- Author: Larry I Lutwick, MD; Chief Editor: Mark R Wallace, MD, FACP, FIDSA more...
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- The importance of proper hand hygiene, cough etiquette, and safe food/beverage choices (particularly during travel) cannot be emphasized enough and are the keys to interrupting picornavirus disease transmission.
- The Advisory Committee on Immunization Practices, under the Department of Health and Human Services and the Centers for Disease Control and Prevention, regularly updates immunization recommendations for children, adolescents, and adults in the United States.
- Poliomyelitis vaccine recommendations are as follows:
- The current recommendation for IPV is 4 doses, at ages 2 months, 4 months, 6-18 months, and 4-6 years. The efficacy of IPV after only 1-2 doses is lower than the equivalent number of OPV doses.
- Outside the United States, OPV is given in 4 doses, at ages 2 months, 4 months, 6-18 months, and 4-6 years. The main disadvantage of OPV is the very rare occurrence of vaccine virus-associated poliomyelitis (ie, 8 cases annually in the United States). The mechanism by which vaccine virus strains cause paralytic disease is not fully understood.
- OPV is not recommended for use in the Unites States except for certain circumstances, as follows:
- Rapid control of an outbreak
- IPV is unavailable
- Children of parents who do not accept the recommended number of vaccine injections
- Unvaccinated children traveling within 4 weeks to endemic areas
- HAV vaccine is recommended for the following:
- All children aged 12 months and older
- Populations at increased risk of infection
- Persons traveling to endemic countries
- Men who have sex with men
- Users of illegal drugs
- Patients with chronic liver disease or clotting factor deficiencies
- People who may have occupational risk for exposure, including sewage workers, plumbers, primate handlers, medical and nursing staff, and daycare staff
- Populations recommended to receive HAV immunoglobulin after exposure or as an alternative for HAV immunization include the following:
- Patients exposed to HAV in the past 14 days who may be susceptible to the disease
- Household and sexual contacts of known cases
- Staff and attendees of daycare centers or homes after 1 or more cases occur in children and employees or 2 or more cases occur in the household of attendees
- Fellow food handlers
- Those at risk who work in schools and hospitals or other work settings
- Patients in outbreak situations with suspected exposure
- Children younger than 2 years
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- Respiratory compromise is caused by paralysis of the respiratory muscles, by airway obstruction due to involvement of cranial nerve nuclei, or by respiratory center lesions.
- Postpolio syndrome (newly onset weakness, fatigue, breathing or sleeping difficulty, myalgias and/or arthralgias) may affect poliomyelitis survivors months to years after recovery.
- Gastrointestinal events (eg, hemorrhage, paralytic ileus, gastric dilatation) may complicate acute paralysis.
- Chronic nonischemic cardiomyopathy and pneumonitis has been associated with coxsackieviruses.
- Fatal encephalitis has been observed in enterovirus 71 infections.[30, 19]
- Echovirus and parechovirus infections in children treated with aspirin may lead to Reye syndrome.
- A connection between pancreatitis and diabetes mellitus type 1 is still being sought.[39, 40]
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- Postpolio syndrome is generally not life-threatening unless it involves respiratory or airway muscles.
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