enteroviruses pcfm reporting

ENTEROVIRUSES

Presented By:Andrea Dora J. Ortaliz

MD-2

TERMS Bornholm disease: Contagious viral

infection Cold-like symptoms: Symptoms

similar to the common cold. Digestive Diseases: Diseases that

affect the digestive system Dilated cardiomyopathy: A rare

chronic heart muscle condition where one or both heart ventricles are dilated or have impaired contractility.

Encephalitis: Dangerous infection of the brain

Fever: Elevation of the body temperature above the normal 37 degrees celsius

Flu-like symptoms: Symptoms similar to flu including fever

Myocarditis: Inflammation of the myocardium (muscle walls of the heart)

Paralysis: The loss of motor function due to dysfunction of the spinal cord

Polio: Dangerous virus now rare due to vaccination.

Respiratory symptoms: Symptoms affecting the breathing systems.

Paralysis: The loss of motor function due to dysfunction of the spinal cord

Sudden Digestive Conditions: Various forms of sudden acute digestive upset.

Vague symptoms: Vague, unclear, mild or non-specific symptoms

Viral diseases: Any disease that is caused by a virus

Viral gastroenteritis: Virus causing gastroenteritis of digestive tract.

Viral meningitis: Viral meningitis refers to meningitis caused by a viral infection

INTRODUCTION Picornaviruses represent a very large virus family with respect to

the number of members but one of the smallest in terms of virion size and genetic complexity. They include two major groups of human pathogens: enteroviruses and rhinoviruses. Enteroviruses are transients of the human alimentary tract and may be isolated from the throat or lower intestine.

Many picornaviruses cause diseases in humans. Etiology is difficult to establish, as different viruses may produce the same syndrome; as the same picornaviruses may cause more than a single syndrome; and some clinical symptoms cannot be distinguished from those caused by other types of viruses. The most serious disease caused by any enterovirus is poliomyelitis.

INTRODUCTION Enteroviruses are a genus of the

picornavirus family which replicate mainly in the gut.

Single stranded naked RNA virus with icosahedral symmetry

Unlike rhinoviruses, they are stable in acid pH

Capsid has 60 copies each of 4 proteins, VP1, VP2, VP3 and VP4 arranged with icosahedral symmetry around a positive sense genome.

At least 72 serotypes are known: divided into 5 groups

Polioviruses

Coxsackie A viruses

Coxsackie B viruses

Echoviruses

Enteroviruses (more recently, new enteroviruses subtype have been allocated sequential numbers (68-71))

INTRODUCTION Three serotypes comprise the polioviruses 23 serotypes comprise coxsackievirus

group A 6 serotypes comprise coxsackievirus group

B 29 serotypes comprise the echoviruses.

ENTEROVIRUSES

Enterovirus Polio Coxsackie A and BEchoOther enteroviruses

Diseases of the human (and other) alimentary tract (e.g. polio virus)

ENTEROVIRUSESVIRUS FAMILY SEROTYPES

Polio 1-3

Coxsackie A 1-22, 24

Coxsackie B 1-6

Echovirus 1-9, 11-21, 25-26, 27, 29-33

Enteroviruses 68-71

Epidemiology Distributed worldwide Are influenced by season and climate Infections occur in summer and early fall in temperate

areas, while tropical and semitropical areas bear the brunt all year.

AHC occurs as epidemics in tropical countries during the hot and rainy season.

The worldwide prevalence of poliomyelitis has decreased significantly because of improved economic conditions and availability of vaccines

EPIDEMIOLOGY In 2008, 1,652 confirmed cases of paralytic polio were

reported worldwide. Polio is endemic in 4 countries: Afghanistan, India, Nigeria, and Pakistan.

