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Public Health Dispatch: Outbreak of Poliomyelitis --- Cape Verde, 2000

During August 16--October 17, 2000, 33 cases of acute flaccid paralysis (AFP), including seven (21%) deaths, were reported in Cape Verde, an archipelago of 10 islands west of Senegal and Mauritania. Preliminary laboratory results identified wild type 1 poliovirus among eight cases. The first patient was a child aged 2 years from the capital city of Praia; paralysis onset occurred August 16. The child had received one dose of the recommended three doses of oral poliovirus vaccine (OPV). Twenty-two cases were reported from the island of Santiago, seven from Sal, three from San Vincente, and one from Maio. The ages of the AFP patients ranged from 3 months--38 years; 11 (33%) were aged <5 years, 15 (46%) were 5--14 years, and seven (21%) were >15 years. No deaths were reported among patients aged <5 years. Three deaths (case fatality rate [CFR]: 20%) occurred among patients aged 5--14 years and four deaths occurred among patients aged >15 years (CFR: 57%). Of 33 cases with known vaccination status, 13 (39%) were fully vaccinated.

The estimated population of Cape Verde in 2000 was 437,500 (World Health Organization [WHO], unpublished data, 2000). Reported routine vaccination coverage with three doses of OPV has been <80% every year since 1995. The country has not conducted mass vaccination campaigns against poliomyelitis and has not established AFP surveillance. In response to the outbreak, a mass vaccination campaign was initiated October 16 with the goal of vaccinating every child aged 0--59 months with two OPV doses. Investigations by the Cape Verde Ministry of Health and WHO are under way to determine the circumstances associated with the outbreak, whether the outbreak has spread to other territories such as the neighboring countries of West Africa, and whether additional interventions will be required to control the outbreak, including a mass campaign targeting persons aged 5--14 years.

Travelers to Cape Verde and West Africa who are not vaccinated adequately must be considered at risk for polio. Recommendations for children in the United States include a four-dose vaccination series with inactivated poliovirus vaccine (IPV) at ages 2, 4, and 6--18 months, and 4--6 years. Unvaccinated adults should receive three doses of IPV, the first two doses at 4--8 week intervals and the third dose 6--12 months after the second. If three doses cannot be administered within the recommended intervals before protection is needed, alternative schedules are proposed (1). For incompletely vaccinated persons, additional IPV doses are recommended to complete a series. Booster IPV doses should be considered for persons who have completed a primary series of poliovirus vaccination and who may be traveling to areas where poliomyelitis is endemic.

Reported by: Ministry of Health, Country Office, Praia, Cape Verde; Intercountry Office for West Africa, Abidjan, Cote d'Ivoire; Intercountry Office for Southern Africa and Regional Office for Africa, Harare, Zimbabwe. Institute Pasteur, Dakar, Senegal. National Institute of Virology, Johannesburg, South Africa. Vaccines and Other Biologicals Dept, World Health Organization, Geneva, Switzerland. Div of Quarantine and Respiratory and Enteric Viruses Br, Div of Viral and Rickettsial Diseases, National Center for Infectious Diseases; Vaccine Preventable Disease Eradication Div, National Immunization Program, CDC.

Reference

  1. CDC. Poliomyelitis prevention in the United States: updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2000;49(no. RR-5).

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