From July 31 to September 28, 1988, 16 persons in Israel
(population
4.6 million) were reported with confirmed or suspected paralytic
poliomyelitis. Thirteen cases were reported from the District of
Hadera
(population 180,000), located approximately 30 miles northeast of
Tel
Aviv.
Eight cases occurred in persons 20-33 years old, four in persons
11-19
years old, one in a 5-year-old child, and three in children 2-21
months
old. Of the three cases not occurring in residents of Hadera, two
were
in children 9 and 21 months of age. To date, Type I poliovirus has
been
isolated from eight persons.
Israel began vaccination against polio with inactivated polio
vaccine
(IPV) in 1957. In the early 1960s, oral polio vaccine (OPV)
replaced
IPV nationwide. The vaccine schedule consisted of OPV given at 2,
4, 6,
and 12-14 months of age. Between 1971 and 1981, an average of 14
paralytic poliomyelitis cases was reported annually in Israel.
Hadera
had reported the highest incidence of paralytic polio before 1982.
In
1982, the use of an enhanced potency IPV (eIPV) was instituted in
Hadera and one other of the 15 districts in Israel. Between 1982
and
1987, fewer than two cases of paralytic poliomyelitis were reported
annually in Israel. None of the cases in the current outbreak
occurred
in eIPV recipients.
Because of the outbreak, vaccination of all persons less than or
equal
to39 years was carried out in Hadera and in the second eIPV
district,
primarily with OPV. Vaccination in other districts is in progress.
It
is anticipated that vaccination of the entire national population
less
than or equal to39 years will be completed within 2 weeks.
Reported by: Dept of Epidemiology, Ministry of Health, Jerusalem,
Israel. 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
temporarily includes Israel, be immunized. Schedules for primary
immunization against poliomyelitis require three or more doses. In
general, OPV is the vaccine of choice for persons less than 18
years of
age. Unimmunized adults greater than or equal to18 years should
receive
at least two doses of eIPV at least 4 weeks apart, and preferably a
complete primary series, before traveling. If travel plans do not
permit this interval, one dose of OPV or eIPV 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 eIPV can be used to complete the series.
One
additional dose of either OPV or eIPV should be given to travelers
of
all ages who completed a primary series of OPV or IPV. Ideally,
this
booster dose should be administered at least 2 months before
scheduled
departure to ensure maximum protective benefit. ACIP
recommendations on
poliomyelitis prevention should be consulted for further details
(1,2).
World Health Organization consultants in Israel expect that the
containment measures in progress and those planned will terminate
the
outbreak.
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