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Poliomyelitis -- Finland

As of January 9, 1985, four cases of paralytic and one case of nonparalytic poliomyelitis had been diagnosed and confirmed during the previous 2 months from various parts of Finland, including the vicinities of Helsinki and Turku. The outbreak apparently began in late October 1984, when a 6-year-old boy developed aseptic meningitis; type 3 poliovirus was isolated from his stool. In mid-November, paralytic poliomyelitis occurred in a 17-year-old male who had previously received five doses of inactivated poliomyelitis vaccine (IPV). Subsequently, three other cases of paralytic poliomyelitis were diagnosed from mid-November to mid-December. One patient, a 12-year-old boy, had previously received five doses of IPV; one, a 31-year-old pregnant woman, was unvaccinated; and one, a 33-year-old man with Hodgkin's disease, was incompletely immunized. Poliovirus type 3 was isolated from stool specimens of all four individuals with paralytic disease; these isolates have been characterized as "not vaccine-like" by the method of van Wezel (1). Poliovirus type 3 has also been isolated from approximately 15% of 700 stool samples or throat swabs from children without clinical illness, most of whom were residents of communities with cases.

Since 1960, routine vaccination against poliomyelitis using IPV has been performed in Finland. Before this outbreak, paralytic poliomyelitis was last reported in Finland in 1964. Sewage surveys conducted from 1971-1981 had failed to detect any poliovirus. Epidemiologic investigations are currently being conducted. All children 6 months to 18 years old have been given an additional dose of IPV. Vaccination of the entire population with oral poliomyelitis vaccine (OPV) is to begin soon. Reported by National Board of Health, Government of Finland; Div of Immunization, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: In developed countries, such as Japan, Australia, New Zealand, Canada, and the countries of industrialized Europe, the risk of acquiring poliomyelitis is usually no greater than in the United States. In contrast, all developing countries should generally be considered endemic for poliomyelitis. Proof of poliomyelitis immunization is not required for international travel. However, the Immunization Practices Advisory Committee (ACIP) recommends that travelers to countries where poliomyelitis is occurring--which now includes Finland--be immunized. Schedules for primary immunization against poliomyelitis require three or more doses. In general, OPV is the vaccine of choice for persons under 18 years of age. Unimmunized adults (18 years and older) should receive at least two doses of IPV, 4 or more weeks apart, and preferably a complete primary series, before traveling; if an individual's travel plans do not permit this interval, then a single dose of OPV is recommended. For adults incompletely immunized with OPV or IPV, the remaining doses should be given to complete the primary series, regardless of the interval since the last dose or the type of vaccine previously received; either OPV or IPV can be used to complete the series. A single additional dose of either OPV or IPV should be given to travelers who have previously completed a primary series of OPV or IPV. ACIP recommendations on poliomyelitis prevention should be consulted for further details (2).

Reference

  1. van Wezel AL, Hazendonk AG. Intratypic serodifferentiation of polomyelitis virus strains by strain specific antisera. Intervirology 1979;11:2-8.

  2. ACIP. Poliomyelitis prevention. MMWR 1982;31:22-6, 31-4.

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