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Volume 15, Number 11—November 2009

Synopsis

Public Health Response to Imported Case of Poliomyelitis, Australia, 2007

John A. CarnieComments to Author , Rosemary Lester, Rodney Moran, Lynne Brown, Julian Meagher, Jason A. Roberts, and Bruce R. Thorley
Author affiliations: Department of Human Services, Melbourne, Victoria, Australia (J.A. Carnie, R. Lester, R. Moran, L. Brown, J. Meagher); Victorian Infectious Diseases Reference Laboratory, Melbourne (J.A. Roberts, B.R. Thorley)

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Table 1

Summary of the public health response and the outcomes to the importation of wild poliovirus, Australia, July 2007*

"I would like to expand my network with women of substance
while keeping it classy and away from the usual club scene."
Persons investigated Response Outcome
Index patient Isolated in hospital after magnetic resonance image was suggestive of poliomyelitis. Discharged when 2 fecal specimens, collected at least 7 d apart, were negative for enterovirus by cell culture and RT-PCR (total of 34 d).
Household contacts 5 housemates, 1 visitor, and the housekeeper received IPV and placed in home quarantine under a Public Health Order. Recommend serum collection before vaccinating contacts to test for IgM against polio. Another friend who visited the residence of the index case was boosted with IPV only. Home quarantine lifted when 2 fecal specimens, collected 24–48 h apart, were negative for enterovirus by cell culture and RT-PCR. Housemates required support to ensure compliance, which included grocery deliveries, bill payments, and a range of other assistance.
Airplane contacts Media release informing public of imported case of polio and offer of vaccination for persons who disembarked in Melbourne. DHS provided with 235 Passenger Declaration cards of persons who disembarked in Melbourne. DHS undertook contact tracing of airplane passengers (Table 2). One teenage passenger hospitalized with fever and diarrhea. 10 persons not on the airplane manifest were vaccinated as their details could not be readily determined; 7 airport workers who cleaned the plane were vaccinated with IPV. Hospitalized passenger: single CSF and 3 fecal specimens (collected more than 24 h apart), were tested for enterovirus; CSF positive for enterovirus RNA by RT-PCR; all other tests negative by cell culture and RT-PCR.
Medical clinic contacts 14 staff members and 81 patients initially regarded as potentially at risk for exposure
Nine staff identified as at risk and offered vaccination with IPV. 24 patients and 6 relatives/friends identified as at risk and offered vaccination with IPV. Letters sent to a further 8 recommending vaccination. Adult patient later hospitalized with fever, gastrointestinal illness and general weakness and spouse had respiratory illness. Upon discharge, they were asked to remain at home pending specimen results. 7-y-old child was later hospitalized with seizures. Adult admitted to hospital and spouse: 2 fecal specimens, collected more than 24 h apart, negative for enterovirus by cell culture and RT-PCR. Child who was hospitalized: 1 CSF and a fecal specimen tested for enterovirus; CSF positive for enterovirus RNA by RT-PCR, fecal specimen negative for enterovirus by RT-PCR and cell culture.
Contacts at Box Hill Hospital 102 patients and 63 relatives/friends from either the Emergency Department or the Ward were identified as at risk: 17 were not contactable; 37 were vaccinated by their own doctors; 83 HCWs were identified as at risk and vaccinated with IPV. Identification of 9 overseas-born HCWs without evidence of recent polio vaccination. Symptomatic HCW with back pain: single fecal specimen negative for enterovirus by RT-PCR and cell culture. HCWs without evidence of recent polio vaccination: 2 fecal specimens, collected more than 24 h apart, negative for enterovirus by RT-PCR and cell culture.

*IPV, inactivated polio vaccine; RT-PCR, reverse transcription–PCR; Ig, immunoglobulin; CSF, cerebrospinal fluid; HCW, healthcare worker.

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