DOCSLIB.ORG

British Medical Journal

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
British Medical Journal BRITISH MEDICAL JOURNAL LONDON: SATURDAY, -JULY 11th, 1936 EPIDEMIC POLIOMYELITIS EPIDEMIOLOGY, CAUSES, AND PREVENTION * BY SIR ARTHUR S. MAcNALTY, K.C.B., M.A., M.D., F.R.C.P. CHIEF MEDICAL OFFICER OF THE MINISTRY OF HEALTH Poliomyelitis has been described by Simon Flexner as Wickman (1901 and 1905), Strauss (1910), and Peabody, " one of the saddest of diseases," and Dr. Thomas Buzzard Draper and Dochez (1912). characterized it as being " peculiarly cruel " to its hapless Striimpell gave the first complete account of the ceretral victims. Apart from the fact that the majority of the type of poliomyelitis (polio-encephalitis) in 1884. The first adult case of poliomyelitis was described by Vogt in 1859. sufferers are young children, it leaves a considerable pro- portion of the survivors permanently paralysed, and so crippled as to constitute for them a life-long handicap in Pathology the struggle for existence. The studies of Flexner and Lewis, Leiner and von and and others have The has been described by somewhat cumbrous Wiesner, Landsteiner Levaditi, malady shown that the disease is due to a virus which passes names. It is scientifically known as acute poliomyelitis through the finest filter and that the filtrate is capable of (including polio-encephalitis and polio-encephalo-myelitis). reproducing the disease in monkeys. The virus attacks " infantile It has long been known under the name of the nervous system, causing inflammation of- the grey paralysis," but the term is inisleading, for the disease may rmatter, especially of the anterior cornua of the spinal cord. occur in adults, though not so frequently as in children, Most I'he histological lesions are hyperaemia, exudation of and paralysis does not always supervene. lymphocytes round the blood vessels, and degeneration of as epidemiologists prefer to speak of the disease simply the motor cells. Occasionally the whole thickness of " large epidemic poliomyelitis." the cord may become involved and a transverse myelitis result. The brain may be primarily or secondarily History affected (polio-encephalitis a-nd polio-encephalo-myelitis) Acute poliomyelitis appears to have existed from very and the meninges implicated. Widespread visceral lesions early times. are found, such as hyperplasia of the tonsils, the spleen and " Since the days of Mephibosheth," wrote Osler, " parents the lymphatic glands, together with cloudy swelling of the have been inclined to attribute this form of paralysis to the kidney and liver. carelessness of nurses in letting the children fall, but very rarely is the disease induced by traumatism." Sir Walter Clinical Features Scott was attacked in 1773 when 18 moilths old. He describes Acute poliomyelitis is best described as an acute it as " the fever which often accompanies the cutting of large infectious fever which may or may not proceed to invasion teeth " (Lockhart's Life of Sir Walter Scott). Scott's right of the nervous system. Walshe' submits that a precise leg was paralysed and permanent lameness resulted. and practical conception of poliomyelitis is obtained by The first medical description of poliomyelitis appears to recognizing the existence of three clinically and pathologi- have been given by an English practitioner, Michael in Underwood, in the first-edition of his treatise on the Diseases cally distinct stages its evolution: one of general infection of Children in 1784. He devotes two pages in his book to during which the virus obtains lodgment in the liver, spleen, the disease under the title of " Debility of the Lower lymphatic glands and bone-marrow, in all of which tissues Extremities." In 1822 Shaw-reported a few cases. Dr. John Iesions are found; one of invasion of the subarachnoid Badham, of Worksop, Notts, in 1835 described four cases, space, when the virus gives rise to- a characteristic and for the first time drew attention to the cerebral symptoms meningeal reaction as revealed by examination of the of the disease. Jacob Heine in 1840 wrote an instructive cerebro-spinal fluid; and a third of invasion of the grey monograph and is regarded generally as the pioneer contributor matter of the central nervous system, where the virus to modern knowledge of poliomyelifis. Some thirty years later, Medin of Stockholm called attention to the fact that produces inflammatory lesions. Walshe's classification is the disease occurred occasionally in epidemics; hence the adopted in the following description of the clinical features, term " Heine-Medin disease," which is commonly used in but it must be emphasized that the three stages- often Germany and Scandinavia to include the various clinical forms overlap or synchronize. of acute epidemic poliomyelitis. From the writings of Underwood in 1784 up to 1863, the Clinical Character clinical side of poliomyelitis was chiefly studied and there was 1. Initial Stage.