eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Poliomyelitis: Follow-up

Author: Benjamin Estrada, MD, Professor, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Infectious Diseases, University of South Alabama College of Medicine, University of South Alabama Children's and Women's Hospital
Contributor Information and Disclosures

Updated: Aug 31, 2009

Follow-up

Further Inpatient Care

  • Patients with poliomyelitis may develop bladder dysfunction for which catheterization is frequently required.

Further Outpatient Care

  • Patients who suffer from long-term complications of poliomyelitis should be included in rehabilitation programs that focus on individual needs.7

Deterrence/Prevention

  • Two types of vaccines used in the prevention of poliomyelitis are inactivated poliovirus vaccine (IPV) administered parenterally and oral attenuated poliovirus vaccine (OPV).
    • Inactivated poliovirus vaccine
      • IPV was the first polio vaccine available on the market, and its widespread administration began in the 1950s. An enhanced inactivated poliovirus vaccine (eIPV) formulation is now available. Nonenhanced early formulations had the disadvantages of not being as immunogenic as OPV, not being able to induce mucosal immunity, and having to be administered parenterally, which increased costs and decreased compliance.8
      • One of the major advantages of IPV is that it contains an inactivated virus; for that reason, IPV is not associated with the development of vaccine-associated poliomyelitis. Although they do not induce mucosal immunity, new eIPV formulations have been proven to be as immunogenic as OPV. For that reason, countries in which no cases of wild-type disease have been reported during the last several years (eg, the United States) have now adopted eIPV immunization schedules. This new prophylactic approach has the advantage of eliminating vaccine-associated cases.
      • This vaccine is administered when individuals are aged 2 months, 4 months, and 6-12 months and before school entry, which is usually at age 4 years.9,10
      • IPV is now included in different combination vaccine products available in the United States.11
    • Oral attenuated poliovirus vaccine
      • Trivalent OPV has been used since the early 1960s. Immunization with this formulation was responsible for the significant decrease in the prevalence of disease throughout the world. This formulation has the advantages of inducing mucosal immunity, providing appropriate herd immunity, and increasing vaccine uptake because of oral administration. Additionally, it is cost-effective, especially in countries in the developing world.
      • The major disadvantage of trivalent OPV is its association with vaccine-associated paralytic poliomyelitis (VAPP). Although the virus contained in this formulation is attenuated, it may occasionally become neurotropic and be able to produce disease similar to wild-type virus.
      • Trivalent OPV is being administered in developing countries when individuals are aged 2 months, 4 months, and 6 months and with a booster at age 4 years. VAPP occurs most frequently after the first dose of OPV but may also occur after administration of the second or third doses.
      • A new high-potency monovalent oral poliovirus type 1 vaccine (mOPV1) was introduced in India in April 2005. This vaccine is targeted to eliminate some of the last poliovirus reservoirs. This product constitutes part of an international effort to eradicate wild poliovirus. Studies have revealed that mOPV1 is 3 times more effective against type 1 poliomyelitis than trivalent OPV. In addition, it has been demonstrated to be particularly efficacious in areas in which the efficacy of trivalent OPV may be compromised by the high prevalence of diarrhea and other infectious processes. mOPV1 may be the preferred option to control a poliovirus outbreak in areas that have already been declared free of wild poliovirus transmission.12,13

Prognosis

  • Bulbar paralytic poliomyelitis has been associated with the highest rate of complications and a mortality rate as high as 60%; spinal poliomyelitis follows. Patients with inapparent or abortive poliomyelitis recover without significant sequelae.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Administration of OPV is contraindicated in children who are immunocompromised and in children whose caretakers are immunocompromised. A risk for development of poliomyelitis is present in those individuals who receive this vaccine and are immunocompromised. Although OPV is no longer included in the routine vaccination schedule in the United States, its administration remains a common practice in other countries.
 


More on Poliomyelitis

Overview: Poliomyelitis
Differential Diagnoses & Workup: Poliomyelitis
Treatment & Medication: Poliomyelitis
Follow-up: Poliomyelitis
Multimedia: Poliomyelitis
References
Further Reading
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References

  1. Heymann D, Aylward B. Polio will soon be history. Bull World Health Organ. Jan 2007;85(1):7-8. [Medline].

  2. CDC. Poliovirus infections in four unvaccinated children--Minnesota, August-October 2005. MMWR Morb Mortal Wkly Rep. Oct 21 2005;54(41):1053-5. [Medline]. [Full Text].

  3. Resurgence of wild poliovirus types 1 and 3 in 15 African countries, January 2008-March 2009. Wkly Epidemiol Rec. Apr 17 2009;84(16):133-40. [Medline].

  4. Stewardson AJ, Roberts JA, Beckett CL, Prime HT, Loh PS, Thorley BR, et al. Imported case of poliomyelitis, Melbourne, Australia, 2007. Emerg Infect Dis. Jan 2009;15(1):63-5. [Medline].

  5. Cashman NR, Maselli R, Wollmann RL. Late denervation in patients with antecedent paralytic poliomyelitis. N Engl J Med. Jul 2 1987;317(1):7-12. [Medline].