3 epidemiologic phases of Poliomyelitis: Endemic Epidemic Vaccine era Occurs in all age group but children are more

susceptible (“infantile paralysis”)

Epidemiology Direct correlation between poor hygiene, poor

sanitation, and overcrowded living condition to the acquisition of infection and antibodies at an early age

MORTALITY/MORBIDITY >90% of infections caused by the nonpolio

enteroviruses ---- asymptomatic or result in only an

undifferentiated febrile illness Myopericarditis carries a mortality rate of 0%-4%.

EPIDEMIOLOGY Prior to the vaccine era, the mortality rate in polio

epidemics was 5%-7%.

SEX The male-to-female ratio of myopericarditis is 2:1. The

risk of cardiac involvement is higher during pregnancy and immediately postpartum.

The prevalence of polio infection is equal in boys and girls, although paralysis is more common in boys. Among adults, women are at increased risk of infection and the postpolio syndrome

Epidemiology Aseptic meningitis is approximately twice as common in

males as in females.

AGE Enteroviral infections are most common in young

children. Herpangina primarily affects children aged 3 months to

16 years. Poliomyelitis is observed in children younger than 15

years.

Epidemiology Aseptic meningitis due to enteroviral infection is more

common in infants than in adults. Most cases of pleurodynia occur in children and adults younger than 30 years.

Myopericarditis is most prevalent in young adults, especially those who are physically active. AHC is most prevalent in adults aged 20-50 years.

Neonates are at high risk for severe sepsis due to

enterovirus infections

INCIDENCE (ANNUAL) OF ENTEROVIRUSES estimated 10-15 million cases

annually in USA Extrapolation of Incidence

Rate for Enteroviruses to Countries and Regions

Enteroviruses in Southeastern Asia (Extrapolated Statistics)

East Timor

37,472 1,019,252²

Indonesia 8,766,652 238,452,952²

Laos 223,092 6,068,117²

Malaysia 864,797 23,522,482²

Philippines

3,170,650 86,241,697²

Singapore

160,069 4,353,893²

Thailand 2,384,761 64,865,523²

Vietnam 3,039,073 82,662,800²

About prevalence and incidence statistics in general for Enteroviruses: ‘prevalence’ of Enteroviruses usually means the

estimated population of people who are managing Enteroviruses at any given time (i.e. people with Enteroviruses).

‘incidence’ of Enteroviruses means the annual diagnosis rate, or the number of new cases of Enteroviruses diagnosed each year (i.e. getting Enteroviruses).

INCIDENCE RATE/PREVALENCE Incidence Rate of Enteroviruses: approx 1 in 27 or

3.68% or 10 million people in USA.

Prevalance of Enteroviruses: Non-polio enteroviruses

are second only to the "common cold" viruses, the rhinoviruses, as the most common viral infectious agents in humans. The enteroviruses cause an estimated 10-15 million or more symptomatic infections a year in the United States.

Poliovirus3 types (1-3)

Paralytic poliomyelitisAseptic meningitis

Febrile illness

Coxsackie group A23 types (A1-22, A24)

Aseptic meningitisHerpangina

Febrile illnessConjunctivitis

Hand, foot and mouth disease

Coxsackie group B6 types (B1-6)

Aseptic meningitisSevere neonatal disease

MyopericarditisBornholm disease

EncephalitisFebrile illness

Echovirus31 types (1-9, 11-27)

Aseptic meningitisRas

Febrile illnessConjunctivitis

Severe generalized neonatal disease

Enterovirus4 types (68-71)

Polio-like illnessAseptic meningitis

Hand, foot and mouth (E71)Epidemic conjunctivitis (E70)

INFECTIOUS DISEASE PROCESS POLIOMYELITISAGENT: poliovirusRESERVOIR: HumanPORTAL OF ENTRY/EXIT: Fecal-

oralINCUBATION PERIOD: 7-

14days; may range from 3-35 days

MODE OF TRANSMISSION: Fecal-oral; person-to-person direct contact, droplet/respiratory secretions, contaminated objects

SUSCEPTIBLE HOST: infants; younger children

COXSACKIE GROUP AAGENT: coxsackievirus ARESERVOIR: HumanPORTAL OF ENTRY/EXIT: Fecal-

oralINCUBATION PERIOD: 2-9/2-10

daysMODE OF TRANSMISSION:

