Intestinal infections

• Intestinal infections are common diseases of

the digestive tract.
• It is a common illness with variety of causes
including viruses,bacteria and parasites.
 Intestinal infections
• Poliomyelitis
• Viral hepatitis
• Acute diarrhoeal diseases
• Cholera
• Typhoid fever
• Food poisoning
• Amoebiasis
• Ascariasis
POLIO

By Dr Maria Naeem
Poliomyelitis
 Polio
• Acute viral infection caused by RNA virus.
• Primarily a GIT infection.
• In 1% of cases, it affects CNS.
 Problem statement
• In pre-vaccination era – polio virus used to be
found in all countries of the world.
• 1988 – World Health Assembly adopted
resolution for the global eradication of polio.
• 1994 – Americas was the first to be announced
as polio-free.
• 2002 – Europe certified polio-free.
• 2014 – Only Three countries in the world left
where Polio is still endemic.
 Polio eradication and endgame
strategic plan (2013-2018)
• The plan has 4 objectives:
1) Detect and interrupt all polio transmission.
2) Strengthen immunization system and
withdraw OPV.
3) Containment and certification.
4) Legacy planning.
 Agent factors
• Agent – Poliovirus, three serotypes 1, 2 , 3. Most
outbreaks of paralytic polio are due to type -1.
• Transmission – faecal-oral route. In cold environment,
survives in water for 4 months and in faeces for 6
months.
• Reservoir – Man is the only reservoir. Most infections
subclinical which play a major role in spread of infection.
• Infectious material – Virus is found in faeces and
oropharyngeal secretions.
• Period Of Communicability – 7 to 10 days before and
after onset of symptoms.
 Host factors
• Age – Essentially a disease of infancy and
childhood.
• Sex – ratio of 3 males to one female.
• Risk Factors – fatigue, trauma, intramuscular
injections, operative procedures.
• Immunity: maternal antibodies gradually
disappear during 6 months of life.
 Environmental factors
• Polio is more likely to occur during the rainy
season (June to September).
• Environmental sources of infection are
contaminated water, food and flies.
• Polio virus survives for a long time in a cold
environment.
• Overcrowding and poor sanitation provide
opportunities for exposure to infection.
 Polio
• Mode of transmission – faecal-oral route,
spreads through infected fingers, contaminated
water, milk, food, flies; droplet infection.
• Incubation Period – 7 to 14 days (range 3 to
35 days).
Clinical spectrum
 Clinical spectrum
• Subclinical (Inapparent) infection – 95% of
poliovirus infection.No presenting symptoms.
• Abortive Polio(Minor illness) – occurs in 4 to
8% of polio infections, self-limiting.
• Non-paralytic Polio – Occurs in 1% of cases,
stiffness and pain in the neck and back.
Recovery is rapid.Disease lasts 2-10 days.
• Paralytic Polio – Occurs in less than 1% of
infections. Weakness of muscle or muscle
groups (flaccid paralysis).
 Other associated symptoms:
• Malaise
• Anorexia
• Nausea,Vomiting
• Headache,Sore throat,Constipation
• Signs of meningeal irritation(stiffness if neck
and back muscles)
• Tripod sign:Child finds difficulty in sitting and
sits by supporting hand at the back.By partly
flexing the hips and knees.
Paralytic polio
 Treatment
• No cure.
• Supportive treatment – good nursing care,
non-narcotic analgesics, hydration and proper
nutrition, respiratory support.
• Can only be prevented by immunization.
 Prevention
• Immunization
 OPV(oral polio vaccine) – called Sabin, easy
to give, cheaper, more effective, produces both
intestinal and systemic immunity.
 IPV (injectable polio vaccine) - costly, given
parenterally, produces only systemic
immunity, trained persons required for its
administration.
 Oral Polio Vaccine (OPV)
• It is recommended that OPV should be stored at -20
degree centigrade, but certain vaccine brands can
remain effective between the temperature of 2 to 8
degree centigrade.
• As the rural areas of Pakistan are suffering from regular
load shedding of 12-18 hours, this can affect the
storage of OPV.
 Epidemiological investigations
• The occurrence of a single case of polio is now
considered as an epidemic.
• Sample of faeces from all cases or suspected
cases.
POLIO - WORLD VS PAKISTAN

Pakistan is included in the countries of

the world where Polio is still endemic.
 Strategies for polio eradication
a) Conduct pulse polio immunization days every
year until polio is eradicated.
b) Sustain high level of routine immunization
coverage.
c) Moniter OPV coverage at district level and
below.
d) Improve surveillance capable of detecting all
cases of AFP due to polio and non polio.
e) Arrange follow up of all cases of AFP at 60 days
to check residual paralysis.
 Line listing of cases
All cases of acute flaccid paralysis must be reported
immediately to the chief medical officer/district
immunization officer with the following details :
• Name, age and sex of the patient
• - Father's name and complete address
• - Vaccination status
• Date of onset of paralysis and date of reporting
• Clinical diagnosis
• - Doctor's name, address and phone number
 Mopping up
• Mopping up activities are usually the last stage
in polio eradication.
• The strategy of mopping up involves door to
door immunization in high risk district ,where
wild polio virus is known.
 Pakistan’s battle against Polio
• Polio immunization started in 1974, it’s eradication officially started
in 1993.
• Intensive eradication campaigns such as door-to-door vaccinations
only started after 1999.
• Eradications efforts reduced the incidence of the disease from 2980
reported cases in 1980 to 306 cases in 2014.
BUT
• Polio is still endemic in Pakistan.
• Pakistan is now informally labelled as an ‘Exporter of polio’. The
term was slapped on following recent developments of the virus strain
originating from Pakistan being found in China, Egypt, Syria, and
Palestine.
• WHO reported the presence of the Polio virus in Lahore, Rawalpindi
and Peshawar’s sewage system.
Resurgence of Polio virus in Pakistan is a national emergency
 Factors affecting eradication
• Opposition from Clerics
• Failure to vaccinate
• Drone attacks
• CIA fake vaccination campaign
• Violence against Polio workers
• Pakistan army operation in FATA; and IDP (internally
displaced people).
• Vaccine Failure.
 Current Situation
WHO has recommended Polio vaccination as mandatory
for all travelers from the country and to carry polio
vaccination certificate with them.
 How Can We Eradicate ?
• Take tribal leaders on board and involve them in the
campaigns.
• Through advertisements and effective Public relations,
all misconceptions about the vaccine should be
minimized.
• Take the input of all concerned stakeholders and
entities that can influence and facilitate the journey
towards a polio-free Pakistan.
THANK YOU