Skip Navigation LinksSkip Navigation Links
Centers for Disease Control and Prevention
Safer Healthier People
Blue White
Blue White
bottom curve
CDC Home Search Health Topics A-Z spacer spacer
Blue curve MMWR spacer

Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: Type 508 Accommodation and the title of the report in the subject line of e-mail.

Public Health Dispatch: Poliomyelitis --- Madagascar, 2002

Surveillance for acute flaccid paralysis (AFP) in Madagascar has detected a cluster of four cases of paralytic poliomyelitis from which type-2 vaccine-derived polioviruses have been isolated. Preliminary data indicate that these patients, residing in the Tolagnaro district of Toliara province in southeastern Madagascar, had onset of paralysis during March 20--April 12, 2002. None of the children affected was vaccinated fully. During March--April 2002, provincial authorities conducted a small-scale house-to-house vaccination response. Genetic sequencing studies of these vaccine-derived viruses indicate substantial genetic drift and recombination with nonpolio enteroviruses. These findings are compatible with an outbreak of paralytic polio associated with a circulating vaccine-derived poliovirus (cVDPV); however, further investigation is required.

The three outbreaks of cVDPV described previously occurred in areas where routine oral polio vaccine (OPV) coverage is low, AFP surveillance is suboptimal, and supplementary vaccination activities have not been conducted for years (1,2). Vaccination coverage data suggest that during 1999, 37% of children aged <1 year had received 3 doses of OPV. In 2001, the nonpolio AFP rate of 0.3 case per 100,000 population aged <15 years was below the target level of 1.0.

A joint mission by the Ministry of Health of Madagascar, the Pasteur Institute of Madagascar, the World Health Organization, and United Nations Children's Fund (UNICEF) is ongoing to 1) conduct a field investigation of the cases to verify early reports, 2) review health facility records for any missed cases, 3) enhance the quality of AFP surveillance nationwide, and 4) plan for a nationwide house-to-house polio vaccination response. The work of this mission is being complemented by laboratory work in Madagascar, South Africa, France, and the United States.

Reported by: Ministry of Health; Pasteur Institute, Madagascar. National Institute for Communicable Diseases, South Africa. Pasteur Institute, Paris, France. World Health Organization Regional Office for Africa, Harare, Zimbabwe. Vaccines and Biologicals Dept, World Health Organization, Geneva, Switzerland. Div of Viral and Rickettsial Diseases, National Center for Infectious Diseases; Global Immunization Div, National Immunization Program, CDC.


  1. CDC. Acute flaccid paralysis associated with circulating vaccine-derived poliovirus---Philippines, 2001. MMWR 2001;50:874.
  2. CDC. Outbreak of poliomyelitis---Dominican Republic and Haiti, 2000--2001. MMWR 2001;50:147.

Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.

References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.

Disclaimer   All MMWR HTML versions of articles are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the electronic PDF version and/or the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.

**Questions or messages regarding errors in formatting should be addressed to

Page converted: 7/18/2002


Safer, Healthier People

Morbidity and Mortality Weekly Report
Centers for Disease Control and Prevention
1600 Clifton Rd, MailStop E-90, Atlanta, GA 30333, U.S.A


Department of Health
and Human Services

This page last reviewed 7/18/2002