-This stage is variable in duration; it little or no knowledge of the pathological processes involved. may last only a few hours and be unrecognized, or on the But in 1863 von Reinecker and von Recklinghausen in other hand it may extend to five or even ten days. The Germanv, and Cornil in France, described the lesions in the be those associated with anterior horns and the lateral columns of the spinal cord. initial symptoms may commonly Then followed a long procession of workers. Rissler first the pre-eruptive period of the exanthemata-headache, investigated the histology of the acute cases and his work has pyrexia (102°-103°), malaise, sore throat, tonsillitis, been completed by the studies of Harbitz and Scheel (1907), coryza, nasal- discharge and irritability of temper. Epistaxis may occur and, in some epidemics, vomiting and * A Chadwick Lecture delivered at the Royal United Services Institution on March 19th, 1936. diarrhcea are leadilig symptoms. There is no typical skin [3940] Tux BRIMTIW 58 JULY 11, 1936 EPIDEMIC POLIOMYELITIS MEDICAL JOURNAL 2 eruption; herpes and herpes zoster have been noted; After-effects erythematous or morbilliform rashes may occur, and cases In the poliomyelitic form the paralysis may persist and have been erroneously diagnosed as scarlet fever or the patient is to a degree corresponding with the measles. The condition may clear up rapidly and complete crippled extent of the damage to the spinal cord. In the recovery ensue (mild or abortive cases). On the other encephalitic form, though the risk of fatality is greater, hand, the initial stage may merge into a second phase. Ex- there are commonly no after-effects on recovery. ceptionally therc may be a remission period of some hours, or even days, between these phases in which the temperature falls to normal, the child appears to have recovered and Diagnosis perhaps is allowed to go about on the assumption that he The initial symptoms of poliomyelitis are indistinguish- has had a slight febrile ailment. But there comes a able from those of the onset of other infectious diseases, recrudescence of temperature and an accentuation of the but it must be remembered that in poliomyelitis this stage disease. may pass very rapidly into that of involvement of the 2. The preparalytic stage indicates subarachnoid or central nervous system, and, if there be any cause for meningeal invasion. It varies in intensity and duration, suspicion of poliomyelitis, the patient should be kept under being at times so slight and transient as to be unnoticeable, close medical supervision so that the physician may detect and at others of great severity. On the whole its duration the earliest signs of meningeal invasion. is short and it ends either in speedy recovery or passes into As regards the polio-encephalitic form, the implication the paralytic stage within a few hours. The chief signs of the brain, medulla, meninges or spinal nerves may give are continuation (or renewal) of the pyrexia and headache, rise to varying symptoms (for example, in bulbar paralysis onset of pains in the back and limbs with tenderness speech disturbances are noted). There may be confusion in over the upper dorsal vertebrae, stiffness of the neck and the differential diagnosis between polio-encephalitis and spine with resistance to passive flexion, muscular twitch- cerebro-spinal meningitis, encephalitis lethargica, tubercu- ings (often indicating the site of future paralysis), lous meningitis or septic meningitis. The previous history hyperaesthesia, retention of urine, drowsiness and some- of the patient and the presence of similar cases in the times deep stupor, occasionally even opisthotonos. vicinity, together with the examination of the cerebro- Diminution or disappearance of the superficial or some of spinal fluid, will assist in the determination of the the deep tendon reflexes may be the first indication of the diagnosis. nature of the case. Kernig's sign is frequently present. The Cerebro-spinal Fluid 3. Paralytic Stage (stage of invasion of the central Examination of the cerebro spinal fluid is often of value nervous system).-Once the virus is established in the in the diagnosis of poliomyelitis. central nervous system paralytic phenomena may appear, In the initial stage the cerebro-spinal fluid is normal with their character being dependent on the localization and a cell count of from 0 to 10 c.mm. In the preparalytic stage intensity of the lesions. (subarachnoid or meningeal invasion) the fluid is usually under (a) Poliomyelitic Form.-In this form the lesions moderately increased pressure (aggravated by anaesthesia) and involve the lower motor neurons, giving rise to flaccid appears to be clear, though when viewed by transmitted light " " it presents a faint haziness or ground glass appearance. paralysis affecting one or two muscles, or a group of There is an increase in the number of cells (mononuclear and muscles, or one or more limbs. The paralysis comes on polymorphonuclear), the count usually being between 50 and as a rule three or four days after the onset of illness, but 250 per c.mm., but occasionally it may be as high as 700 to it may be the first sign of the disease detected.
