Progress Toward Poliomyelitis Eradication - Afghanistan and Pakistan, 2008 by ProQuest


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									198                                                                            MMWR                                                              March 6, 2009

outerwear; 2) gloves, if touching blood, body fluids, secretions,                      Progress Toward Poliomyelitis
excretions, mucous membranes, or non-intact skin (including
wounds); and 3) face protection, if splashes or sprays might                           Eradication — Afghanistan and
occur. During a MRSA cluster or outbreak, wound cultures of                                    Pakistan, 2008
animals and humans are indicated, especially if skin pustules                         Afghanistan and Pakistan, two of the four remaining coun-
are present. In addition, training employees working with                          tries where wild poliovirus (WPV) transmission has never
animals about their risk for MRSA infection, recommended                           been interrupted (1),* represent one epidemiologic reservoir.
work practices, and the proper care and use of PPE is impor-                       During 2008, both countries continued to conduct coordi-
tant in reducing their risk for exposure to MRSA and other                         nated supplemental immunization activities (SIAs)† against
zoonoses. In addition, cleaning equipment and surfaces with                        type 1 WPV (WPV1) and type 3 WPV (WPV3) using oral
detergent-based cleaners or Environmental Protection Agency                        polio vaccine (OPV). Much of Afghanistan remained polio-
(EPA)-registered detergent-disinfectants, followed by disinfec-                    free in 2008, with the exception of the conflict-affected South
tion of contaminated surfaces, is important to remove MRSA                         Region. In Pakistan, however, WPV transmission increased,
from the environment.                                                              particularly after WPV1 reintroduction into polio-free areas of
                                                                                   Punjab Province. In total, 149 WPV cases (31 in Afghanistan
                          Acknowledgments                                          and 118 in Pakistan) were confirmed in 2008, compared with
  This report is based, in part, on contributions by C Peter, PhD,                 49 cases in 2007. Serious security problems in areas along the
M Victoria, G Washabaugh, MPH, R Patel, MS, R Jansen, and
                                                                                   common border limited access by vaccination teams to large
P Temprendola, County of San Diego Public Health Laboratory;
W Probert, PhD, and J O’Connell, Microbial Disease Laboratory
                                                                                   numbers of children in the two countries. In Pakistan, contin-
Br, California Dept of Public Health; and G Fosheim, MPH, Div                      ued managerial and operational problems impeded full imple-
Healthcare Quality Promotion, National Center for Preparedness,                    mentation of SIAs and adversely affected vaccination coverage
Detection, and Control of Infectious Diseases, CDC.                                in areas not affected by security problems. This report updates
                                                                                   previous reports (1,2) and describes polio eradication activities
 1. Fridkin SK, Hageman JC, Morrison M, et al. Methicillin-resistant               in Afghanistan and Pakistan during January–December 2008.
    Staphylococcus aureus disease in three communities. N Engl J Med               Further progress toward interruption of WPV transmission in
    2005;352:1436–44.                                                              Afghanistan and Pakistan will require continued measures to
 2. Walther B, Wieler LH, Friedrich AW, et al. Methicillin-resistant
    Staphylococcus aureus (MRSA) isolated from small and exotic animals at         overcome access problems in conflict-affected areas of both
    a university hospital during routine microbiological examinations. Vet         countries and improvements in the quality of SIAs and delivery
    Microbiol 2008;127:171–8.                                                      of routine immunization services in Pakistan.
 3. Leonard FC, Markey BK. Methicillin-resistant Staphylococcus aureus in
    animals: a review. Vet J 2008;175:27–36.
 4. Loeffler A, Boag AK, Sung J, et al. Prevalence of methicillin-resistant        Immunization Activities
    Staphylococcus aureus among staff and pets in a small animal referral
    hospital in the UK. J Antimicrob Chemother 2005;56:692–7.                        In 2007, the most recent year for which data were available,
 5. van Loo I, Huijsdens X, Tiemersma E, et al. Emergence of methicillin-          routine immunization coverage of infants with 3 doses of tri-
    resistant Staphylococcus aureus of animal origin in humans. Emerg Infect       valent oral poliovirus vaccine (OPV3) by age 12 months was
    Dis 2007;13:1834–9.
 6. Devriese LA, Van Damme LR, Fameree L. Methicillin (cloxacillin)-
                                                                                   83% overall in both Afghanistan and Pakistan (3). However,
    resistant Staphylococcus aureus strains isolated from bovine mastitis cases.   acute flaccid paralysis (AFP) surveillance data§ suggest that
    Zentralbl Veterinarmed B 1972;19:598–605.                                      actual routine OPV3 coverage was much lower nationally and
 7. Cefai C, Ashurst S, Owens C. Human carriage of methicillin-resistant           varied widely by political area (province, territory, or region)
    Staphylococcus aureus linked with pet dog. Lancet 1994;344:539–40.
 8. Weese JS, Caldwell F, Willey BM, et al. An outbreak of methicillin-resis-      in both countries. Based on AFP surveillance data reported
    tant Staphylococcus aureus skin infections resulting from horse to human       during 2008, routine OPV3 coverage among children aged
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