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Geneva, Switzerland, World Health Organization [WHO], Stop TB Department, 2003.  p. (WHO/CDS/TB/2003.319; WHO/HIV/2003.01)The main aim of the guidelines is to enable the central units of national TB and HIV/AIDS programmes to support districts to plan, coordinate and implement collaborative TB/HIV activities. The guidelines are intended for countries with either an overlapping TB and HIV epidemic or where there is an increasing HIV rate which may fuel the TB epidemic. The WHO “Strategic Framework to Reduce the Burden of TB/HIV" provides the evidence base for these guidelines. The guidelines are designed to implement the interventions as described in this framework. The guidelines reflect lessons learned from TB/HIV field sites including ProTEST with experience from comprehensive TB/HIV health services and interventions. The guidelines are structured in line with the main theme of putting these interventions into action: what to implement, how to implement it and by whom. The health situation is urgent and requires a move away from small scale, often costly and time-limited pilot projects to phased implementation of collaborative TB/HIV activities. Phased implementation will build on experience learned form ProTEST pilot sites. Human and financial constraints make phased implementation necessary. (excerpt)
Harare, Zimbabwe, WHO, Regional Office for Africa, 2003 Sep. xi, 56 p.A detailed review of the HIV/AIDS situation and surveillance practices in the 46 countries of the WHO African Region was published in 20001. The current report presents an update of the HIV/AIDS epidemic in the WHO African Region based predominantly on data from country surveillance reports produced for 2001 and 2002. Additional data included in the report are from population-based surveys and selected research studies. The report does not provide HIV/AIDS estimates, but presents a synthesis and analysis of data generated by existing surveillance systems. The focus of the report is on the assessment of trends in HIV prevalence within countries and sub-regions. In addition, data are presented on the current situation and trends in sexually transmitted infections and sexual behaviour, which are both part of comprehensive HIV surveillance systems. The report is comprised of two parts. Part I presents a comprehensive review of the most recent data in the WHO African Region as a whole. It also provides data by sub-region with the exception of the Indian Ocean sub-region where no data for the last two years were available. Part II is published separately and consists of country profiles that include brief descriptions of the most recent data and trends, with a focus on young people. (excerpt)
VIDAS. 1999 Jan; 2(12):5-8.According to the most recent estimates of the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO), at the end of 1998 the number of people living with HIV (the virus that causes AIDS) will have grown to 33.4 million, 10% more than just a year earlier. The epidemic has not been controlled anywhere. In practically all countries of the world, new infections occurred in 1998. (excerpt)
Anti-tuberculosis drug resistance in the world. Third global report. The WHO / IUATLD Global Project on Anti-Tuberculosis Drug Resistance Surveillance, 1999-2002.
[Geneva, Switzerland], World Health Organization [WHO], WHO / IUATLD Global Project on Anti-Tuberculosis Drug Resistance Surveillance, . 129 p.This is the third report of the WHO/IUATLD Global Project on Anti-Tuberculosis Drug Resistance Surveillance. The two previous reports were published in 1997 and 2001 and included data from 35 and 58 settings respectively. The main conclusions of the two previous reports were that drug-resistant tuberculosis (TB) was present in all settings surveyed, multi-drug resistance (MDR) was identified in most settings, and that good TB control practices were associated with lower or decreasing levels of resistance. The goal of the third report is to expand knowledge of the prevalent patterns of resistance globally and explore trends in resistance over time. This report includes new data from 77 settings or countries collected in the third phase of the project, between 1999 and 2002, representing 20% of the global total of new smear-positive TB cases. It includes 39 settings not previously included in the Global Project and reports trends for 46 settings. Data were included if they adhered to the following principles: (1) the sample was representative of all TB cases in the setting under evaluation; (2) new patients were clearly distinguished from those with previous treatment; and (3) optimal laboratory performance was assured and maintained through links with a supranational reference laboratory (SRL). Data were obtained through routine or continuous surveillance of all TB cases (38 settings) or from specific surveys of sampled patients, as outlined in approved protocols (39 settings). Data were reported on a standard reporting form, either annually or at the completion of the survey. (excerpt)
Generic protocol to estimate the burden of Shigella diarrhoea and dysenteric mortality. Field test version, May 1999.