Load more

Recommended publications
  • Poliomyelitis and Polio-Encephalitis
    POLIOMYELITIS AND POLIO-ENCEPHALITIS. 151 Postgrad Med J: first published as 10.1136/pgmj.2.22.151 on 1 July 1927. Downloaded from coryza, or gastro-intestinal symptoms such as vomiting and diarrhoea. The lymphatic glands are POLIOMYELITIS enlarged. The temperature rises, often ranging AND POLIO-ENCEPHALITIS.* between 101° and 103°F., and there is general malaise often accompanied by profuse sweating. BY In some cases both local and general symptoms are E. A. COCKAYNE, M.D. OXF., F.R.C.P. LOND., so slight that they may be overlooked and the PHYSICIAN TO THE MIDDLESEX HOSPITAL; PHYSICIAN rise of temperature may be very small. After TO OUT-PATIENTS, HOSPITAL FOR SICK CHILDREN, lasting from one to four days the illness may end GREAT ORMOND-STREET. at this stage. If it continues headache, drowsiness POLIOMYELITIS, like other specific fevers, has its and irritability, pain and stiffness in the back, special age and seasonal incidence; it is commonest accompanied sometimes by twitching of the in the late summer and early autumn, and the limbs or retraction of the head, may develop, and majority of its victims are children between the these indicate involvement of the meninges. ages of 1 and 5 years. The earliest symptoms are Hyperssthesia of skin and muscles may also be constitutional, malaise and fever, and in some prominent. Then if the grey matter of the central cases the involvement of the nervous system, to nervous system becomes infected, weakness, paresis, which it owes its name, never occurs. Such and paralysis of muscles develops. Paralyses cases are usually regarded as abortive, but in may appear to be dramatically sudden, but my opinion this view is not the correct one.
    [Show full text]
  • SOS – Save Our Shoulders: a Guide for Polio Survivors
    1 • Save Our Shoulders: A Guide for Polio Survivors A Guide for Polio Survivors S.O.S. Save Our Shoulders: A Guide for Polio Survivors by Jennifer Kuehl, MPT Roberta Costello, MSN, RN Janet Wechsler, PT Funding for the production of this manual was made possible by: The National Institute for Disability and Rehabilitation Research Grant #H133A000101 and The U.S. Department of the Army Grant #DAMD17-00-1-0533 Investigators: Mary Klein, PhD Mary Ann Keenan, MD Alberto Esquenazi, MD Acknowledgements We gratefully acknowledge the contributions and input provided from all of those who participated in our research. The time and effort of our participants was instrumental in the creation of this manual. Jennifer Kuehl, MPT Moss Rehabilitation Research Institute, Philadelphia Roberta Costello, MSN, RN Moss Rehabilitation Research Institute, Philadelphia Janet Wechsler, PT Moss Rehabilitation Research Institute, Philadelphia Mary Klein, PhD Moss Rehabilitation Research Institute, Philadelphia Mary Ann Keenan, MD University of Pennsylvania, Philadelphia Alberto Esquenazi, MD MossRehab Hospital, Philadelphia Cover and manual design by Ron Kalstein, MEd Albert Einstein Medical Center, Philadelphia Table of Contents 1. Introduction . .5 2. General Information About the Shoulder . .6 3. Facts About Shoulder Problems . .8 4. Treatment Options . .13 5. About Exercise . .16 6. Stretching Exercises . .19 7. Cane Stretches . .22 8. Strengthening Exercises . .25 9. Tips to Avoid Shoulder Problems . .29 10. Conclusion . .31 11. Resources . .31 The information contained within this manual is for reference only and is not a substitute for professional medical advice. Before beginning any exercise program consult your physician. Save Our Shoulders: A Guide for Polio Survivors • 4 Introduction Many polio survivors report new symptoms as they age.
