AFP surveillance reverse cold chain polio vaccine --> live attenuated paediatrics community medicine microbiology serotype 3 new vaccine schedule IPV added to go national immunisation schedule d

1. POLIO

2. POLIO VIRUS
• NON ENVELOPED RNA VIRUS BELONGING TO PICORNA VIRUS

3. TYPE P1
• MOST
COMMON
• CAUSES MOST
EPIDEMICS
TYPE P2
• MOST
ANTIGENIC
• MOST EASILY
ERADICABLE
TYPE P3
• MOST
COMMONLY
ASSOCIATED
WITH PARALYSIS
CAUSED BY
WILD POLIO
VIRUSType 2 causes vaccine
associated paralytic polio

4. • MAN IS THE ONLY RESERVOIR
• NO CHRONIC CARRIER STATE
• TRANSMISSION BY FAECO-ORAL ROUTE
• SUBCLINICAL INFECTIONS (95 % OF POLIO INFECTION) PLAY SIGNIFICANT ROLE IN
TRANSMISSION OF DISEASE
• INFECTIVE MATERIAL ARE FAECES & NASOPHARYNGEAL SECRETIONS
• VIRUS IS SHED IN FAECES 2 WEEK BEFORE PARALYSIS TO AS LONG AS 3-4 MONTHS IN FAECES

5. • MORE COMMON IN AGE GROUP 6 MONTHS – 3 YEARS
• WITH SLIGHT MALE PREPONDERANCE

6. PATHOGENESIS OF POLIOVIRUS INFECTION
CONTACT WITH HOST
DIGESTIVE TRACT
MULTIPLICATION IN LYMPHOID ORGANS (PHARYNX OR
SMALL INTESTINE)
DISSEMINATION VIA LYMPH AND BLOOD
THE VIRUS REACHES THE CNS

7. PATHOGENESIS OF POLIO VIRUS INFECTION

9. CLINICAL SPECTRUM OF POLIO
• SUBCLINICAL (INAPPARENT INFECTION) 95 % MC
• MINOR ABORTIVE ILLNESS 4.8 %
• ASEPTIC MENINGITIS /NONPARALYTIC POLIO
• PARALYTIC POLIO (<!%)

11. • ANTERIOR HORN CELLS ARE AFFECTED
• AUTONOMIC & MOTOR FUNCTIONS ARE
AFFECTED
• DEEP TENDON REFLEXES ARE AFFECTED
• NO SENSORY IMPAIREMENT

12. PATHOGENESIS
• POLIO VIRUS SPREAD BOTH HEMATOGENOUSLY & BY NEURAL ROUTE
• SPREADS HEMATOGENOUSLY & INFECT NEURONS
• MULTIPLIES IN NEURONS & DESTROYS THEM

13. PARALYSIS IN POLIO
• DESCENDING
• ASYMMETRICAL
• NON PROGRESSIVE
• PROXIMAL >> DISTAL
• LOWER MOTOR NEURON TYPE
• NO SENSORY INVOLVEMENT

14. INCREASED RISK OF PARALYTIC POLIO
• TONSILLECTOMY
• TOOTH EXTRACTION
• ADENOIDECTOMY
• STRENOUS PHYSICAL EXERCISE
• FATIGUE
• PERGNANCY
• CORTISONE ADMINISTRATION
• IM JUNCTION

15. • PARALYTIC POLIO INCREASED RISK IN MALES

16. • MC MUSCLE AFFECTED IN POLIO  QUADRICEPS
• MC MUSCLE TO UNDERGO COMPLETE PARALYSIS  TIBIALIS ANTERIOR
• MC MUSCLE AFFECTED IN HAND  OPPONENS POLLICIS

17. PARALYTIC POLIO PRESENTATIONS
• SPINAL PARALYTIC POLIO  MC
• BULBAR POLIOMYELITIS  2 % CASE FATALITY UPTO 40 % RESPIRATORY INVOLVEMENT
• BULBOSPINAL POLIO  20 %
• POLIOENCEPHALITIS  ALTERED SENSORIUM SEIZURES

19. RESIDUAL PARALYSIS
• PARLYSIS WHICH PERSIST AFTER 60 DAYS

20. • MC CAUSE OF DEATH IN POLIO
• RESPIRATORY PARALYSIS (A/C BULBAR PALSY)

21. RX
• NO SPECIFIC RX
• BED REST
• SISTER KENNYS TREATMENT
• HOT MOIST PACKS APPLIED TO MUSCLES TO RELIEVE PAIN & SPASM

22. LAB DIAGNOSIS
• VIRUS ISOLATION FROM FECAL SAMPLES 24-48 HRS APART
• PRIMARY MONKEY KIDNEY IS USED FOR ISOLATION

23. VACCINES
• IPV (SALK VACCINE)
• OPV (SABIN VACCINE)

24. OPV
• 2 DROPS  0.5 ML
• TRIVALENT POLIO VACCINE
• OVER 3,00,000 TCID 50 OF TYPE 1 POLIO
• OVER 1,00,000 TCID 50 OF TYPE2 POLIO
• OVER 3,00,000 TCID 50 OF TYPE 3 POLIO

