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Public Health Dispatch: Outbreak of Poliomyelitis -- Iraq, 1999

Since May 1999, 86 cases of acute flaccid paralysis (AFP) have been reported in Iraq. Sixteen cases with onset during May-July have been confirmed as paralytic poliomyelitis by isolation of wild poliovirus type 1; the remaining cases are either negative, pending virus isolation (n=10), or positive for type 1 poliovirus with intratypic differentiation pending (n=nine). The first confirmed case occurred in a person residing in Ninevah governorate in the northern part of the country; subsequently, confirmed cases were reported from nine of the 18 governorates in Iraq, suggesting widespread transmission of poliovirus. Before this outbreak, the last confirmed cases of wild polioviruses occurred in Iraq during April-May 1997.

Nine of the 16 case-patients with confirmed wild poliovirus were members of nomadic cattle-herding families; most cases reported since August occurred among children of resident families. Fourteen case-patients were aged less than or equal to 2 years, and 11 had not received oral poliovirus vaccine or were incompletely vaccinated.

To ensure prompt reporting of all AFP cases, surveillance has been enhanced at major hospitals and other health facilities most likely to see children with acute paralysis. To control the outbreak and to interrupt poliovirus transmission, Iraq will conduct two rounds of National Immunization Days (NIDs)* in October and November 1999. In addition, two rounds of NIDs will be conducted in the spring of 2000. To assure that all children in high-risk populations are covered, existing NIDs planned at governorate and district levels will be strengthened.

Factors contributing to the outbreak include declining routine vaccination coverage in many areas and insufficient NID coverage in southern and central governorates, especially among high-risk populations. The outbreak presents a challenge to the polio eradication initiative in Iraq and threatens reintroduction of virus into neighboring countries, especially Iran, Jordan, Syria, and Turkey. Iraq is part of a region that includes border areas of Turkey, Syria, and Iran, where poliovirus transmission has been maintained until recently because of civil unrest, insufficient routine health services, and migration of minority populations across national boundaries. Preliminary genomic sequencing results indicate that the polioviruses in Iraq are similar to polioviruses in southeastern Turkey in 1998 and are not related to contemporary polioviruses from Pakistan and southern Asia. These findings indicate that the reason for the outbreak may have been continued undetected wild poliovirus transmission in the border areas of northwest Iraq.

Reported by: Ministry of Health; Country Office, Baghdad, Iraq; Eastern Mediterranean Regional Office, Alexandria, Egypt; Vaccine and Biologicals Dept, World Health Organization, Geneva, Switzerland. National Public Health Institute, Bilthoven, Netherlands. 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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Page converted: 9/30/1999


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