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Archive Number 20111020.3128
Published Date 20-OCT-2011
Subject PRO/EDR> Poliomyelitis, vaccine derived - Madagascar: (TL) RFI
POLIOMYELITIS, VACCINE DERIVED - MADAGASCAR: (TOLIARA) 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>
Date: Wed 19 Oct 2011
Source: Linfo Reunion [in French, trans., edited]
<http://www.linfo.re/-Societe,402-/Madagascar-l-epidemie-de-poliomyelite-reapparait>
Madagascar: the epidemic of polio reappears
-------------------------------------------
While no cases of polio have been detected in Madagascar since the
late 1990s, the authorities announced that they had identified 6 new
cases in the south of the country, raising fears of a new resurgence
of the epidemic of polio. The low immunization rates combined with the
health problems and malnutrition may well contribute to a reoccurrence
of this disease.
While polio has virtually disappeared from the Big Island since 1997,
the Ministry of Health said it had identified 6 cases [of polio] in
unvaccinated children in the remote areas of Fort Dauphin and Tulear.
A study conducted by the Pasteur Institute has indicated that the
virus involved in these cases is derived from a vaccine virus and
therefore would be less virulent causing a slight paralysis, while the
wild-type virus usually causes severe paralysis. [This is not correct
as vaccine derived poliomyelitis cases do present with significant
paralytic disease. - Mod.MPP]
However, those cases associated with poliovirus vaccine derived from
making the eradication of polio more complex, according to scientists,
especially in the wild south of Madagascar, the location of the new
epidemic, where they are struggling with challenges related to the
health and sanitation including malnutrition. This compounds the
problem of low vaccination coverages.
A report released by the Ministry of Health in 2010 showed that only
70 per cent of Malagasy children were vaccinated against polio and
this nationwide rate includes areas in the south, the most vulnerable
zones on the large island.
An epidemiological investigation will permit identifying if there are
other cases [of circulating vaccine derived poliovirus (cVDPV)
paralytic disease] in other regions of the country. But in the
meantime, a mass vaccination campaign was launched beginning Monday,
[17 Oct 2011] in order to increase the immunity level [against
poliovirus infection] of the population, mainly in children.
--
communicated by:
ProMED-mail from HealthMap alerts
<promed@promedmail.org>
[Madagascar had identified circulating vaccine derived poliovirus
(cVDPV) associated paralytic disease in 2001-2002. At that time there
were 5 cases of type 2 cVDPV associated cases reported from the same
province -- Toliara -- where these current cases have been identified.
The 1st case had date of onset in 2001 and was a resident of Toliara
(Tulear). The other 4 cases with dates of onset in March and April
2002 were in a rural village about 400 km (250 mi) from Toliara. None
of those cases had a history of having completed a 3 dose series of
polio vaccination. According to genetic studies on the involved
viruses in the cases and contacts, the cases from the 2 different
areas represented 2 genetically distinct, independent cVDPV lineages.
At that time, the OPV (oral polio vaccine) coverage in Madagascar was
less than 50 per cent countrywide.
According to the Polio Eradication Initiative website, in 2005, there
were 3 additional type 2 VDPV (vaccine derived polioviruses) cases
identified in the same province (Toliara) as in the 2001-2002 cases
(see Table on cVDPV isolates by
country and VDPV type, 2000-2001
<http://www.polioeradication.org/Dataandmonitoring/Poliothisweek/Circulatingvaccinederivedpoliovirus.aspx>).
Of note, according to Rakoto-Andrianarivelo M et al (see ref 7 below),
in 2005 type 3 or type 2 VDPV was isolated from 5 paralytic cases and
from healthy contacts. The isolated strains were classified into 4
recombinant lineages that showed complex mosaic genomic structures
originating from different vaccine strain serotypes and probably from
human enterovirus C (HEV-C) species. Genetic relatedness could be
observed among these 4 lineages. At that time, the OPV coverage in the
affected province was less than 80 per cent.
Given the history of 2 prior outbreaks of paralytic disease associated
with cVDPVs in the same province (Toliara), it would be of interest to
see the phylogenetic trees of these current isolates compared with
those involved in the outbreaks in 2001/2002 and 2005 -- one wonders
if there has been continued circulation of the VDPV lineages
associated with the prior outbreaks or if repeated lapses in OPV
coverages have led to the emergence of different lineages of VDPVs in
the region.
Fort Dauphin is now known as Tolanaro or Tolagnaro. it is the capital
of the Anosy Region and the Tolanaro district, located in the extreme
south of the country in the province of Toliara. Tulear is now known
as Toliara and is the capital of the Atsimo-Andrefana region, in
province of Toliara (from Wikipedia information on administrative
divisions of Madagascar, <http://en.wikipedia.org/wiki/Madagascar>.)
For a map of Madagascar showing provinces, see
<http://www.madbookings.com/madagascar/maps/madagascar_political_map.jpg>.
