title: Poliomyelitis-related case-fatality ratio in India, 2002-2006.
abstract: BACKGROUND
  On the basis of studies from developed countries, the case-fatality ratio (CFR) of poliomyelitis generally ranges from 2%-5% among children <5 years of age to 10%-30% among adults. However, little information is available for poliomyelitis-related CFR in developing countries. We conducted a study to determine the CFR in India, 1 of the 4 remaining countries with endemic wild poliovirus (WPV) circulation, during outbreaks of WPV infection during 2002 and 2006 and during the inter-epidemic years of 2003-2005.
  
  
  METHODS
  We conducted a descriptive analysis with use of data from the acute flaccid paralysis surveillance system in India. Variables analyzed included age, caregiver-reported vaccination status, date of paralysis onset, laboratory results, final case classification, and survival outcome. Our analysis also accounted for surveillance changes that occurred in 2005, impacting case definitions and final classification.
  
  
  RESULTS
  In 2006, 45 deaths occurred among 676 WPV cases in India, yielding a CFR of 6.7%. By comparison, in 2002, there were 66 deaths among 1600 reported WPV cases (CFR, 4.2%) and during 2002-2005, CFR was 1.5%-5.2%. All 45 deaths were among 644 (95%) WPV cases in children aged <5 years (CFR, 7.0%). Among those who died, 33 (73%) were children aged <2 years (CFR, 7.1%).
  
  
  CONCLUSIONS
  The CFR among children aged <2 years in India is high compared with previously published CFRs for young children, in part because of improved case finding through enhanced surveillance techniques. Fatal cases emphasize the lethal nature of the disease and the importance of achieving polio eradication in India.
authors.affiliation: Global Immunization Division, National Center for Immunization and Respiratory Diseases and Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
authors.forename: Sucheta J
authors.initials: SJ
authors.lastname: Doshi
authors.forename: Hardeep S
authors.initials: HS
authors.lastname: Sandhu
authors.forename: Linda V
authors.initials: LV
authors.lastname: Venczel
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Hymbaugh
authors.forename: Jagadish M
authors.initials: JM
authors.lastname: Deshpande
authors.forename: Mark A
authors.initials: MA
authors.lastname: Pallansch
authors.forename: Sunil
authors.initials: S
authors.lastname: Bahl
authors.forename: Jay D
authors.initials: JD
authors.lastname: Wenger
authors.forename: Steve L
authors.initials: SL
authors.lastname: Cochi
mesh_terms: D002675:Child, Preschool; D016000:Cluster Analysis; D003906:Developing Countries / Q000706:statistics & numerical data; D005843:Geography; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D011051:Poliomyelitis / Q000453:epidemiology* / Q000401:mortality; D017955:Poliovirus / Q000235:genetics