Poliomyelitis

Dr.T.V.Rao MD
 What is Poliomyelitis
 Poliomyelitis (polio) is a highly
infectious viral disease, which mainly
affects young children. The virus is
transmitted through contaminated
food and water, and multiplies in the
intestine, from where it can invade
the nervous system.
 How Polio presents
 Initial symptoms of polio include
fever, fatigue, headache, vomiting,
stiffness in the neck, and pain in the
limbs. In a small proportion of cases,
the disease causes paralysis, which
is often permanent. Polio can only be
prevented by immunization.
 Where is Polio present
TODAY
 In 2008, only four countries in the
world remain with polio-endemic,
down from more than 125 in 1988.
The remaining countries are
Afghanistan, India, Nigeria and
Pakistan.
 POLIOMYLETIS.
 Involves CNS, produces serious
Illness.
 Causes Destruction of Motor Neurons

in Spinal cord.
 Produces FLACID PARALYSIS.

 India has still has many cases of

Poliomyelitis.
 Polio An Enterovirus
 Poliovirus, the causative agent of
poliomyelitis, is a human enterovirus
and member of the family of
Picornaviridae.Poliovirus is composed
of a RNA genome and a protein
capsid. The genome is single-
stranded positive-sense RNA genome
that is about 7500 nucleotides long.
The viral particle is about 300
Ångström in diameter with
icosahedral symmetry.
Pioneers who Discovered
Vaccine
 Poliomyelitis
 First described by Michael Underwood
in 1789
 First outbreak described in U.S.
in 1843
 21,000 paralytic cases reported in the
U. S. in 1952
 Global eradication in near future
 Classification of Polio virus.
 Type 1- Brunhilde and Mahoney.
 Type 2- Lansing and Mefi.
 Type 3- Leon and Salkett.
 Properties of Polio virus,
 Size is 27 nm
 Contains 4 viral
protein
VP1 to VP 4
 VP1 Carries the
major antigenic
site, and combines
with type specific
neutralizing
antibodies
 Properties of Polio virus.
 Typical Entero virus.
 Inactivated at 550 c for 30 mt.

 Chlorine at 0.1 ppm

 Ether is not effective.

 Animal susceptibility.

Monkey brain
Requires Primate specific membranes.
Contains 3 Antigenic types 1,2,3
Can be differentiated by ELISA and CF
methods.
 Polio Infection.
 Incubation 3 – 21 days
 On average 14 days

 Predisposing factors.

Severe muscular acitivity can lead to

paralysis, as it increases the blood flow
May produce paralysis in the limb or bulbar
region
Injecting vaccines with adjuvant can predispose to
paralysis
Patients who underwent tonsillectomy have higher
incidence as Ig G secretion is reduced
Rarely oral Polio vaccine produces poliomyelitis.
Pathogenesis and pathology.
 Enter through Mouth,
 Multiplies in Oropharynx tonsils and
Intestines,
 Excreted in Stool.
 Enters the CNS from Blood.
 Spread along the Axons of peripheral
nerves to CNS.
 Progress along the fibers of the lower
motor neurons spinal cord or brain.
 Pathology and Pathogenesis.
 Destroy the Anterior horn cells of the
Spinal Cord
 Do not Multiply in Muscles only

muscles manifest with weakness and

flaccid paralysis result is secondary.
 Occasionally produce

Myocarditis,
Lymphatic hyperplasia.
 Clinical Manifestations.
 In apparent, Only 1% manifest with
clinical features.
 Can lead to permanent paralysis.

