ProMED: Two cases of vaccine-derived polio reported in Zakarpattia, Ukraine - WHO confirmed

[alert]

Published Date: 2015-09-01 13:23:52
Subject: PRO/EDR> Poliomyelitis update (04): Ukraine, 2 cases, RFI
Archive Number: 20150901.3616015
POLIOMYELITIS UPDATE (04): UKRAINE, 2 CASES, REQUEST FOR INFORMATION
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Date: Tue 1 Sep 2015
Source: Ukrinform - Ukrainian News Agency [edited]
http://www.ukrinform.ua/eng/news/two..._region_334008


Two cases of polio have been reported in the westernmost Zakarpattia region.

Health Minister Alexander Kvitashvili told reporters at a briefing on [Tue 1 Sep 2015], a Ukrinform correspondent reports.

"Lately, 2 cases of polio have been confirmed in the Zakarpattia region. Our goal is to notify the World Health Organization and our partners in Europe and take all possible measures in order to prevent spreading of the epidemic throughout Ukraine," Kvitashvili said. He noted that these cases have been localized.

The minister said that the polio vaccine is available in the country in sufficient supply.

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[Presumably, since this announcement is attributed to the Minister of Health, this report refers to confirmed cases of poliovirus-associated disease. The report does not specify the actual virus(es) isolated as to whether they are wild poliovirus (WPV) or vaccine-derived poliovirus (VDPV), a distinction that is relevant. More information on these cases would be greatly appreciated. Information on the genetic profile of the poliovirus(es) isolated would be helpful in determining the origin of the virus(es) involved as well as the results of epidemiologic investigations.

According to the WHO archive on reported cases of polio, the last reported case of polio in the Ukraine was in 1996 (there was 1 case in 1996, 1 case in 1995, 14 cases in 1994, 5 cases in 1993, 12 cases in 1992, and 3 cases in 1991 -- the 1st year when individual reports were received from the Ukraine -- see http://apps.who.int/immunization_mon...encepolio.html)

If confirmed as due to WPV, these cases would represent the 1st cases of WPV in a non-endemic country reported in 2015. The most recent case of WPV associated disease reported from a non-endemic country was in Somalia and had a date of onset of 11 Aug 2014 (see table in Poliomyelitis update (03): Nigeria, Pakistan, global update, chronic shedder 20150901.3614553). The European region of WHO was certified as polio free in 2002 with the last endemic case reported from Turkey in November 1998. Importations of the virus with local transmission occurred in the European region in 2005 in Tajikistan and in 2013-2014 in Israel (http://ecdc.europa.eu/en/healthtopic...ges/index.aspx).

Of note, in a media report in Newsweek on 1 May 2015 (http://www.newsweek.com/2015/05/01/m...cs-323992.html) there was an alarmist description of the situation with vaccinations in the Ukraine. "Ukraine is in imminent danger of experiencing the 1st polio epidemic Europe has seen for decades, health experts have revealed, warning that millions of children are at risk from a range of crippling or fatal infectious diseases, including measles, diphtheria, and rubella. The rate of protection against contagious disease in the country has dropped rapidly since 2008, when a 16-year-old boy died days after he was given a shot against measles and rubella, leading to a media storm. Although the United Nations concluded that the death was unrelated to the vaccine, demand for vaccines fell dramatically to what the UN describes today as "zero coverage." With an average of 500 000 children born each year in Ukraine, the number of infants vulnerable to infection is approaching 3 million."

In a 2013 UNICEF media report (published in Lancet, http://www.unicef.org/ceecis/media_24342.html), UNICEF had the following information: "WHO and UNICEF have also recently said that an outbreak of polio is a real danger. The disease is rarely seen in Europe today but Ukraine is particularly vulnerable to an outbreak, experts say, with only 74 percent of the population immunised against it. This compares to average coverage in Europe and the USA of more than 90 percent. The chances of an outbreak are so great that Ukraine last month [May 2013] hosted a WHO-led polio simulation exercise. Concerns are rooted in low coverage for vaccinations, brought about because of not only supply problems but also the fact that a large minority of parents refuse to have their children vaccinated. "Public trust in vaccinations has been eroded in recent years and this has to be changed. People's confidence in vaccinations has to be won back," Dorit Nitzan, head of WHO's Ukrainian branch, tells The Lancet. A survey by UNICEF last year [2012] showed that as many as 1/3 of Ukrainian parents are against vaccinations. Only around 50 percent of children in the Ukraine are fully immunised against polio, measles, rubella, and other diseases."

