Poliomyelitis outbreaks in Angola genetically linked to India: Risk factors and implications for prevention of outbreaks due to wild poliovirus importations

• Published in: Vaccine Vol. 29; no. 21; pp. 3760 - 3766
• Main Authors: Kidd, Sarah, Goodson, James L., Aramburu, Javier, Morais, Alda, Gaye, Abou, Wannemuehler, Kathleen, Buffington, Joanna, Gerber, Sue, Wassilak, Steven, Uzicanin, Amra
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 12.05.2011; Elsevier; Elsevier Limited
• Subjects: adults; Age; Allergy and Immunology; Angola; Angola - epidemiology; Applied microbiology; Biological and medical sciences; Case-Control Studies; Child; Child, Preschool; confidence interval; Disease Outbreaks; Disease transmission; Disease Transmission, Infectious - prevention & control; Enterovirus C; Female; Fundamental and applied biological sciences. Psychology; Households; Human viral diseases; Humans; Immunization; Importation; India; India - epidemiology; Infant; Infectious diseases; interviews; Laboratories; Male; Mass Vaccination - statistics & numerical data; Medical sciences; Microbiology; Miscellaneous; Multivariate Analysis; Odds Ratio; Outbreaks; Paralysis; Patients; Poliomyelitis; Poliomyelitis - epidemiology; Poliomyelitis - prevention & control; Poliomyelitis - transmission; Poliovirus; Poliovirus - immunology; Poliovirus Vaccine, Oral - administration & dosage; Poliovirus Vaccine, Oral - immunology; Questionnaires; Risk assessment; Risk Factors; Surveillance; Travel; Vaccination; Vaccines; Vaccines, antisera, therapeutical immunoglobulins and monoclonal antibodies (general aspects); Viral diseases; Viral diseases of the nervous system; Virology; Angola; India; Asia; Southern Africa; Africa; South Asia; Nigeria; Poliomyelitis; Vaccination; Angola; Nervous system diseases; Picornaviridae; Tropical zone; Enterovirus; Acute anterior poliomyelitis; Poliovirus; Infection; Virus; Prevention; Viral disease; Central nervous system disease; Risk factor; Spinal cord disease
• ISSN: 0264-410X; 1873-2518; 1873-2518
• DOI: 10.1016/j.vaccine.2011.03.034

We conducted an investigation of two outbreaks of poliomyelitis in Angola during 2007–2008 due to wild poliovirus (WPV) genetically linked to India. A case-control study including 27 case-patients and 76 age- and neighborhood-matched control-subjects was conducted to assess risk factors associated with paralytic poliomyelitis, and epidemiologic links to India were explored through in-depth case-patient interviews. In multivariable analysis, case-patients were more likely than control-subjects to be undervaccinated with fewer than four routine doses of oral poliovirus vaccine (adjusted matched odds ratio [aMOR], 4.1; 95% confidence interval [CI], 1.2–13.6) and have an adult household member who traveled outside the province of residence in the 2 months preceding onset of paralysis (aMOR, 3.2; 95% CI, 1.2–8.6). No epidemiologic link with India was identified. These findings underscore the importance of routine immunization to prevent outbreaks following WPV importations and suggest a possible role of adults in sustaining WPV transmission.