Two weeks ago I wrote ” target=”_blank”>an article in this week’s New England Journal of Medicine.
China had eliminated polio by 2000, though it has had small outbreaks of polio imported from other countries since then. The public health response in the summer and fall of 2011 involved a multifaceted attack, including mandatory reporting of all cases of acute paralysis, laboratory testing of patients and their close contacts, and a mass vaccination campaign for vulnerable populations.
Over the subsequent months 21 cases of polio were confirmed and 23 more were suspected but did not yield laboratory confirmation. Over 1,000 health workers were trained to respond to the outbreak and over 43 million doses of vaccine were administered over the following year. A massive media campaign including text messages informed the population of the vaccination program. The study authors estimate that the public health response cost approximately $26 million.
The last confirmed case of polio in the region was in October 2011. The outbreak was stopped within four months of the initial case. Genetic testing of the isolated virus suggested it had been imported from Pakistan, though no contact of the initial patient with a traveler from Pakistan was discovered.
The contrasts between the Syrian outbreak and that in China are stark. The contrast reminds us that a robust public health infrastructure is critical. But in the age of global travel even this well-organized and well-funded public health system was insufficient to keep the country free of polio. The authors of the article and ” target=”_blank”>Polio-free countries still face threat, scientists say (Fox News)
” target=”_blank”>Identification and Control of a Poliomyelitis Outbreak in Xinjiang, China (NEJM article, free without subscription)
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Polio Outbreak in Syria (my post two weeks ago)
Tangential Miscellany
Last week I wrote about ” target=”_blank”>This New York Times article reports the problem with the calculator. So for now, the fourth group of patients for whom statins are to be prescribed is on hold. I know you join me in hoping that the calculator is fixed soon, perhaps with the help of any spare programmers from the healthcare.gov site.
Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice. Anything that I write is no exception. I’m a doctor, but I’m not your doctor.
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