Jpn. J. Infect. Dis., 53, 2000

Laboratory and Epidemiology Communications

A Case of Poliomyelitis Associated with Infection ofWild Polibvirus
in qinghai Province, China, in October 1999
Yasuo Chiba*, Hitoshi Murakami, Makoto Kobayashi, Hiroyuki Shimizul ,Hiromu Yoshidal, Tetsuo Yoneyamal, Tatsuo Miyamural , Yu Jingjin2 and Zhang Libi3
Bureau ofInternational Cooperation, International Medical Center ofJapan,

Toyama I‑21‑1, Shinjuku‑ku, Tob70, 162‑8655,

JDepartment of Viy10logy II, National Instilule of Infectious Diseases,

Gakuen 4‑7‑1, Musashimurayama, Tob70, 208‑0011,
2Department of Diseases Control, Ministyy of Public Health,Xi Zhi Men Wai Nan Lu No 1, Xi Cheng District, Beljing, 100044 and3Department of Virology, Chinese Academy ofPrevenlive Medicine,Nan Wei Lu 27, Beljing, 100050, Peoples i Republic of China
Communicated by Hiroshi Yoshikura(Accepted July 14, 2000)

In China, case of poliomyelitis associated wim wild polio‑

EpidemiologlCal investlgations were perfわrmed in thevirus infection had not been identified for more than 3 years

Xunhua Sara ethnic minoritycounty and in neighboring areas
inhabited by the Sara people. Active surveillance was also
conducted in major medical facilities in Qinghai and 2 neigh‑boring provinces, Gansu and Ningxia, for the discovery andfollowlng‑uP Of under‑reported AFP cases. No evidence ofafter the detection of4 cross‑border cases from Myanmarin
1995 and 1996. However, a case ofwild‑virus poliomyelitis

was detected in qinghai province in northwestem China in
October 1 999 ( I). This report outlines the caseand the measurescontinued viral circulation was found. Wild polioviruses hadtaken in reaction to it.

TTle Patient was a 1 6‑month‑old boy of Sara etlmicancestry,

probably circulated in a restricted manner in Sara and otherwho resided in仇e autonomous Xu血ua Sara ethnic minority

Muslim ethnic minorities that frequently mIgrate between

county ofQinghai province. He had no history of immunization

Qinghai and the Tibetan border area and are known to haveby poliovims vaccine (OPV). In仇is county, approximately

lower immunization coverage than other ethnic populations.

60% orpopulation are Muslims, including the Sara ethnic

It is not known, however, when the wildtype poliovims wasminorlty. Coverage fわr 3 doses orOPV was estimated to beimported into the community and to what extent the virus

60% in this county according to surveys conducted after

circulated before infecting the boy.

detection of this patient. The patient and his family members

Asmentioned, China had already detected 4 cases imported

did not have a history oftravelling to neighboring polio‑endemic

intothe Yunnan border areas from Myarmar in 1 995 and I 996.

countries but had participated in a festival of the Sala people

Ou他reaks in Cana血as well as in Malaysla Were also due toheld 2 Weeks befわre development or polio in the child.

importation of polioviruses, which subsequently circulated

The child developed flaccid paralysis in theright leg in theamong people belonglng tO a Special religious communlty

presence offever on October 1 I, 1999. Type I polioviruses,(2,3). Thus, the cross‑border importation or poliomyelitis,which becomes a serious threat to the goal ofachievlng POlio

which were soon identified as wild viruses, were isolated fromeradication, may not be a rare event worldwide. We need tothe stools or仇is case and his contact. The analysts in temsof the sequences of 300 nucleotides in VPl reglOn demon‑
strated that the Qinghai strain was unrelated to viruses having
circulated in China until 1994, but was related to a group or

maintain good immunization programs and poliovirus
surveillance until the inte汀uption or poliovims circulation

has been achieved globally.

polioviruses in Myanmar, Bangladesh, and India (92%

genomic identity) (ngure). The closest link was obtained

Poliomyelitis eradication in China has been supported

between the Qinghai poliovirus and isolates in Madhya

strongly by仇e WHO, Japan (China Polio Control Prqject ofJapan Intemational Cooperation Agency), and the Centers for
Disease Control and Prevention (CDC) orthe US.
Viruses subjected to molecular analysts included isolates

Pladesh of india isolated in 1998 by the sequence relation‑
ships in VPl/2Ajunction region (98%) (016n 比ew, personalcommunication).

In December 1999 and January 2000, Qinghaiand 2 neigh‑provided by Dr. Jagadish Deshpande, Enterovirus Researchboring provinces, Gansu and Ningxla, COnducted Hmopplng‑up" immunization by OPV, followed by another session inCenter, Mumbai, India; Dr. HumayunAsghar, National lrutituteMarch in 12 provinces including Tibet and Xinjiang. TheNational Institute of Health, Nonthaburi(Bangkok), Thailand;

immunization coverage or the campalgn in January wasDr. Mohammed Moyez Uddin, Institute of Public Health,estimated to be very highaccording to quick surveys conductedDhaka, Bangladesh.

of Health, Islamabad, Pakistan; Dr. Yaowapa Pongsuwanna,

Surveillance activities in China were in part supported by(1).

grants‑in‑aid from the Minis廿y of Health and Welfare, Japan.

*ComSpOnding author: Fax: +81 3 3205 7860, E‑mail: ychiba@tkh. act.net.jp135Jpn. J. Infect. Dig., 53, 2000

0.1 3IJbJtltutlon I 81te

Figure･ Phylogenetic trees oftypel wild polioviruses isolated inAsia. The isolate kom the Sala child, Qinghai/China 99, wasmore closely related to viruses found in the group of countries in southernAsia, Myanmar, Bangladesh and India, than thosepreviously fわund in China.

2. World Health Organization (1993): WHO Expanded

REFERENCES

Programme on Immunization: wild poliovirus isolated

Teclmical Advisory Group onthe Expanded Programmein Alberta, 1993. Wkly. Epidemiol. Rec., 68, 235‑236.
3･ World Health Organization (1993): WHO Expanded

on Immunization and Poliomyelitis Eradication in theProgramme on Immunization: poliomyelitis outbreak,Western Pacific Region. April 2000. WPRO, Manila,Malaysla, 1992. Wkly. Epidemiol. Rec., 68, 297‑300.

1. World Health Organization (2000): 10仇Meeting of thePhilipplneS.

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