Fecal-oral; person-to-person direct contact, droplet/respiratory secretions, contaminated objects

SUSCEPTIBLE HOST: Children 3-10 years old

INFECTIOUS DISEASE PROCESS COXSACKIE GROUP BAGENT: coxsackievirus BRESERVOIR: HumanPORTAL OF ENTRY/EXIT: Fecal-

oralINCUBATION PERIOD: 2-9/2-10

daysMODE OF TRANSMISSION:

Fecal-oral; person-to-person direct contact, droplet/respiratory secretions, contaminated objects

SUSCEPTIBLE HOST: below 1-year-old; older children

ECHOVIRUS (ENTERIC CYTOPATHIC HUMAN ORPHAN VIRUSES)

Nonpolio enterovirus infectionAGENT: echovirusRESERVOIR: HumanPORTAL OF ENTRY/EXIT: Fecal-

oralINCUBATION PERIOD: 2-7 daysMODE OF TRANSMISSION: Fecal-

oral; (airborne) air to other hosts 1–3 weeks after infection and can spread through feces to other hosts eight weeks after infection

SUSCEPTIBLE HOST: Infants; young children

INFECTIOUS DISEASE PROCESS

Everyone is at risk. Infants, children, and adolescents are more likely to be susceptibleto infection and illness from these viruses, but adults can also become infected and ill if they do not have immunity to a specific enterovirus.

Syndrome Polio Cox A Cox B Echo

Paralytic disease

+ + + +

Meningitis-encephalitis

+ + + +

Carditis + + + +

Neonatal disease

- - + +

Pleurodynia - - + -

Herpangina - + - -

Syndrome Polio Cox A Cox B Echo

Rash disease - + + +

Respiratory Infections

+ + + +

Undifferentiated fever

+ + + +

Diabetes/pancreatitis

- - + -

Disease in immunocomp.

+ + - +

CLINICAL FINDINGS/MANIFESTATIONS Most patients infected with an enterovirus

remain asymptomatic but in small children benign fevers caused by unidentified enteroviruses are relatively common (non-specific febrile illness).

Many outbreaks of febrile illness accompanied by

rashes are also caused by enteroviruses.

CLINICAL FINDINGS/MANIFESTATIONS PoliomyelitisAlternate Names :

Infantile Paralysis, Polio

Three basic patterns of polio infection:

subclinical infections Nonparalytic Paralytic

Approximately 95% of these are subclinical infections, which may go unnoticed.

Clinical poliomyelitis affects the central nervous system (brain and spinal cord) and is divided into nonparalytic and paralytic forms. It may occur after recovery from a subclinical infection.

CLINICAL FINDINGS/MANIFESTATIONS Clinical poliomyelitis

affects the central nervous system (brain and spinal cord);

DIVIDED into :

nonparalytic paralytic forms It may occur after

recovery from a subclinical infection.

possible outcomes following poliovirus infection:

Subclinical infection (90 - 95%) - inapparent subclinical infection

account for the vast majority of poliovirus infections.

no symptoms, or symptoms lasting 72 hours or less

slight fever headache general discomfort or

uneasiness (malaise) sore throat red throat vomiting

CLINICAL FINDINGS/MANIFESTATIONS Poliomyelitis

Abortive infection (4 - 8%) influenza-like

symptoms such as fever, malaise, drowsiness, headache, nausea, vomiting, constipation and sore throat

Recovery within few days and the diagnosis can only be made by the laboratory

may be accompanied by aseptic meningitis - similar to the meningitis caused by other enteroviruses


resolve without sequelae within 2 - 10 days.


resolve without sequelae within 2 - 10 days.

