POLIO MYELITIS

SUBMITTED BY- KUMKUM PANCHOLI

SUBMITTED TO- DR. SHILPA WALKIKAR
ROLL NO- 20
BAMS 3RD YEAR
INDEX
 History
 Prevalence
 Types of polio virus
 Incubation period
 Vaccine
 OPV
 IPV
 OPV Vs IPV
 VAPP
 Diagnosis
 Differential diagnosis
 Treatment
 Post polio syndrome
 Pulse polio program
 Indradhanush program
Introduction

Origin:
Polios means grey and myelos means spinal cord

Definition:
Poliomyelitis or Polio is an infectious viral disease caused
by polio virus that affects the central nervous system
leading to muscle weakness and flaccid paralysis.

causing agent:
Enterovirus

Route:
Feco-oral route
HISTORY
Prevalence across the globe
Immunization across the globe
Prevalence in India
STRUCTURE-

Poliovirus is composed of an
RNA genome and a protein
capsid.
-The genome is a single stranded
positive-sense RNA
genome that is about 7500
nucleotides long.
-The viral particle is about 30
nm in diameter
-Icosahedral symmetry
-Non enveloped
 TYPES OF POLIO VIRUS
The three serotypes of poliovirus, PV1, PV2, and PV3, each
have a slightly different capsid protein. Capsid proteins define
cellular receptor specificity and
virus antigenicity.

-Type 1 (also known as Brunhilde), As of November 2014, wild PV1 is

highly localized to regions in Pakistan and Afghanistan. It is the type most
often isolated
-Type 2(Lansing), Wild PV2 was declared eradicated in September 2014
after last being detected in October 1999 in Uttar Pradesh, India.
-Type 3 (Leon), As of November 2014, wild PV3 has not been seen since its
2012 detection in parts of Nigeria and Pakistan.

They got their names from the cases in which they were first
isolated.
HOST

Age
Most vulnerable- 6 months to three years

Sex
M: F ratio 3:1

Immunity
-First 6 months maternal antibody Acquired –
through infection with the wild virus
-Immunization
ENVIRONMENT

-Seasonal
-More during rainy season

-Environmental sources of infection

-Contaminated water and food flies
-Overcrowding and poor sanitation
Incubation
.
.
Paralytic poliomyelitis

There are three types of paralytic poliomyelitis:

Spinal

Bulbar Bulbospinal
 PREVENTION IS
BETTER THAN CURE
WHY THERE IS A NEED OF VACCINE ?

-Polio (poliomyelitis) mainly affects children under

5 years of age.
-1 in 200 infections leads to irreversible paralysis.
Among those paralyzed,5% to 10% die when their
breathing muscles become immobilized.
-Polio cases have decreased by over 99% since
1988, from an estimated of 350,000 cases then, to
74 reported cases in 2015. The reduction is the
result of the global effort to eradicate the disease.
 Polio virus vaccine

-Oral polio vaccine or OPV

-Inactivated polio virus or IPV

OPV (Oral Polio Vaccine /Sabin Vaccine)
 Vial with specific dropper
 Contents- sabin live attenuated polio virus strain
 Conc- per dose Type I -
Type II -
Type III -
 Ideal dose on initiating- at birth ( recommended by WHO )
 Schedule- 3 dosage ( at 4-8 weeks interval)
 Boosters – 2 (1st at 1.5 yr 2nd at 4-5 yr )
 Dose – 2 drops
 Route – oral
 Site of administration – N/A
 Preparation of site – N/A
 Instruction to mother – none
 Efficacy – 100% almost
 Contraindication – immunocompromise host , his family members
 Side effect – none
 Complications – vaccine induced polio myelitis
STORAGE

 When not in use – 2-4° C ( uppermost compartment of refrigerator )

 During immunisation – on icepacks
 During electricity failure – in ice box
 IPV( Inactivated Polio Myelitis Vaccine/ Killed
Vaccine / Salk’s Vaccine )

 Contents – Type I – 40 D
Type II – 8D
Type III – 32 D
 Ideal age of initiation – 6 weeks
 Schedule of primary vaccination – 3 dose (at 4-8 weeks interval )
 Boosters -2 ( 1st at 1.5 yr 2nd at 5 yr )
 When recommended – routine immunization , immunocompromise host
 Route – intramuscular , deep intramuscular
 Site – anterolateral aspect of thigh
 Preparation of site – clean site with spirit
 Instructions to mother – none
 Efficacy – 90-100 %
 Contraindications – none reported yet
 STORAGE

