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    Dr. Sanjeev Gupta

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    Poliomyelitis is caused by an RNA virus that infects the alimentary tract but can spread to the central nervous system. While most cases are mild or asymptomatic, 1% of infections result in paralysis or death. It is primarily spread through the fecal-oral route. The disease has been largely eradicated through widespread vaccination programs using both inactivated polio vaccine (IPV) and oral polio vaccine (OPV). OPV provides both intestinal and systemic immunity but rare cases of vaccine-derived poliovirus can occur. Treatment focuses on rehabilitation rather than a cure.

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    Dr. Sanjeev Gupta

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    51 views73 pages
    Poliomyelitis is caused by an RNA virus that infects the alimentary tract but can spread to the central nervous system. While most cases are mild or asymptomatic, 1% of infections result in paralysis or death. It is primarily spread through the fecal-oral route. The disease has been largely eradicated through widespread vaccination programs using both inactivated polio vaccine (IPV) and oral polio vaccine (OPV). OPV provides both intestinal and systemic immunity but rare cases of vaccine-derived poliovirus can occur. Treatment focuses on rehabilitation rather than a cure.

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    polio epidemiology....

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    POLIO2

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    Poliomyelitis is caused by an RNA virus that infects the alimentary tract but can spread to the central nervous system. While most cases are mild or asymptomatic, 1% of infections result in paralysis or death. It is primarily spread through the fecal-oral route. The disease has been largely eradicated through widespread vaccination programs using both inactivated polio vaccine (IPV) and oral polio vaccine (OPV). OPV provides both intestinal and systemic immunity but rare cases of vaccine-derived poliovirus can occur. Treatment focuses on rehabilitation rather than a cure.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    51 views73 pages

    Dr. Sanjeev Gupta

    Uploaded by

    drsanjeev15
    Poliomyelitis is caused by an RNA virus that infects the alimentary tract but can spread to the central nervous system. While most cases are mild or asymptomatic, 1% of infections result in paralysis or death. It is primarily spread through the fecal-oral route. The disease has been largely eradicated through widespread vaccination programs using both inactivated polio vaccine (IPV) and oral polio vaccine (OPV). OPV provides both intestinal and systemic immunity but rare cases of vaccine-derived poliovirus can occur. Treatment focuses on rehabilitation rather than a cure.

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    of 73

    Poliomyelitis

    Dr. Sanjeev Gupta


    Introduction
    Poliomyelitis is an acute viral infection
    Cause by an RNA virus
    It is primarily an infection of the human
    alimentary tract but the virus may infect the
    central nervous system.
    1% cases resulting the paralysis and possibly
    death
    Problem statement in the world
    Fore Regions Polio-free

    1.America
    2.Europe
    3.Western pacific
    4.SEAR
    Problem statement in the world
    Indian Scenario
    India biggest achievement against polio
    In India vaccination against polio started in
    1978. it was successful in covering around
    40%.
    Universal immunization programme (UIP) was
    launched 1995
    Pulse polio immunization programme along
    with UIP
    Indian Scenario
    On 27th March 2014 India was declared as
    non-endemic country for polio.
    Polio achieved and implementing polio
    endgame strategy
    Polio Eradication and Endgame
    Strategic plan 2013-2018
    1. To detect and interrupt poliovirus
    transmission
    2. To strengthen immunization systems and
    withdraw oral polio vaccine
    3. To contain poliovirus and certify
    interruption of transmission
    4. To plan how to utilize the legacy of the fight
    against polio
    Polio Surveillance
    1- Acute flaccid paralysis surveillance

    2- Environmental surveillance
    Acute flaccid paralysis surveillance
    1. Finding and reporting children with acute
    flaccid paralysis (AFP)
    2. Transporting stool samples for analysis
    3. Isolating poliovirus
    4. Mapping the virus
    AFP- Case Definition
    Any child < 15 years who has acute onset of
    flaccid paralysis for which no obvious cause
    (such as severe trauma or electrolyte
    imbalance) is found, or paralytic illness in a
    person of any age in which polio is suspected.
    Commonest causes of AFP

    Poliomyelitis
    Gullain Barre Syndrome
    Traumatic neuritis
    Transverse Myelitis
    Case Notification
    from where ? - RUs, Clinics, Pvt.Practitioners

    who reports ? - nodal person/ informer


    when ? - immediately on coming
    across an AFP case
    whom to report ? - DHO/SMO
    by what means ? - fastest mode of communication
    phone, fax,
    what information ? - name, address, date of onset
    Confirm AFP
    investigate the case - at hospital / at home
    use case definition
    Stool sample
    Number -Two stool samples, with a gap of at
    least 24 hours between two samples

