L8: Acute Flaccid Paralysis (Polio)

Question 1

Epidemeology of AFP

Answer 1

• Only 1 in 200 polio infections leads to irreversible paralysis.
• Among those paralysed, 5 to 10% die from respiratory muscles paralysis.

Question 2

International Epidemeology of Poliomyelitis

Answer 2

Since 1979, no cases of Polio in the U.S due to widespread polio vaccination.

Question 3

Countries in which Poliomyelitis is endemic

Answer 3

Afghanistan - Pakistan - Nigeria

Question 4

Countries in which Poliomyelitis causes epidemic outbreaks

Answer 4

• Democratic Republic of the Congo
• Syria

Question 5

National epidemeology of Poliomyelitis

Answer 5

Question 6

Epidemic threshold of Poliomyelitis

Answer 6

One confirmed case.

Question 7

Suspected Case of Poliomyelitis

Answer 7

Any pathological condition associated with acute
flaccid paralysis that occurs in a child under 15 years suffering from acute flaccid paralysis .

Question 8

Probable Case of Poliomyelitis

Answer 8

none

Question 9

Confirmed Case of Poliomyelitis

Answer 9

• A case of acute flaccid paralysis confirmed by laboratory investigations (virulent polio virus isolated from a faecal sample),

OR

• epidemiologically liked to a confirmed polio case

Question 10

Causative agent of Poliomyelitis

Answer 10

• Poliovirus; 3 types (Type I, II, III).
• there is no cross-immunity between the three viral types .

Question 11

Types of Poliomyelitis

Answer 11

Question 12

What age group is mostly affected by Poliomyelitis?

Answer 12

• mainly affects children < 5 years.
• Rarely, it can occur at older ages among those who are not immune

Question 13

Reservoir of Poliomyelitis

Answer 13

• The human being is the only reservoir (case or carrier) & for every case of polio, it is estimated that 200 subclinical cases occur.
• The reservoir of infection is usually young children .

Question 14

MOT of Poliomyelitis

Answer 14

Question 15

IP of Poliomyelitis

Answer 15

From 3 to 35 days (usually 7-14 days).

Question 16

Infectivity Period of Poliomyelitis

Answer 16

Infected persons are

❶ most infectious from 7−10 days before and after the onset of symptoms

❷ For 14 days after paralysis.

❸ However, poliovirus is excreted in the stools for up to 6 weeks .

Question 17

Susceptibility of Poliomyelitis

Answer 17

• anyone who hasn’t been vaccinated is at risk of developing the disease .
• A person becomes immune after at least 3 valid doses of either Sabin or Salk vaccine.

Question 18

General Prevention of Poliomyelitis

Answer 18

(refer to general epidemiology lectures).

Question 19

Specific Prevention of Poliomyelitis

Answer 19

• Vx
• Seroprophylaxis

Question 20

What is the most important preventive measure in Poliomyelitis?

Answer 20

Vx, Most important preventive measure and the main way to keep the zero-polio status

Question 21

Types of Vx in Poliomyelitis

Answer 21

• Oral sabin
• Injectable salk

Question 22

Compare between Salk & sabin in terms of:

• Nature
• Characters
• Control Epidemics
• Herd Immunity
• Doses
• Indication for Vx

Answer 22

Question 23

Seroprophylaxis in Poliomyelitis

Answer 23

Immunoglobulins for contacts with immunodeficiency disease, cortisone therapy, etc

Question 24

National Control Measure for Case in Poliomyelitis

Answer 24

Question 25

Notification in Poliomyelitis

Answer 25

• to the WHO, from all health care facilities serving children <15 years (group A).
• Weekly zero reporting from all reporting sites nationwide upwards  then to the Directorate  then to the Expanded Program of Vaccinations.

Question 26

Isolation in Poliomyelitis

Answer 26

At fever hospital

Question 27

TTT in Poliomyelitis

Answer 27

no specific treatment but bed rest + analgesics + artificial respiration +physiotherapy

Question 28

Contact Measures in Poliomyelitis

Answer 28

❶ Enlistment

❷ Surveillance

❸ Booster dose of vaccine Or immunoglobulin

Question 29

Epidemic Measures in Poliomyelitis

Answer 29

❶ In countries with polio eradication, single case of poliomyelitis is considered public emergency

❷ MOH should determine whether disease represents an indigenous, imported or VAPP (vaccine acquired polio paralysis) case

❸ Case & contact control measures

Question 30

International Measures in Poliomyelitis

Answer 30

Question 31

Measures taken by MOH to eradicate poliomyelitis (Polio eradication programs applied by the year 2005)

Answer 31