As of January 9, 1985, four cases of paralytic and one case of
nonparalytic poliomyelitis had been diagnosed and confirmed during
the
previous 2 months from various parts of Finland, including the
vicinities of Helsinki and Turku. The outbreak apparently began in
late October 1984, when a 6-year-old boy developed aseptic
meningitis;
type 3 poliovirus was isolated from his stool. In mid-November,
paralytic poliomyelitis occurred in a 17-year-old male who had
previously received five doses of inactivated poliomyelitis vaccine
(IPV). Subsequently, three other cases of paralytic poliomyelitis
were diagnosed from mid-November to mid-December. One patient, a
12-year-old boy, had previously received five doses of IPV; one, a
31-year-old pregnant woman, was unvaccinated; and one, a
33-year-old
man with Hodgkin's disease, was incompletely immunized. Poliovirus
type 3 was isolated from stool specimens of all four individuals
with
paralytic disease; these isolates have been characterized as "not
vaccine-like" by the method of van Wezel (1). Poliovirus type 3
has
also been isolated from approximately 15% of 700 stool samples or
throat swabs from children without clinical illness, most of whom
were
residents of communities with cases.
Since 1960, routine vaccination against poliomyelitis using IPV
has been performed in Finland. Before this outbreak, paralytic
poliomyelitis was last reported in Finland in 1964. Sewage surveys
conducted from 1971-1981 had failed to detect any poliovirus.
Epidemiologic investigations are currently being conducted. All
children 6 months to 18 years old have been given an additional
dose
of IPV. Vaccination of the entire population with oral
poliomyelitis
vaccine (OPV) is to begin soon.
Reported by National Board of Health, Government of Finland; Div of
Immunization, Center for Prevention Svcs, CDC.
Editorial Note
Editorial Note: In developed countries, such as Japan, Australia,
New
Zealand, Canada, and the countries of industrialized Europe, the
risk
of acquiring poliomyelitis is usually no greater than in the United
States. In contrast, all developing countries should generally be
considered endemic for poliomyelitis. Proof of poliomyelitis
immunization is not required for international travel. However,
the
Immunization Practices Advisory Committee (ACIP) recommends that
travelers to countries where poliomyelitis is occurring--which now
includes Finland--be immunized. Schedules for primary immunization
against poliomyelitis require three or more doses. In general, OPV
is
the vaccine of choice for persons under 18 years of age.
Unimmunized
adults (18 years and older) should receive at least two doses of
IPV,
4 or more weeks apart, and preferably a complete primary series,
before traveling; if an individual's travel plans do not permit
this
interval, then a single dose of OPV is recommended. For adults
incompletely immunized with OPV or IPV, the remaining doses should
be
given to complete the primary series, regardless of the interval
since
the last dose or the type of vaccine previously received; either
OPV
or IPV can be used to complete the series. A single additional
dose
of either OPV or IPV should be given to travelers who have
previously
completed a primary series of OPV or IPV. ACIP recommendations on
poliomyelitis prevention should be consulted for further details
(2).
Reference
van Wezel AL, Hazendonk AG. Intratypic serodifferentiation of
polomyelitis virus strains by strain specific antisera.
Intervirology 1979;11:2-8.
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