For the interactive HealthMap/ProMED-mail map of Toliara province, see
<http://healthmap.org/r/1lUh>. For a map of the location of the 2005
cVDPV cases in Madagascar, see ref 7 below, Figure 1, available at
<http://jid.oxfordjournals.org/content/197/10/1427/F1.expansion.html>.
References
----------
1. Kew OM, Wright PF, Agol VI, et al. Circulating vaccine-derived
polioviruses: current state of knowledge. Bull World Health Organ.
2004 Jan; 82(1):16-23. Epub 2004 Feb 26 (full article available at
<http://www.scielosp.org/scielo.php?pid=S0042-96862004000100006&script=sci_arttext&tlng=es>).
2. Tebbens RJ, Pallansch MA, Kew OM, et al. Risks of paralytic disease
due to wild or vaccine-derived poliovirus after eradication. Risk
Anal. 2006 Dec; 26(6): 1471-505 (full article available at
<http://www.kidrisk.org/images/riskanal26.6.1471.pdf>).
3. Wringe A, Fine PE, Sutter RW, Kew OM. Estimating the extent of
vaccine-derived poliovirus infection. PLoS One. 2008; 3(10): e3433.
Epub 2008 Oct 29 (full article available at
<http://www.plosone.org/article/info:doi/10.1371/journal.pone.0003433>).
4. Centers for Disease Control and Prevention (CDC). Update on
vaccine-derived polioviruses -- worldwide, January 2008-June 2009.
MMWR Morb Mortal Wkly Rep. 2009 Sep 18; 58(36): 1002-6 (full article
available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5836a3.htm>).
5. CDC. Update on vaccine-derived polioviruses. MMWR Morb Mortal Wkly
Rep. 2006 Oct 13; 55(40); 1093-7 (full article available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5540a3.htm>).
6. CDC. Update on vaccine-derived polioviruses -- worldwide, July
2009-March 2011. MMWR Morb Mortal Wkly Rep. 2011 Jul 1; 60(25): 846-50
(full article available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6025a3.htm>).
7. Rakoto-Andrianarivelo M, Gumede N, Jegouic S, et al: Reemergence of
recombinant vaccine-derived poliovirus outbreak in Madagascar. J
Infect Dis. 2008 May 15; 197(10): 1427-35 (full article available at
<http://jid.oxfordjournals.org/content/197/10/1427.long>). - Mod.MPP]
Archive Number 20111020.3128
Published Date 20-OCT-2011
Subject PRO/EDR> Poliomyelitis, vaccine derived - Madagascar: (TL) RFI
POLIOMYELITIS, VACCINE DERIVED - MADAGASCAR: (TOLIARA) 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>
Date: Wed 19 Oct 2011
Source: Linfo Reunion [in French, trans., edited]
<http://www.linfo.re/-Societe,402-/Madagascar-l-epidemie-de-poliomyelite-reapparait>
Madagascar: the epidemic of polio reappears
-------------------------------------------
While no cases of polio have been detected in Madagascar since the
late 1990s, the authorities announced that they had identified 6 new
cases in the south of the country, raising fears of a new resurgence
of the epidemic of polio. The low immunization rates combined with the
health problems and malnutrition may well contribute to a reoccurrence
of this disease.
While polio has virtually disappeared from the Big Island since 1997,
the Ministry of Health said it had identified 6 cases [of polio] in
unvaccinated children in the remote areas of Fort Dauphin and Tulear.
A study conducted by the Pasteur Institute has indicated that the
virus involved in these cases is derived from a vaccine virus and
therefore would be less virulent causing a slight paralysis, while the
wild-type virus usually causes severe paralysis. [This is not correct
as vaccine derived poliomyelitis cases do present with significant
paralytic disease. - Mod.MPP]
However, those cases associated with poliovirus vaccine derived from
making the eradication of polio more complex, according to scientists,
especially in the wild south of Madagascar, the location of the new
epidemic, where they are struggling with challenges related to the
health and sanitation including malnutrition. This compounds the
problem of low vaccination coverages.
A report released by the Ministry of Health in 2010 showed that only
70 per cent of Malagasy children were vaccinated against polio and
this nationwide rate includes areas in the south, the most vulnerable
zones on the large island.
An epidemiological investigation will permit identifying if there are
other cases [of circulating vaccine derived poliovirus (cVDPV)
paralytic disease] in other regions of the country. But in the
meantime, a mass vaccination campaign was launched beginning Monday,
[17 Oct 2011] in order to increase the immunity level [against
poliovirus infection] of the population, mainly in children.
--
communicated by:
ProMED-mail from HealthMap alerts
<promed@promedmail.org>
[Madagascar had identified circulating vaccine derived poliovirus
(cVDPV) associated paralytic disease in 2001-2002. At that time there
were 5 cases of type 2 cVDPV associated cases reported from the same
province -- Toliara -- where these current cases have been identified.
