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

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Presentation on theme: "Poliomyelitis ד"ר אלכס גורי מחלות זיהומיות בילדים, ב"ח קפלן."— Presentation transcript:

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

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

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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)

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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 Monovalent originally VAPP 1:2.6 million 25%(VAPP) inimmune deficient (B-cell) Chumakov Mikhail

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20 Epidemiology

21 VDPD outbreaks

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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


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