    [Show full text]
  • What Having Had Polio Causes, Might Cause and Does Not Cause Marny K
    What Having Had Polio Causes, Might Cause and Does Not Cause Marny K. Eulberg, MD, Family Practice, Denver, Colorado Introduction: As time has elapsed since the major poliomyelitis epi- demics ended, following the widespread introduction of the polio vaccines, persons affected by polio, their families and their health- care providers seem to have less and less clear understanding about what symptoms are caused by polio, which are associated with polio and which are not. Many healthcare providers in practice today have had little experience or training in the care of polio survivors, and they studied the basic pathology that the poliovirus causes years ago. Organizations, such as Post-Polio Health International, which exist to provide information to polio survivors, are frequently asked questions Marny K. Eulberg, MD about various symptoms and the relationship to the acute polio. Post-polio groups and expert professionals have indicated that many individuals have been given incorrect or confusing information. Attributing symptoms or changes in symptoms and try to understand them. functioning to one’s previous polio Often a symptom can be caused by when the symptom is, in fact, due to many different mechanisms and a disease or condition that should be sometimes even by a combination treated by an entirely different medi- of factors. cal regime than polio/post-polio is not This article is not meant to be all- only not helpful but may be danger- inclusive and list every possible cause/ ous. Polio clinics can help with symp- disease but to discuss the most com- toms that are polio related and can mon and most frequent conditions.
    [Show full text]
  • Polio Fact Sheet
    Polio Fact Sheet 1. What is Polio? - Polio is a disease caused by a virus that lives in the human throat and intestinal tract. It is spread by exposure to infected human stool: e.g. from poor sanitation practices. The 1952 Polio epidemic was the worst outbreak in the nation's history. Of nearly 58,000 cases reported that year, 3,145 people died and 21,269 were left with mild to disabling paralysis, with most of the victims being children. The "public reaction was to a plague", said historian William O'Neill. "Citizens of urban areas were to be terrified every summer when this frightful visitor returned.” A Polio vaccine first became available in 1955. 2. What are the symptoms of Polio? - Up to 95 % of people infected with Polio virus are not aware they are infected, but can still transmit it to others. While some develop just a fever, sore throat, upset stomach, and/or flu-like symptoms and have no paralysis or other serious symptoms, others get a stiffness of the back or legs, and experience increased sensitivity. However, a few develop life-threatening paralysis of muscles. The risk of developing serious symptoms increases with the age of the ill person. 3. Is Polio still a disease seen in the United States? - The last naturally occurring cases of Polio in the United States were in 1979, when an outbreak occurred among the Amish in several states including Pennsylvania. 4. What kinds of Polio vaccines are used in the United States? - There is now only one kind of Polio vaccine used in the United States: the Inactivated Polio vaccine (IPV) is given as an injection (shot).