Geneva, Switzerland, World Health Organization [WHO], Department of Vaccines and Biologicals, 1999. 37 p. (WHO/V&B/99.26)The WHO Department of Vaccines and Biologicals (V&B) has an increasing interest in vaccines against Shigella, and several candidate vaccines are being tested in clinical trials. The promise of having a new generation of vaccines available in the relatively near future emphasizes the need to understand the disease burden and the epidemiology of Shigella infection in developing countries. The V&B Steering Committee on Epidemiology and Field Research and the V&B Steering Committee on Diarrhoeal Disease Vaccines jointly identified the need for a practical method for immunization programme managers and clinical epidemiologists to assess the local disease burden due to Shigella. At the request of these Steering Committees, this generic protocol was prepared by staff at the U.S National Institute of Child Health and Human Development, the University of Maryland, and the U.S. Centers for Disease Control and Prevention. This protocol provides a general outline for a study and describes the main procedures involved. However, it will need to be adapted to the local setting, and details of field work and operational procedures should be added by local investigators with experience in conducting field studies of diarrhoeal diseases. WHO provides this protocol free-of-charge. In return, WHO would appreciate being informed about studies conducted using this protocol. This WHO document should be referenced in any publication resulting from its use. Comments or suggestions for improving this generic protocol are welcome and should be sent to the Department of Vaccines and Biologicals, WHO, 1211 Geneva 27, Switzerland. (excerpt)
Geneva, Switzerland, WHO, Division of Emerging and Other Communicable Diseases Surveillance and Control, 1998. 59 p. (WHO/EPI/GEN/98.09)Yellow fever is a viral haemorrhagic fever transmitted by mosquitos infected with the yellow fever virus. The disease is untreatable, and case fatality rates in severe cases can exceed 50%. Yellow fever can be prevented through immunization with the 17D yellow fever vaccine. The vaccine is safe, inexpensive and reliable. A single dose provides protection against the disease for at least 10 years and possibly life-long. There is high risk for an explosive outbreak in an unimmunized population—and children are especially vulnerable—if even one laboratory-confirmed case of yellow fever occurs in the population. Effective activities for disease surveillance remain the best tool for prompt detection and response to an outbreak of yellow fever especially in populations where coverage rates for yellow fever vaccine are not high enough to provide protection against yellow fever. The guidelines in this manual describe how to detect and confirm suspected cases of yellow fever. They also describe how to respond to an outbreak of yellow fever and prevent additional cases from occurring. The guidelines are intended for use at the district level. (excerpt)
International Coordinating Group (ICG) on Vaccine Provision for Epidemic Meningitis Control. Report of the ninth meeting, Ouagadougou, Burkina Faso, 15–16 December 2003. [Groupe de Coordination Internationale (GCI) sur l'Approvisionnement en Vaccins en vue de la Lutte contre la Méningite. Rapport de la neuvième réunion, Ouagadougou, Burkina Faso, 15-16 décembre 2003]
Geneva, Switzerland, World Health Organization [WHO], Department of Communicable Disease Surveillance and Response, 2004.  p. (Global Health Security. Epidemic Alert and Response; WHO/CDS/CSR/GAR/2004.17)At present, Aventis Pasteur has 50 million doses of bivalent vaccine in its stores. For 2004, the doses requested by the ICG will be available at US$ 0.27 per dose. GSK has produced 7,172,000 doses of trivalent vaccine, which will be available to the ICG at €1.00 per dose for 2004. For oily chloramphenicol, the International Dispensary Association’s (IDA) new facility in Malta has a production capacity of 660 000 vials per year, which will be available in 2004 at a similar price to 2003. Two important research studies were conducted during 2002–2003. A clinical equivalence trial undertaken by Epicentre concluded that ceftriaxone is a very good alternative treatment for epidemic meningitis – cheaper than oily chloramphenicol and also more effective against Streptococcus pneumoniae (Sp) and Haemophilus influenzae. However, before its widespread use as an alternative