 When not in use – 2-8° C ( lower compartment of refrigerator )

 During immunisation – kept vaccine vial at room temperature
 During electricity failure – in cool box
HEAT MARKER
 OPV & IPV DIFFERENCE
OPV
 Contains life attenuated virus
 Route oral
 Easy to manufacture less virus
content and is cheaper
 Useful in epidemic situation
 Prevents paralysis and reinfection
 Immune gut also
 can occur
Storage and supply at 0° C
 Short shelf life
IPV
 Contains killed virus
 Route intramuscular
 Difficult to manufacture
 Virus content is 10000 more and
costlier
 Not useful in epidemics
 Prevents paralysis but reinfection
 Not give gut immunity
 Easy storage and supply
 Has longer shelf life
 VAPP
The major risks of OPV vaccination are the appearance of
Vaccine-Associated Paralytic Poliomyelitis cases (VAPP) and
the emergence of Vaccine Derived Polioviruses strains
(VDPV).

The VDPV strains could be circulant (cVDPV, which can spread

in populations with low level of vaccine coverage), could emerge
after replication in immunodeficient persons exposed to OPV
(iVDPV), or could be ambiguous VDPV (aVDPV, when they
are isolated from immunocompetent persons or the
environmental source has not been identified).
 LATEST RECOMMENDED USE

-An increasing number of industrialized, polio-free countries

are using IPV as the vaccine of choice. This is because the
risk of paralytic polio associated with continued routine use of
-OPV is deemed greater than the risk of imported wild virus.
However, as IPV does not stop transmission of the virus, OPV
is used wherever a polio outbreak needs to be contained,
even in countries which rely exclusively on IPV for their
routine immunization programme.

-WHO also recommends that all countries currently using only

OPV add at least 1 dose of IPV to the schedule.
-Once polio has been eradicated, use of all OPV will need to
be stopped to prevent re-establishment of transmission due to
VDPVs.
Diagnosis

History
Clinical examination
Stool examination
CSF examination
Serological tests
Stool examination
collection of sample:

two samples- 24 hours apart

within 14 days of onset of paralysis
collect in a clean and wide mouth bottle with screw
cap
sample to be stored below 8 degree Celsius.
CSF examination
Serological tests
For the detection of 3 types of antibody in the
sample:

Neutralizing antibodies IgG

antibodies of C antigens IgM
anti-D antibodies
Differential Diagnosis
Most common:
GB syndrome
Transverse myelitis

Others:
Traumatic neuritis
Meningitis
Encephalitis
Diphtheria
Botulism
TREATMENT

Bed rest
Relief of pain and spasm of muscles
Neutral positioning of the limbs
Physiotherapy
Good Nursing
Bed Rest
Essential during acute phase as physical activities and
traumas increase the risk of paralytic polio

posture should be changes every 2-3 hours to eliminate the

chance of bed rest prone wounds.

Child to be placed on stomach for short periods each day to

prevent pneumonia.
Optimum position for limbs:

Hip- slight flexion

Knee- 5 degree flexion
Foot- 90 degree support against
the sole

Pain Relief and management:

Hot moist pack applied to muscles to
relieve spasm and pain

Analgesics
PHYSIOTHERAPY

 METHOD
• Joints & paralyzed muscles – moved
passively through full range
• For 10 min , 2-3 times/day
 BENEFITS
• Prevents deformities and contracture
• Promote development of muscle power in
non-paralyzed muscles
GOOD NURSING

Diet:
Nutritious , balanced & wholesome
In non paralytic polio- normal diet
In paralytic-Fed by Ryle’s tube

In dysphagia pt. nursed in prone position with foot

end raised – gravity drainage of pooled secretions
in pharynx
Respiratory failure : Tracheostomy
assisted respiration with mechanical ventilator
REHABILITATION

PHYSICAL
EMOTINAL AND PSYCHOLOGICAL
SOCIAL
COMPLICATIONS

Myocarditis -
Hypertension
Pulmonary edema
Pneumonia
Urinary tract infections

Skeletal deformities –
equinus foot
scoliosis
osteoporosis
bone fractures
Compression neuropathy
PROGNOSIS

Non paralytic cases – complete recovery

Paralytic polio – permanent weakness in 2/3rd
cases
Worse – older children
sudden onset of illness with high fever
 POST-POLIO SYNDROME
Observed in people who had polio during their childhood.
Affects about 25-50 % of the polio survivors.
More common in females
-General fatigue
-muscular weakness
-joint pain
-breathing problems are seen in affected
 PULSE POLIO PROGRAMME

History
In India, vaccination against polio started in 1978 with Expanded
Program on Immunization (EPI). By 1984, it covered around 40% of
infants, giving three doses of OPV to each.