  6. Laguna R, Barrientos J. Total hip arthroplasty in paralytic dislocation from poliomyelitis. Orthopedics. Feb 2008;31(2):179. [Medline].

  7. Lund ML, Lexell J. Perceived participation in life situations in persons with late effects of polio. J Rehabil Med. Aug 2008;40(8):659-64. [Medline].

  8. McBean AM, Thoms ML, Albrecht P. Serologic response to oral polio vaccine and enhanced-potency inactivated polio vaccines. Am J Epidemiol. Sep 1988;128(3):615-28. [Medline].

  9. [Guideline] AAP. Prevention of poliomyelitis: recommendations for use of only inactivated poliovirus vaccine for routine immunization. Committee on Infectious Diseases. American Academy of Pediatrics. Pediatrics. Dec 1999;104(6):1404-6. [Medline].

  10. [Guideline] Conclusions and recommendations of the Advisory Committee on Poliomyelitis Eradication, November 2008. Wkly Epidemiol Rec. Jan 16 2009;84(3):17-28. [Medline].

  11. Weston WM, Klein NP. Kinrix: a new combination DTaP-IPV vaccine for children aged 4-6 years. Expert Rev Vaccines. Nov 2008;7(9):1309-20. [Medline].

  12. Jenkins PC, Modlin JF. Decision analysis in planning for a polio outbreak in the United States. Pediatrics. Aug 2006;118(2):611-8. [Medline].

  13. Grassly NC, Wenger J, Durrani S, et al. Protective efficacy of a monovalent oral type 1 poliovirus vaccine: a case-control study. Lancet. Apr 21 2007;369(9570):1356-62. [Medline].

  14. Aylward RB, Sutter RW, Heymann DL. Policy. OPV cessation--the final step to a "polio-free" world. Science. Oct 28 2005;310(5748):625-6. [Medline].

  15. Bernier RH. Improved inactivated poliovirus vaccine: an update. Pediatr Infect Dis. May-Jun 1986;5(3):289-92. [Medline].

  16. CDC. From the Centers for Disease Control and Prevention. Progress toward poliomyelitis eradication--African Region, 1999-March 2000. JAMA. Oct 11 2000;284(14):1781-2. [Medline].

  17. CDC. From the Centers for Disease Control and Prevention. Progress toward poliomyelitis eradication--Eastern Mediterranean Region, 1998-October 1999. JAMA. Jan 12 2000;283(2):195-6. [Medline].

  18. CDC. Progress toward poliomyelitis eradication--India, January 2004-May 2005. MMWR Morb Mortal Wkly Rep. Jul 8 2005;54(26):655-9. [Medline].

  19. Kew OM, Sutter RW, de Gourville EM, Dowdle WR, Pallansch MA. Vaccine-derived polioviruses and the endgame strategy for global polio eradication. Annu Rev Microbiol. 2005;59:587-635. [Medline].

  20. Lahariya C, Pradhan SK. Prospects of eradicating poliomyelitis by 2007: compulsory vaccination may be a strategy. Indian J Pediatr. Jan 2007;74(1):61-3. [Medline].

  21. Lim JY, Kim KE, Choe G. Myotonic dystrophy mimicking postpolio syndrome in a polio survivor. Am J Phys Med Rehabil. Feb 2009;88(2):161-4. [Medline].

  22. Prevots DR, Strebel PM. Poliomyelitis prevention in the United States: new recommendations for routine childhood vaccination place greater reliance on inactivated poliovirus vaccine. Pediatr Ann. Jun 1997;26(6):378-83. [Medline].

  23. Sutter RW, Prevots DR, Cochi SL. Poliovirus vaccines. Progress toward global poliomyelitis eradication and changing routine immunization recommendations in the United States. Pediatr Clin North Am. Apr 2000;47(2):287-308. [Medline].

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Further Reading

Oshinsky DM. Polio. An American Story. Oxford University Press, 2005.

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Keywords

poliomyelitis, flaccid paralysis, nonparalytic poliomyelitis, paralytic poliomyelitis, wild-type poliovirus, paralysis, anorexia, abdominal pain, polio, postpolio syndrome, meningitis, respiratory failure, HIV infection, severe combined immunodeficiency, SCID, B-cell dysfunction, treatment, diagnosis

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Contributor Information and Disclosures

Author

Benjamin Estrada, MD, Professor, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Infectious Diseases, University of South Alabama College of Medicine, University of South Alabama Children's and Women's Hospital
Benjamin Estrada, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Sanofi-Pasteur Honoraria Speaking and teaching

Medical Editor

Leonard R Krilov, MD, Chief of Pediatric Infectious Diseases, Vice Chair, Department of Pediatrics, Professor of Pediatrics, Winthrop University Hospital
Leonard R Krilov, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research
Disclosure: Medimmune Grant/research funds Cliinical trials; Medimmune Honoraria Speaking and teaching; Medimmune Consulting fee Consulting

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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