25. • OPV INDUCES HERD IMMUNITY
• WIDESPREAD HERD IMMUNITY EVEN IF ONLY 66 % OF THE COMMUNITY IS IMMUNIZED

26. OPV IPV
LIVE ATTENUATED FORMALIN INACTIVATED (KILLED)
GIVEN ORALLY GIVEN IM OR SC
INDUCES Ab QUICKLY  USED IN EPIDEMIC
BOTH HUMORAL & INTESTINAL IMMMUNITY
INDUCE SLOW Ab FORMATION  NOT USEFUL IN
EPIDEMIC
INDUCES HUMORAL IMMUNITY
CHEAPER COSTLIER (MORE VIRUS CONTENT)
THERMOLABILE VACCINE MAINTENNACE OF COLD
CHAIN IS REQUIRED & VACCINE IS STORED @-20*C
DOES NOT REQUIRE STRINGENT TRANSPORT
CONDITIONS FOR STORAGE  LONGER HALF LIFE
CANNOT BE GIVEN TO IMMUNICOMPROMISED CAN BE GIVEN TO IMMUNOCOMPROMISED

31. POLIO END GAME STRATEGY

35. VACCINE DERIVED POLIO VIRUS (VDPV)
CIRCULATING cVDPV
• Person to person
transmission
• In areas with poor
OPV coverage
IMMUNIDEFICIENCY
ASSOCIATED VDPV
(iVDPV)
• Isolated from pateints
with primary
immunodeficiency
AMBIGUOUS
VDPV(aVDPV)
• Clinical Isolates from
person with no
immunodeficiency or
sewage isolates whose
source is unknown

37. • TYPE 2 COMPONENT OF OPVA/W VACCINE ASSOCIATED PARLYTIC POLIO

38. EPIDEMIC OF POLIO

39. EPIDEMIC OF POLIO
• 2 OR MORE CASES OF POLIO BY SAME VIRUS TYPE IN ANY 4 WEEKS PERIOD

40. • NO SEROTYPE 2 WILD POLIO VIRUS HAS BEEN DETECTED IN WORLD SINCE 1999
• TYPE 1 & 3 HAVE BEEN DETECTED

41. POLIO ENDEMIC COUNTRIES
• NIGERIA
• PAKISTHAN
• AFGANISTHAN

42. POLIO ERADICATION IS CONDUCTED AT REGIONAL
BASES
• EACH REGION CAN CONSIDER CERTIFICATION ONLY WHEN ALL COUNTRIES IN THE AREA
DEMONSTARTE ABSENCE OF WILD POLIO VIRUS TRANSMISSION FOR ATLEAST 3
CONSECUTIVE YEARS

43. IN INDIA
• NO CASES OF POLIO SINCE 13 JANUARY 2011
• 25TH FEBRUARY 2012 INDIA WAS REMOVED FROM LIST OF POLIO ENDEMIC COUNTRIES BY
WHO

44. AFP- CASE DEFINITION
SUDDEN ONSET WEAKNESS AND FLOPPINESS IN ANY PART OF THE BODY IN A CHILD < 15
YEARS OF AGE OR PARALYSIS IN A PERSON OF ANY AGE IN WHICH POLIO IS SUSPECTED
WITH NO HISTORY OF TRAUMA OR ELECTROLYTE IMBALANCE .

45. ADEQUATE SPECIMEN FOR POLIO
• 2 SPECIMENS (FECAL SAMPLES)
• WITH IN 14 DAYS OF ONSET OF AFP
• ATLEAST 24 HOURS APART
• ADEQUATE VOLUME (8-10GM/ADULT THUMB
SIZE)

46. TRANSPORT OF STOOL SAMPLE
• COLLECTED WITH IN 48 HRS OF ONSET
• 2 STOOL SAMPLES 24-48 HRS APART
• TRANSPORTED AT 4-8 * C (REVERSE COLD CHAIN)
• SHOULD ARRIVE WHO ACCREDITED LAB WITH IN 72 HOURS OF COLLECTION

47. AFP
Wild poliovirus confirm
No wild
poliovirus
inadequate
specimens
two adequate
specimens discard
discard
residual
weakness,
died or lost
to follow-up
compatible
no residual
weakness
discard
expert
review
Virological Classification of AFP Cases

48. MOPPING UP
• FOR EVERY DETECTED POLIO CASE IN THE LOCALITY
• HOUSE TO HOUSE
• 2 ROUNDS OF POLIO IMMUNISATION 4-6 WEEKS APART
• ALL CHILDREN BELOW 5 YRS

49. OTHER ENTEROVIRUS

50. COXSACKIE VIRUS
COXSACKIE A
• ASEPTIC MENINGITIS
• HERPANGINA
• A/C HEMORHHAGIC CONJUNCTIVITIS
COXSACKIE B
• ASEPTIC MENINGITIS
• BORNHOLM DISEASE(PLEURODYNIA)

51. HERPANGINA
• ENTEROVIRUS 71 &
COXSACKIE A

52. A/C HEMORRHAGIC CONJUNCTIVITS
• CAUSED BY
ENTEROVIRUS 70 &
COXSACKIE A24

53. PLEURODYNIA / BORNHOLM DISEASE
• PAROXYSMAL THORACIC PAIN D/T MYOSITIS INVOLVING CHEST & ABDOMINAL WALL
MUSCLES
• COXSACKIE B VIRUS 3,5,1 & 2

54. HAND FOOT MOUTH DISEASE
• COXSACKIE A 16
• ALSO ENTEROVIRUS 71  MORE SEVERE THAN COXSACKIE A 16
• OCCASIONALLY A/W COMPLICATIONS LIKE MYOCARDITIS PERICARDITIS

55. ENTEROVIRUS 72  HEPATITIS A
• HEPARANA VIRUS

56. • ENTEROVIRUS DONOT CAUSE HAEMORRHAGIC FEVER

57. ENTEROVIRUS
• MC CAUSE OF ASEPTIC MENINGITIS (ECHOVIRUS)
• MC CLINICAL MANIFESTATION OF ENTEROVIRUS IS NONSPECIFIC FEBRILE ILLNESS