 Incubation 7-14 days, ( 3-35 )

 May be abortive Poliomyelitis,

Only Fever, Malaise, Drowsiness,

Non paralytic Poliomyelitis,
Aseptic Meningitis.
Outcomes of Poliovirus Infection

Asymptomatic Minor non-CNS illness

Aseptic menigitis Paralytic

0 20 40 60 80 100
Percent
 Paralytic Poliomyelitis.
 Manifest as Flaccid Paralysis.( Caused due
to damage to Lower Motor Neurons.)
 Partial recovery within 6 months.
 Patient may continue with life time
disability
 Can involve Spinal cord, and Bulbo spinal
region
 Bulb spinal involvement can paralyze
respiratory muscle and lead to Respiratory
failure
.
Cripples a Grwoing Child
Clinical presentation of typical
Polio
 Aseptic Meingitis

 Present with Non paralytic form with

stiffness and pain in the back and
neck region
 Lasts for 2 -10 days

 Recovery rapid and complete

 On rare occasions advance to

paralysis
 Laboratory Diagnosis.
 Viral isolation from
Throat swabs,
Rectal swabs.
Stool
specimens,
 Transported in frozen containers.

 Produce cytopathic effect on

Human and
Monkey cells
 Produce cytopathic effects.
 Viral Isolation
 From feces - present in 80% of
cases in 1st week
 In 50 % till 3rd week

 In 25 % till several weeks

 Collect the fecal sample at the

earliest.
 Primary monkey kidney is the ideal

cell line for isolation of virus

 Viral isolation must be interpreted

with caution and clinical presentation

 Laboratory Diagnosis
(Serology )
 Estimation of Antibodies Ig M
 A paired sample is essential.
 Immunity.
 Permanent type specific.
 1 and 2 types have Heterotypic

resistance.
 Mother to Off spring immunity lasts

for less than 6 months.

 Epidemiology
 Endemic
 Epidemic

 Hygiene plays in spread of diseases.

 Children < 5 in Developing countries.

 Prevention and Control.
(Vaccines)
 Sabin’s Live attenuated vaccine
 Grown in Monkey kidney cells, Human
Diploid cells. Preserved at 4 c
 Multiple doses are given
 Given as oral Drops
 At present only vaccine given in our
National Programme of Immunization
 Boosts Immunity with Production Ig G ,Ig
M
 And also Ig A Participate as participant in
Prevention.
 Vaccination Sabin's- Oral
Administration
 Sabin’s vaccine is administered
orally.
 Contains

Type 1 – 10 lakhs,
Type 2- 2 lakhs
Type 3- 3 Lakhs.
The virus are stable with Mg cl.
 Oral Polio Vaccine

 Highly effective in producing

immunity to poliovirus
 50% immune after 1 dose
 >95% immune after 3 doses
 Immunity probably lifelong
Sabin's Vaccine
 Live Polio vaccines –Protects
Society too

 The Live Polio vaccine infects

multiples in the Intestines and thus
Immunizes the Individual
 Vaccines not only produces IgM and

IgG in the blood but also IgA

antibodies in the Intestines.
 Which help the gut immunity
 Live Vaccine Associated Polio
 On few occasions type 2 and type 3
virus may mutate in the course of
multiplication
 May lead to Vaccine associated Polio

 But very negligible

 Role Of Immunoglobulins in
Prevention

 Immunoglubulins can provide

protection for a few weeks against
the paralytic polio
 But does not prevent subclinical

infection
 Effective if given shortly before

infection
 No value once the clinical symptoms

develop
 Salk Vaccines
 Salk Vaccine - A Killed Vaccine.
 Four Injections are administered in a

period of two years,

 Administration of periodic booster

recommended.
 Most of the Western Nations do use

it.
Salk Vaccine ( Killed-Inject able)
 Vaccination in
Immunodeficient

Only Killed viral vaccines

used in Immunodeficient
persons
( SALK )
Present prevalence of Polio
attacks
Wild Poliovirus 2006
 Global Eradication

 WHO target date - year 2000

 Yet in 2008 we have Polio cases
Pulse Polio Immunization
 Global Eradication.
 The Indian Programme of PULSE
POLIO Immunization is a part of it to
eradicate Polio
 Recent resurgence in UP and Bihar is

a threat to the desired Goal.

 In spite of best efforts thousands

occur globally in Africa and Indian

subcontinent.
Let us be partners in Eradication of
Polio
 Created for
Undergraduate Teaching
Programme
Dr.T.V.Rao,MD
Email
doctortvrao@gmail.com