    [Show full text]
  • An Epidemic of Acute Encephalitis in Young Children
    Arch Dis Child: first published as 10.1136/adc.9.51.153 on 1 June 1934. Downloaded from AN EPIDEMIC OF ACUTE ENCEPHALITIS IN YOUNG CHILDREN BY AGNES R. MACGREGOR, M.B., F.R.C.P.E., AND W. S. CRAIG, B.Sc., M.D., M.R.C.P.E. (From the Departments of Pathology and Child Life and Health, Univer- sity of Edinburgh, and the Western General Hospital, Edinburgh.) This paper is concerned with a small outbreak of illness of an unusual nature occurring in the Children's Unit of the Western General Hospital, Edinburgh. In addition to the clinical interest of the cases, there are features of considerable pathological and epidemiological importance con- nected with the outbreak. Clinical Records. Case 1. I.M.S., female, aged 1 year 7 months, was admitted to the Western General Hospital in March, 1933, at the age of 1 year 3 months. - At this time http://adc.bmj.com/ she was noted as being slightly undersized but well nourished and the liver showed moderate enlargement. Prior to admission she had been treated elsewhere for gonococcal vaginitis: during the three succeeding months her health was good and progress uninterrupted, but a positive Wassermann reaction, present on admission, persisted. On the evening of July 22, 1933, the patient was noticed to be less active than usual and generally ' out of sorts ': her conditiQn remained unchanged throughout the rest of the day, and on the 23rd she was 'Ptill quieter and less responsive to all forms of attention and refused food. By the afternoon on October 2, 2021 by guest.
    [Show full text]
  • Polio Laboratory Manual
    WHO/IVB/04.10 ORIGINAL: ENGLISH Polio laboratory manual 4th edition, 2004 The World Health Organization has managed The evaluation of the impact of vaccine- cooperation with its Member States and preventable diseases informs decisions to provided technical support in the fi eld of introduce new vaccines. Optimal strategies vaccine-preventable diseases since 1975. and activities for reducing morbidity and In 2003, the offi ce carrying out this function mortality through the use of vaccines are was renamed the WHO Department of implemented (Vaccine Assessment and Immunization, Vaccines and Biologicals. Monitoring). The Department’s goal is the achievement Efforts are directed towards reducing fi nancial of a world in which all people at risk are and technical barriers to the introduction protected against vaccine-preventable of new and established vaccines and diseases. Work towards this goal can be immunization-related technologies (Access to visualized as occurring along a continuum. Technologies). The range of activities spans from research, development and evaluation of vaccines Under the guidance of its Member States, to implementation and evaluation of WHO, in conjunction with outside world immunization programmes in countries. experts, develops and promotes policies and strategies to maximize the use and delivery WHO facilitates and coordinates research of vaccines of public health importance. and development on new vaccines and Countries are supported so that they immunization-related technologies for viral, acquire the technical and managerial skills, bacterial and parasitic diseases. Existing competence and infrastructure needed to life-saving vaccines are further improved and achieve disease control and/or elimination new vaccines targeted at public health crises, and eradication objectives (Expanded such as HIV/AIDS and SARS, are discovered Programme on Immunization).
    [Show full text]
  • Coronavirus (COVID-19) and Polio Survivors Spring 2020
    Coronavirus (COVID-19) and Polio Survivors PHI Official Statement By Dr. Marny Eulberg Everyone seems to be talking about, worrying about, and asking questions about coronavirus and that includes polio survivors. As we have seen, this is a rapidly evolving situation and what we know today may change next week or next month. Some facts that are not likely to change are: Polio and late effects of polio do not, in themselves, cause immune compromise. Therefore, polio survivors are no more likely to contract a coronavirus infection or develop serious illness from it than people who never Spring 2020 Winter 2017 had polio! Wheelchairs & Getaway 1 Most polio survivors in the United States and COVID 2 Conserve to Canada are over 60 years old which places us in PHI New Resource 5 Preserve 2 Traveling Clinic 4 the “higher risk” category with a greater Exec. Committee Meetings 5 Pearls of Wisdom 5 likelihood of developing severe disease after Disaster being infected with the virus than younger FDA Removes 6 Zantac Preparedness 7 people. COVID & Polio 7 Sleep! Breathe! Polio survivors who had breathing muscle Caring for Live! 7 involvement with their original illness and/or Yourself 10 Probiotics & Bone now have respiratory problems of any kind are Calendar 13 Strength 12 at “high risk” when they become ill Executive 14 Executive with any respiratory infection including Council Committee 14 coronaviruses. Support Groups 14 Support Groups 14 {PHI COVID-19 continued on page 9} ATTENTION: Wheelchair and Assistive Technology Users PRECAUTIONS for COVID-19 Greetings from Beneficial Designs. My name is Peter Axelson.
