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.