Since July 12, 2000, 19 persons with acute flaccid paralysis (AFP) have been identified in the Dominican Republic.  These include six laboratory-confirmed cases with poliovirus type 1 isolates.  Type 1 poliovirus is usually the most neurovirulent.  All AFP cases were either unvaccinated or inadequately vaccinated.  In Haiti, a single case of laboratory-confirmed poliovirus type 1 has been reported to date.  The last reported case of AFP had a date of onset of November 18, 2000.

 It appears that the outbreak virus is derived from oral polio vaccine (OPV) virus, has approximately 97% genetic identity to the parental strain, and appears to have recovered the neurovirulence and transmissibility characteristics typical of wild poliovirus type 1.  Nucleotide sequencing suggests that the virus has been circulating for about 2 years.  The origin and continued circulation of these strains is in an area where routine vaccination coverage is low.

Paralytic poliomyelitis typically presents with rapid onset of flaccid paralysis and fever.  Paralysis progresses to its maximal extent within a few days, and usually progresses no further once fever resolves.  Paralysis is typically asymmetric, associated with decreased or complete loss of deep tendon reflexes and without involvement of sensory nerves.  Paralysis – if not complete- is usually more marked proximally.   

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Call to action:

Since these cases have occurred in proximity to the United States and there is frequent travel between the United States and the Dominican Republic and Haiti, CDC is advising:

1. All State Health Departments to enhance their poliomyelitis surveillance, especially in communities with large immigrant populations from these countries.

2. The diagnosis of poliomyelitis should be considered in all patients who present with acute flaccid paralysis, especially those who have traveled to or have been exposed to persons who have traveled to the Dominican Republic or Haiti.  

3. If poliomyelitis is suspected, clinicians should promptly obtain stool samples, throat swabs, acute and convalescent serum samples, and cerebrospinal fluid samples for viral culture.  

4. State Health Departments and their laboratories should advise physicians about collecting specimens and arranging cultures.  The CDC Enteroviral Laboratory can be reached at 404-639-2749 for further information about laboratory specimens.  

5. State Health Departments should alert clinicians who are most likely to see cases of acute flaccid paralysis.  These clinicians include: emergency room physicians, neurologists, and infectious disease physicians, among others, especially those serving communities with large numbers of immigrants from the Dominican Republic or Haiti.  

6. Clinicians should be advised if they see a patient with a clinically consistent illness to collect the appropriate laboratory specimens and to notify their State and local health authorities immediately.  

7. Additionally, we recommend that State Health Departments assess immunization coverage for polio, especially in communities with large immigrant populations from the Dominican Republic or Haiti.  If coverage is found to be low, health departments should consider undertaking special immunization activities to raise coverage.  

8. Clinicians should be knowledgeable of polio vaccination recommendations for children and adults traveling to the Dominican Republic.  See CDC Travelers Health, for more information.

For more information or questions related to the evaluation of suspected poliomyelitis cases, please contact: 

Child Vaccine Preventable Diseases Branch
National Immunization Program
(404) 639-8255

This page last modified on December 8, 2000