The 2010 outbreak of poliomyelitis in Tajikistan: epidemiology and lessons learnt

M L Yakovenko; A P Gmyl; O E Ivanova; T P Eremeeva; A P Ivanov; M A Prostova; O Y Baykova; O V Isaeva; G Y Lipskaya; A K Shakaryan; O M Kew; J M Deshpande; V I Agol

doi:10.2807/1560-7917.ES2014.19.7.20706

Surveillance and outbreak reports Open Access

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The 2010 outbreak of poliomyelitis in Tajikistan: epidemiology and lessons learnt
M L Yakovenko^1,2,3 , A P Gmyl^1,3,4 , O E Ivanova^1,3 , T P Eremeeva¹ , A P Ivanov¹ , M A Prostova¹ , O Y Baykova¹ , O V Isaeva¹ , G Y Lipskaya² , A K Shakaryan¹ , O M Kew⁵ , J M Deshpande⁶ , V I Agol^1,2
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Affiliations: ¹ M.P. Chumakov Institute of Poliomyelitis and Viral Encephalitides, Russian Academy of Medical Sciences, Moscow, Russia ² A.N. Belozersky Institute of Physical-Chemical Biology, M.V. Lomonosov Moscow State University, Moscow, Russia ³ These authors contributed equally to this study ⁴ Faculty of Biology, M.V. Lomonosov Moscow State University, Moscow, Russia ⁵ Centers for Disease Control and Prevention, Atlanta, Georgia, United States ⁶ Enterovirus Research Centre, Indian Council of Medical Research, Mumbai, India

Correspondence:
V Agol
agol belozersky.msu.ru
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Citation style for this article: Yakovenko M L, Gmyl A P, Ivanova O E, Eremeeva T P, Ivanov A P, Prostova M A, Baykova O Y, Isaeva O V, Lipskaya G Y, Shakaryan A K, Kew O M, Deshpande J M, Agol V I. The 2010 outbreak of poliomyelitis in Tajikistan: epidemiology and lessons learnt. Euro Surveill. 2014;19(7):pii=20706. https://doi.org/10.2807/1560-7917.ES2014.19.7.20706 Received: 01 Sept 2013

Abstract

A large outbreak of poliomyelitis, with 463 laboratory-confirmed and 47 polio-compatible cases, took place in 2010 in Tajikistan. Phylogenetic analysis of the viral VP1 gene suggested a single importation of wild poliovirus type 1 from India in late 2009, its further circulation in Tajikistan and expansion into neighbouring countries, namely Kazakhstan, Russia, Turkmenistan and Uzbekistan. Whole-genome sequencing of 14 isolates revealed recombination events with enterovirus C with cross-overs within the P2 region. Viruses with one class of recombinant genomes co-circulated with the parental virus, and representatives of both caused paralytic poliomyelitis. Serological analysis of 327 sera from acute flaccid paralysis cases as well as from patients with other diagnoses and from healthy people demonstrated inadequate immunity against polio in the years preceding the outbreak. Evidence was obtained suggesting that vaccination against poliomyelitis, in rare cases, may not prevent the disease. Factors contributing to the peculiarities of this outbreak are discussed. The outbreak emphasises the necessity of continued vaccination against polio and the need, at least in risk areas, of quality control of this vaccination through well planned serological surveillance.