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N Engl J Med. 2013 Nov 21;369(21):1981-90. doi: 10.1056/NEJMoa1303368.

Identification and control of a poliomyelitis outbreak in Xinjiang, China.

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From the Chinese Center for Disease Control and Prevention, National Immunization Program (H.-M.L., W.-Z.Y., N.W., H.-Q.W., H.-B.W., J.-S.Z., F.-Q.C., L.-X.H., C.-X.F., G.-J.N., D.-W.L., G.-M.Z., Y.-S.C., Y.-M.L., D.-P.Y., K.-L.L., Y.W., W.-Z.Y.), the Ministry of Health Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention (Y.Z., D.-M.Y., D.-X.L., S.-L.Z., S.-W.W., D.-Y.W., G.-H.H., H.Z., Y.-X.J., W.-B.X.), the Health Emergency Control Center (Z.-J.F.), and the Division of Infectious Disease Control, Chinese Center for Disease Control and Prevention (H.-J.Y.) - all in Beijing; Xinjiang Uyghur Autonomous Region Center for Disease Control and Prevention (X.-Q.W., F.W., H.C., J.N., A.G., X.-C.F., X.-L.L., H.-S.T.) and the Center for Disease Control and Prevention of the Xinjiang Production and Construction Corps (J.-P.W., J.-P.F., S.-S.M.), Urumqi; and Shandong Center for Disease Control and Prevention, Jinan (A.-Q.X.) - all in China.



The last case of infection with wild-type poliovirus indigenous to China was reported in 1994, and China was certified as a poliomyelitis-free region in 2000. In 2011, an outbreak of infection with imported wild-type poliovirus occurred in the province of Xinjiang.


We conducted an investigation to guide the response to the outbreak, performed sequence analysis of the poliovirus type 1 capsid protein VP1 to determine the source, and carried out serologic and coverage surveys to assess the risk of viral propagation. Surveillance for acute flaccid paralysis was intensified to enhance case ascertainment.


Between July 3 and October 9, 2011, investigators identified 21 cases of infection with wild-type poliovirus and 23 clinically compatible cases in southern Xinjiang. Wild-type poliovirus type 1 was isolated from 14 of 673 contacts of patients with acute flaccid paralysis (2.1%) and from 13 of 491 healthy persons who were not in contact with affected persons (2.6%). Sequence analysis implicated an imported wild-type poliovirus that originated in Pakistan as the cause of the outbreak. A public health emergency was declared in Xinjiang after the outbreak was confirmed. Surveillance for acute flaccid paralysis was enhanced, with daily reporting from all public and private hospitals. Five rounds of vaccination with live, attenuated oral poliovirus vaccine (OPV) were conducted among children and adults, and 43 million doses of OPV were administered. Trivalent OPV was used in three rounds, and monovalent OPV type 1 was used in two rounds. The outbreak was stopped 1.5 months after laboratory confirmation of the index case.


The 2011 outbreak in China showed that poliomyelitis-free countries remain at risk for outbreaks while the poliovirus circulates anywhere in the world. Global eradication of poliomyelitis will benefit all countries, even those that are currently free of poliomyelitis.

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