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Public Health Dispatch: Outbreak of Poliomyelitis -- Kunduz, Afghanistan, 1999

Since May 10, 1999, 26 cases of acute flaccid paralysis (AFP), including five cases with isolation of wild poliovirus type 1 and one with type 3, have been reported from Kunduz province in northern Afghanistan. Fifteen (54%) case-patients resided in Kunduz city, and the remaining patients resided in the districts surrounding Kunduz. Although the exact causes for the outbreak are not known, the discontinuation of polio vaccination activities in mid-1997 in northern Afghanistan because of ongoing civil conflict may have facilitated the outbreak.

AFP surveillance was established in northern Afghanistan in early May 1999 and was instrumental in detecting and reporting AFP cases and collecting stool specimens for virus isolation in the World Health Organization network laboratory in Pakistan. To determine the extent of the outbreak, health facilities and nongovernmental organizations providing health care in northern Afghanistan have been asked to immediately report all suspected AFP cases to the Ministry of Public Health. To control the outbreak, a large-scale house-to-house vaccination campaign with oral poliovirus vaccine (OPV), targeting the greater than 130,000 children aged less than 5 years in the province, was conducted during August 7-12, 1999. A second round is scheduled for September 7-12, 1999.

During 1997-1999, Afghanistan conducted three National Immunization Days (NIDs)*, providing an additional six doses of OPV to most children aged less than 5 years; however, none of these NIDs covered every district. Because of the conflict, the 1998 NIDs were not conducted in Kunduz and other areas of northern Afghanistan. In 1999, NIDs were conducted in May (round 1) and June (round 2) in all areas of the country and are scheduled again for October (round 3) and November (round 4). These scheduled NIDS will attempt to ensure complete coverage of the country.

Control of the outbreak is complicated by the several thousand internally displaced persons who are now moving into the Kunduz area, following renewed fighting north of Kabul. Efforts are under way to provide OPV vaccine to the children of these displaced families. Two rounds of mopping-up vaccination with OPV in the border districts of Tajikistan and Uzbekistan will be conducted in October and November to minimize any risk for poliovirus importation to these neighboring countries.

Reported by: Ministry of Public Health, Kabul, Afghanistan; Afghanistan Country Office, World Health Organization, Islamabad, Pakistan. Eastern Mediterranean Regional Office, World Health Organization, Alexandria, Egypt. Vaccines and Other Biologicals Department, World Health Organization, Geneva, Switzerland. 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.

* Mass campaigns over a short period (days to weeks) in which two doses of oral poliovirus vaccine are administered to all children in the target group (usually aged 0-4 years) regardless of previous vaccination history, with an interval of 4-6 weeks between doses.

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