Kamadjeu Raoul, Mahamud Abdirahman, Webeck Jenna, Baranyikwa Marie Therese, Chatterjee Anirban, Bile Yassin Nur, Birungi Julianne, Mbaeyi Chukwuma, Mulugeta Abraham
Somalia Liaison, World Health Organization.
Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
J Infect Dis. 2014 Nov 1;210 Suppl 1(Suppl 1):S181-6. doi: 10.1093/infdis/jiu453.
For >2 decades, conflicts and recurrent natural disasters have maintained Somalia in a chronic humanitarian crisis. For nearly 5 years, 1 million children <10 years have not had access to lifesaving health services, including vaccination, resulting in the accumulation by 2012 of the largest geographically concentrated cohort of unvaccinated children in the world. This article reviews the epidemiology, risk, and program response to what is now known as the 2013 wild poliovirus (WPV) outbreak in Somalia and highlights the challenges that the program will face in making Somalia free of polio once again.
A case of acute flaccid paralysis (AFP) was defined as a child <15 years of age with sudden onset of fever and paralysis. Polio cases were defined as AFP cases with stool specimens positive for WPV.
From 9 May to 31 December 2013, 189 cases of WPV type 1 (WPV1) were reported from 46 districts of Somalia; 42% were from Banadir region (Mogadishu), 60% were males, and 93% were <5 years of age. All Somalian polio cases belonged to cluster N5A, which is known to have been circulating in northern Nigeria since 2011. In response to the outbreak, 8 supplementary immunization activities were conducted with oral polio vaccine (OPV; trivalent OPV was used initially, followed subsequently by bivalent OPV) targeting various age groups, including children aged <5 years, children aged <10 years, and individuals of any age.
The current polio outbreak erupted after a polio-free period of >6 years (the last case was reported in March 2007). Somalia interrupted indigenous WPV transmission in 2002, was removed from the list of polio-endemic countries a year later, and has since demonstrated its ability to control polio outbreaks resulting from importation. This outbreak reiterates that the threat of large polio outbreaks resulting from WPV importation will remain constant unless polio transmission is interrupted in the remaining polio-endemic countries.
二十多年来，冲突和反复发生的自然灾害使索马里一直处于长期人道主义危机之中。近五年来，100万10岁以下儿童无法获得包括疫苗接种在内的救生医疗服务，导致到2012年时，世界上地理分布最为集中的未接种疫苗儿童群体在索马里聚集。本文回顾了对现在所知的2013年索马里野生脊灰病毒（WPV）疫情的流行病学、风险及项目应对情况，并强调了该项目在使索马里再次消除脊灰方面将面临的挑战。
急性弛缓性麻痹（AFP）病例定义为15岁以下突然发热并出现麻痹症状的儿童。脊灰病例定义为粪便标本中WPV呈阳性的AFP病例。
2013年5月9日至12月31日，索马里46个地区报告了189例1型野生脊灰病毒（WPV1）病例；42%来自巴纳迪尔地区（摩加迪沙），60%为男性，93%年龄小于5岁。所有索马里脊灰病例均属于N5A簇，已知该簇自2011年以来一直在尼日利亚北部传播。为应对此次疫情，开展了8次补充免疫活动，针对不同年龄组，包括5岁以下儿童、10岁以下儿童以及任何年龄的个体，使用口服脊灰疫苗（OPV；最初使用三价OPV，随后使用二价OPV）。
此次脊灰疫情在长达6年多的无脊灰时期之后爆发（上一例病例于2007年3月报告）。索马里于2002年中断了本土WPV传播，一年后从脊灰流行国家名单中除名，此后一直显示出其控制输入性脊灰疫情的能力。此次疫情再次表明，除非在其余脊灰流行国家中断脊灰传播，否则WPV输入导致大规模脊灰疫情的威胁将持续存在。