A map showing the location of the Zakarpattia oblast can be found at https://en.wikipedia.org/wiki/Zakarpattia_Oblast. Zakarpattia is located in the southwest of the Ukraine. It is located the Carpathian Mountains, and borders with Poland, Slovakia, Hungary, and Romania. It has been a major tourist destination with ski and spa resorts in the mountains.

- Mod.MPP]

 

[alert]

The above article is very vague. Are these wild polio virus (WPV) cases? Cases of circulating vaccine-derived virus (cVDPV)? Or something else? Perhaps AFP cases of undetermined cause?

If this is polio, sequencing should tell us from where the virus has been imported. Only 37 WPV cases have been reported worldwide this year so far.

Either way, this is an unusual report.

 

[tetano]

Circulating vaccine-derived poliovirus type 1 confirmed in Ukraine


On 28 August 2015, the WHO Regional Office for Europe was notified of two confirmed cases of circulating vaccine-derived poliovirus type 1 (cVDPV1) in Ukraine. The two cases have a genetic similarity, which indicates that active transmission of cVDPV1 is ongoing. WHO and UNICEF are supporting the Ministry of Health of Ukraine in conducting an urgent, robust response.
The strain was isolated from two children in Zakarpatskaya oblast, in south-western Ukraine. One child was 4 years old and the other 10 months old at the time of onset of paralysis; neither had been vaccinated against polio.
Circulation of cVDPV occurred because of the low immunization coverage in Ukraine since 2008. In 2014, only 49% of children were fully vaccinated against polio. Currently, the rate of vaccination against polio among children under 1 year old is only 14.1%, because of a shortage of vaccine.
WHO and UNICEF are providing the Ministry of Health with both technical and on-site support in planning and implementing large-scale supplementary immunization activities with oral polio vaccine (OPV) to rapidly stop circulation of the virus. OPV is the most effective vaccine for stopping the spread of poliovirus and ensuring collective immunity.
WHO recommends that all countries, in particular those from which there is frequent travel and contacts with polio-affected countries and areas, strengthen surveillance for cases of acute flaccid paralysis and maintain high routine immunization coverage. All travellers to polio-affected areas should be fully vaccinated against polio.


http://www.euro.who.int/en/health-to...med-in-ukraine

 

[alert]

Nice find. So at least it's vaccine-derived and a local problem, and not indicative of ongoing spread of WPV. Moreover, it does not imply undetected transmission of WPV elsewhere in Ukraine or in the world.

 

[Shiloh]

Source: http://www.who.int/csr/don/01-september-2015-polio/en/
[h=1]Circulating vaccine-derived poliovirus ? Ukraine[/h] Disease outbreak news
1 September 2015

In Ukraine, 2 cases of circulating vaccine-derived poliovirus type 1 (cVDPV1) have been confirmed, with dates of onset of paralysis on 30 June and 7 July 2015. Both are from the Zakarpatskaya oblast, in south-western Ukraine, bordering Romania, Hungary, Slovakia and Poland. One child was 4 years old and the other 10 months old at the time of onset of paralysis.
Ukraine had been at particular risk of emergence of a cVDPV, due to inadequate vaccination coverage. In 2014, only 50% of children were fully immunized against polio and other vaccine-preventable diseases.
[h=3]Public health response[/h] Discussions are currently ongoing with national health authorities to plan and implement an urgent outbreak response. An outbreak response of internationally-agreed standard, as adopted by the World Health Assembly in May 2015, requires a minimum of three large-scale supplementary immunization activities with an appropriate oral polio vaccine, to begin within two weeks of confirmation of the outbreak and covering a target population of 2 million children aged less than five years, and the public declaration of the outbreak as a national public health emergency.
[h=3]WHO risk assessment[/h] Circulating VDPVs are rare but well-documented strains of poliovirus that can emerge in some populations which are inadequately immunized. A robust outbreak response can rapidly stop such events. Given substantial vaccination coverage gaps across the country and subnational surveillance deficits, the risk of further spread of this strain within the country is deemed to be high. The emergence of cVDPV strains underscores the importance of maintaining high levels of routine vaccination coverage. WHO currently assesses the risk of international spread from Ukraine to be low, but notes that the infected oblast shares borders with four countries (Romania, Hungary, Slovakia and Poland).
WHO emphasises the need for a full and complete implementation of an outbreak response of the internationally-agreed standard. WHO will continue to evaluate the epidemiological situation and outbreak response measures being implemented.
[h=3]WHO advice[/h] It is important that all countries, in particular those with frequent travel and contacts with polio-affected countries and areas, strengthen surveillance for cases of acute flaccid paralysis (AFP) in order to rapidly detect any new virus importation and to facilitate a rapid response. Countries, territories and areas should also maintain uniformly high routine immunization coverage at the district level to minimize the consequences of any new virus introduction.
WHO recommends that all travelers to polio-affected areas be fully vaccinated against polio. Residents (and visitors for more than 4 weeks) from infected areas should receive an additional dose of oral polio vaccine (OPV) or inactivated polio vaccine (IPV) within 4 weeks to 12 months of travel.

