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ACUTE
FLACCID
PARALYSIS
KANISHK DEEP SHARMA
ROLL NO. 50
DEFINITION
Sudden onset of weakness or paralysis over a period of 15
days in a patient aged less than 15 years age
DDX
POLIOMYELITIS
Non enveloped, positive stranded RNA virus
Genus ENTEROVIRUS
family PICORNAVIRIDAE
3 antigenically distinct ...
•Entry into mouth.
•Replication in pharynx, GI tract, Local Lymphatic.
•Hematologic spread to lymphatic and central nervou...
IMMUNITY
•Initially protected by maternal antibodies for first few weeks
of life
TYPES
• Asymptomatic
• Abortive Polio
• Non-paralytic
• Paralytic
• Spinal
• Bulbar
• Bulbospinal
CF- ASYMPTOMATIC
• Accounts for approximately 95% of cases
• Virus stays in intestinal tract and does not attack the nerve...
CF-ABORTIVE
•Does not lead to paralysis
•Mild symptoms seen such as sore throat, fever, n/v, diarrhea,
constipation ( Mino...
CF- NON PARALYTIC
( Major illness)
– Occurs in 1-2% of polio infections
– Symptoms are stiffness in the neck, back, and/or...
CF- PARALYTIC
Paralytic Polio Fewer than 1% of those infected develop this
type
Acute flaccid paralysis seen.
Initially fo...
SPINAL POLIO
Most common form of paralytic
79% –Attacks motor neurons and causes paralysis of
muscles of respiration and...
BULBAR POLIO
• Accounts for 2% of paralytic polio
• Virus attacks motor neurons in brainstem
•Affects cranial nerve functi...
BULBOSPINAL POLIO
•Accounts for 19% of paralytic cases
• Affects extremities and cranial nerves
• Leads to severe respirat...
DDX
CHARACTERISTICS
•Asymmetric AFP
•Fever & muscle pain at onset
•Rapid progress, from onset to max. paralysis in <4days
...
TREATMENT IN PAST
Iron Lung
a sealed chamber with an electrically driven bellows that
regulates breathing.
PRESENT TREATMENT
• Antibiotics for infection
• Analgesics for pain
• Portable Ventilators for breathing problem
• Moderat...
PREVENTION
•Oral polio vaccine
• Formed by sabin
• Produces both Humoral & local immunity Contributes to
herd immunity
• 50% immune a...
•Inactivated polio vaccine
• Humoral immunity and to some extend pharyngeal immunity
• Duration of immunity not known with...
STRATEGIES
FOR POLIO
ERADICATION
Global Polio Eradication Initiative launched in 1988
Polio cases have decreased by over 99%
1988 - >125 countries
In 2010 ...
CORE STRATEGIES
1. High infant immunization coverage with four doses of
oral poliovirus vaccine (OPV) in the first year of...
IMMUNISATION IN
INDIA
POLIO VACCINATION
UNDER UIP
OPVº birth
OPV1 6 wks
OPV2 10 wks
OPV3 14 wks
OPV4 16-24 Months
PULSE POLIO
IMMUNIZATION (PPI)
The supplementary immunization activities (SIAs) in India
launched in 1995
Irrespective of ...
AIM
Providing additional OPV doses to every child aged <5 years
at intervals of 4-6 weeks during National Immunization Day...
OUTBREAK RESPONSE
IMMUNIZATION (ORI)
House-to-house immunization following the AFP case
investigation and stool specimen c...
ACTIVE CASE SEARCH
Where an AFP case resides – or where an AFP case has
visited during the incubation period for polio (4-...
Acute flaccid paralysis
Acute flaccid paralysis
Acute flaccid paralysis
Acute flaccid paralysis
Acute flaccid paralysis
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Acute flaccid paralysis

