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Update on polio outbreak in Indonesia
22 July 2005 – Two new polio cases were confirmed in Indonesia today in West
Java province, bringing the total number of cases to 155. One case is from Cianjur, and the other is from a newly infected district, Kota Bekasi.
These new cases are within the areas included during the two emergency
vaccination campaigns held on 31 May and 28 June, but with onset of paralysis
between the rounds. Plans are underway for National Immunization Days targeting
24.4 million children <5 years old throughout the country on 30 August and 27
September.
Prior to this outbreak following an importation, Indonesia has not had a wild
poliovirus case since 1995.
Background
21 April: the National Polio Laboratory in Bandung reported a wild poliovirus
isolate, from an acute flaccid paralysis (AFP case) identified by the national
surveillance system in Giri Jaya village, Sukabumi District, West Java,
Indonesia. The 18-month old child, who was previously un-immunized, had onset of
paralysis on 13 March 2005.
23 April: a team comprising staff from the Ministry of Health, West Java
provincial health authority, Sukabumi district health authority and WHO was in
the infected area to conduct an immediate investigation and response. On 26 and
27 April, additional WHO staff from the Regional Office, New Delhi, and from WHO
Geneva joined this team to support and guide the investigation and response.
The Ministry of Health, Indonesia, supported by WHO, immediately intensified AFP
surveillance in the infected district and surrounding areas and conducted an
outbreak response immunization (ORI) in four villages in the immediate area of
the case, reaching 4,000 children aged less than five years. The intensified AFP
surveillance had detected seven additional AFP cases in the village of the index
case. The findings of the investigation demonstrates recent introduction of wild
poliovirus.
26 April: the Ministry of Health, in collaboration with WHO, sent the poliovirus
isolate from this case to WHO’s global reference laboratory in Mumbai, India,
for genetic sequencing.
2 May 2005: the global reference laboratory in Mumbai, India, confirmed the wild
poliovirus type 1 isolate from the AFP case identified by the national
surveillance system in Indonesia. The findings of the investigation suggest
recent introduction of wild poliovirus - genetic analysis of the virus
demonstrates that its origin is in west Africa, similar to the viruses which
caused the 2003/04 outbreak. Further analysis suggests the virus traveled to
Indonesia through Sudan, and is similar to recently isolated viruses in Saudi
Arabia and Yemen.
31 May and 28 June: Extensive mop up immunization activities took place
targeting 6.4m children <5 years in 3 provinces: Banten, DKI Jakarta, and West
Java. Coverage data indicates that the first round vaccinated 6.5m children and
the second round vaccinated 5.5m. The drop off in children vaccinated may have
been due to negative media coverage and to a variety of operational issues.
26 June: An outbreak response immunization activity targeting 78,000 children
aged less than five years was held around the case in Central Java.
Risks
The outbreak may continue to spread in the immediate area of the case and
outside. Circulation of wild poliovirus could be occurring in other provinces in
Indonesia; however this is unknown at the moment. The costs of the mopping up
campaign are as follows: vaccine costs US$1.17 million and operations costs
US$1.2 million.
Experience in polio eradication demonstrates that outbreaks can be quickly
contained with high quality immunization campaigns which reach every child under
five years of age. Global eradication efforts have reduced the number of polio
cases from 350,000 annually in 1988, to 1,266 cases in 2004. Six countries
remain polio-endemic, with a further six where polio transmission is
re-established.
Polio status in Indonesia
Indonesia has not had a wild poliovirus case since 1995.
The Ministry of Health conducted national immunization campaigns each year from
1995 to 1997, followed by sub-national immunization campaigns in 1999, 2000 and
2001. A further national campaign was implemented in 2002 to maintain high
levels of immunity in children. Routine polio immunization coverage of infants
has been consistently above 90% nationally, although this average masks pockets
where coverage is considerable lower.
Indonesia’s surveillance system for paralysis in children is meeting globally
recognized minimum standards, and a review by a team of international experts in
June 2003 found that surveillance was adequate to detect wild poliovirus
transmission.
Further information
Oliver Rosenbauer
Tel +41.22.791.3832
rosenbauero@who.int
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