CLINICAL FINDINGS/MANIFESTATIONS

Major illness (POLIOMYELITIS)

(1 - 2%) - may present 2 - 3 days following the minor illness

without evidence of any preceding minor illness

Signs of aseptic meningitis are common

Involvement of the anterior horn cells lead to flaccid paralysis

Painful muscle spasms and incoordination of non-paralysed muscles may occur

Painful muscle spasms and incoordination of non-paralysed muscles may occur

Involvement of the medulla may lead to respiratory paralysis and death

The paralysis usually develops over several days and some recovery may take place

Any effects persisting for more than 6 months are usually permanent.


Major illness Nonparalytic

Poliomyelitis (Aseptic Meningitis)

Stiffness and pain in the back and neck

Lasts 2 – 10 days recovery is rapid and complete

May advance to paralysis

symptoms last 1 to 2 weeks

moderate fever headache stiff neck vomiting diarrhea excessive tiredness, fatigue


Major illness Nonparalytic Poliomyelitis (Aseptic

Meningitis) irritability pain or stiffness of the back, arms, legs, abdomen muscle tenderness and spasm in any area of the body neck pain pain front part of neck neck stiffness back pain or backache leg pain (calf muscles) skin rash or lesion with pain muscle stiffness


Paralytic Poliomyelitis

Predominating complaint is flaccid paralysis LMN damage

Incoordination secondary to brainstem invasion and painful spasms of nonparalyzed muscles

Maximal recovery within 9 months residual paralysis last much longer

Maximal recovery within 9 months residual paralysis last much longer

fever, occurring 5 to 7 days before other symptoms

headache stiff neck and back muscle weakness,

asymmetrical rapid onset progresses to paralysis location depends on where

the spinal cord is affected

CLINICAL FINDINGS/MANIFESTATIONSParalytic

Poliomyelitis

abnormal sensations (but not loss of sensation) of an area

sensitivity to touch, mild touch may be painful

difficulty beginning to urinate

constipation bloated feeling of

abdomen swallowing difficulty

muscle pain muscle contractions or

muscle spasms, particularly in the calf, neck, or back

drooling breathing difficulty irritability or poor temper

control positive Babinski's reflex


Progressive Postpoliomyelitis Muscle Atrophy

Specific syndromeRecrudescence ofparalysis and musclewastingNot a consequence but aresult of physiologic andaging changesburdened by loss ofneuromuscular functions

CLINICAL FINDINGS/MANIFESTATIONS Coxsackieviruses

Aseptic meningitis Caused by Cox A and B Fever, malaise, headache, nausea and abdominal

pain early symptoms May progress to mild paresis recover completely

Herpangina Severe febrile pharyngitis Cox A (2 – 6, 8, 10) Abrupt onset of fever and sore throat Pharynx is hyperemic with vesicles on the posterior

half of the pharynx, tonsils or tongue


Hand-foot-and-mouth disease (Coxsackievirus)

Oral and pharyngeal ulcerations

Vesicular rash of the palms and soles may spread to arms and legs

Vesicles heal without crusting

Particularly associated with Cox A16, A 5 and A10

Virus may be recovered in the blister fluid, stool and pharyngeal swab.

Must not be confused with foot-and-mouth disease of the cattle unrelated

Pleurodynia Bornholm disease

(Epidemic myalgia) Cox B Sudden onset of

fever, myalgia, HA, anorexia and stabbing chest pain

Enteroviruses. This is the skin of a young boy after 3 days of an echovirus type 9 infection; treated at New York

Presbyterian Hospital.