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ACUTE FLACCID PARALYSIS
Kanishk Deep Sharma
definition
Sudden onset of weakness or paralysis over a period of 15 days in a patient aged less than 15 years age
Ddx

poliomyelitis
Non enveloped, positive stranded RNA virus
Genus ENTEROVIRUS
family PICORNAVIRIDAE
3 antigenically distinct serotypes:-1,2,3
pathogenesis
•Entry into mouth.
•Replication in pharynx, GI tract, Local Lymphatic.
•Hematologic spread to lymphatic and central nervous system.
•Viral spread along nerve fibers.
•Destruction of motor neurons
Immunity
Initially protected by maternal antibodies for first few weeks of life
Types
Asymptomatic
Abortive Polio
Non-paralytic
Paralytic
Spinal
Bulbar
Bulbospinal
Cf- asymptomatic
• Accounts for approximately 95% of cases
• Virus stays in intestinal tract and does not attack the nerves
• Virus is shed in the stool so infected individual is still able to infect others
Cf-abortive
•Does not lead to paralysis
•Mild symptoms seen such as sore throat, fever, n/v, diarrhea, constipation ( Minor illness)
•Most recover in <1><5><4days />95% immune after 3 doses
Immunity probably lifelong

Inactivated polio vaccine
Humoral immunity and to some extend pharyngeal immunity
Duration of immunity not known with certainty

Strategies for polio eradication

Global Polio Eradication Initiative launched in 1988
Polio cases have decreased by over 99%
1988 - >125 countries
In 2010 - 4 countries
The remaining countries are Afghanistan, India, Nigeria and Pakistan
Core strategies
High infant immunization coverage with four doses of oral poliovirus vaccine (OPV) in the first year of life
Supplementary doses of OPV to all children under five years of age during national immunization days
AFP surveillance among children under fifteen years of age
Targeted “mop-up” campaigns once wild poliovirus transmission is limited to a specific focal area.
Immunisation in india
Polio Vaccination under UIP
OPVº birth
OPV1 6 wks
OPV2 10 wks
OPV3 14 wks
OPV4 16-24 Months
Pulse Polio Immunization (PPI)
The supplementary immunization activities (SIAs) in India launched in 1995
Irrespective of the immunisation status
Usually Dec & Jan – Peak transmission
aim
Providing additional OPV doses to every child aged <5><15 years who have had the onset of flaccid paralysis within the preceding 60 days
All cases that are found are investigated immediately, with collection of two stool specimens before administration of OPV.

Published in: Health & Medicine
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Acute flaccid paralysis

