Polio outbreak in Tajikistan: new update

As of 28 April 2010, the health authorities in Tajikistan have reported 171 cases of acute flaccid paralysis (AFP) to WHO. Laboratory tests have confirmed wild poliovirus type 1 in 32 cases; classification is pending for the remaining 139. Out of 68 administrative territories in Tajikistan, 24 are affected. All cases have been reported from the south-west of the country. To date, there have been 12 deaths among the reported AFP cases: 10 in children (under 15 years of age) and 2 in adults. The presence of wild poliovirus type 1 in one of these cases has been confirmed. Genetic sequencing has determined that the poliovirus found in Tajikistan is most closely related to virus from Uttar Pradesh, India.

A WHO expert team has been in Tajikistan since 16 April 2010, investigating the outbreak and providing technical support to the Government, in partnership with the United Nations Children’s Fund (UNICEF) and the US Centers for Disease Control and Prevention (CDC). WHO keeps all WHO Member States informed about its epidemiological and clinical findings through channels established by the International Health Regulations (IHR). On 26 April, 4 million doses of monovalent oral polio vaccine (mOPV1), supplied and deployed by UNICEF, arrived in Tajikistan. According to current plans, 1 090 000 children under 6 years of age will be vaccinated in three rounds of immunization starting next week.

WHO’s technical assistance programme in Tajikistan has short- and medium-term goals. In the short term, WHO is conducting a comprehensive outbreak investigation to support authorities in strengthening AFP surveillance and active case finding, ensure appropriate clinical management of patients and coordinate the nationwide vaccination programme. In the medium term, WHO supports the Government in strengthening its health system, including AFP surveillance structures, immunization programmes and capacities for outbreak response. WHO will continue this support until the outbreak is brought under control and advanced surveillance and immunization programmes are put in place.

Prevention and preparedness in the neighbouring region

WHO is in close contact with governments of Kazakhstan, Kyrgyzstan, Turkmenistan and Uzbekistan about preparedness and response measures. In Uzbekistan, 23 AFP cases were reported from the beginning of the year to 28 April 2010. Four of these were reported in weeks 15 and 16 in regions near Tajikistan. With its partners, WHO will assist in managing a two-round national polio immunization campaign in Uzbekistan. The governments of Kazakhstan, Kyrgyzstan and Turkmenistan have formed task forces and strengthened surveillance, and are considering vaccination campaigns. The Government of Kyrgyzstan began a subnational polio immunization campaign this week in the areas bordering Tajikistan. In neighbouring Afghanistan, authorities will begin a nationwide campaign on 3 May 2010. WHO has begun a risk assessment to identify other Member States at high risk of polio importation.

Partnerships and emergency appeals

In preparing their response, the health ministries of Tajikistan and Uzbekistan are receiving support from WHO, UNICEF, US CDC, the International Federation of Red Cross and Red Crescent Societies and other members of the Global Polio Eradication Initiative. WHO and UNICEF are urgently seeking funds to support their work. Rotary International, US CDC, the US Agency for International Development (USAID), and the UK Department for International Development (DFID) have already pledged emergency funding to support WHO’s work on the ground and UNICEF’s vaccination and social mobilization activities. Over US$ 1.2 million was raised during the past week.

WHO recommendations for travel to Tajikistan remain the same as for any other polio-infected country – immunization or boosting of past immunization. No further actions or travel restrictions are recommended.