Investigation of elevated case-fatality rate in poliomyelitis outbreak in Pointe Noire, Republic of Congo, 2010.
BACKGROUND
Multiple cases of paralysis, often resulting in death, occurred among young adults during a wild poliovirus (WPV) type 1 outbreak in Pointe Noire, Republic of Congo, in 2010. We conducted an investigation to identify factors associated with fatal outcomes among persons with poliomyelitis in Pointe Noire.


METHODS
Polio cases were defined as acute flaccid paralysis (AFP) cases reported from 7 October to 7 December 2010 with either a stool specimen positive for WPV or clinically classified as polio-compatible. Data were obtained from medical records, hospital databases, AFP case investigation forms and, when possible, via interviews with persons with polio or surrogates using a standard questionnaire.


RESULTS
A total of 369 polio cases occurred in Pointe Noire between 7 October and 7 December 2010. Median age was 22 years for nonsurvivors and 18 years for survivors (P = .01). Small home size, as defined by ≤2 rooms, use of a well for drinking water during a water shortage, and age ≥15 years were risk factors for death in multivariate analysis.


CONCLUSIONS
Consideration should be given during polio risk assessment planning and outbreak response to water/sanitation status and potential susceptibility to polio in older children and adults. Serosurveys to estimate immunity gaps in older age groups in countries at high risk of polio importation might be useful to guide preparedness and response planning.
Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA. hgk4@cdc.gov
Christopher J
CJ
Gregory
Serigne
S
Ndiaye
Minal
M
Patel
Elisaphan
E
Hakizamana
Kathleen
K
Wannemuehler
Edouard
E
Ndinga
Susan
S
Chu
Pascal
P
Talani
Katrina
K
Kretsinger
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D003223:Congo / Q000453:epidemiology; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005243:Feces / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010243:Paralysis; D011051:Poliomyelitis / Q000453:epidemiology / Q000401:mortality* / Q000821:virology; D017955:Poliovirus / Q000302:isolation & purification; D062486:Public Health Surveillance; D012307:Risk Factors; D014881:Water Supply; D055815:Young Adult