POLIOMYEITIS

Polio myelitis

■ Acute viral infection by RNA virus of picorna viridae

■ Primarily affects alimentary tract
■ May infect the CNS
Epidemiological factors
Agent factors
■ Agent :polio virus ;3 serotypes: 1, 2 ,3
■ Reservoir : man
■ Infectious material: faeces and oro-pharyngeal secretions
■ Period of communicability: 7-10 days before and after symptoms onset
Host factors
 Age : all ages, more in children (3-6 years)
 Sex: males are more affected
 Immunity: following infection is fairly solid
Environmental factors: rainy season ( sources: contaminated food, water and flies)
Mode of transmission

■ Faecal-oral route : direct or indirect transmission

■ Droplet infection: occur in acute phase
Incubation period:
 7-14 days
Clinical spectrum
■ Inapparent infection: no presenting symptoms. Recognition by virus isolation or rising antibody
titre
■ Abortive polio/ minor illness: mild self –limiting illness due to viraemia. Recovers quickly
■ Non-paralytic polio: stiffness and pain in the neck and back. Lasts 2-10 days. Rapid recovery
■ Paralytic polio: predominant sign is asymmetric flaccid paralysis. Malaise, anorexia, nausea,
vomiting, headache, sore throat, constipation and abdominal pain and signs of meningeal irritation
1. tripod sign
2. descending paralysis
Classified as,
 Spinal polio: asymmetric paralysis involving legs
 Bulbar polio: weakness of muscles innervated by cranial nerves
 Bulbo spinal polio: combination of bulbar and spinal polio
Treatment

■ No cure
■ Heat and physical therapy
■ Antispasmodic drugs relax muscles
 Prevention
■ Inactivated polio vaccine (salk) : IM ( IPV) or intra dermal (Fipv)
4 doses
Protection against paralytic polio, do not prevent reinfection of gut by wild virus
safe to administer
 Sabin (oral) : discovered by SABIN. It contains 3 types of live viruses
UIP: 3 doses at 1 month interval,first-6 weeks. Zero dose at birth
2 drops given by mouth.
Infect the intestinal epithelial cells.-to payers patches-circulating antibodies.
Excreted in faeces_herd immunity develops
Advantages:
Contraindications : leukemia, malignancy.
Complications : vaccine associated paralytic polio
Differences between IPV and OPV
■ IPV ■ OPV

Killed formalized Live attenuated virus

Given sub-Q or IM Given orally

Induces circulating antibody ,no local
antibody
Not useful in controlling epidemic
More difficult to manufacture
Costlier
Not require stringent conditions for
storage and transport
Both humoral and intestinal immunity
Induces antibodies quickly
Prevents paralysis and intestinal
reinfection
Effectively used in epidemics
Easy to manufacture
Cheaper
Storage and transport in sub-zero
temperatures
Fractional dose IPV

■ Alternative to full dose IM

■ 2 doses of Fipv at 6 and 14 weeks intradermally
■ Produces more immunogenicity than single dose at 14 weeks
Polio eradication strategies in India
■ PPI every year
■ Sustain high levels of routine immunization
■ Surveillance of AFP
■ Ensure rapid case investigation
■ Follow –up of AFP at 60days
■ Conduct outbreak control
Single case-outbreak and reporting of AFP under 15 years of age
Line listing of cases: to avoid duplication
Mopping up: last stage in eradication. Door to door immunization in case of WPV
PPI: First in 9th DEC 1995 and 20th Jan 1996. targeted all children under 3yrs irrespective of
their immunization status. Extra doses.
VVM IN 1998
Polio eradication and end game strategic
plan 2013-2018
■ To stop the use of OPV world wide and to introduce at least 1 dose of IPV starting with
making OPV bivalent.
■ By end of 2015, introduce at least 1 dose IPV at least 6months before switch from
trivalent to bivalent
■ During 2016, switch from trivalent to bivalent
■ Plan for eventual withdrawal