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Poliomyelitis in Syria and Worldwide, Update (ECDC/CDTR, November 4 2013, edited)
[Source: European Centre for Disease Prevention and Control (ECDC), full PDF document: (LINK). Extract.]
COMMUNICABLE DISEASE THREATS REPORT
Week 44, 27 Oct - 2 Nov 2013
(...)
Poliomyelitis - Multistate (world) - Monitoring global outbreaks
Opening date: 8 September 2005 Latest update: 31 October 2013
Epidemiological summary
In the past week, five new WPV1 cases were reported to WHO: one case in Afghanistan, three cases in Pakistan and one case in Cameroon. This is the first WPV case in Cameroon since 2009.
No new WPV cases were reported from the Horn of Africa.
Ethiopia and Somalia have deployed permanent vaccination points at all major entry points.
Worldwide, as of 23 October 2013, 301 cases of poliomyelitis have been notified to WHO compared with 175 for the same period
in 2012.
Eight countries have recorded cases in 2013:
In August 2013, although no case of paralytic polio was reported, WPV1 was detected in 96 sewage samples from 27 sampling sites in Israel indicating widely spread transmission.
In early October 2013, a cluster of acute flaccid paralysis (AFP) cases was detected in Deir Al Zour province in the Syrian Arab Republic. For more information about this cluster, please refer to the dedicated section.
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ECDC assessment
Europe is declared polio free. The last polio cases in the EU occurred in 2001 in Bulgaria with a WPV that originated from India. The latest outbreak in the WHO European Region was in Tajikistan in 2010, when WPV1 imported from Pakistan caused an outbreak of 460 reported cases. The last indigenous WPV case in Europe was in Turkey in 1998. An outbreak in the Netherlands in a religious community opposed to vaccinations caused two deaths and 71 cases of paralysis in 1992.
The recent detection of WPV in environmental samples in Israel and the suspected cases in Syria highlight the risk of reimportation in Europe.
Recommendations are provided in the recent risk assessments produced by ECDC: Rapid Risk Assessment on suspected polio cases in Syria and the risk to the EU/EEA Wild-type poliovirus 1 transmission in Israel ����what is the risk to the EU/EEA?
Actions
ECDC follows reports on polio cases worldwide through epidemic intelligence in order to highlight polio eradication efforts and identify events that increase the risk of re-introduction of wild poliovirus into the EU. The threat is followed on a bi-weekly basis.
Outbreak of poliomyelitis - Syria ?2013
Opening date: 22 October 2013 Latest update: 29 October 2013
Epidemiological summary
On 19 October 2013, WHO announced a cluster of AFP cases in Deir Al Zour province in Syria, located 250 km from Damascus in the east of the country along the Iraqi border. The cluster consists of 22 cases and the age distribution was five cases under one year old, 13 cases one-to-two years old and four cases over two years old. The first cases were detected in early October. Wild poliovirus type 1 (WPV1) has been isolated from ten of the cases under investigation. Final genetic sequencing results are pending to determine the origin of the isolated viruses.
The Syrian Arab Republic and the neighbouring countries began planning and implementation of a large-scale outbreak response before the cases were laboratory confirmed. On 24 October 2013 a comprehensive supplementary immunisation activity was launched in Syria, with a target to vaccinate 1.6 million children against polio, measles, mumps and rubella, in both government-controlled and contested areas. WHO anticipates a larger-scale outbreak response across the Syrian Arab Republic and neighbouring countries in early November 2013, and this to last for at least six to eight months depending on the area and based on evolving epidemiology. In the meantime a surveillance alert has been issued for the region to actively search for additional potential cases.
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ECDC assessment
As a result of the ongoing conflict in Syria, public health services are failing, vaccination coverage has dropped dramatically, sanitary conditions have deteriorated, displaced people are living under crowded conditions and there are large movements of people. These are all conditions that favour the spread of infectious and vaccine-preventable diseases.
The probability is very high that the cluster of cases of acute flaccid paralysis in Deir Al Zour province in Syria is caused by wildtype poliovirus.
Confirmation of a polio outbreak in Deir Al Zour province would signal widespread transmission of poliovirus in Syria and possibly in the areas bordering Syria.
This cluster of cases, if confirmed, increases the risk for the importation of wild polio virus to the EU/EEA and further re-establishment and transmission in the Member States. It is expected that the number of asylum seekers, refugees and illegal migrants entering the EU will continue to be high and possibly increase as the conflict evolves.
In the ECDC rapid risk assessment it is recommended that:
Actions
ECDC published an epidemiological update on 30 October. ECDC published a rapid risk assessment on 24 October.
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COMMUNICABLE DISEASE THREATS REPORT
Week 44, 27 Oct - 2 Nov 2013
(...)
Poliomyelitis - Multistate (world) - Monitoring global outbreaks
Opening date: 8 September 2005 Latest update: 31 October 2013
Epidemiological summary
In the past week, five new WPV1 cases were reported to WHO: one case in Afghanistan, three cases in Pakistan and one case in Cameroon. This is the first WPV case in Cameroon since 2009.
