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Poliomyelitis

Poliomyelitis, caused by the poliovirus, has a complex history beginning from the first descriptions in 1890. Characterized by symptoms ranging from asymptomatic to severe paralysis, the disease exhibits varying clinical features. Understanding its virology, including its enterovirus classification and serotypes, is crucial in addressing outbreaks. The disease primarily affects children, and certain risk factors increase severity. Vaccination strategies, including IPV and OPV, have significantly impacted poliovirus transmission. Current recommendations emphasize timely vaccination for at-risk populations, particularly preterm infants.

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Poliomyelitis

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  1. Poliomyelitis ד"ר אלכס גורי מחלות זיהומיות בילדים, ב"ח קפלן

  2. Introduction • “Polios” = “gray”, “myelos”= “spinal cord” • First descriptions Medin (Sweden) 1890 • First epidemics – Scandinavia, USA 189* • 1950++ regular epidemics 25/100.000 • 1952 USA 58000 cases, 3145 fatalities, 21269 handicapped

  3. Virology • Enterovirus • 3 serotypes, lifelong specific immunity to each serotype • Humans are only natural host • Wild type, live-attenuated, VDPV (vaccine-derived)

  4. Pathogenesis

  5. Clinical • Incubation 9-12 (range 5-35) from contact to prodrome, 11-17 day to paralysis

  6. Clinical features • 60-1000/1 unapparent/clinically recognized (95% unapparent) • Abortive pm (4-8%) 2-3 dd fever, headache, sore throat, abd pain, vomiting • Nonparalytic pm = enteroviral meningitis • Spinal paralytic pn 0.1% of all infections Meningitis, muscle pain, involuntary spasm and then asymmetric flaccid paralysis, almost never sensory, 66% permanent • Bulbar pn Cranial nerves involvement 5-35% of paralytic cases

  7. Increased incidence in pregnant women • Girls and boys equal infection, boys>girls paralysed • Exercise during illness increases severity • IM injection provocation • Tonsillectomy increases risk of bulbar PM • Postpoliomyelitis syndrome (20-30%) 30yy after • Overall mortality 5-10% for paralytic disease

  8. DD • Entero 71 • West Nile virus • Guillain-Barre (symmetrical, ascending, lost of sensation, 1-2 weeks of progress, protein in CSF)

  9. Dx • Isolation (RT-PCR) in stool, rarely in CSF/brain biopsy, serology (no vaccine/wild differentiation)

  10. IPV • Jonas Salk 1955

  11. IPV • High titers of ab, no secretory ab

  12. OPV • Sabin OPV field trials 1955-59 • Monovalent originally • VAPP 1:2.6 million • 25%(VAPP) inimmune deficient (B-cell) Chumakov Mikhail

  13. Epidemiology

  14. VDPD outbreaks

  15. Advantages and Disadvantages

  16. ב01.09.2013 משרד הבריאות הפיץ המלצה לפיה יש להקפיד לחסן את הפגים לפי הגיל הכרונולוגי גם אם עודנו מאושפז כאשר גיל מינימום למתן IPV הוא 37 שבועות

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