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2 : Polio Reemerges in the Americas: a Vaccine-Derived Outbreak in Hispaniola in 2000 and 2001
The strategies for polio eradication used in the Americas relied on the achievement and maintenance of high immunization levels in the population at risk and disease surveillance. The basic issue that needed to be addressed at the launch of the polio eradication initiative in the Americas was to determine the optimal strategy for achieving and maintaining high vaccination coverage. The results of vaccination program in Brazil were critical to the development of the approaches to be used in the different countries in the Americas. If the case was acute flaccid paralysis (AFP), it would be classified as probable poliomyelitis, and two stool specimens would be collected 24 h apart and sent to one of the laboratories included in a network of diagnostic laboratories that had been established. After 10 weeks, the case would be classified as confirmed poliomyelitis if the wild poliovirus had been isolated from the stools or if the patient had no adequate stool specimens and died within 60 days of the onset of symptoms or was not available for follow-up. Intensive case-finding activities were initiated to determine the extent and magnitude of the outbreak, to identify foci of disease activity, and to organize areas for vaccination activities. A special call was issued to countries in the Americas and worldwide to remain highly vigilant by maintaining high levels of oral polio vaccine (OPV) coverage and active surveillance throughout each country.