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POLIOMYELITIS

Global Scenario Wild Poliomyelitis virus confirmed cases globally Total cases Globally In endemic countries In non-endemic countries Total in 2006 Total in 2007 Year-to-date 2008 1997 1869 128 1308 1201 107 191 184 7 Polio endemic countries: India.asp viewed on 25th March 2008 . Nigeria & Afghanistan http://www.polioeradication. Pakistan.org/casecount.

132 are from India • Asymptomatic individuals also excrete polio virus http://www.Indian Scenario Wild Poliomyelitis virus confirmed cases in India Year 2000 2001 2002 2003 2004 2005 2006 2007 Yeartodate20 08 265 268 1600 225 134 66 676 866 132 India • Year-to-date 2008.polioeradication.asp viewed on 25th March 2008 . 184 cases reported of wild poliomyelitis • Out of 184.org/casecount.

) Wild Poliomyelitis virus confirmed in India 1600 1600 http://www.polioeradication.org/casecount.asp viewed on 25 Mar 2008 No. of confirmed cases 1400 1200 1000 800 600 400 200 0 2000 2001 2002 2003 265 268 225 134 66 676 866 2004 2005 2006 2007 Year .Indian Scenario (contd.

Polio disease Clinical types of poliomyelitis Clinical types Features No symptoms Most common form Abortive Polio Aseptic meningitis Minor illness No neurologic symptoms Symptoms – mild transient muscle Weakness or paralysis Paralytic polio Virus in the CNS Meningel irritation Flaccid paralysis In case of flaccid paralysis.1 – 2% .gov/vaccines/pubs/pinkbook/downloads/polio.cdc.pdf viewed on 25 Mar 2008 Accounts for 95% Asymptomatic infection Minor viremia 4 – 8% 1 – 5% 0. bulbospinal accounts for 19% & bulbar accounts for 2% of paralytic cases http://www. spinal poliomyelitis accounts for 79%.

of doses 3 8 10-15 Type 1 73% 90% 99-100% Type 2 90% 90% 99-100% Type 3 70% 90% 99-100% *Provided efficacy & cold chain is maintained .Antibody titres following OPV No.

Endemic polio cases  Mostly Type 3 Few type 1 No case of Type 2   .

Efficacy of Trivalent & Monovalent Polio 100 80 60 40 20 0 50 90 75 60 90 99 % Protection tOPV mOPV Type 1 Type 2 Type 3 .

OPV has few shortfalls! Requires more than 15 doses Requires an efficient cold chain maintenance being highly thermolabile Requires more than 95% coverage Associated with VAPD (VDPV)     VDPV is a mutant Polio virus  cVDPV – circulating person-to-person  iVDPV – in immunodefficient  aVDPV – associated with outbreaks .

How to eradicate Polio from India Elimination – 1 year Eradication – 3 years         Requires more than 95% coverage with cold chain maintenance NID SNID MoP UP AFP Surveillance Mono OPV eIPV OPV + eIPV .

Result: 1 mth. 6: supplement 2 . of age Method: 3 doses of eIPV injected at a month’s interval.   Grenier B. Reviews of Infectious Diseases 1984.Immunogenicity & safety of IPV in infants All of the infants vaccinated with eIPV had significant serologic responses after 2 doses injected 1 mth apart & this response bore no relation to the level of maternally transmitted specific antibodies at the start of immunization  Objective: Open label study to test the tolerance & serologic potency of eIPV prepared from cultures of vero cells in 36 infants of 2 – 11 mths. all of the 36 infants had neutralizing antibodies against the 3 serotypes of polio virus with no difference between the titres after the 2nd & 3rd dose. after the 1st 2 doses of the vaccine. et al.

type II – 2.D antigen type I – 40. type II – 8.eIPV is best for 100% polio eradication! • eIPV is best for ‘immunodefficients’ Polio eradication has to be done in a phased manner OPV to be stopped gradually after achieving eradication • • Antigen concentration: IPV – D antigen type I – 20. type III – 4 eIPV . type III – 32 .

Use of eIPV  For eradication in endemic area With or without OPV With mono/trivalent polio   .

Scheduling eIPV with OPV eIPV can be started with OPV 2 – 3 doses of eIPV from 2 months – 2 years of age Next year – 2 – 3 doses below 1 year of age Next year – All 3 doses to all children & booster doses at 1 & a half and 5 years     .

Conclusion eIPV is –  Safe 100% effective No VDPV Good for immunocompromised Good for eradication Cost effective      .

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