1. ד"ר אלכס גורי מחלות זיהומיות בילדים, ב"ח קפלן
Poliomyelitis
ד"ר אלכס גורי
מחלות זיהומיות בילדים, ב"ח קפלן

3. Introduction “Polios” = “gray”, “myelos”= “spinal cord”
First descriptions Medin (Sweden) 1890
First epidemics – Scandinavia, USA 189*
regular epidemics 25/
1952 USA cases, 3145 fatalities, handicapped

4. Virology
Enterovirus
3 serotypes, lifelong specific immunity to each serotype
Humans are only natural host
Wild type, live-attenuated, VDPV (vaccine-derived)

5. Pathogenesis

6. Clinical
Incubation 9-12 (range 5-35) from contact to prodrome, day to paralysis

7. Clinical features
/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 infections
Meningitis, muscle pain, involuntary spasm and then asymmetric flaccid paralysis, almost never sensory, 66% permanent
Bulbar pn
Cranial nerves involvement 5-35% of paralytic cases

9. 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

10. DD Entero 71 West Nile virus
Guillain-Barre (symmetrical, ascending, lost of sensation, 1-2 weeks of progress, protein in CSF)

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

16. IPV
Jonas Salk 1955

17. IPV
High titers of ab, no secretory ab

18. OPV Sabin OPV field trials 1955-59 Monovalent originally
VAPP 1:2.6 million
25%(VAPP) inimmune deficient (B-cell)
Chumakov Mikhail

20. Epidemiology

21. VDPD outbreaks

27. Advantages and Disadvantages

28. ב משרד הבריאות הפיץ המלצה לפיה יש להקפיד לחסן את הפגים לפי הגיל הכרונולוגי גם אם עודנו מאושפז כאשר גיל מינימום למתן IPV הוא 37 שבועות