to oily chloramphenicol can be recommended, the impact of its introduction should be evaluated by the 13th Expert Committee on the Selection and Use of Essential Medicines. A study of the effectiveness of trivalent vaccine undertaken by WHO with the Centers for Disease Control and Prevention (CDC) estimated that the vaccine was 96% against Nm A+ W135 and 98% effective against Nm A alone. There were no evidence of adverse side-effects causally linked to the vaccine . Results from an immunogenicity study in Ghana are expected in 2004. Since inception of the ICG in 1997, its terms of reference have been revised at each annual meeting. Moreover, the ICG has been growing in scope and responsibility. Meeting participants concluded that a new structure was needed in order to adjust the role of the ICG according to its origin, as well as to respond to the increasing need for a forum to address various technical subjects on epidemic meningitis. (excerpt)
AIDS. 2004; 18 Suppl 3:S49-S53.The widespread use of any antimicrobial agent, including antiretroviral agents, has the potential to select drug-resistant populations of microorganisms. HIV drug-resistant strains have been recognized as a serious threat to the efficacy of current antiretroviral treatments and could jeopardize efforts to increase access to treatment in countries most affected by the HIV epidemic. The WHO Global HIV Drug Resistance Surveillance Programme aims at enhancing and enabling the response to the threat of antiretroviral drug resistance by assessing the geographical and temporal trends in HIV drug resistance, increasing our understanding of the determinants of HIV drug resistance, and identifying ways to minimize its appearance, evolution and spread. Based on a global network of experts and collaborating institutions, the programme is developing and field-testing tools and guidelines for the regular monitoring of the level and spread of HIV resistance, particularly in treatment-naive patients. Although relevant progress has been made, several important challenges still exist to the implementation of this essential and innovative programme. (author's)
Emerging Infectious Diseases. 1998 Jul-Sep; 4(3):398-403.A recent upsurge of malaria in endemic-disease areas with explosive epidemics in many parts of Africa is probably caused by many factors, including rapidly spreading resistance to antimalarial drugs, climatic changes, and population movements. In Africa, malaria is caused by Plasmodium falciparum and is transmitted by Anopheles gambiae complex. Control efforts have been piecemeal and not coordinated. Strategies for control should have a solid research base both for developing antimalarial drugs and vaccines and for better understanding the pathogenesis, vector dynamics, epidemiology, and socioeconomic aspects of the disease. An international collaborative approach is needed to build appropriate research in a national context and to effectively translate research results into practical applications in the field. The Multilateral Initiative for Malaria in Africa can combine all of the above strategies to plan and coordinate partnerships, networking, and innovative approaches between African scientists and their Northern partners. (author's)
Current Opinion in Obstetrics and Gynecology. 2004 Feb; 16(1):27-29.The issue of whether there might be an increased risk of cervical cancer associated with the use of oral contraceptives has been debated for decades. Early studies found a modest association with long-term use. A literature review was performed over the past 3 years, to establish whether there is any new evidence linking cervical cancer with the use of oral contraceptives. A new analysis from eight studies conducted by the International Agency for Research on Cancer and a systematic review of cervical cancer and the use of hormonal contraceptives are two recent major epidemiological links strongly suggesting the increased risk of cervical cancer (up to twofold), but only for women who were both long-term users (5 years or more) and who had persistent human papilloma virus infections of the cervix. These findings seem biologically plausible, but weighing the various risks and benefits, the World Health Organization does not recommend any change in oral contraceptive use or practice. (author's)
International Coordinating Group (ICG) on Vaccine Provision for Epidemic Meningitis Control. Report of the seventh meeting, Geneva, Switzerland, 18-19 September 2001.
