Washington, DC, January 26, 2011 (PAHO/WHO) — Officials from the Pan American Health Organization/World Health Organization (PAHO/WHO), along with colleagues from Haiti's Ministry of Health and the U.S. Centers for Disease Control and Prevention (CDC), are looking into four cases of paralysis in recovering cholera patients in Port-de-Paix, Haiti, and are likely to rule out polio as a cause, pending laboratory results.
Experts including toxicologists are investigating possible contamination at a hospital or at home from medication, food, or another source as the cause of death in these cases. PAHO and CDC officials are conducting field studies and will report their findings as soon as laboratory results are available.
Polio was one of the first possibilities looked into because of the public health implications. However, the clinical characteristics and epidemiology of these cases make poliomyelitis a remote possibility; in simple terms, polio does not produce a high mortality rate. Although considered highly unlikely, polio has not been completely ruled out, pending laboratory results of samples.
PAHO/WHO has suggested that health officials remain vigilant for further cases and has supported local health authorities in the investigation with technical staff including epidemiologists, a clinician and an immunization nurse to continue the investigations. A nurse who works with PAHO/WHO's immunization program returned from visiting the affected communities Monday with samples from some of the families. A PAHO/WHO clinician and a PAHO/WHO immunization advisor are participating in the investigation.
PAHO/WHO field epidemiologists and local health authorities from the Department of Nord-Ouest first reported a cluster of acute neurological syndromes in that department January 10, 2011. As of January 24, 2011, four cases with acute neurological syndrome, including three deaths, were reported, with dates of onset from November to December 2010 in the La Pointe area, Commune Port-de-Paix, and the neighboring commune of Saint Louis du Nord. All of the cases were seen at the same cholera treatment center and returned 2-4 days later with neurological symptoms, at which point they were hospitalized.
Working with the Director of the Department of Nord-Ouest and local officials, interviews with medical staff and relatives showed that the patients were admitted to the hospital between early November and the end of December. These patients, hospitalized for severe cholera, presented an ascending bilateral flaccid paralysis of acute onset 24 to 72 hours after the end of the cholera treatment. No additional cases were detected after the initial field investigation in the Nord-Ouest Department. Samples of blood, feces, and CSF were taken from one patient, and laboratory results are still pending. PAHO/WHO field epidemiologists and local health authorities notified the central Alerts and Response Unit of these cases January 10.
Of the suspected cases, only four had symptoms and signs compatible with paralysis. Three have died, and one is hospitalized in Port-au-Prince. He is recovering slowly. As a prudent measure, polio vaccine has been added to an upcoming vaccination campaign against diphtheria and measles in the Nord-Ouest Department.
Polio was eradicated from the Americas in 1994, three years after the last case was reported in Junín, Peru. A global polio eradication initiative was launched in 1988 and has reduced the incidence of polio worldwide by more than 99%. When it was launched in 1988, more than 350 000 children were paralyzed in more than 125 endemic countries. In 2009, 1 595 children were paralyzed in 24 countries. Today, only four countries remain endemic: Afghanistan, India, Nigeria, and Pakistan and in those countries with endemic poliovirus transmission, cases of poliomyelitis had declined by 85% in 2010 compared to the same period in 2009.