    [Show full text]
  • Pn0607 Meningitis.Pdf
    Accurate diagnosis and an extensive work-up can avoid unnecessary treatments. As the meningitis season heats up, here’s how to be ready. iral meningitis is a significant cause of morbidi- nective tissue diseases, partially treated bacterial meningitis, ty and mortality. There are over 100,000 cases of parameningeal infections and drug-induced meningitis.2 aseptic meningitis annually in the United Some viral pathogens may cause “pure” meningitis in which States.1 The term “aseptic meningitis” refers to the signs of brain involvement and spinal cord inflammation both infectious and noninfectious causes of are absent. Viral infection may also result in a combined syn- meningitisV for which no etiology is identified after routine drome of menigoencephalitis or encephalomyelitis.3 The clini- evaluation and culture of the cerebrospinal fluid (CSF). The cal features associated with viral meningitis are often non-spe- differential diagnosis for aseptic meningitis is quite broad. cific, so awareness of epidemiology, including seasonality and Although viruses are the major cause of acute meningitis, the geographic distribution of the various pathogens, becomes clinical presentation and CSF findings are often indistinguish- important in establishing a diagnosis. Given the paucity of able from other causes of aseptic meningitis, presenting a diag- effective therapies for viral meningitis, preventive measures nostic challenge. Therefore, knowledge of unique clinical fea- have an important role in reducing morbidity and mortality. A tures and epidemiology for the causative agents of viral menin- detailed look at the unique characteristics of the common gitis is especially important for diagnosis, treatment and pre- pathogens in viral meningitis will aid in clinical recognition.
    [Show full text]
  • INFLAMMATORY/POST-INFECTIOUS ENCEPHALOMYELITIS L Bennetto, N Scolding I22
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.2003.034256 on 20 February 2004. Downloaded from INFLAMMATORY/POST-INFECTIOUS ENCEPHALOMYELITIS L Bennetto, N Scolding i22 J Neurol Neurosurg Psychiatry 2004;75(Suppl I):i22–i28. doi: 10.1136/jnnp.2003.034256 ost-infectious and inflammatory encephalomyelitis are broadly represented by the syn- drome acute disseminated encephalomyelitis (ADEM). ADEM forms one of several Pcategories of primary inflammatory demyelinating disorders of the central nervous system. Others include multiple sclerosis (MS), acute transverse myelitis, and Devic’s disease. It should be remembered that these are syndromically defined diseases at present. There are no diagnos- tic tests presently available short of brain biopsy, but future advances may reveal diagnostic biological markers of disease and in so doing dramatically advance the pathophysiological and therapeutic understanding of these conditions. A wholesale change in classification and nomenclature may well follow. In the meantime clinicians must remain keenly appreciative of subtle shades of grey: ADEM, first MS relapse, or ultimately benign clinically isolated syn- drome? The answers are relevant to prognosis and, more recently, selection of the correct therapeutic strategy. c ACUTE DISSEMINATED ENCEPHALOMYELITIS ADEM is an inflammatory demyelinating disorder of the central nervous system that is usually monophasic, but a relapsing variant distinct from MS—multiphasic disseminated encephalomyelitis (MDEM) is well-described. ADEM is predominantly, though by no means copyright. exclusively, a disease of children and in particular infants. Historically it includes post- infectious encephalomyelitis and post-vaccination encephalomyelitis. While these two syndromes were distinguished by their precipitant it was realised that clinically and pathologically they were very similar.