Geneva, Switzerland, WHO, 2002. 52 p. (WHO/CDS/CSR/GAR/2002.2)The seventh meeting of the International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control (ICG) was held on 18 and 19 September 2001 at the Palais des Nations, Geneva at the invitation of the WHO. This ICG meeting follows a scientific consultation meeting on the emergence of Neisseria meningitidis serogroup W135 as a public health problem. Dr Guenael Rodier, Director of the WHO Department of Communicable Disease Surveillance and Response, welcomed the participants. In his opening address Dr Rodier outlined the structure and the successes of the ICG partnership. He underlined some of the challenges that had arisen in recent times: the global vaccine shortage and the misunderstanding of countries about the goal of the ICG, which is to facilitate the timely supplies from a global buffer stock upon urgent request from countries affected by epidemic meningococcal disease. Although epidemic meningococcal disease is not one of the three priority communicable diseases for WHO, namely tuberculosis, HIV/AIDS and malaria, it remains a major public health problem in the African meningitis belt area. Disappointment was expressed that major vaccine manufacturers were absent from the meeting, however the report of the meeting will be shared with them and communications with these manufacturers will continue. The preliminary agenda was adopted by the meeting. Dr. Max Hardiman was elected chairman, with Steve Edgerton as rapporteur. (excerpt)
Lancet. 2004 May; 4(5):262-263.In May 1988, the WHO decided to embark on the eradication of poliomyelitis by the year 2000. Due to changing epidemiology, polio was causing large outbreaks in many developing countries such as Jordan, and the infectious agent causing the disease fulfilled the criteria for an eradicable agent. Polio was believed to be eradicable because the poliovirus infects only human beings in nature causing a recognisable, although not diagnostic, clinical entity—namely acute flaccid paralysis (AFP)—it does not lead to a chronic carrier state, it is readily identifiable as a causative agent of the disease by simple laboratory tests, and, most importantly, it is easily controlled in endemic and epidemic situations by a widely available and affordable vaccine that leads to lifelong immunity. (excerpt)
Geneva, Switzerland, WHO, 2004. 60 p.By tracking the past course of the HIV/AIDS epidemic, warning of possible future spread and measuring changes in infection and behaviour over time, second- generation surveillance is designed to produce information that is useful in planning and evaluating HIV/AIDS prevention and care activities over time. This objective has been met in many countries, where useful, high-quality data are now available. Nevertheless, a gap remains between the collection of useful data and the actual use of these data to reduce people's exposure to HIV infection and to improve the lives of those infected. More effort has been put into improving the quality of data collection than into ensuring the appropriate use of data. Collecting high-quality data is an important prerequisite to using them well, but why are available data not used better? One reason is that surveillance systems are often fragmented. This means that many departments or groups are responsible for various aspects of data collection. Each considers its job done after it has held its own "dissemination workshop". No single entity is responsible for compiling all the data, analysing them and presenting them as a cohesive whole. Further, very few countries budget adequately for analysing, presenting and using data, either the financial or human resources. When financial resources are allocated, people often underestimate the skills and time required to use data well. Many surveillance officials responding to an informal WHO/UNAIDS survey gave one final reason: they simply do not know how to use the data. This is hardly surprising: most people responsible for surveillance systems are physicians and public health professionals who are good at interpreting trends in disease but who have limited training in the different ways HIV surveillance data can be used to improve programming, measure the success of prevention, lobby for policy change and engage affected communities in the response. This publication aims to provide guidance in these areas. It discusses the three major areas of data use: programme planning, programme monitoring and evaluation and advocacy, giving examples of how data can be used effectively in these contexts. The publication concentrates on the mechanics of using data: not just what can be done with data but how it can be done. How can data be packaged for different audiences? Who should be involved in dissemination? What makes a good press release? What steps are required to produce a national report? Practical guidance is given on how to develop interesting and persuasive presentations and how to present data effectively. Suggestions are made for bringing together programme planning and advocacy. Different countries have different epidemics, different surveillance systems and different data use needs. It is hoped, however, that all countries can find some general principles that will provide pointers on how to improve performance in areas of data use relevant to them. (excerpt)
Clinical Infectious Diseases. 2003 Jan 15; 36 Suppl 1:S24-S30.Resistance to antituberculosis drugs has been a problem since the era of chemotherapy began. After dramatic outbreaks of multidrug-resistant tuberculosis (MDR-TB) in the early 1990s, resistance became recognized as a global problem. MDR-TB now threatens the inhabitants of countries in Europe, Asia, Africa, and the Americas. An understanding of the molecular basis of drug resistance may contribute to the development of new drugs. Management of MDR-TB relies on prompt recognition and treatment with at least 3 drugs to which an isolate is susceptible. (author's)
Lancet. 2003 Sep 13; 362(9387):917.I find reassuring the fact that the Child survival series could constitute a renaissance in child-health matters, as suggested by Boniface Kalanda in the accompanying Debate section online. To remain quiet while 10 million children die every year, mostly in developing countries, is certainly unacceptable. (excerpt)
Lancet Infectious Diseases. 2003 Feb; 3(2):65.A 30-year campaign has successfully ended the blight of river blindness in west Africa. This monumental achievement is the result of the Onchocerciasis Control Programme (OCP), established in 1974 under the joint auspices of the United Nations Development Programme, World Bank, WHO, and the UN Food and Agriculture Organization. (author's)
AIDS Alert. 2003 Feb; 18(2):22.HIV prevention continues to offer the world's best hope in stopping the AIDS epidemic, and recent success stories in South Africa and Uganda prove that these work, according to the recent AIDS Epidemic Update report by UNAIDS and the World Health Organization (WHO) in Geneva, Switzerland. (excerpt)
Transmission intensity index to monitor filariasis infection pressure in vectors for the evaluation of filariasis elimination programmes.
