Poliomyelitis-wps Office 2

POLIOMYELITIS
Definition
• It is an acute viral infection caused by an RNA
VIRUS.
• It is primarily an infection of the Human ailmentary
tract but the virus may infect the CNS invery small
percentage (about 1%)
• It may result in varying degrees of paralysis and
possibly death.
PROBLEM STATEMENT
• In the pre-vaccination Era, poliomyelitis was found in
all countries of the world . The extensive use of polio
vaccines since 1954 eliminated the disease in
developed countries.
• In 1988, the World Health Assembly resolved to
eradicate poliomyelitis globally . Since then ,
implementation on eradication strategies has reduced
the number of polio endemic countries from more
than 125 in 1988 to 2 in 2012 .
• Since the 1988 World Health Assembly resolution to
eradicate poliomyelitis, transmission of all the 3
types of WILD POLIOVIRUS (WPV ) has been greatly
reduced .
Problem statement
• WPV type 2 was declared eradicated in September
2015.
• WPV type 3 has not been detected since November
2012 .
• WPV type 1 is likely to be the sole WPV remaining in
circulation . This marked progress has been achieved
through widespread use of trivalent oral polio
vaccine (tOPV).
• The attenuated polio viruses in OPV can undergo
genetic changes during replication and in
communities with low vaccination coverage .
Problem statement
• Rarely , results in vaccine derived polioviruses
(VDPV) that can cause paralytic polio
indistinguishable from the disease caused by WPV .
• Eliminating the risk of polio caused by VDPVs
requires stopping of all OPV use.
• Recognising the epidemiological opportunity , a
new Polio Eradication and Endgame Startegic Plan
2013-2018 was developed.
• The plan was to eradicate all types of polio disease
simultaneously - both due to WPV and VDPV .
POLIO ERADICATION AND
ENDGAME STRATEGIC PLAN
2013 - 2018
• It represents a major milestone in polio
eradication and describes specific steps to
successfully achieve eradication.
• The plan has four objectives :
BENEFITS
• IPV will be introduced through routine
immunization delivery systems .
• Strengthing routine immunization is necessary to
achieve and maintain high population immunity
against polio viruses, especially type 2 , after OPV
type 2 withdrawn
• This is an opportunity for the global polio
eradication initiated to use its infrastructure to
contribute more systematically to strengthing
routine immunization systems
BENEFITS
• One of the goals is to improve infant routine
immunization coverage in countries which have
lowest protein immunization coverage
The third dose of DPT containing vaccine will be
used to measure routine immunization coverage
improvements .
Therefore it is recommended that the dose of
IPV be added at 14 weeks when the third dose of
DPT or pentavalent vaccine is given or at the contact
soon thereafter.
THE POLIO
ERADICATION STRATEGY
2022-2026
• It offers a comprehensive set of actions to
permanently interrupt all polio virus transmission in
the final WPV endemic countries (Afghanistan &
Pakistan) and to stop circulating vaccine - derived
polio virus transmission and prevent outbreaks in
non endemic countries.
FRACTIONAL DOSE IPV
• It is an alternative to full dose intramuscular
injection of IPV .
POLIO SURVEILLANCE
• It identifies new cases and detects eradication of wild
polio virus
1. ACUTE FLACCID PARALYSIS SURVEILLANCE

There are four steps of AFP SURVEILLANCE
a)Finding and reporting children with AFP :
The first link in the survelliance chain are staff in all health
centres - from district centres to large hospitals.
The number of AFP cases reported each year is used as an
indicator of countries ability to detect polio
b) Transporting stool samples for analysis :
● All the children with AFP should be reported and
tested for WPV in 48hrs of onset .
● Fecal specimens are analyzed for presence of
polio virus . Two specimens 24hrs and 48hrs are
required .
● Stool specimens should be sealed in container
and stored at 4-8°C in a cold box
● Delayed or prolonged exposure to heat may
destroy the virus .
c) Isolating polio virus :
●Isolating virus from stool samples
● Distinguish between wild (naturally occurring)
and vaccine related polio virus because the oral vaccine
contains attenuated live polio viruses and resembles
wild viruses .
d) Mapping the virus :

Once wild polio virus is identified further tests are
carried out to determine where the strains may have
originated .
When polio has been pinpointed to a precise
geographical area , it is possible to identify the source
of importation of polio viruses - long range and cross -
border
2. ENVIRONMENTAL SURVEILLANCE :
It involves testing sewage or other environmental
samples for the presence of polio virus
It often confirms WPV infections in the absence of
cases of paralysis .
VACCINE DERIVED
POLIO VIRUSES (VDPV)
☆ It is a safe vaccine , on rare occasions adverse
events mai occur
☆ Vaccine associated paralytic poliomyelitis ( VAPP ) .
It is the most important of these rare adverse
events .
☆ Cases of VAPP cannot be clinically
indistinguishable from poliomyelitis caused by WPV
but can be distinguished by laboratory analysis
☆ Incident been estimated at 4 cases / 1000,000
birth .
EPIDEMIOLOGICAL
DETERMINANTS
AGENT FACTORS
☆ AGENT : The causative agent is POLIO VIRUS .
● It has three serotypes 1,2,3
● Most outbreaks are due to type 1 virus .
● They can survive for long period in external
environment.
●Well adapted for fecal-oral route of transmission.
☆RESERVIOR OF INFECTION - MAN is only known
reservoir of infection.
☆INFECTIOUS MATERIAL : Virus is found in faeces
and oropharyngeal secretions of infected person
☆ PERIOD OF COMMUNICABILITY : Cases are more
infectious 7-10 days before and after onset of
symptoms .
●In feaces virus is commonly excreted for 2-3 weeks
or sometimes as long as 3-4 weeks .
HOST FACTORS
☆ AGE : Occurs in all age group . Children are usually
for susceptible, than adults due to acquired
immunity of adult population .
☆SEX : more in Males
☆ RISK FACTORS:
●Tonsillectomy especially during epidemics of polio .
●Intramuscular injection
● Trauma .
●Administration of immunising agents (alum
containing DPT )
☆IMMUNITY :
● Maternal antibodies disappear during the 1st
6months of life .
●Reinfection can occur since infection with one type
does not protect completely against the other two
type of viruses .
ENVIRONMENTAL
FACTORS
● Polio is more likely to occur in RAINY SEASON .
● 60% of cases recorded in India were during June to
September.
●Source of infection are contaiminated water , food
and flies .
●Virus survives for long time in cold environment.
● Overcrowding and poor sanitation provide
opportunity for exposure to infection .
MODE OF
TRANSMISSION
☆FAECAL ORAL ROUTE :
● It is main route of spread in developing countries .
●Infection may spread directly through contaiminated
fingers or indirectly through contaiminated water ,
food , milk , flies and articles of daily use .
☆DROPLET INFECTION :
● In acute phase of disease when the virus occurs in
throat
●Close personal contact with an infected person
facilitates DROPLET spread
INCUBATION PERIOD
● Usually 7-14 days .
( ranges from 3 - 35 days )

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POLIOMYELITIS

1. ACUTE FLACCID PARALYSIS SURVEILLANCE

d) Mapping the virus :

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