known ability to revert to a form that can achieve neurological infection and cause paralysis.[34] Clinical disease, including paralysis, caused by vaccine-derived poliovirus (VDPV) is indistinguishable from that caused by wild polioviruses.[35] This is believed to be a rare event, but outbreaks of vaccine-associated paralytic poliomyelitis (VAPP) have been reported, and tend to occur in areas of low coverage by OPV, presumably because the OPV is itself protective against the related outbreak strain.[36][37]

Thanks Alert. I do not see "wild type" polio addressed here.

[alert]

Re: Tajikistan hit by deadly polio outbreak: WHO

Thanks Alert. I do not see "wild type" polio addressed here.

"Wild type" is referred to as simply "wild polioviruses" here. Almost all polio is wild type, except those few cases coming from vaccine derived strains.

[sharon sanders]

Re: Tajikistan hit by deadly polio outbreak: WHO

Via WHO statement in post #1 -

Preliminary data suggests >45% had four or more doses of oral polio vaccine.

[alert]

Re: Tajikistan hit by deadly polio outbreak: WHO

Via WHO statement in post #1 -

Preliminary data suggests >45&#37; had four or more doses of oral polio vaccine.

And that is what is difficult to explain. Perhaps they had the wrong monovalent vaccine, perhaps those are just the individuals in which the vaccine did not take, or perhaps some of those cases are background noise and not polio (remember only 7 of the 128 cases are confirmed). If the virus really had mutated to evade the vaccine, you would see far more adults ill, and the labs would not easily have confirmed the virus as type 1 wild poliovirus.

[Treyfish]

Re: Tajikistan hit by deadly polio outbreak: WHO

Tajikistan hit by deadly polio outbreak: WHO
<!-- end: .tools -->
<!-- end: .hd --> <CITE class=caption>AFP/File ? World Health Organization headquarters in Geneva. The World Health Organisation said Friday that it was ? </CITE>

<!-- end #main-media -->
<!-- end .primary-media -->
<!-- end .related-media --><ABBR class=recenttimedate title=2010-04-23T09:09:38-0700>20 mins ago</ABBR>
<!-- end .byline -->GENEVA (AFP) ? The World Health Organisation said Friday that it was investigating a confirmed polio outbreak in Tajikistan which has killed 10 children and marked renewed spread of the disease in central Asia.
A team of WHO experts was sent to the country after local authorities alerted the UN health agency about cases of acute flaccid paralysis detected early this month in southwestern Tajikistan, in an area bordering Afghanistan and Uzbekistan.
"Laboratory tests by the WHO Collaborating Centre in Moscow confirmed polio virus as the cause of the outbreak," the WHO said in a statement.
"WHO immediately alerted all other countries of this new public health risk in Eastern Central Asia, as required under the International Health Regulations."
By April 22, 128 cases of paralysis were reported and 10 of the infected children had died, the agency added.
Tajikistan's last case of clinically confirmed polio occurred in 1997.
But the disease is still present in neighbouring Afghanistan, which is one of the four remaining polio endemic countries in the world along with Pakistan, India and Nigeria.
Polio has spread again in recent years with imported cases, especially in Africa, in a setback to global attempts to eradicate the crippling and lethal disease.
WHO said three nationwide vaccination campaigns will be launched shortly in Tajikistan to halt the outbreak.
It also urged nearby Uzbekistan, Turkmenistan, Kyrgyzstan and Kazakhstan to step up polio surveillance and rapidly conduct immunisation campaigns.
The WHO said vaccination coverage in Tajikistan was last estimated at about 87 percent in 2008.
Some 7.6 million children were being immunised last year in Afghanistan, where 38 cases of polio were confirmed in 2009 and another eight so far this year, according to the Global Polio Eradication Initiative.http://news.yahoo.com/s/afp/20100423...20100423160945