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Poliomyelitis Outbreak -- Albania, 1996

During April 17-September 16, 1996, an ongoing outbreak of paralytic poliomyelitis in Albania resulted in 66 cases of acute flaccid paralysis (AFP), including seven (11%) deaths. Wild poliovirus type 1 was isolated from seven cases.

The first case-patient, a 12-month-old child, had onset of paralysis on April 17; ages of AFP patients ranged from 4 months to 46 years (median age: 20-24 years). Of the reported AFP cases, 46 (70%) occurred among persons aged 10-30 years, and 13 (20%) occurred among persons aged greater than or equal to 30 years. Seven cases occurred among children aged 0-9 years; five (8%) were among children aged less than 5 years. Cases have been reported from 18 of 37 districts, primarily in the northern and central parts of the country; no cases have been reported from the southernmost districts.

National Immunization Days (NIDs) were successfully completed on April 8 and May 17, during which reported coverage with oral poliovirus vaccine (OPV) was greater than 97% among children aged less than 5 years, the targeted age group. Albania's Ministry of Health is organizing a mass vaccination campaign with OPV for children and adults (aged 0-50 years) to control the outbreak.

Reported by: A Sallabanda, MD, L Diamante, MD, A Ylli, MD, Institute of Public Health, Ministry of Health, Albania. National Institute of Health, Rome, Italy. Regional Office for Europe, World Health Organization, Copenhagen, Denmark; Global Program on Vaccines and Immunization, World Health Organization, Geneva, Switzerland. Respiratory and Enterovirus Br, Div of Viral and Rickettsial Diseases, National Center for Infectious Diseases; Polio Eradication Activity, National Immunization Program, CDC.

Editorial Note

Editorial Note: Preliminary results of the outbreak investigation suggest that factors contributing to this outbreak include 1) problems with the delivery of routine vaccination services before 1993, 2) an increase in contacts with persons from polio-endemic countries since 1991, and 3) sanitation problems resulting from recent large-scale movement of segments of the Albanian population to urban areas. The relatively low incidence among children aged less than 5 years may be a result of the recent NIDs and improvements in the cold chain for routine vaccination services since 1993. The high case-fatality rate may be due to the high proportion of cases among older children and adults -- who are known to be at higher risk for bulbar paralysis -- and may be aggravated by delays in seeking medical care.

Travelers to Albania who have received a primary series of polio vaccine should receive a booster dose before departure. Travelers who are inadequately vaccinated against polio or whose past vaccination history is uncertain should contact their physician to discuss polio vaccination options before leaving for Albania.

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