 

[Gert van der Hoek]

Two polio cases were found earlier this year in Zakarpattia Oblast (Region) ; Lviv Oblast is bordering Zakarpattia Oblast, testresults of 2 suspected poliocases are pending in Lviv Oblast.

Lviv recorded 11 cases of suspected polio this year

02.11.2015

[FONT=clear_vgo]In the Lviv region from the beginning of the year recorded 11 cases of suspected acute flaccid paralysis, which causes polio virus.[/FONT] [FONT=clear_vgo]This was during a press conference the Chief Specialist Department of Health Lviv Regional State Administration of Epidemiology Natalia Timko, informs correspondent of "Vgolos".[/FONT]

[FONT=clear_vgo]According to her, in 9 cases of polio virus has not been confirmed. Results of two studies on cases of suspected acute flaccid paralysis yet.[/FONT]
[FONT=clear_vgo]"Materials research in two suspected cases are still at work, ie the final results we have," - said Natalia Timko.[/FONT]

[FONT=clear_vgo]She also said that according to the user if the hospital gets child under 15 years of gait disturbance and not a fracture, dislocation and not about stroke, to govern its hospital infection department. Next - doctors in this patient material selected for the study, which govern the laboratory where confirm or rule out polio virus.[/FONT]

[FONT=clear_vgo]However Specialist of Epidemiology assured that doctors can not 100% suspected case of polio, the disease if not accompanied by disorders of the motor areas.[/FONT]

[FONT=clear_vgo]"Polio virus can cause movement disorders only 10% of all cases. The rest - aseptic meningitis (10%), disorders of the gastrointestinal tract and acute respiratory disease, "- explained the specialist.[/FONT]

 

[Gert van der Hoek]

Children from Transcarpathia, who developed polio, fully recovered - Perehinets

10.22.2015

[FONT=clear_vgo]Two children from Transcarpathian region where poliovirus found cVDPV1 fully resumed its functions.[/FONT] [FONT=clear_vgo]This was announced by Deputy Minister of Health of Ukraine Igor Perehinets during a press conference today, the correspondent of "Vgolos".[/FONT]

[FONT=clear_vgo]Recall that in September laboratory WHO confirmed poliovirus cVDPV1 two children from Transcarpathian region. The spread of poliovirus cVDPV was the result of low vaccination coverage in the country since 2008, said the ministry. In 2014 only 49% of children were fully vaccinated from field.[/FONT]

 

[Shiloh]

Source: http://www.usnews.com/news/world/ar...o-outbreak-in-ukraine-is-a-state-of-emergency


UN health agency: Ukraine should declare a state of emergency in wake of polio outbreak
Associated Press
Dec. 1, 2015 | 11:24 a.m. EST

KIEV, Ukraine (AP) ? The World Health Organization is urging Ukraine's health ministry to declare a state of emergency due to a polio outbreak, a move meant to prompt more action from the government in Kiev.

In September, Ukraine announced two polio cases ? the first in Europe since 2010...

 

[Shiloh]

Source: http://www.medicaldaily.com/ukraine...oncerned-about-first-cases-europe-2010-363844


Ukraine's Polio Outbreak: Why We Should Be Concerned About The First Cases In Europe Since 2010
Dec 3, 2015 02:15 PM By Lecia Bushak

Only half the population in Ukraine is vaccinated against polio (or vaccinated in general), so it?s concerning to learn that two cases of polio have appeared in the country ? the first European nation to see the disease since 2010...