Afghanistan and Pakistan, two of the four remaining counties where wild poliovirus (WPV) transmission has never been interrupted. Updates on previous reports on WPV transmission in Afghanistan and Pakistan are presented and polio eradication activities in both countries during January-December 2008 are described. A CDC editorial note is also included.
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 References 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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