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Epidemiology & Control of
poliomyelitis
poliomyelitis
Infectious Agent
Poliovirus : Types I, II, III
Characteristics of the virus:
• The polioviruses are resistant to bile salts &
they are stable in acidic conditions.
• They survive for long periods at -20°c & for
years at -70°c.
• Rapidly inactivated by heat , formaldehyde ,
chlorine ,and ultra violate light ( U.V.L ) .
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Reservoir of infection
Humans
Mode of transmission
1. person – to – person (direct faeco – oral
route)
2. Ingestion of contaminated water & food.
3. Pharyngeal spread (air borne) in areas where
sanitation is good.
Incubation period
3 – 21 days ( average 10 days)
Clinical features
The disease may take one of the following forms:
1. Inapparent infection ( Asymptomatic
infection) in more than 90% of cases.
2. Non-paralytic febrile illness (Non specific
fever).
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3. Aseptic meningitis ( non paralytic poliomyelitis)
in about 1% of the cases.
4. Paralytic poliomyelitis in less than 1%.
Symptoms
Fever, malaise, headache, nausea & vomiting.
if the disease progress, stiffness of the neck with
or without paralysis .
• Case fatality for paralytic cases is 2 – 10 %, it
increases with age.
Factors which determine the development of
paralytic poliomyelitis
1) The state of immunity of the affected
individual
2) Trauma , excessive fatigue, pregnancy, and
intramuscular injection during the period of
acute febrile illness may precipitate paralysis
3) Tonsillectomy increases the risk of paralysis
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Characteristics of the paralysis
• Asymmetrical with fever present at the onset.
• The site of paralysis depends on the location
of nerve cell destruction in the spinal cord or
brain stem.
• The legs are affected more often than the
arms.
• Paralysis of the respiratory muscles lead to
death.
Diagnosis
• Clinical features.
• Isolation of the virus from stool, CSF or
nasopharyngeal secretions (cell culture).
• Detection of type specific antibodies.
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Period of communicability
• The virus is detected in throat secretions 36
hours after infection& in stool 72 hours after
infection in both clinical & in asymptomatic
cases.
• The virus persists in the throat for one week
and in the stool for 3 – 6 weeks.
• Cases are most infectious during the few
days before & the few days after onset of
symptoms.
Epidemiology
Poliomyelitis is about to be eradicated
worldwide.
The disease has been eradicated in the western
hemisphere.
The disease is now limited to few developing
countries .
-The disease primarily affects children below
3 years of age.
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Control
I. General Preventive measures:
1. Sanitary disposal of human excreta
2. Health education to raise the standards of
personal hygiene
II. Specific preventive measures:
Measures for Patients:
Notification is very important
Isolation of the patient is desirable
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Disinfection and safe disposal of patients faeces and
pharyngeal discharges
Treatment of patients
Measures for Contacts:
Surveillance of contacts for 3 weeks from their last
contact with the patient
Vaccination with OPV
Tonsillectomy & dental extraction should be postponed
when poliomyelitis epidemic is present and injections of
any kind reduced to the minimum
Avoid over-exertion such as games and swimming.
Vaccination
Vaccination is the most effective method of
preventing poliomyelitis.
Two types of polio vaccines are available:
1- Oral Polio Vaccine (OPV) or Sabin Vaccine:
trivalent live attenuated vaccine.
It contains all the three viruses
3 doses are required at 6 – 8 weeks interval
Induces both circulating antibodies &
intestinal immunity
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2- Injectable Polio Vaccine (IPV) or Salk
Vaccine:
injectable, inactivated polio vaccine.
It contains all three polio viruses
3 doses are required.
First 2 doses are given at 1 – 2 months
interval
3rd dose 6 – 12 months after the 2nd .
Mainly induces circulating antibodies
• WHO recommends the use of OPV because:
1- low cost
2- Ease of administration
3- Capacity to provide population immunity
(immunizes some susceptible contacts through
secondary spread).
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Disadvantages of OPV
1) unstable especially in tropical climates
2) Interference by other enteric viruses
3) May cause paralytic poliomyelitis
Vaccine-Associated paralytic poliomyelitis
(VAPP).
Vaccine-Associated paralytic
Poliomyelitis = VAPP
The occurrence of clinical paralytic
poliomyelitis after the use of OPV
among vaccine recipients or among
their contacts
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VAPP
Vaccine recipients contacts of vaccine
recipients
1 / 2.4 million 1 / 5.9 million doses
doses
(mainly among adults)
with the first subsequent doses
dose
1/ 750,000 1/ 5.1 million
doses doses
Contraindications to OPV
1- Diseases associated with immune-
suppression e.g Aids, malignancy.
2- Presence of immunodeficcent individuals in
the household of vaccine recipients.
3- Diarrhoea is not a contraindication to OPV.
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Advantages of Salk Vaccine:
1) Safe
2) Stable
3) Induce reliable humoral immunity not affected
by other viruses
Disadvantages of Salk Vaccine:
1) Expensive
2) Administration by injection
3) High coverage is needed to protect populations
Recommended schedule
0 dose at birth
1st dose 2 months
2nd dose 4 months
3rd dose 6 months
1st booster dose 18 months
2ndbooster dose 4 – 6 years
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Polio Eradication Strategy
• In 1988 WHO declared (stated) the goal of
eliminating poliomyelitis in the World by the
year 2000
The strategy for eradication consists of the
following:
1. Achievement of high routine immunization
coverage with OPV
2. Supplementary immunization in the form of
National Immunization Days (NIDs)
3. Effective surveillance
4. Mopping up campaign: Door-to-door
immunization campaigns in areas where the
virus persists
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