    [Show full text]
  • Chapter 18: Polio
    Poliomyelitis Concepcion F. Estivariz, MD; Ruth Link-Gelles, PhD, MPH; and Tom Shimabukuro, MD, MPH, MBA Descriptions of polio-like illnesses have been around since antiquity, including a funerary stele depicting a man with Poliomyelitis a withered leg leaning on a staff. Michael Underwood first ● First described by Michael described a debility of the lower extremities in children that was Underwood in 1789 recognizable as poliomyelitis in England in 1789, but the disease ● Developed countries in was not observed in epidemics until the late 19th century. Northern Hemisphere During the first half of the 20th century, developed countries in suffered increasingly severe the Northern Hemisphere suffered epidemics each summer and epidemics in the first half fall that became increasingly severe. Polio infections peaked in of the 20th century the United States in 1952, with more than 21,000 paralytic cases. Following introduction of effective vaccines in 1955 (inactivated ● More than 21,000 paralytic polio vaccine, IPV) and 1961 (oral poliovirus vaccine, OPV), cases reported in the U.S. polio incidence declined rapidly. The last case of wild poliovirus in 1952 acquired in the United States was in 1979. ● Last case of wild poliovirus acquired in the U.S. was 1979 Poliovirus Poliovirus is a member of the enterovirus subgroup, family Picornaviridae. Picornaviruses are small, ether-insensitive viruses Poliovirus with an RNA genome. ● Enterovirus (RNA) ● Three serotypes: type 1, type 2, There are three poliovirus serotypes (type1, type 2, and type type 3 3); immunity to one serotype does not produce significant immunity to the other serotypes. ● Immunity to one serotype does not produce significant Poliovirus is rapidly inactivated by heat, formaldehyde, chlorine, immunity to other serotypes and ultraviolet light.
    [Show full text]
  • Impact of the COVID-19 Pandemic on Polio Care: a Warning
    European Review for Medical and Pharmacological Sciences 2021; 25: 1167-1168 Impact of the COVID-19 pandemic on polio care: a warning Dear Editor, The recent coronavirus disease (COVID-19) pandemic has had an immense impact on health- care systems worldwide, which have to deal with the challenge of simultaneously responding to the needs of COVID-19 patients and managing other life-threatening disorders. Several Western and developed Asian countries (e.g., South Korea, Japan), hit by the pandemic had to substan- tially reorganize their healthcare systems, redistributing personnel and resources to deal with the uncontrolled spread of COVID-191. Many polio services and teams in many countries, including Pakistan, have been closed, according to local and WHO health resources and organizations2. These actions have impacted standard polio care, including the delivery of time-dependent treatments and patients’ relation- ships with their families. Every year on October 24, the world celebrates World Polio Day, particularly celebrating the determination that has enabled the world to almost completely eradicate polio. On this day, healthcare providers around the world consider how to eliminate this disease completely. In Africa, thousands of polio eradicators have fought the disease, and by the passing year, polio has been completely eradicated from Africa. However, in two countries worldwide, including Pakistan and Afghanistan, there is still transmission of wild poliovirus3. However, polio workers have faced many challenges in 2020 due to the COVID-19 pandemic. It has been estimated that, during the last eight months, eighty million infants have missed critical vaccines, leading to massive increase in many vaccine-preventable diseases, such as polio4.
    [Show full text]
  • The Use of Oral Polio Vaccine (OPV) to Prevent SARS-Cov2
    The use of oral polio vaccine (OPV) to prevent SARS-CoV2 There is no evidence that oral poliovirus vaccine (OPV) protects people against infection with COVID-19 virus. A clinical trial addressing this question is planned in the USA, and WHO will evaluate the evidence when it is available. In the absence of evidence, WHO does not recommend OPV vaccination for the prevention of COVID-19. WHO continues to recommend OPV as part of essential immunization services to prevent poliomyelitis and as part of global polio eradication efforts. There are experimental signals from various studies over the years that OPV has non-specific effects on the immune system. These effects have not been well characterized and their clinical relevance is unknown. Such non-specific effects may not be limited to OPV, as other live vaccines have also been associated with non-specific protective effects (such as BCG vaccine against tuberculosis). Non- live vaccines in contrast do not seem to have the same effects. The exact mechanism of non-specific protection induced by live vaccines needs to be elucidated further. Clinical studies could begin immediately because the vaccines in question are licensed and have an excellent safety record. Clinical trials involving off-label use of various drugs licensed for other indications are currently underway. The existing scientific rationale suggests that the same should be done for OPV and other live vaccines. A study is currently being discussed with various partners and vaccine manufacturers, including the US FDA, the outcomes of which will be carefully assessed to determine potential use in the context of the spread of SARS-CoV2 until the time when specific vaccines and antiviral therapies are ready.
    [Show full text]