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“EXCELLENCE THROUGH KNOWLEDGE” P A G E 50 Editor’s Note: This case study was published in the West Indian Medical Journal, Vol.57, No.5, Nov. 2008. mmol, CSF/6.1mmol blood glucose) and a CSF protein value of 0.1g/L. The whole blood WBC count was elevated at 17 900/mm3 with a differential of 62% neutrophils, 24.5% lymphocytes, 10.9% monocytes and 1% basophils. Viral cultures were positive for enterovirus in the CSF, throat and rectal swab. The isolates were initially identified by an indirect immunofluorescence assay (IFA) by Chemicon International®. Further typing by IFA confirmed the isolate as Polio type 2 virus. The isolate was subsequently characterized by molecular analysis as a derivative of the Sabin OPV vaccine. The child remained in hospital for seven days and recovered completely without complications at the time of discharge. Follow-up of this case, however, was not completed as a result of non-attendance to clinic appointments. Jamaica immunization coverage for polio was 84% as reported by the WHO in 2005. Prior immunization survey results in 1985 showed seropositive coverage of 81.4%, 94.7% and 72.3% for Polio types 1, 2 and 3 respectively in Jamaican children. Studies have confirmed the role of environmental surveillance of sewage from populations with high (>95%) immunity and have identified evolutionary clusters of VDPVs. These findings indicate the need to incorporate environmental surveillance in the overall polio surveillance system, particularly in countries in which the OPV vaccine is still in use. The tropical climate of Jamaica, deficiencies in the hygiene/sanitation environment, the continued use of the OPV and immunization coverage to polio less than 95% are critical risk factors for the evolution and circulation of cVDPV. The significance of the circulation of neuro-virulent cVDPVs in Jamaica must be addressed urgently. The finding of cVDPV as documented is indicative of possible gaps in the immunization coverage. Continued assessment of immunization coverage and immunization campaigns are essential if a goal of 95% polio vaccine coverage is to be achieved. Health Policy makers must aim to replace the OPV vaccine with the use of inactivated polio vaccine. Necessary economic and health budget adjustments need to be reviewed to ensure availability and accessibility of the IPV vaccine. Environmental surveillance for possible reservoirs of cVDPV need to be identified and continued community education, encouragement and rewards for compliance with health regulations may create a favourable working community response. Polio developed into a pandemic over a period of four hundred years, reaching its peak in the 1950s. Paralysis was the most significant feature of this pandemic, although it is known that paralytic poliomyelitis occurs in 0.1 – 2% of infected persons. Asymptomatic and non-paralytic poliomyelitis must have contributed significantly to the perpetuation of this disease. Achievement of the global eradication of Polio will necessitate increased consideration of risks associated with the potential transmission of non-paralytic neurovirulent cVDPV and the surveillance of such viruses in Jamaica and worldwide.