710. Poliomyelitis-related case fatality ratio (CFR) during a large outbreak - India, 2006
Session: Poster Session: Viruses
Saturday, October 6, 2007: 12:00 AM
Room: Poster Halls G-H
Background:
The case fatality ratio (CFR) for poliomyelitis, defined as the number of deaths due to wild poliovirus (WPV) divided by the total number of WPV cases, generally ranges from 2-5% among children <5 years of age to 10% among adults based on studies from developed countries. India is one of the 4 remaining countries with endemic WPV circulation and little literature is available for poliomyelitis-related CFR. We conducted this study to determine the CFR in India during a WPV outbreak in 2006.
Methods:
We conducted a descriptive analysis using data from the acute flaccid paralysis (AFP) surveillance system in India. Data included information on age, caregiver-reported vaccination status, date of paralysis onset, laboratory results, final case classification and survival outcome. Supplemental detail on clinical presentation was available for cases from Moradabad district (MRD) in Uttar Pradesh (UP) state.
Results:
Based on data reported by April 20, 2007, there were 674 WPV cases in India with paralysis onset in 2006, of which 46 died, yielding a CFR of 6.8%; 83% of all WPV cases and 72% of WPV cases that died had received >3 oral polio vaccine doses. More than 95% of WPV cases and all 46 deaths occurred in children aged <5 years (CFR=7.2%). Among those who died, 34(74%) were children aged <2 years (CFR=7.3%). In UP, 39 of 546 WPV cases died (CFR=7.1%); CFR among children aged <2 years was 7.4%. In MRD, 8 of 65 WPV cases died (CFR=12.3%); all 8 deaths were among 47 WPV cases aged <2 years (CFR = 17%). Seven of these 8 deaths presented with rapidly progressive bulbar paralysis and all 8 deaths occurred within 7 days of paralysis onset.
Conclusion:
The CFR among children aged <2 years in India is high compared to previously published CFRs for young children. Fatal cases presented with classic poliomyelitis symptoms, emphasizing the lethal nature of the disease and the importance of achieving polio eradication in India.
Karen Hymbaugh, MPH1, Linda Venczel, PhD, MPH2, Mark Pallansch, PhD2, Stephen Cochi, MD, MPH2, Sucheta Doshi, MD, MPH2, Sunil Bahl, MD3, Hamid Jafari, MD3, Hardeep Sandhu4, Jay Wenger, MD3 and  S.J. Doshi, None; H. Sandhu, None; L. Venczel, None; S. Bahl, None; M.A. Pallansch, None; K. Hymbaugh, None; H. Jafari, None; J. Wenger, None; S.L. Cochi, None., (1)CDC, New Delhi, India, (2)CDC, Atlanta, GA, (3)World Health Organization, New Delhi, India, (4)GLOBAL Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA


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