02/05/1443

Epidemiology & Control of

poliomyelitis

poliomyelitis
Infectious Agent
Poliovirus : Types I, II, III
Characteristics of the virus:
• The polioviruses are resistant to bile salts &
they are stable in acidic conditions.
• They survive for long periods at -20°c & for
years at -70°c.
• Rapidly inactivated by heat , formaldehyde ,
chlorine ,and ultra violate light ( U.V.L ) .

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Reservoir of infection
Humans
Mode of transmission
1. person – to – person (direct faeco – oral
route)
2. Ingestion of contaminated water & food.
3. Pharyngeal spread (air borne) in areas where
sanitation is good.

Incubation period
3 – 21 days ( average 10 days)
Clinical features
The disease may take one of the following forms:
1. Inapparent infection ( Asymptomatic
infection) in more than 90% of cases.
2. Non-paralytic febrile illness (Non specific
fever).

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3. Aseptic meningitis ( non paralytic poliomyelitis)

in about 1% of the cases.
4. Paralytic poliomyelitis in less than 1%.

Symptoms
Fever, malaise, headache, nausea & vomiting.
if the disease progress, stiffness of the neck with
or without paralysis .
• Case fatality for paralytic cases is 2 – 10 %, it
increases with age.

Factors which determine the development of

paralytic poliomyelitis
1) The state of immunity of the affected
individual
2) Trauma , excessive fatigue, pregnancy, and
intramuscular injection during the period of
acute febrile illness may precipitate paralysis
3) Tonsillectomy increases the risk of paralysis

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Characteristics of the paralysis

• Asymmetrical with fever present at the onset.
• The site of paralysis depends on the location
of nerve cell destruction in the spinal cord or
brain stem.
• The legs are affected more often than the
arms.
• Paralysis of the respiratory muscles lead to
death.

Diagnosis

• Clinical features.

• Isolation of the virus from stool, CSF or

nasopharyngeal secretions (cell culture).

• Detection of type specific antibodies.

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Period of communicability

• The virus is detected in throat secretions 36

hours after infection& in stool 72 hours after
infection in both clinical & in asymptomatic
cases.
• The virus persists in the throat for one week
and in the stool for 3 – 6 weeks.
• Cases are most infectious during the few
days before & the few days after onset of
symptoms.

Epidemiology

Poliomyelitis is about to be eradicated

worldwide.
 The disease has been eradicated in the western
hemisphere.
The disease is now limited to few developing
countries .
-The disease primarily affects children below
3 years of age.

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Control
I. General Preventive measures:
1. Sanitary disposal of human excreta
2. Health education to raise the standards of
personal hygiene
II. Specific preventive measures:
 Measures for Patients:
 Notification is very important
 Isolation of the patient is desirable

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 Disinfection and safe disposal of patients faeces and

pharyngeal discharges
 Treatment of patients
 Measures for Contacts:
 Surveillance of contacts for 3 weeks from their last
contact with the patient
 Vaccination with OPV
 Tonsillectomy & dental extraction should be postponed
when poliomyelitis epidemic is present and injections of
any kind reduced to the minimum
 Avoid over-exertion such as games and swimming.

Vaccination
Vaccination is the most effective method of
preventing poliomyelitis.
Two types of polio vaccines are available:
1- Oral Polio Vaccine (OPV) or Sabin Vaccine:
trivalent live attenuated vaccine.
 It contains all the three viruses
 3 doses are required at 6 – 8 weeks interval
 Induces both circulating antibodies &
intestinal immunity

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2- Injectable Polio Vaccine (IPV) or Salk

Vaccine:
injectable, inactivated polio vaccine.
 It contains all three polio viruses
 3 doses are required.
First 2 doses are given at 1 – 2 months
interval
3rd dose 6 – 12 months after the 2nd .
 Mainly induces circulating antibodies

• WHO recommends the use of OPV because:

1- low cost
2- Ease of administration
3- Capacity to provide population immunity
(immunizes some susceptible contacts through
secondary spread).

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Disadvantages of OPV

1) unstable especially in tropical climates

2) Interference by other enteric viruses
3) May cause paralytic poliomyelitis
Vaccine-Associated paralytic poliomyelitis
(VAPP).

Vaccine-Associated paralytic
Poliomyelitis = VAPP
The occurrence of clinical paralytic
poliomyelitis after the use of OPV
among vaccine recipients or among
their contacts

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VAPP

Vaccine recipients contacts of vaccine

recipients
1 / 2.4 million 1 / 5.9 million doses
doses
(mainly among adults)

with the first subsequent doses

dose
1/ 750,000 1/ 5.1 million
doses doses

Contraindications to OPV

1- Diseases associated with immune-

suppression e.g Aids, malignancy.
2- Presence of immunodeficcent individuals in
the household of vaccine recipients.
3- Diarrhoea is not a contraindication to OPV.

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Advantages of Salk Vaccine:

1) Safe
2) Stable
3) Induce reliable humoral immunity not affected
by other viruses
Disadvantages of Salk Vaccine:
1) Expensive
2) Administration by injection
3) High coverage is needed to protect populations

Recommended schedule
0 dose at birth
1st dose 2 months
2nd dose 4 months
3rd dose 6 months
1st booster dose 18 months
2ndbooster dose 4 – 6 years

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Polio Eradication Strategy

• In 1988 WHO declared (stated) the goal of
eliminating poliomyelitis in the World by the
year 2000
The strategy for eradication consists of the
following:
1. Achievement of high routine immunization
coverage with OPV
2. Supplementary immunization in the form of
National Immunization Days (NIDs)

3. Effective surveillance
4. Mopping up campaign: Door-to-door
immunization campaigns in areas where the
virus persists

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