In 1985, the Universal Immunization Program (UIP) was launched to

cover all the districts of the country. UIP became a part of child survival
and safe motherhood program (CSSM) in 1992 and Reproductive and Child
Health Program (RCH) in 1997. This program led to a significant increase in
coverage, up to 95%. The number of reported cases of polio also declined from
28,757 during 1987 to 3,265 in 1995.

In 1995, following the Global Polio Eradication Initiative of the World Health
Organization (1988), India launched Pulse Polio immunization program with
Universal Immunization Program which aimed at 100% coverage.
KEY OBJECTIVES

The Pulse Polio Initiative (PPI) aims at covering every individual in

the country. It aspires to reach even children in remote
communities
through an improved social mobilization plan.
Not a single child should miss the immunization, leaving no
chance of
polio occurrence.
Cases of acute flaccid paralysis (AFP) to be reported in time and
stool specimens of them to be collected within 14 days.
Outbreak response immunization (ORI) to be conducted as early
as
possible.
Maintaining a high level of surveillance.
Performance of good mop-up operations where polio has
disappeared.
STEPS

-Setting up of booths in all parts of the country.

-Initializing walk-in cold rooms, freezer rooms, deep
freezers, ice-lined refrigerators and cold boxes for a steady
supply of vaccine to booths.
Arranging employees, volunteers, and vaccines.
-Ensuring vaccine vial monitor on each vial.
-Immunizing children with OPV on national immunization
days.
-Identifying missing children from immunization process.
-Surveillance of efficacy.
-Publicity was extensive and included replacing the
national telecoms' authority ringtone with a
vaccination day awareness message, posters, TV and
cinema
-spots, parades, rallies, and one-to-one
communication from volunteers.
Two million healthcare workers and US$2.3 billion
in government funding went into the campaign.

DIFFICULTIES
Testing showed that three doses of vaccine was
enough to protect children in developed countries,
but it became obvious that this was not enough in
some areas of India.
The Ministry of Health and Family Welfare recommended
eight to ten doses for each child.

Children in some areas of India are weaker and often had

diarrhoea, which reduced the efficiency of the vaccine.
Open defecation, monsoon flooding, and a lack of water
treatment made it easier for a child to swallow more polio
virus. As a result, children with too few doses of vaccine
were not fully protected and sometimes got polio.

The eradication program therefore gave drops over and

over again, to boost children's immunity higher and as a
precaution against missed children
ELIMINATION OF POLIO IN INDIA

The last reported cases of wild polio in India were in

West Bengal and Gujarat on 13 January 2011.

On 27 March 2014, the World Health Organization

(WHO) declared India a polio free country, since no
cases of wild polio had been reported in for three
years.

Only Afghanistan, Nigeria and Pakistan have wild

polio Cases
INDRADHANUSH PROGRAMME

LAUNCH DATE
Mission Indradhanush is a health mission of the government of
India. It was launched by Union Health Minister J. P. Nadda on 25
December 2014.

Objective
Aims to cover all those children by 2020 who are either
unvaccinated, or are partially vaccinated against 7 vaccine
preventable diseases
The diseases are – diphtheria, whooping cough, tetanus, polio,
tuberculosis, measles and hepatitis-B
The government's ambitious ‘Mission Indradhanush’
programme, which provides immunization against seven life
threatening diseases, as four new vaccines have been added
into it.
Four new vaccinations - rotavirus, measles rubella,
inactivated polio vaccine bivalent and Japanese Encephalitis
are added.
REFERRENCES

 www.cdc.gov
 www.nhp.gov.in
 www.wikipedia.org
 www.ncbi.nih.com
 www.healthline.com
 www.medicalnewstoday.com
 www.nhs.uk.com
 www.who.int.com
THANK YOU