CLINICAL FINDINGS/MANIFESTATIONS Pleurodynia

Chest pain maybe on either side or substernal, intensified by movement and lasts for 2 to 14 days

Abdominal pain – children

Self-limited with complete recovery; relapses are common

Myocarditis Severe / serious / fatal

adults and children Cox B

May cause permanent heart damage

Persistent viral infections of the heart muscle may occur sustaining chronic infection

May trigger host autoimmune response responses that lead to cardiomyopathies

CLINICAL FINDINGS/MANIFESTATIONS Acute Hemorrhagic

conjunctivitis coxsackie A24 B2

(Echo 7 and 11, and enterovirus 70)

isolated from the conjunctiva in sporadic cases

majority of the epidemics are due to enterovirus 70

generally localized to the eye and there is characteristic subconjunctival hemorrhage, either petechial or larger "blotches", and transient keratitis

neurological complications may occur polio-like paralytic illness

neurological involvement may develop 2 or more weeks after the onset of conjunctivitis

OTHERS

Respiratory infection common colds

Cox A21, A24, B1 and B3 - 5

Gastrointestinal symptoms diarrhea


Neonatal Infection/ Generalized disease of infants

coxsackie B and echoviruses

severe and often fatal infection in newborn infants.

Simultaneous viral infections multiple organ infection

may be transmitted transplacentally in late pregnancy, with the infant developing heart failure following delivery from a severe myocarditis, hepatitis, pneumonia or a meningoencephalitis

May be transmitted during the birth process or in postnatally via the mother or other virus-infected infants in the hospital

may develop illness at 3 - 7 days of age which may range from a mild febrile illness to a severe fulminating multisystem disease and death

virus can be recovered from the feces, brain, spinal cord and myocardium


Diabetes and pancreatitis

Coxsackie B particularly B4

juvenile onset IDDM 30% of children with

IDDM have IgM antibodies to coxsackie B viruses compared to 5 - 8% for matched controls

Postviral Fatigue Syndrome

Aka. myalgic encehalomyelitis (ME)

occurs as both sporadic and epidemic cases

poorly characterized illness cardinal feature being excess fatigability of the skeletal muscles, muscle pain, headache, inability to concentrate, paresthesiae, impairment of short term memory and poor visual accommodation


Postviral Fatigue Syndrome

focal neurological signs are rare

nonspecific viral illness and some lymphadenopathy may be present

Routine laboratory investigations are usually normal

Recovery usually takes place within a few weeks or months but the illness may persists in some patients with periods of remission and relapse.

ECHOVIRUS (ENTERIC CYTOPATHIC

HUMAN ORPHAN VIRUSES)

ECHO viruses cause a wide variety of conditions. Symptoms depend on the type of disease:

Aseptic meningitis Croup Encephalitis Mouth sores (herpangina) Myocarditis Pericarditis

CLINICAL FINDINGS/MANIFESTATIONS ECHOVIRUS Pneumonia Skin rashes Upper respiratory infection Viral pharyngitis

DIAGNOSIS/DIAGNOSTIC TESTS Laboratory Diagnosis (Enteroviruses): Virus/Viral Isolation Viral cultures – throat washing, stool, or CSF Throat swabs after onset of illness/Throat culture Rectal swabs of stool samples Rectal culture PCR/RT-PCR Assays CSF Analysis/Spinal fluid culture Microneatralization Test Serology

DIAGNOSIS/DIAGNOSTIC TESTS Imaging Studies

(Enteroviruses):

Chest radiography Echocardiography

Other Tests (Enteroviruses):

ECG Electroencephalography Ophthalmic slit-lamp

examination

Diagnosis/Diagnostics Tests Differential Diagnosis Adenoviruses MyocardialInfarction Botulism Pharyngitis, BacterialEhrlichiosisPharyngitis, ViralHand-Foot-and-MouthDisease Pleurodynia Herpangina Rocky Mountain SpottedFever Herpes Simplex VaricellaZoster Virus Lyme Disease

TREATMENT Polio management is supportive

in nature. The goal of treatment is to control

symptoms while the infection runs its course.

Lifesaving measures, particularly assistance with breathing, may be necessary in severe cases.

Symptoms are treated according to their presence and severity. Antibiotics may be used to treat urinary tract infections.

Medications, such as bethanechol, may reduce urinary retention. Analgesics are used to reduce headache, muscle pain, and spasms. Narcotics are not usually given because they increase the risk of breathing difficulty.

Moist heat (heating pads, warm towels, etc.) may reduce muscle pain and spasm.