No new WPV cases were reported from the Horn of Africa.
Ethiopia and Somalia have deployed permanent vaccination points at all major entry points.
Worldwide, as of 23 October 2013, 301 cases of poliomyelitis have been notified to WHO compared with 175 for the same period
in 2012.
Eight countries have recorded cases in 2013:
- Somalia (174),
- Nigeria (49),
- Pakistan (46),
- Kenya (14),
- Afghanistan (8),
- Ethiopia (6),
- South Sudan (3) and
- Cameroon (1).
In August 2013, although no case of paralytic polio was reported, WPV1 was detected in 96 sewage samples from 27 sampling sites in Israel indicating widely spread transmission.
In early October 2013, a cluster of acute flaccid paralysis (AFP) cases was detected in Deir Al Zour province in the Syrian Arab Republic. For more information about this cluster, please refer to the dedicated section.
(?)
ECDC assessment
Europe is declared polio free. The last polio cases in the EU occurred in 2001 in Bulgaria with a WPV that originated from India. The latest outbreak in the WHO European Region was in Tajikistan in 2010, when WPV1 imported from Pakistan caused an outbreak of 460 reported cases. The last indigenous WPV case in Europe was in Turkey in 1998. An outbreak in the Netherlands in a religious community opposed to vaccinations caused two deaths and 71 cases of paralysis in 1992.
The recent detection of WPV in environmental samples in Israel and the suspected cases in Syria highlight the risk of reimportation in Europe.
Recommendations are provided in the recent risk assessments produced by ECDC: Rapid Risk Assessment on suspected polio cases in Syria and the risk to the EU/EEA Wild-type poliovirus 1 transmission in Israel ����what is the risk to the EU/EEA?
Actions
ECDC follows reports on polio cases worldwide through epidemic intelligence in order to highlight polio eradication efforts and identify events that increase the risk of re-introduction of wild poliovirus into the EU. The threat is followed on a bi-weekly basis.
Outbreak of poliomyelitis - Syria ?2013
Opening date: 22 October 2013 Latest update: 29 October 2013
Epidemiological summary
On 19 October 2013, WHO announced a cluster of AFP cases in Deir Al Zour province in Syria, located 250 km from Damascus in the east of the country along the Iraqi border. The cluster consists of 22 cases and the age distribution was five cases under one year old, 13 cases one-to-two years old and four cases over two years old. The first cases were detected in early October. Wild poliovirus type 1 (WPV1) has been isolated from ten of the cases under investigation. Final genetic sequencing results are pending to determine the origin of the isolated viruses.
The Syrian Arab Republic and the neighbouring countries began planning and implementation of a large-scale outbreak response before the cases were laboratory confirmed. On 24 October 2013 a comprehensive supplementary immunisation activity was launched in Syria, with a target to vaccinate 1.6 million children against polio, measles, mumps and rubella, in both government-controlled and contested areas. WHO anticipates a larger-scale outbreak response across the Syrian Arab Republic and neighbouring countries in early November 2013, and this to last for at least six to eight months depending on the area and based on evolving epidemiology. In the meantime a surveillance alert has been issued for the region to actively search for additional potential cases.
(?)
ECDC assessment
As a result of the ongoing conflict in Syria, public health services are failing, vaccination coverage has dropped dramatically, sanitary conditions have deteriorated, displaced people are living under crowded conditions and there are large movements of people. These are all conditions that favour the spread of infectious and vaccine-preventable diseases.
The probability is very high that the cluster of cases of acute flaccid paralysis in Deir Al Zour province in Syria is caused by wildtype poliovirus.
Confirmation of a polio outbreak in Deir Al Zour province would signal widespread transmission of poliovirus in Syria and possibly in the areas bordering Syria.
This cluster of cases, if confirmed, increases the risk for the importation of wild polio virus to the EU/EEA and further re-establishment and transmission in the Member States. It is expected that the number of asylum seekers, refugees and illegal migrants entering the EU will continue to be high and possibly increase as the conflict evolves.
In the ECDC rapid risk assessment it is recommended that:
- Countries hosting Syrian citizens in designated areas (camps) should assess the level of transmission of wild poliovirus among them. Such assessments can be carried out through enhanced clinical surveillance, environmental surveillance, and systematic collection of stool samples from symptomatic and asymptomatic persons;
- EU Member States receiving refugees and asylum seekers from Syria should assess their vaccination status on arrival and provide polio vaccination and other vaccinations as needed;
- Regional and international efforts to assess the risk and provide vaccination and other public health services in Syria and to Syrian refugees hosted by neighbouring countries should be supported;
- Member States should consider implementing the recommendations made in the ECDC risk assessment of wild-type poliovirus transmission in Israel;
- Countries should review their national preparedness plans, and ensure that items such as a framework and responsibilities for outbreak response, enhanced activities and reporting timelines, and vaccine of choice for outbreak response are in place.
Actions
ECDC published an epidemiological update on 30 October. ECDC published a rapid risk assessment on 24 October.
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