Active Surveillance, Early Reporting

     

02 November 2017

Dear Colleagues, A major global initiative directed towards the final stages of eradication of poliomyelitis has reduced the worldwide polio burden from upwards of 350,000 in a majority of countries in the world in the early 1980s to 12 cases of wild poliovirus (WPV) in two of the three endemic countries remaining today. However, another side of the eradication effort has been the identification of circulating vaccine derived polioviruses (cVDPV) - viruses that start out as attenuated viruses in oral polio vaccine, but reverse their neurovirulence after passage through vaccine recipients. Their behavior is then similar to the WPV, infecting susceptible populations and producing paralytic disease.   ProMED posted an Arabic media account on 5 May 2017 stating that 15 registered cases of suspected polio had been reported in Deir Ez Zour, a rural area in eastern Syria controlled by Islamic State. Diagnoses had been made clinically by specialist physicians in the province, but were not laboratory confirmed. Medical sources noted that polio vaccination campaigns in the region have stalled since July 2016 and that medical conditions have deteriorated.   Seeking confirmation of this report, ProMED contacted reliable sources in the region; one week later it reported confirmation that there was, indeed, a cluster of 23 acute flaccid paralysis cases in Mayadeen district and one of the specimens was a possible vaccine derived poliovirus (VDPV); samples had been sent to Atlanta for further testing. ProMED also reported that there was concern that the VDPV was a type 2 circulating vaccine derived poliovirus (cVDPV), considered to behave just like a wild poliovirus. Then, on 24 May 2017, ProMED learned from another reliable source that there was a VDPV identified in the Democratic Republic of the Congo (DRC). The Global Polio Eradication Initiative's weekly update published on 25 May 2017 included confirmatory laboratory findings of a cVDPV type 2 responsible for both of the outbreaks.   As of 25 October 2017, there have been 52 cases of cVDPV2 reported from Syria with additional suspected cases still pending laboratory results; nine cases of cVDPV2 have been reported from two distinct outbreaks in the DRC.   Early reports of suspected cases of polio are critical. Alerting the international infectious disease community of the occurrence of these events, timely reporting can prompt health authorities to initiate vaccination activities, ensuring that populations are well immunized so that outbreaks do not spread. ProMED, with its global network of rapporteurs, moderators, and editors, provides a worldwide community of infectious disease practitioners with the news, information, and analysis that can help them prevent infections, illness, and fatalities. ProMED's staff of infectious disease experts are available 24 hours a day, 7 days a week to add perspective and analysis, and provide the level and quality of information that makes ProMED a valuable and useful service to the global community.  Please join your colleagues with a donation to ProMED today.   In 2004, a surge in polio cases in northern Nigeria was associated with rumors about the vaccine, leading to decreased vaccine acceptance. Over the following two years, WPV from Nigeria spread to 19 previously polio-free countries. cVDPVs have been documented to spread within countries; in Syria cases have been confirmed in three governorates. So far, cVDPVs have not been shown to have spread across international borders. But if they do, surveillance, accurate, rapid reporting, timely dissemination of unbiased information, and expert analysis - such as ProMED provides every day - will be essential to averting a crisis. The international ID community's commitment and generosity make ProMED's work possible.   Today, we need your help to ensure that ProMED-mail continues to publish the information you and your colleagues need. Please contribute as generously as you can.    Sincerely,   Marjorie P. Pollack Deputy Editor, ProMED-mail   P.S. ProMED is a program of the International Society for Infectious Diseases and reflects its global mission. Sparking and sustaining critical connections through surveillance, research, education, and advocacy, ISID - by supporting people and institutions around the world - is a singular force in creating and sharing the knowledge necessary to prevent, manage, and treat infectious disease, when and where it matters most. Thank you for supporting ProMED.  International Society of Infectious Diseases | membership@isid.org |http://www.isid.org 9 Babcock St., Unit 3 Brookline, MA 02446