Bull. Org. mond. Sante' 1956, 15, 43-121 Bull. Wld Hlth Org. POLIOMYELrIIS IN 1954 A. M.-M. PAYNE, M.D., M.R.C.P. Division of Communicable Disease Services, World Health Organization M.-J. FREYCHE, M.D. Division ofEpidemiological and Health Statistical Services, World Health Organization SYNOPSIS As in an earlier study, the authors have endeavoured to review the world incidence of poliomyelitis on the basis of the available statis- tical information (official notifications of cases and deaths) and to compare these data with data received from various sources regard- ing the prevailing viruses. It is certainly not yet possible to establish side by side the carto- graphy of actual poliomyelitis cases and that of the prevalence and distribution of the polioviruses. However, it may not be too early to make a start in this direction. In Africa there was a rise of about 40% in the number of polio- myelitis notifications. Part of this increase is probably due to improved reporting. Characteristic epidemics were observed in the west (Senegal, Cameroons under French administration), as well as in the east (Sudan, Kenya, Tanganyika, Northern and Southern Rhodesia, Union of South Africa). In America the most outstanding outbreaks were observed in Alaska, in Wyoming, Nebraska, Iowa, Florida, and California, and all round the Caribbean Sea (Costa Rica, Guatemala, Haiti, Jamaica, Puerto Rico, Trinidad). In the Asiatic countries the number of notifications was generally of the same order as in 1953. The incidence also declined in Europe, in spite of the fact that Greece was afTected by the most serious epidemic recorded in its history. Other outbreaks were recorded in Finland, Switzerland, and Austria, where the incidence had also been high in the previous year. An increase was also noted in Scotland. Finally, in Oceania, poliomyelitis took on epidemic proportions in Australia (in the territory of the Federal Capital and in the States of Victoria and Western Australia) and in the Hawaiian Islands. The present article is another contribution to the series of similar studies which have appeared since 1935 in the epidemiological publications of the League of Nations Health Organisation and of the World Health Organization.4-7, 15-18, 40-42 503 - 43 44 A. M.-M. PAYNE & M.-J. FREYCHE In 1955 we published I such data as were available to us on the incidence of poliomyelitis in 1953 together with information regarding the types of poliovirus isolated in that year and in previous years. We also indicated that we considered that certain other information was important in planning to apply control measures against the disease-particularly, the age incidence of clinical disease, the age incidence of infection and the state of immunity of the population, and the characteristics of prevalent viruses including those other than poliovirus which might cause clinical symptoms similar to poliomyelitis. The present article includes similar data on the incidence of polio- myelitis in 1954 a together with data regarding the age incidence in certain countries. We have also included such information as we have been able to collect regarding the prevalent types of poliovirus in 1953, 1954, and 1955. Further information regarding the age incidence of clinical disease and of infection and the status of immunity of populations and their significance in planning vaccination programmes will be the subject of a subsequent study. As we have previously stressed, the information regarding prevalent virus types is at present fragmentary and restricted to a relatively small part of the world. Furthermore, the statistical information itself is subject to the well-known errors arising from variable standards of reporting and the lack of specificity of the diagnosis of non-paralytic poliomyelitis, the figures for which in many countries cannot be separated from the figures for the more specific diagnosis of paralytic poliomyelitis. Caution should therefore be used in drawing conclusions from such data. REPORTED INCIDENCE Africa (Table I) In 1954, some 3900 cases of poliomyelitis were recorded for the greater part of the African continent, as against about 2800 In 1953. These figures do not include those for the Anglo-Egyptian Sudan, for which the informa- tion available regards only the number of hospitalized cases during the first six months of the year. Nine-tenths of the cases occurred in no more than eight countries or territories: the Belgian Congo, Egypt, Union of South Africa, Kenya, Senegal (French West Africa), Tanganyika, Southern Rhodesia, Angola. In all these territories, except the last named, the number of notifications exceeded-sometimes considerably-the figures for the previous year. It also increased in the French Cameroons as well as in a For some countries we have received revised or final figures for one or more of the years 1950-53 since our previous study was published.7 These are given in the present paper and explain certain differences in data that may be observed between the two publications. POLIOMYELITIS IN 1954 45 Northern Rhodesia and in Ruanda-Urundi, but