Physical therapy, braces or corrective shoes, orthopedic surgery, or similar interventions may eventually be necessary to maximize recovery of muscle strength and function.

TREATMENT Abortive polio: Treatment with bed rest

and minimal exertion may be done at home. Supportive treatment with analgesics and sedatives may be used.

Nonparalytic polio: Management is similar to that of abortive polio. Combine analgesic therapy with hot packs for pain relief.

Paralytic polio: In contrast to abortive and nonparalytic polio, which can be managed at home, patients with paralytic polio require hospitalization.

Bed rest is required during the early stages of the disease because exertion may worsen the paralysis.

Applying hot packs to affected muscles may alleviate pain.

Align the body in a neutral position to minimize deformity. Patients should start physical therapy soon after the resolution of pain. Physical therapy should include both active and passive exercises.

Mechanical ventilation may be required if respiratory muscles are affected.

Postural drainage and suction should be implemented in mild bulbar polio.

Patients with weakness or paralysis of the bladder may be treated with cholinergic agents, the sound of running water, or catheterization.

TREATMENT Pleurodynia: Treatment is

symptomatic, using analgesics and heat application for pain relief. Severe pain may require opiate analgesics.

Aseptic meningitis: Treatment is symptomatic, with analgesics for headache relief. Headache is often severe and prolonged in adults; potent analgesics should be administered, when necessary.

Myopericarditis Treatment is mainly

supportive in nature and involves management of pericardial pain, pericardial effusion, arrhythmias, and heart failure.

Bed rest is important since exercise can increase the degree of myocardial necrosis.

Intravenous immunoglobulin (IVIG) therapy has shown some benefit in small case-control studies. Nevertheless, most reports lack statistical significance, and randomized trials are needed.53,54

Capsid-binding inhibitors belong to a class of drugs that have shown benefit in some immunosuppressed patients with myocarditis. However, these drugs are not available for use in the United States.

Corticosteroids

TREATMENT

Acute hemorrhagic conjunctivitis

Treatment is primarily symptomatic in nature.

Antimicrobial agents are not indicated unless bacterial superinfection occurs. Corticosteroids are contraindicated.

Cold compresses may be used, along with antihistamine/decongestant eye drops

Herpangina and hand-foot-and-mouth disease

Symptomatic treatment for sore throat is the mainstay of treatment, including analgesics, topical anesthetics, mouth wash, and saline rinses.

Viscous lidocaine (2% solution) may be helpful.

ECHO virus infections tend to clear up on their own. No specific antiviral medications are available.

An immune booster called IVIG may help patients with severe ECHO virus infections who have a compromised immune system.

TREATMENT Surgical Care

Cardiac transplantation may be required in severe cases of dilated cardiomyopathy due to enteroviral infection.

Consultations Consultation with a physiatrist is

helpful to plan specific exercise programs, to direct physical therapy, and to provide adaptive equipment for patients with paralytic polio.

Consultation with a cardiologist may be requested in myopericarditis for management of arrhythmias.

Consultation with a cardiovascular surgeon may be required for the management of complicated pericardial effusions and in some cases for cardiac transplantation.

Consultation with an ophthalmologist is appropriate for AHC.

Consultation with a neurologist is recommended in cases of paralytic polio.

Physical and occupational therapists help patients with polio to establish a safe exercise program, to adapt the home environment, and to use mechanical aids (eg, grab bars).

Consultation with an infectious disease specialist may be useful in cases of unexplained aseptic meningitis or myopericarditis.

TREATMENT Diet Patients with paralytic polio should

be encouraged to maintain a high fluid intake.

The application of hot packs leads to sweating, meaning that fluids need to be replenished.

High fluid intake protects against nephrocalcinosis and urinary tract infections due to prolonged immobilization.

A diet rich in L-carnitine is under research as a treatment for postpolio syndrome.

Patients with herpangina should consume soft bland foods and fluids and avoid pain-inducing salty foods and citrus fruits.

