American Society of Tropical Medicine and Hygiene (ASTMH)

American Society of Tropical Medicine and Hygiene (ASTMH)

December 06, 2011
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High case-fatality rate during polio outbreak examined in Republic of Congo

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2011 ASTMH

PHILADELPHIA — The lack of clinical evidence regarding risk factors for death during polio outbreaks launched an investigation to identify variables associated with polio deaths in Pointe Noire in the Republic of Congo, according to a presenter at the American Society of Tropical Medicine and Hygiene’s 60th Annual Meeting.

In October 2010, multiple cases of acute flaccid paralysis, often resulting in death, were recorded among young adults in Pointe Noire, the second largest city in the Republic of Congo. Wild poliovirus type 1 was confirmed as the cause of the outbreak, notable for both its size — with 445 reported polio cases from September 2010 to January 2011 — and a significant elevation in high case-fatality rate of 47% in the Pointe Noire area.

Polio cases were defined as acute flaccid paralysis cases reported in Pointe Noire from Oct. 7 to Dec. 7, 2010, with either a stool specimen positive for wild poliovirus or clinically classified as polio-compatible by the Republic of Congo National Polio Expert Committee. Christopher Gregory, MD, MPH,and colleagues examined clinical and epidemiological data from medical records, hospital databases, acute flaccid paralysis case investigation forms and via interviews with case-patients or surrogates using a standard questionnaire.

“Considerable progress has been made towards polio eradication in 2011, especially in India which has not had a polio case in over 10 months,” Gregory told HemOnc Today. “However, lack of progress elsewhere, particularly in Pakistan, puts the global polio eradication goal in jeopardy.”

Data were collected for 96 case-patients (26% of 369 polio cases from Pointe Noire during the study period). The median age was 22 years for non-survivors and 18 years for survivors (P=.01). Complete data were available on 78 cases (42 deaths) for regression analysis. Small home size, as defined by 2 rooms or fewer (adjusted OR= 3.9; P=.01), use of a well for drinking water during a water shortage (adjusted OR=5.1; P=.003) and aged older than 15 years (adjusted OR=7.2, P=.01) were risk factors for death after stepwise selection.

The roles of overcrowding, poor access to clean water and adequate sanitation in elevated death rates during polio outbreaks in developing countries need further investigation, according to the researchers, who added that serosurveys to estimate immunity gaps in older age groups in countries at high risk of polio importation may be useful to guide preparedness and response planning.

“To focus and strengthen efforts to meet the goal of eradicating polio by the end of 2012, on December 2, 2011 CDC declared polio a global public health emergency and activated its Emergency Operations Center, which will centralize polio management to allow rapid expansion of activities and scale up of current CDC efforts,” said Gregory. “One of these key efforts is the Stop Transmission of Polio Program through which CDC and WHO place hundreds of medical and public health professionals in volunteer 3 month assignments in polio-endemic, reinfected or at-risk countries to work with and assist local health authorities in preventing polio transmission.”

“To focus and strengthen efforts to meet the goal of eradicating polio by the end of 2012, on December 2, 2011 CDC declared polio a global public health emergency and activated its Emergency Operations Center, which will centralize polio management to allow rapid expansion of activities and scale up of current CDC efforts,” said Gregory. “One of these key efforts is the Stop Transmission of Polio Program through which CDC and WHO place hundreds of medical and public health professionals in volunteer 3 month assignments in polio-endemic, reinfected or at-risk countries to work with and assist local health authorities in preventing polio transmission.”

Disclosure: Dr. Gregory reports no relevant financial disclosures.

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