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Poliomyelitis Eradication. Field Guide. Third Edition Poliomyelitis Eradication Field Guide Third Edition Scientific and Technical Publication No. 607 PAN AMERICAN HEALTH ORGANIZATION Pan American Sanitary Bureau, Regional Office of the WORLD HEALTH ORGANIZATION 525 Twenty-third Street, N.W. Washington, D.C. 20037 www.paho.org 2006 Also published in Spanish (2005) with the title: Erradicación de la poliomielitis: guía práctica. (ISBN 92 75 31607 4) PAHO HQ Library Cataloguing-in-Publication Data Pan American Health Organization Poliomyelitis Eradication. Field Guide. Washington, D.C.: PAHO, © 2006. (Scientific and Technical Publication No. 607) ISBN 92 75 11607 5 I. Title II. Series 1. POLIOMYELITIS - prevention & control 2. POLIOMYELITIS - epidemiology 3. EPIDEMIOLOGIC SURVEILLANCE 4. MASS VACCINATION 5. POLIOVIRUS VACCINES 6. GUIDEBOOKS [PUBLICATION TYPE] NLM WC556 This guide was prepared by the Immunization Unit of the Pan American Health Organization. Cover photos: Pan American Health Organization The Pan American Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applications and inquiries should be addressed to the Publications Program, Pan American Health Organization, Washington, D.C., U.S.A., which will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. © Pan American Health Organization, 2006 Publications of the Pan American Health Organization enjoy copyright protection in accor- dance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights are reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the Pan Ameri- can Health Organization concerning the status of any country, territory, city, or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the Pan American Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. CONTENTS About the Immunization Field Guides . vii Preface . ix 1. Introduction . 1 1.1 Background . 1 2. Epidemiology . 1 2.1 Infectious Agent . 1 2.2 Distribution and Frequency . 1 2.3 Transmission . 2 2.4 Reservoir . 2 2.5 Incubation . 2 2.6 Immunity . 4 2.7 Changes in Epidemiology . 4 3. Clinical Aspects . 4 3.1 Pathogenesis . 4 3.2 Clinical Features . 4 3.3 Differential Diagnosis . 5 3.4 Complications . 6 3.5 Treatment . 8 4. Vaccines . 8 4.1 Immunity . 9 4.2 Vaccination Schedule, Contraindications, and Adverse Events . 9 4.3 Dosage and Administration . 10 4.4 Cold Chain and Supply . 10 4.5 Vaccine Efficacy . 10 5. Immunization Activities . 11 5.1 Routine Immunization . 11 5.2 Mass Campaigns . 12 iii iv PAN AMERICAN HEALTH ORGANIZATION 5.3 Coverage of At-Risk Groups . 13 5.4 Missed Vaccination Opportunities . 14 6. Epidemiologic Surveillance . 16 6.1 Case Definitions . 16 6.2 Detection and Notification of Probable Cases . 17 6.3 Case Investigation . 18 6.4 Laboratory Confirmation . 21 6.5 Monitoring and Feedback . 27 6.6 Surveillance Indicators for Acute Flaccid Paralysis . 27 6.7 Response to Outbreaks . 29 6.8 Information and Data Analysis Systems . 30 7. Certification of Polio Eradication in the Americas . 33 8. The Final Phase of Global Eradication of Poliomyelitis . 34 Bibliography . 38 Annexes . 39 Annex 1. Poliomyelitis outbreak caused by vaccine-derived virus in Haiti and the Dominican Republic . 41 Annex 2. Distribution of diagnoses for discarded cases of acute flaccid paralysis . 45 Annex 3. Description of differential diagnosis of poliomyelitis . 46 Annex 4. Refrigerator record form . 51 Annex 5. Immunization coverage of < 1-year-old children . 52 Annex 6. Coverage of 1-year-old population with at least three doses of OPV . 53 Annex 7. Acute flaccid paralysis case investigation form . 54 Annex 8. Line-listing of probable cases . 56 Annex 9. Polio outbreak control measures—summary form . 58 Annex 10. Specimen tracking form . 59 Annex 11. Polio Weekly Bulletin . 60 Annex 12. Laboratory line-listing . 62 POLIOMYELITIS ERADICATION FIELD GUIDE v Annex 13. Guidelines for laboratories within a network . 63 Annex 14. Mop-up worksheet . 64 Annex 15. Mop-up vaccination form . 65 Annex 16. Weekly reporting monitor form . 66 Annex 17. Summary of weekly reports . 68 Annex 18. Key surveillance indicators . 69 Annex 19. Active search for cases of paralysis . 70 Annex 20. Sample presentation on surveillance of acute flaccid paralysis . 74 Tables Table 1. Criteria for the differential diagnosis of poliomyelitis . 7 Table 2. Specimens for poliovirus detection . 22 Table 3. Rate of reported cases of acute flaccid paralysis per 100,000 population under 15 years of age, by department (fictitious data) . 28 Figures Figure 1. OPV3 coverage and incidence of poliomyelitis in the Region of the Americas, 1969–2003 . x Figure 2. Polio cases in the Americas, 1985 . ix Figure 3. Areas in Haiti and the Dominican Republic with confirmed cases of polio, 2000–2001 . x Figure 4. Wild poliovirus, 2004–2005 . 3 Figure 5. Spread of wild poliovirus, 2004–2005 . 3 Figure 6. Pathogenesis and clinical course of acute poliomyelitis . 5 Figure 7. Vaccine efficacy . 11 Figure 8. Map displaying OPV coverage by municipality in children less than 1 year of age. January–December 2003 (fictitious) . 13 Figure 9. Investigation of a probable case of poliomyelitis . 17 Figure 10. Case investigation decision tree . 20 Figure 11. Packaging for virological specimens . 24 Figure 12. Polio reference laboratory network in the Americas . 26 Figure 13. Progress of polio eradication, 1988 and 2004 . 34 Figure 14. Outbreaks caused by circulating vaccine-derived poliovirus (cVDPV) . 35 ABOUT THE IMMUNIZATION FIELD GUIDES The Expanded Program on Immunization is viewed as one of the most successful public health experiences in the Americas because it has played a pivotal role in reducing infant mortality from vaccine-preventable diseases in the Region. In fact, since the program was launched the countries stopped the transmission of wild poliovirus in the Region in 1991 and interrupted indigenous measles transmission in November 2002; they also are making significant gains in the battle to eliminate rubella and congenital rubella syndrome. In addition, national immunization pro- grams are undertaking extraordinary efforts to identify at-risk populations and over- come.
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