Tropical Medicine and International Health. 2003 Sep; 8(9):812-819.We conducted longitudinal studies on filariasis control in Villupuram district of Tamil Nadu, south India, between 1995 and 2000. Overall, 23 entomological (yearly) data sets were available from seven villages, on indoor resting collections [per man hour (PMH) density and transmission intensity index (TII)] and landing collections on human volunteers [PMH and annual transmission potential (ATP)]. All four indices decreased or increased hand-in-hand with interventions or withdrawal of inputs and remained at high levels without interventions under varied circumstances of experimental design. The correlation coefficients between parameters [PMH: resting vs. landing (r = 0.77); and TII vs. ATP (r = 0.81)] were highly significant (P < 0.001). The former indices from resting collections stand a chance of replacing the latter from landing collections in the evaluation of global filariasis elimination efforts. The TII would appear to serve the purpose of a parameter that can measure infection pressure per unit time in the immediate household surroundings of human beings and can reflect the success or otherwise of control/elimination efforts along with human infection parameters. Moreover, it will not pose any additional risk of new infection(s) and avoids infringement of human rights concerns by the experimental procedures of investigators, unlike ATP that poses such a risk to volunteers. (author's)
Epidemiology of measles in the central region of Ghana: a five-year case review in three district hospitals.
East African Medical Journal. 2003 Jun; 80(6):312-317.Objective: As part of a national accelerated campaign to eliminate measles, we conducted a study, to define the epidemiology of measles in the Central Region. Design: A descriptive survey was carried out on retrospective cases of measles. Setting: Patients were drawn from the three district hospitals (Assin, Asikuma and Winneba Hospitals) with the highest number of reported cases in the region. Subjects: Records of outpatient and inpatient measles patients attending the selected health facilities between 1996 and 2000. Data on reported measles eases in all health facilities in the three study, districts were also analysed. Main outcome measures: The distribution of measles eases in person (age and sex), time (weekly, or monthly, trends) anti place (residence), the relative frequency, of eases, and the outcome of treatment. Results: There was an overall decline in reported eases of measles between 1996 and 2000 both in absolute terms and relative to other diseases. Females constituted 48%- 52% of the reported 1508 eases in the hospitals. The median age of patients was 36 months. Eleven percent of eases were aged under nine months; 66% under five years and 96% under 15 years. With some minor variations between districts, the highest and lowest transmission occurred in March and September respectively. Within hospitals, there were sporadic outbreaks with up to 34 weekly eases. Conclusion: In Ghana, children aged nine months to 14 years could be appropriately targeted for supplementary, measles immunization campaigns. The best period for the campaigns is during the low transmission months of August to October. Retrospective surveillance can expediently inform decisions about the timing and target age groups for such campaigns. (author's)
American Journal of Clinical Nutrition. 2003 Aug; 78(2):291-295.Background: Opinions and recommendations about the optimal duration of exclusive breastfeeding have been strongly divided, but few published studies have provided direct evidence on the relative risks and benefits of different breastfeeding durations in recipient infants. Objective: We examined the effects on infant growth and health of 3 compared with 6 mo of exclusive breastfeeding. Design: We conducted an observational cohort study nested within a large randomized trial in Belarus by comparing 2862 infants exclusively breastfed for 3 mo (with continued mixed breastfeeding through = 6 mo) with 621 infants who were exclusively breastfed for = 6 mo. Regression to the mean, within-cluster correlation, and cluster- and individual-level confounding variables were accounted for by using multilevel regression analyses. Results: From 3 to 6 mo, weight gain was slightly greater in the 3-mo group [difference: 29 g/mo (95% CI: 13, 45 g/mo)], as was length gain [difference: 1.1 mm (0.5, 1.6 mm)], but the 6-mo group had a faster length gain from 9 to 12 mo [difference: 0.9 mm/mo (0.3, 1.5 mm/mo)] and a larger head circumference at 12 mo [difference: 0.19 cm (0.07, 0.31 cm)]. A significant reduction in the incidence density of gastrointestinal infection was observed during the period from 3 to 6 mo in the 6-mo group [adjusted incidence density ratio: 0.35 (0.13, 0.96)], but no significant differences in risk of respiratory infectious outcomes or atopic eczema were apparent. Conclusions: Exclusive breastfeeding for 6 mo is associated with a lower risk of gastrointestinal infection and no demonstrable adverse health effects in the first year of life. (author's)
