Low immunization rates in parts of U.S. could pave way for polio outbreak

Jul 15, 2010 – Michael Brady, M.D., FAAP

A recent polio outbreak in Tajikistan shows how precarious our control of the disease can be when immunization rates fall below the World Health Organization target level of 90%. The polio immunization rate in Tajikistan is 87%.

This is the first persistent polio outbreak in a certified polio-free country, with more than 560 cases of flaccid paralysis reported.

Cases also are appearing in Russia and Uzbekistan. It appears that asymptomatic polio-infected individuals were responsible for transmission out of Tajikistan. The occurrence of polio in Tajikistan and spread within the region documents that global travel can result in polio occurring anywhere in the world where immunization rates are inadequate.

In the United States, we are comforted by the fact that the Western Hemisphere was certified polio-free in the early 1990s. Since that time, there have been occasional imported cases with no evidence of further transmission. However, polio immunization rates are lower than 90% in many areas of the United States due to a lack of concern with polio due to no recent experience in the United States, concerns about vaccine safety, religious objections to immunization and anti-vaccine activities. With increasing globalization, the United States could be just an asymptomatic traveler away from an outbreak.

Pediatricians need to ensure that their patients are fully vaccinated against polio. They also should report any case of flaccid paralysis to their local health departments.

The outbreak in Tajikistan represents 75% of the world’s polio cases so far for 2010. Most polio cases had been associated with India and Nigeria, which have not been certified polio-free. There also was an outbreak in the Dominican Republic and Haiti in 2000.

Dr. Brady is chair of the AAP Committee on Infectious Diseases.

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