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International Notes Poliomyelitis -- Israel

From July 31 to September 28, 1988, 16 persons in Israel (population 4.6 million) were reported with confirmed or suspected paralytic poliomyelitis. Thirteen cases were reported from the District of Hadera (population 180,000), located approximately 30 miles northeast of Tel Aviv.

Eight cases occurred in persons 20-33 years old, four in persons 11-19 years old, one in a 5-year-old child, and three in children 2-21 months old. Of the three cases not occurring in residents of Hadera, two were in children 9 and 21 months of age. To date, Type I poliovirus has been isolated from eight persons.

Israel began vaccination against polio with inactivated polio vaccine (IPV) in 1957. In the early 1960s, oral polio vaccine (OPV) replaced IPV nationwide. The vaccine schedule consisted of OPV given at 2, 4, 6, and 12-14 months of age. Between 1971 and 1981, an average of 14 paralytic poliomyelitis cases was reported annually in Israel. Hadera had reported the highest incidence of paralytic polio before 1982. In 1982, the use of an enhanced potency IPV (eIPV) was instituted in Hadera and one other of the 15 districts in Israel. Between 1982 and 1987, fewer than two cases of paralytic poliomyelitis were reported annually in Israel. None of the cases in the current outbreak occurred in eIPV recipients.

Because of the outbreak, vaccination of all persons less than or equal to39 years was carried out in Hadera and in the second eIPV district, primarily with OPV. Vaccination in other districts is in progress. It is anticipated that vaccination of the entire national population less than or equal to39 years will be completed within 2 weeks. Reported by: Dept of Epidemiology, Ministry of Health, Jerusalem, Israel. 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 temporarily includes Israel, be immunized. Schedules for primary immunization against poliomyelitis require three or more doses. In general, OPV is the vaccine of choice for persons less than 18 years of age. Unimmunized adults greater than or equal to18 years should receive at least two doses of eIPV at least 4 weeks apart, and preferably a complete primary series, before traveling. If travel plans do not permit this interval, one dose of OPV or eIPV 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 eIPV can be used to complete the series. One additional dose of either OPV or eIPV should be given to travelers of all ages who completed a primary series of OPV or IPV. Ideally, this booster dose should be administered at least 2 months before scheduled departure to ensure maximum protective benefit. ACIP recommendations on poliomyelitis prevention should be consulted for further details (1,2).

World Health Organization consultants in Israel expect that the containment measures in progress and those planned will terminate the outbreak.

References

  1. Immunization Practices Advisory Committee. Poliomyelitis prevention. MMWR 1982; 31:22-6,31-4.

  2. Immunization Practices Advisory Committee. Poliomyelitis prevention: enhanced-potency inactivated poliomyelitis vaccine--supplementary statement. MMWR 1987;36:795-8.

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