Poliomyelitis

ד"ר אלכס גורימחלות זיהומיות

בילדים, ב"ח קפלן

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

Virology

• Enterovirus

• 3 serotypes, lifelong specific immunity to each serotype

• Humans are only natural host

• Wild type, live-attenuated, VDPV (vaccine-derived)

Pathogenesis

Clinical

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

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 infectionsMeningitis, muscle pain, involuntary spasm and then asymmetric

flaccid paralysis, almost never sensory, 66% permanent

• Bulbar pnCranial nerves involvement 5-35% of paralytic cases

• 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

DD

• Entero 71

• West Nile virus

• Guillain-Barre (symmetrical, ascending, lost of sensation, 1-2 weeks of progress, protein in CSF)

Dx

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

IPV

• Jonas Salk 1955

IPV

• High titers of ab, no secretory ab

OPV

• Sabin OPV field trials 1955-59

• Monovalent originally

• VAPP 1:2.6 million

• 25%(VAPP) inimmune deficient (B-cell)

Chumakov Mikhail

Epidemiology

VDPD outbreaks

Advantages and Disadvantages

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