The 1st case had date of onset in 2001 and was a resident of Toliara
(Tulear). The other 4 cases with dates of onset in March and April
2002 were in a rural village about 400 km (250 mi) from Toliara. None
of those cases had a history of having completed a 3 dose series of
polio vaccination. According to genetic studies on the involved
viruses in the cases and contacts, the cases from the 2 different
areas represented 2 genetically distinct, independent cVDPV lineages.
At that time, the OPV (oral polio vaccine) coverage in Madagascar was
less than 50 per cent countrywide.
According to the Polio Eradication Initiative website, in 2005, there
were 3 additional type 2 VDPV (vaccine derived polioviruses) cases
identified in the same province (Toliara) as in the 2001-2002 cases
(see Table on cVDPV isolates by
country and VDPV type, 2000-2001
<http://www.polioeradication.org/Dataandmonitoring/Poliothisweek/Circulatingvaccinederivedpoliovirus.aspx>).
Of note, according to Rakoto-Andrianarivelo M et al (see ref 7 below),
in 2005 type 3 or type 2 VDPV was isolated from 5 paralytic cases and
from healthy contacts. The isolated strains were classified into 4
recombinant lineages that showed complex mosaic genomic structures
originating from different vaccine strain serotypes and probably from
human enterovirus C (HEV-C) species. Genetic relatedness could be
observed among these 4 lineages. At that time, the OPV coverage in the
affected province was less than 80 per cent.
Given the history of 2 prior outbreaks of paralytic disease associated
with cVDPVs in the same province (Toliara), it would be of interest to
see the phylogenetic trees of these current isolates compared with
those involved in the outbreaks in 2001/2002 and 2005 -- one wonders
if there has been continued circulation of the VDPV lineages
associated with the prior outbreaks or if repeated lapses in OPV
coverages have led to the emergence of different lineages of VDPVs in
the region.
Fort Dauphin is now known as Tolanaro or Tolagnaro. it is the capital
of the Anosy Region and the Tolanaro district, located in the extreme
south of the country in the province of Toliara. Tulear is now known
as Toliara and is the capital of the Atsimo-Andrefana region, in
province of Toliara (from Wikipedia information on administrative
divisions of Madagascar, <http://en.wikipedia.org/wiki/Madagascar>.)
For a map of Madagascar showing provinces, see
<http://www.madbookings.com/madagascar/maps/madagascar_political_map.jpg>.
For the interactive HealthMap/ProMED-mail map of Toliara province, see
<http://healthmap.org/r/1lUh>. For a map of the location of the 2005
cVDPV cases in Madagascar, see ref 7 below, Figure 1, available at
<http://jid.oxfordjournals.org/content/197/10/1427/F1.expansion.html>.
References
----------
1. Kew OM, Wright PF, Agol VI, et al. Circulating vaccine-derived
polioviruses: current state of knowledge. Bull World Health Organ.
2004 Jan; 82(1):16-23. Epub 2004 Feb 26 (full article available at
<http://www.scielosp.org/scielo.php?pid=S0042-96862004000100006&script=sci_arttext&tlng=es>).
2. Tebbens RJ, Pallansch MA, Kew OM, et al. Risks of paralytic disease
due to wild or vaccine-derived poliovirus after eradication. Risk
Anal. 2006 Dec; 26(6): 1471-505 (full article available at
<http://www.kidrisk.org/images/riskanal26.6.1471.pdf>).
3. Wringe A, Fine PE, Sutter RW, Kew OM. Estimating the extent of
vaccine-derived poliovirus infection. PLoS One. 2008; 3(10): e3433.
Epub 2008 Oct 29 (full article available at
<http://www.plosone.org/article/info:doi/10.1371/journal.pone.0003433>).
4. Centers for Disease Control and Prevention (CDC). Update on
vaccine-derived polioviruses -- worldwide, January 2008-June 2009.
MMWR Morb Mortal Wkly Rep. 2009 Sep 18; 58(36): 1002-6 (full article
available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5836a3.htm>).
5. CDC. Update on vaccine-derived polioviruses. MMWR Morb Mortal Wkly
Rep. 2006 Oct 13; 55(40); 1093-7 (full article available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5540a3.htm>).
6. CDC. Update on vaccine-derived polioviruses -- worldwide, July
2009-March 2011. MMWR Morb Mortal Wkly Rep. 2011 Jul 1; 60(25): 846-50
(full article available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6025a3.htm>).
7. Rakoto-Andrianarivelo M, Gumede N, Jegouic S, et al: Reemergence of
recombinant vaccine-derived poliovirus outbreak in Madagascar. J
Infect Dis. 2008 May 15; 197(10): 1427-35 (full article available at
<http://jid.oxfordjournals.org/content/197/10/1427.long>). - Mod.MPP]