    Time- First within 14 days of onset of


    paralysis

    Quantity Thumb sized, Sealed containers,


    and stored immediately in cold box.
    Stool sample
    Transport-Maintenance of cold chain from
    collection to the time it reaches lab---- by
    vaccine carrier-
    REVERSE COLD CHAIN
    No leakage, proper labels & packing
    Vaccine carrier once used for transporting stool
    sample is disposed off never used for any
    purpose.
    Environmental surveillance
    Environmental surveillance involves testing
    sewage or other environmental samples for
    the presence of poliovirus.
    Overall indicators and targets
    the "bottom line" on AFP surveillance
    Indicator Target
    number AFP cases >1/1,00,000 children
    reported yearly under 15 years of age

    % cases with 2 >80%


    adequate stools
    Epidemiology of Poliomyelitis
    Epidemiological

    Agent Environment

    Host
    Agent factors
    Viral infection: caused by RNA virus

    Primarily an infection of human alimentary


    tract, but may infect the central nervous system
    Polio virus

    Classification-
    -Wild Virus (WV)
    -Vaccine Virus (VV)
    Serotypes
    Serotypes:
    Type 1, 2 and 3
    All types cause paralysis

    Outbreaks of paralytic polio due to type-1


    Poliovirus can survive for long periods in the
    external environment.
    In water 4 months
    In faeces 6 months
    Epidemiological Characteristics of Polio
    Serotypes
    All types cause paralysis
    Type 1- Most frequent paralysis,
    Highest epidemic potential,
    During polio free last serotype to disappear
    Type 2- Rarely paralytic,
    during polio free first serotype to disappear
    Type 3- Paralysis less frequent
    Less epidemic potential, scattered cases
    During eradication first serotype
    to disappear is 2 >> 3 >>> 1
    In India
    Type 2- last case 1999

    Type 1 -2008

    Type 3- 2011
    Reservoir of infection

    Man is the only reservoir

    Clinical & sub clinical cases


    Every clinical cases >1000 sub clinical cases
    No chronic or carrier stage
    Communicability
    As long as 3-4 months

    Most infectious 7-10 days before & after the


    onset of paralysis
    Host factors
    Age- all age group
    - 6 months 3 years most vulnerable
    -50% cases <1 year of age
    -Can affect children up to 15 years

    Sex- ratio of 3 males to 1 female


    Immunity
    Active
    through immunization / natural
    infection
    Immunity believed to be lifelong

    Passive
    Maternal immunity- protection about 6
    months
    Immunity
    Local- Intestine-
    Prevent the entry of the agent
    By Natural infection &
    Oral Polio Vaccine
    Systemic- Humoral antibodies-
    Prevent agent to reach target organ
    By Natural Infection &
    Injectable & Oral Polio Vaccine
    Environment factors
    Rainy season-Highest transmission
    June- Sept- 60% cases in India
    Half life of excreted virus in sewage in the
    tropical climate- 48 hours
    Long survival in cold climate
    Route of entry- oral cavity

    Infectious material
    Oropharyngeal secretion-
    Feacal material
    Mode of Transmission
    Faeco-oral route
    Directly through contaminated fingers

    Droplet infection
    Close contact personal with infected
    droplet spread.
    Incubation period

    Short incubation period - usually 7-14 days,


    (range 3-35 days)
    Clinical Spectrum
    Clinical Spectrum

    1- Inapparent (Subclinical) Infection


    2- Abortive polio or Minor Illness
    3- Non-paralytic polio
    4- Paralytic polio
    Clinical Outcome of Poliovirus Infections

    Paralytic poliomyelitis

    Abortive-Clinical illness, no paralysis

    Asymptomatic infection

    4-8% 90-95%

    0.1-1%
    Time course of events in infection
    with poliovirus
    Paralytic Polio
    Phases of symptoms
    Non paralytic
    Paralytic
    Clinical aspects

    Non paralytic
    Symptoms similar to minor illness
    Headache nausea vomiting more intense
    Stiffness and soreness of muscles in neck,
    trunk & limbs
    Clinical aspects
    Major phase
    muscle pain, spasms
    return of fever
    rapid onset of flaccid paralysis
    progression usually complete within 72
    hours
    asymmetric paralysis (legs>arms)
    residual flaccid paralysis within 60 days
    Lab. Investigation

    Serum sample

    Stool Sample

    Culture
    Differential diagnosis

    Paralytic poliomyelitis
    Guillain-Barre syndrome
    Transverse myelitis
    Traumatic neuritis
    Prevention
    Prevention

    Primary Secondary Tertiary

    A--Care of exposed
    person -Symptomatic -Rehabilitation
    BImmunization
    C- Polio eradication
    Strategies
    Primary Prevention