  1. 1. ACUTE FLACCID PARALYSIS KANISHK DEEP SHARMA ROLL NO. 50
  2. 2. DEFINITION Sudden onset of weakness or paralysis over a period of 15 days in a patient aged less than 15 years age
  3. 3. DDX
  4. 4. POLIOMYELITIS Non enveloped, positive stranded RNA virus Genus ENTEROVIRUS family PICORNAVIRIDAE 3 antigenically distinct serotypes:-1,2,3
  5. 5. •Entry into mouth. •Replication in pharynx, GI tract, Local Lymphatic. •Hematologic spread to lymphatic and central nervous system. •Viral spread along nerve fibers. •Destruction of motor neurons PATHOGENESIS
  6. 6. IMMUNITY •Initially protected by maternal antibodies for first few weeks of life
  7. 7. TYPES • Asymptomatic • Abortive Polio • Non-paralytic • Paralytic • Spinal • Bulbar • Bulbospinal
  8. 8. CF- ASYMPTOMATIC • Accounts for approximately 95% of cases • Virus stays in intestinal tract and does not attack the nerves • Virus is shed in the stool so infected individual is still able to infect others
  9. 9. CF-ABORTIVE •Does not lead to paralysis •Mild symptoms seen such as sore throat, fever, n/v, diarrhea, constipation ( Minor illness) •Most recover in <1 week
  10. 10. CF- NON PARALYTIC ( Major illness) – Occurs in 1-2% of polio infections – Symptoms are stiffness in the neck, back, and/or legs – Increased or abnormal sensations can occur – Complete recovery after 2-10 days of symptoms
  11. 11. CF- PARALYTIC Paralytic Polio Fewer than 1% of those infected develop this type Acute flaccid paralysis seen. Initially focal but spreads over 3 – 4 days Headache, neck/back stiffness, unusual sensations, increased sensitivity to touch Tripod sign + Descending paralysis Asymmetrical patchy paralysis Deep tendon reflex lost before onset of paralysis
  12. 12. SPINAL POLIO Most common form of paralytic 79% –Attacks motor neurons and causes paralysis of muscles of respiration and muscles of extremities Children <5 years most likely to become paralyzed in one leg Adults are most commonly paralyzed in both arms and legs Those affected still retain sensation in extremities
  13. 13. BULBAR POLIO • Accounts for 2% of paralytic polio • Virus attacks motor neurons in brainstem •Affects cranial nerve function •Primarily inhibits ability to breathe, speak, and swallow effectively Facial asymmetry present
  14. 14. BULBOSPINAL POLIO •Accounts for 19% of paralytic cases • Affects extremities and cranial nerves • Leads to severe respiratory involvement
  15. 15. DDX CHARACTERISTICS •Asymmetric AFP •Fever & muscle pain at onset •Rapid progress, from onset to max. paralysis in <4days •Intact sensory function •Residual weakness/paralysis after 60 days
  16. 16. TREATMENT IN PAST Iron Lung a sealed chamber with an electrically driven bellows that regulates breathing.
  17. 17. PRESENT TREATMENT • Antibiotics for infection • Analgesics for pain • Portable Ventilators for breathing problem • Moderate Exercise • Nutritional Diet
  18. 18. PREVENTION
  19. 19. •Oral polio vaccine • Formed by sabin • Produces both Humoral & local immunity Contributes to herd immunity • 50% immune after 1 dose • >95% immune after 3 doses • Immunity probably lifelong
  20. 20. •Inactivated polio vaccine • Humoral immunity and to some extend pharyngeal immunity • Duration of immunity not known with certainty
  21. 21. STRATEGIES FOR POLIO ERADICATION
  22. 22. Global Polio Eradication Initiative launched in 1988 Polio cases have decreased by over 99% 1988 - >125 countries In 2010 - 4 countries The remaining countries are Afghanistan, India, Nigeria and Pakistan
  23. 23. CORE STRATEGIES 1. High infant immunization coverage with four doses of oral poliovirus vaccine (OPV) in the first year of life 2. Supplementary doses of OPV to all children under five years of age during national immunization days 3. AFP surveillance among children under fifteen years of age 4. Targeted “mop-up” campaigns once wild poliovirus transmission is limited to a specific focal area.
  24. 24. IMMUNISATION IN INDIA
  25. 25. POLIO VACCINATION UNDER UIP OPVº birth OPV1 6 wks OPV2 10 wks OPV3 14 wks OPV4 16-24 Months
  26. 26. PULSE POLIO IMMUNIZATION (PPI) The supplementary immunization activities (SIAs) in India launched in 1995 Irrespective of the immunisation status Usually Dec & Jan – Peak transmission
  27. 27. AIM Providing additional OPV doses to every child aged <5 years at intervals of 4-6 weeks during National Immunization Days (NIDs) & sub-National Immunization Days (SNID's) “Flood” the community with OPV within a very short period of time, thereby interrupting transmission of virus throughout the community. Intensification : house-to-house “search and vaccinate” component.
  28. 28. OUTBREAK RESPONSE IMMUNIZATION (ORI) House-to-house immunization following the AFP case investigation and stool specimen collection
  29. 29. ACTIVE CASE SEARCH Where an AFP case resides – or where an AFP case has visited during the incubation period for polio (4-25 days before paralysis onset) Carried out immediately along with ORI A search is conducted for any children aged <15 years who have had the onset of flaccid paralysis within the preceding 60 days All cases that are found are investigated immediately, with collection of two stool specimens before administration of OPV.

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