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Pediatric Poliomyelitis

  • Author: Benjamin Estrada, MD; Chief Editor: Russell W Steele, MD  more...
 
Updated: May 24, 2016
 

Background

Poliomyelitis is an enteroviral infection that can manifest in 4 different forms: inapparent infection, abortive disease, nonparalytic poliomyelitis, and paralytic disease. Before the 19th century, poliomyelitis occurred sporadically. During the 19th and 20th centuries, epidemic poliomyelitis was more frequently observed, reaching its peak in the mid 1950s. The worldwide prevalence of this infection has decreased significantly since then because of aggressive immunization programs. Eradication of this disease during the present decade is a top priority for the World Health Organization (WHO).[1, 2] See the image below.

The typical contractures of postpolio residual par The typical contractures of postpolio residual paralysis.

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Pathophysiology

Poliovirus is an RNA virus that is transmitted through the oral-fecal route or by ingestion of contaminated water. Three serotypes are able to cause human infection. The incubation period for poliovirus is 5-35 days. The viral particles initially replicate in the nasopharynx and GI tract and then invade lymphoid tissues, with subsequent hematologic spread. After a period of viremia, the virus becomes neurotropic and produces destruction of the motor neurons in the anterior horn and brainstem. The destruction of motor neurons leads to the development of flaccid paralysis, which may be bulbar or spinal in distribution.

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Epidemiology

Frequency

United States

No cases of wild-type poliovirus infection have been reported in the United States since 1979. Until 1998, an average of 8-10 cases associated with the vaccine virus were reported every year. Since the institution of an all-inactivated poliovirus vaccine (IPV) policy in the routine immunization schedule, the number of vaccine-associated cases has significantly decreased. Four cases of vaccine-derived poliovirus were identified in 2005 among unvaccinated children in an Amish community in Minnesota.[3, 4]

International

The global incidence of poliovirus infection has decreased by more than 99% since 1988. Although no outbreaks had been reported in the western hemisphere since 1991, the Pan American Health Organization reported an outbreak in Haiti and the Dominican Republic in 2001. Since 2001, no additional outbreaks of disease caused by wild poliovirus have been reported in the Americas. Clusters of wild-type disease are still found in some areas in Africa and Southeast Asia.

As of 2014, significant progress has been made towards poliomyelitis eradication in India, which is now considered a nonendemic area.[5, 6] Pakistan, Afghanistan, and Nigeria are 4 countries in which indigenous transmission of wild poliovirus still occurs. However, importation of wild poliovirus into countries previously considered free of poliomyelitis continues to be a problem, especially in Africa.[7, 8] In addition, there have been recently confirmed cases of poliomyelitis in Syria and Iraq caused by wild poliovirus type 1 (WPV1).[9]

Concern for importation of cases from Afghanistan and Pakistan into Israel has resulted in a change in their routine polio immunization to include at least one dose of oral vaccine. In 2014, India began requiring a dose of oral polio vaccine for anyone coming from countries where polio is still seen, particularly Afghanistan and Pakistan.[10]

Mortality/Morbidity

Mortality is more frequently observed in cases of paralytic poliomyelitis and is associated with complications such as respiratory failure. No deaths due to wild-type poliovirus have been reported in the United States since 1979.

Although most cases of poliomyelitis (90-95%) are inapparent, 5-10% of patients who acquire this infection develop symptoms.

Sex

Males and females of pediatric age are affected with equal frequency.

Age

Poliovirus affects mainly children. However, individuals of any age (especially those who are immunocompromised) may also develop the disease.

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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, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

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, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Leonard R Krilov, MD Chief of Pediatric Infectious Diseases and International Adoption, Vice Chair, Department of Pediatrics, Winthrop University Hospital; Professor of Pediatrics, Stony Brook University School of Medicine

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, Society for Pediatric Research

Disclosure: Nothing to disclose.

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

  2. Orenstein WA, Committee on Infectious Diseases. Eradicating polio: how the world's pediatricians can help stop this crippling illness forever. Pediatrics. 2015 Jan. 135 (1):196-202. [Medline].

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

  4. Poliovirus. Pediatrics. 2011 Oct. 128(4):805-8. [Medline].

  5. Choudhury P, Thacker N, Gargano LM, et al. Attitudes and perceptions of private pediatricians regarding polio immunization in India. Vaccine. 2011 Oct 26. 29(46):8317-22. [Medline].

  6. Bhandari N. After eradication: India's post-polio problem. BMJ. 2014 Mar 31. 348:g2275. [Medline].

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

  8. Stewardson AJ, Roberts JA, Beckett CL, et al. Imported case of poliomyelitis, Melbourne, Australia, 2007. Emerg Infect Dis. 2009 Jan. 15(1):63-5. [Medline].

  9. Arie S. Polio virus spreads from Syria to Iraq. BMJ. 2014 Apr 2. 348:g2481. [Medline].

  10. Sharif S, Abbasi BH, Khurshid A, et al. Evolution and Circulation of Type-2 Vaccine-Derived Polioviruses in Nad Ali District of Southern Afghanistan during June 2009-February 2011. PLoS One. 2014. 9(2):e88442. [Medline]. [Full Text].

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

  12. Koopman FS, Beelen A, Gilhus NE, de Visser M, Nollet F. Treatment for postpolio syndrome. Cochrane Database Syst Rev. 2015 May 18. 5:CD007818. [Medline].

  13. Ferraz-Filho JR, dos Santos Torres U, de Oliveira EP, Souza AS. MRI findings in an infant with vaccine-associated paralytic poliomyelitis. Pediatr Radiol. 2010 Dec. 40 Suppl 1:S138-40. [Medline].

  14. Choudhary A, Sharma S, Sankhyan N, et al. Midbrain and spinal cord magnetic resonance imaging (MRI) changes in poliomyelitis. J Child Neurol. 2010 Apr. 25(4):497-9. [Medline].

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

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

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

  18. [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. 1999 Dec. 104(6):1404-6. [Medline].

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

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

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

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

  23. Sutter RW, Bahl S, Deshpande JM, Verma H, Ahmad M, Venugopal P, et al. Immunogenicity of a new routine vaccination schedule for global poliomyelitis prevention: an open-label, randomised controlled trial. Lancet. 2015 Dec 12. 386 (10011):2413-21. [Medline].

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

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

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

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

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

  29. 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].

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

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

  32. 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. 1997 Jun. 26(6):378-83. [Medline].

  33. 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. 2000 Apr. 47(2):287-308. [Medline].

 
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The typical contractures of postpolio residual paralysis.
 
 
 
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