Lancet. 2003 Jul 19; 362(9379):223-229.Trachoma is the most common infectious cause of blindness. It is caused by ocular serovars of Chlamydia trachomatis. Transmission is favoured in poor communities, where crowding is common and access to water and sanitation inadequate. Repeated reinfection over many years causes dense scarring of the upper eyelid. The resultant inversion of the lashes abrades the eyeball, and the abrasion leads to corneal opacification and visual impairment. The host immune response is probably at least partly the cause of this process. The “SAFE” strategy is used for the control of trachoma: surgery for inturned lashes, antibiotics for active disease, facial cleanliness, and environmental improvement. The demonstration that a single oral dose of the antibiotic azithromycin is as effective as 6 weeks of topical tetracycline was an important advance in trachoma control. By means of the SAFE strategy, WHO and its partners aim to eliminate trachoma as a public-health problem by the year 2020. (author's)
African countries to cooperate on epidemic control. Experts hope that sharing expertise and resources will help control disease outbreaks in the region.
Lancet. 2003 Jul 19; 362(9379):222.Six countries of the Africa Great Lakes sub-region have signed an agreement to cooperate on the prevention and control of epidemics and diseases that can be prevented by vaccination. Their health ministers signed the protocol of cooperation in the Ugandan capital, Kampala, on June 27. According to a 14-page document the six ministers released jointly, the countries would share epidemic information across borders, harmonise treatment policies and protocols, and standardise laboratory procedures and techniques. They also agreed to coordinate mass vaccination activities, implement joint activities aimed at eliminating measles, vitamin A deficiencies, and maternal and neonatal tetanus. c(excerpt)
JAMA. 2003 Jul 16; 290(3):317-319.An epidemic of Ebola hemorrhagic fever has sputtered along unabated since October 2001 in the dense jungles that span the northern border between Gabon and Congo, raising questions about how health officials respond to outbreaks of the deadly infection. (excerpt)
Promoting behavior change in Botswana: an assessment of the Peer Education HIV / AIDS Prevention Program at the workplace.
Journal of Health Communication. 2003 May-Jun; 8(3):267-281.Botswana has the highest rate of HIV prevalence in the world and AIDS has now reached crisis proportions in the country. Among the initiatives implemented as a response, to promote sexual behavior change, is the Peer Education HIV/AIDS Prevention Program (PEHAPP) at the workplace. This paper assesses the impact and outcome of the PEHAPP. It concludes that the PEHAPP is having a measurable positive impact in the key areas of improving knowledge, attitudes, and practices related to risky sexual behavior which, in turn, should reduce the incidence of transmission of HIV/AIDS and other STDs over the long-term. (author's)
Importation and circulation of poliovirus in Bulgaria in 2001. [Importation et circulation du poliovirus en Bulgarie en 2001]
Bulletin of the World Health Organization. 2003 Jul; 81(7):476-481.Objective: To characterize the circumstances in which poliomyelitis occurred among three children in Bulgaria during 2001 and to describe the public health response. Methods: Bulgarian authorities investigated the three cases of polio and their contacts, conducted faecal and serological screening of children from high-risk groups, implemented enhanced surveillance for acute flaccid paralysis, and conducted supplemental immunization activities. Findings: The three cases of polio studied had not been vaccinated and lived in socioeconomically deprived areas of two cities. Four Roma children from the Bourgas district had antibody titres to serotype 1 poliovirus only, and wild type 1 virus was isolated from the faeces of two asymptomatic Roma children in the Bourgas and Sofia districts. Poliovirus isolates were related genetically and represented a single evolutionary lineage; genomic sequences were less than 90% identical to poliovirus strains isolated previously in Europe, but 98.3% similar to a strain isolated in India in 2000. No cases or wild virus isolates were found after supplemental immunization activities were launched in May 2001. Conclusions: In Bulgaria, an imported poliovirus was able to circulate for two to five months among minority populations. Surveillance data strongly suggest that wild poliovirus circulation ceased shortly after supplemental immunization activities with oral poliovirus vaccine were conducted. (author's)