the number of cases recorded remained small. On the other hand, a considerable fall in the apparent morbidity was noted in Morocco (French zone) and, more especially, in Angola. In half the countries or territories for which statistics are avail- able, the number of notified cases was insignificant (less than 10). North Africa In Morocco (French zone), the number of notifications had more than doubled in 1953 (75) as compared with 1952; in 1954 it dropped back to 57. In the absence of detailed information for 1954, it should be noted that, in 1953, 39 of the cases were recorded during the first seven months of the year in Casablanca, including 28 among Europeans. Among Non- Europeans in Morocco, the majority of the patients were infants under one year of age, while among Europeans, on the contrary, the majority belonged to higher age-groups. Serological examinations carried out in March and August-September 1953 on 360 persons living in Casablanca and district (233 under 20 years of age and 127 aged 20 and over) showed the presence of neutralizing antibodies for the three types of poliomyelitis virus in about 80% of the children under 5 years of age. These results differ sharply from those given by a similar investigation carried out in a district of the United States of America situated in the same latitude.26 The increase in the number of poliomyelitis cases recorded in Egypt in 1952 and 1953 was probably due to more complete notifications than in previous years.7 This increase continued in 1954 for the whole of the country (with the exception of the Governorship of Alexandria, to judge by the 1953 figures relating to the 46-week period for which information for the administrative subdivisions is available); 673 cases (provisional figure) were notified (512 in the Governorship of Cairo, 46 in that of Alexandria, and 115 in the rest of the country), as against 551 (44 deaths) in 1953. West Africa An important epidemic broke out in Senegal (French West Africa) in May. One case only had been notified in 1953 and 80 (7 deaths) during the previous 14 years. Of the 335 cases (13 deaths) recorded during the year, 298 (11 deaths) occurred among the African population and 37 (2 deaths) among persons of European descent. 207 notifications were made in the Dakar " delegation ", with 8 deaths, 50 (1 death) in the Kaolack district, the others occurring mainly in the Saint-Louis subdivision, in the Ziguinchor district (situated between the Gambia and Portuguese Guinea), and in the Thies district. The eastern part of the territory seems to have remained free from the disease. 46 A. M.-M. PAYNE & M.-J. FREYCHE TABLE I. NOTIFIED CASES OF, AND DEATHS FROM, POLIOMYELITIS: VARIOUS COUNTRIES, 1950-54 1950 1951 1952 1953 1954 Country or territory cases deaths cases deaths cases deaths cases deaths cases deaths AFRICA North Africa Algeria 86 28 35 20 36 Egypt 8 18 12 260 23 551 44 681 56 Morocco: French Zone 64 64 33 75 57 Tunisia 24 44 10 24 28 West Africa French West Africa Senegal 20 - 2 335 13 Upper Volta 6 3 35 22 2 Central West Africa Angola 9 764 60 37 2 378 19 123 7 Belgian Congo 337 19 461 27 603 24 736 59 750 43 Cameroons (French) 18 8 2 2 38 2 French Equatorial Africa: Middle Congo 5 1 135 5 46 * 39 21 50 - Central East Africa 156a 7b a b,c a Kenya 126a| 15bc 240 1 9 60d 6d 538 34 Ruanda Urundi 38 3 38 2 21 32 2 73 2 Tanganyika 14 24 5 90 10 153 24 170 12 Uganda 18 l 45 3 253 15 45 3 42 2 South Africa 10 - 22 - 328 4 28 11 * Mauritius at 21 22 - 38 5 7 21 Mozambique i 7 l 221 2 23 2 7 1 30 Northern Rhodesia 6 24 4 4 R1u nion - 57 13 168 14 98 13 28 5 184 16 Southern Rhodesia 161 463 270 339 566e Union of South Africa AMERICA North America 60 4 33 80 2 67 3 365 Alaska See notes on page 50. POLIOMYELITIS IN 1954 47 TABLE I. NOTIFIED CASES OF, AND DEATHS FROM, POLIOMYELITIS: VARIOUS COUNTRIES 1950-54 (continued) 1950 1951 1952 1953 1954 Country or territory _ cases deaths cases deaths cases deaths cases deaths cases deaths AMERICA (continued) Canada (excluding Yukon and North West Territories): all forms 911 41 c 2568 162 c 4755 31 1 8888 481 c 2381 157 c paralytic cases 284 1148 2181 3691 1157 Greenland 25 261 23 - Mexico 804 134 1834 371 771 236 1787 302 609 United States of America: all forms 33 300 1904 c 28 386 1551 c 57 879 3145 c 35 592 1450 c 38 476 paralytic cases 10 037 21 269 15 648 18 308 Central America Costa Rica 28 3 53 5 7 9 6 1081 159 El Salvador 2*g 2/ 371gl 9/ 1l0g 5 15' 4/ 40g Guatemala 13 3 39 1 66 7 37 5 132 15 Nicaragua 10 1 42 1 24 191 5 41 Panama Canal Zone (including cities of Panama and Col6n) 74 38 33 13 19 West Indies Cuba* 32 15 345 37 34 Jamaica 13 1 2 2 2 4 752 Puerto Rico 38 4 89 57 6 31 3 118 Trinidad and Tobago 1 10 3 6 1 189 1 Western South America Chile 653 135 251 43 575 97 554 86 593 Colombia g 133 67 29 154 112 Peru 31 f 53a 27/ 127a 34/ 79a 73a Eastern South America Argentina 586 1015 695 46 2579 179 652* Brazil: Federal District and capitals of States and Territories 66* 17 123* 26 133 25 951 52 487 Uruguay 99 9 95 7 27 56 86 Venezuela 112 9 125 14 260 17 314 39 257* 12* See notes on page 50.