Progress toward poliomyelitis eradication--poliomyelitis outbreak in Sudan, 2004.

After the World Health Assembly of the World Health Organization (WHO) resolved in 1988 to eradicate poliomyelitis globally, the number of countries in which polio is endemic declined from 125 to six by 2003. However, in 2004, polio cases caused by wild poliovirus (WPV) originating from northern Nigeria were reported in 11 countries--Benin, Botswana, Cameroon, Guinea, Mali, Saudi Arabia, Burkina Faso, Central African Republic, Chad, Cote d'Ivoire, and Sudan--reestablishing transmission in the latter five countries. Sudan, a member state of the WHO Eastern Mediterranean Region, initiated poliomyelitis eradication activities in the northern area of the country in 1994 and in the south in 1998. Since 1998, Sudan has made substantial progress in implementing polio eradication strategies, with no WPV reported from May 2001 through April 2004. However, in May 2004, a WPV case was detected in West Darfur, and a polio outbreak is currently affecting 17 of the country's 26 states. This report describes the outbreak and response and provides an update on acute flaccid paralysis (AFP) surveillance and supplementary immunization activities (SIAs) in Sudan. The outbreak underscores the importance of continued SIAs in polio-free countries with low routine vaccination coverage, even in areas with moderate to low population density, as well as the need to ensure uniformly high-quality AFP surveillance.