title: Poliomyelitis outbreaks in Angola genetically linked to India: risk factors and implications for prevention of outbreaks due to wild poliovirus importations.
abstract: We conducted an investigation of two outbreaks of poliomyelitis in Angola during 2007-2008 due to wild poliovirus (WPV) genetically linked to India. A case-control study including 27 case-patients and 76 age- and neighborhood-matched control-subjects was conducted to assess risk factors associated with paralytic poliomyelitis, and epidemiologic links to India were explored through in-depth case-patient interviews. In multivariable analysis, case-patients were more likely than control-subjects to be undervaccinated with fewer than four routine doses of oral poliovirus vaccine (adjusted matched odds ratio [aMOR], 4.1; 95% confidence interval [CI], 1.2-13.6) and have an adult household member who traveled outside the province of residence in the 2 months preceding onset of paralysis (aMOR, 3.2; 95% CI, 1.2-8.6). No epidemiologic link with India was identified. These findings underscore the importance of routine immunization to prevent outbreaks following WPV importations and suggest a possible role of adults in sustaining WPV transmission.
authors: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA United States. hgk9@cdc.gov
authors: Sarah
authors: S
authors: Kidd
authors: James L
authors: JL
authors: Goodson
authors: Javier
authors: J
authors: Aramburu
authors: Alda
authors: A
authors: Morais
authors: Abou
authors: A
authors: Gaye
authors: Kathleen
authors: K
authors: Wannemuehler
authors: Joanna
authors: J
authors: Buffington
authors: Sue
authors: S
authors: Gerber
authors: Steven
authors: S
authors: Wassilak
authors: Amra
authors: A
authors: Uzicanin
mesh_terms: D000810:Angola / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D008297:Male; D032541:Mass Vaccination / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D016017:Odds Ratio; D011051:Poliomyelitis / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D017955:Poliovirus / Q000276:immunology; D011055:Poliovirus Vaccine, Oral / Q000008:administration & dosage* / Q000276:immunology; D012307:Risk Factors; D014195:Travel
chemical_list: D011055:Poliovirus Vaccine, Oral