    Health Education
    Improving Sanitation & Hygiene
    Vaccination
    Polio Vaccine
    Inactivated Polio Vaccine(IPV) by Salk
    Killed
    Systemic immunity only

    Oral Polio Vaccine(OPV) by Sabine


    Live virus
    Both local & systemic immunity

    Both Vaccines contain trivalent antigen


    OPV
    Bivalent, OR trivalent
    2-3 drops
    Useful during epidemic
    Replace wild virus into vaccine virus in guts
    OPV- Draw back
    Heat sensitive->8o C rapidly reduce potency
    After 3 dosed seroconversion rate is 73%,90%,
    70% for type 1,2 & 3 respectively.
    Reasons for low seroconversion
    High level of maternal antibodies & competing
    entero viruses & diarrhoea.
    IPV
    Route of administration- IM (right thigh)
    Doses- 0.5 ml during 14 week
    Heat stable
    Can be used in immuno-compromised patient
    Used in the country where polio is eliminated
    Can not be used during epidemic of polio
    120 countries add the inactivated polio vaccine to
    their routine immunization programmes.

    IPV

    In India IPV will be introduced during oct-nov 2015


    and removal of oral polio vaccines in early 2016,
    a critical element of the plan to achieve a polio-free
    world.
    Vaccine Derived Poliovirus (VDPV)
    OPV is a safe vaccine on rare occasions
    adverse events
    OPV adverse events may occur Vaccine-
    associated paralytic poliomyelitis (VAPP)

    VAPP occurs in both OPV recipients and their


    unimmunized child contacts. It is most
    frequently associated with type 3(sabin) (60%
    of cases) followed by type 2 and type 1
    VDPV are divided into three
    categories
    (circulating VDPV) cVDPV.

    (Immunodeficiency-related VDPV) iVDPV.

    (Ambiguous VDPV) aVDPV.


    TREATMENT AND CONTROL

    THERE IS NO CURE FOR POLIO BUT


    THERE ARE WAYS TO CONTROL THE
    PROGRESS OF THIS DISEASE.
    Healthy muscles can be trained to take over
    Rehabilitation
    some of the functions of nearby muscles that
    are weakened by polio.
    Differences between IPV & OPV
    IPV (Salk type) OPV (Sabin type)
    Killed vaccine Live vaccine
    IM, SC Orally
    Circulating antibody but no Immunity is both humoral
    local and intestinal
    Not useful in epidemics Effectively used in
    controlling epidemics
    Costlier cheaper
    Strategies For Polio
    Eradication
    Strategies For Polio Eradication

    1. Conduct pulse polio immunization days


    every year until poliomyelitis is eradication.
    2. Sustain high levels of routine immunization
    coverage.
    3. Monitor surveillance capable of detecting all
    cases of AFP due to polio and non-polio
    aetiology
    4.Ensure rapid case investigation, including the
    collection of stool samples for virus isolation.
    5. Follow-up of all cases of AFP at 60 days
    6.Conduct outbreak control for cases
    confirmed or suspected to be poliomyelitis to
    stop transmission
    Pulse Polio Immunization
    Started from 1995
    AIM-
    To breaks the chain of transmission of wild
    polio virus existing in the community by
    replacing it with the vaccine virus in the guts.
    Mass Immunization
    campaign (Pulse Polio
    Immunization)

    Pulse- Sudden, mass administration of OPV


    on a single days to all children 0-5 years of age
    irrespective of their previous polio vaccination
    status

    It is additional to routine immunization


    Also known as NIDs (National
    Immunization Days)
    Kept during winter---(Nov. to Feb.)

    Minimum 2 rounds with not less than 4 weeks


    & more than 3 months gap.

    Additional rounds are kept depending on


    incidence of polio cases in a state.
    Why during Winter
    Low transmission
    Better cold chain maintenance
    Better Immunization rate-Less prevalence of
    other intestinal organism
    Better compliance of field staff for H-H
    activities
    IPPI
    Sunday-Booths round

    Successive Monday, Tuesday & Wednesday


    house to house search to vaccinate children who
    have not received vaccine on Sunday.
    Mobile team- IPPI
    round
    Mopping Up

    After the detection of case in an


    area, Immunization to all children
    under 5 years of age in the block /
    district
    Mopping up

    Immune Population
    Polio cases
    Unimmunized Population
    Polio laboratories

    National labs
    Reference labs
    Global
    specialized lab
    for polio
    7
    3
    National Lab BJMC- Identify presence of
    polio virus in sample

    Reference Lab.- Confirms the vaccine or wild


    virus
    Global Specialized lab. For polio
    Identify not only polio strain but its genetic
    derive
    Do Boond Zindagi ki
    .

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