Activity Bed rest is required for patients

in the early stages of paralytic polio. Physical therapy should begin as soon as possible after the resolution of pain. Isometric exercises for select muscle groups can help increase muscle strength. Muscle capacity can also be increased with bracing and orthotics.

Medications Management is supportive and

addresses symptoms. No antiviral medications are currently approved for the treatment of enterovirus infections.

TREATMENT Medications Management is supportive and

addresses symptoms. No antiviral medications are currently approved for the treatment of enterovirus infections.

Inpatient & Outpatient Medications

Pleconaril Immunoglobulins – used

therapeutically and prophylactically for enteroviral CNS infections in neonates and immunocompromised hosts. Pre-exposure prophylaxis with immunoglobulins – known to reduce the risk of paralysis in patients with poliovirus infections.

Latest Treatments for Enteroviruses

Naloxone Thiamine Glucose Mannitol Dilantin Phenobarbital Steroids Acyclovir Ganciclovir Diazepam

Control and Prevention Strategies Hygienic measures such as

adequate disposal of infected secretions and waste disposal help prevent the spread of enteroviral infections.

POLIOMYELITIS: Prevention No specific treatment except

supportive measures in paralytic poliomyelitis

it is possible to prevent the disease through active immunization

3 major discoveries responsible for the development of successful vaccines:

Protection is required against all 3 types of poliovirus.

Poliovirus will replicate readily in cell cultures derived from non-nervous tissue

Viremia is essential for the pathogenesis of paralytic poliomyelitis so that serum antibodies MUST interrupt the viremia

2 vaccines available:

1) inactivated Salk vaccine2) attenuated Sabin vaccine.

Control and Prevention Strategies Inactivated Salk Vaccine

formalin inactivated intramuscular polio vaccine (IPV) - high potency and purity

safe and effective does not induce local IgA

mediated immunity to polioviruses in the gut

had been shown to confer herd immunity against poliovirus

reduce pharyngeal, and fecal shedding of the virus in vaccinated individuals who have been infected by poliovirus in the gut

Recent small outbreak - type 3 strain

Live Attenuated Vaccine (Sabine vaccine)

live attenuated oral polio vaccine (OPV)

advantages over IPV induces long lasting immunity –

similar to natural infection induces IgA formation - local

immunity against reinfection in the pharynx and gut

not seen in IPV regarded as the crucial argument

in favor of OPV mucosal immunity is not life-long

and reinfection is possible within a few months although excretion is short-lived

greater herd immunity based on 2 factors; (1) stimulation of mucosal immunity and resultant curtailment of spread of wild virus (2) displacement of wild virus in the community by vaccine related strains.

inexpensive mass immunization without the need for expensive sterile equipment

Control and Prevention Strategies

1988 WHO established the year 2000 for achieving global poliomyelitis eradication

1994, the Americas were certified as polio-free

All other regions are making steady progress towards the goal of global eradication, which is now scheduled for

2008 reversal to neurovirulence by the strains of virus used in OPV

response rate to OPV may be poor in developing countries with a warm climate

2005:Stop poliovirus transmission

2006:End supplementary vaccination

2007:Complete laboratory containment

2008:Certify global eradication

2009 onwards:Long term immunization policy

Control and Prevention Strategies The spread of AHC is

prevented by hand washing and using separate towels.

Patient Education HFMD is very contagious,

especially during the first week of the illness. The virus can still be spread weeks after symptoms have resolved. As a preventive measure, close contact with affected individuals should be avoided

The Universal Standard

Precaution and preventive measure…

HANDWASHING

Is the best !!!

JOURNAL

Fatal Case of Enterovirus 71 Infection, France, 2007

AbstractA fatal case of enterovirus 71 infection with pulmonary edema and rhombencephalitis occurred in Brest, France, in April 2007. The virus was identified as subgenogroup C2. This highly neurotropic

enterovirus merits specific surveillance outside the Asia-Pacific region.

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