Vaccine-derived poliomyelitis 12 years after infection in Minnesota

A 44-year-old woman with long-standing common variable immunodeficiency who was receiving intravenous immune globulin suddenly had paralysis of all four limbs and the respiratory muscles, resulting in death. Type 2 vaccine-derived poliovirus was isolated from stool. The viral capsid protein VP1 region had diverged from the vaccine strain at 12.3% of nucleotide positions, and the two attenuating substitutions had reverted to the wild-type sequence. Infection probably occurred 11.9 years earlier (95% confidence interval [CI], 10.9 to 13.2), when her child received the oral poliovirus vaccine. No secondary cases were identified among close contacts or 2038 screened health care workers. Patients with common variable immunodeficiency can be chronically infected with poliovirus, and poliomyelitis can develop despite treatment with intravenous immune globulin.

[Poliomyelitis in Tajikistan. Protection of Russia from emergence and spread of wild poliomyelitis virus]

Problem of emergence and spread of poliomyelitis in Russian Federation and neighboring states is examined. Measures taken in Russian Federation to prevent emergence of poliomyelitis cases caused by wild type virus are discussed, as well as treaties and agreements between Russia, Commonwealth of Independent States, Shanghai Cooperation Organization states regarding epidemiological control of poliomyelitis and acute flaccid paralysis. Measure planned by Federal Service for Surveillance for Protection of Consumers Rights and Human Welfare to prevent emergence of poliomyelitis and acute flaccid paralysis cases in Russian Federation and neighboring countries are presented.

[Diagnostics of selected viral infections of central nervous system]

Viral infections of CNS are difficult to diagnose, especially in an early phase. In diagnosis, beside the examination of the cerebrospinal fluid, many other diagnostic tools are used, such a serological tests (in cases with TBE suspicion), PCR (in cases with CMV, VZV, HSV, WNV, enteroviruses infection), CNS imaging and EEG (in cases with HSE, VZV infection). Properly chosen diagnostic tools may result in fast diagnosis and proper treatment.

Pediatric monomelic amyotrophy: evidence for poliomyelitis in vulnerable populations

Pediatric monomelic amyotrophy may present a diagnostic challenge. This is particularly true for immigrant or adopted children who have little or no available medical history. We present clinical and electrophysiological data from 11 children with monomelic amyotrophy who had electrophysiological evidence of a unilateral or profoundly asymmetric motor neuronopathy. The cause of amyotrophy in each case is most consistent with prior: (1) wildtype poliovirus myelitis; (2) "polio-like" virus myelitis, or (3) vaccine associated paralytic poliomyelitis.

Acute flaccid paralysis: a five-year review of cases managed by physiotherapy at the University College Hospital, Ibadan

A 5-year (1999-2004) review of acute flaccid paralysis (AFP) cases managed at the physiotherapy clinic of the University College Hospital, Ibadan Nigeria was carried out. Collection of data involved retrieving the records of all patients seen at the physiotherapy clinic during the study period, from which the paediatric cases were sorted out. The treatment records cards of patients with acute flaccid paralysis were identified and reviewed. Information on age, gender, immunization history, and specific physician diagnosis and discharge practice were collated. A total of 757 paediatric cases reviewed out of which 132 (17.4 %) were AFP case, with mean age of 44.31+ 33.03 months and a 1.2:1.0 male: female ratio. Sciatic nerve palsy accounted for majority (72.0 %) of the AFP; only 43.2 % of the patients had completed immunization before the onset; majority of the cases (78.8 %) were referred to physiotherapy within 6 months of onset and the discharge pattern revealed that only 9.8 % of the patients were formally discharged. With injection palsy accounting for majority of the AFP cases, the need for caution in administration of intramuscular injections at the buttocks of children with febrile illnesses is suggested. Importance of adequate documentation of clinical information by clinicians is also emphasised.

[100 years of studying poliomyelitis virus and nonpoliomyelitis enteroviruses]

M. P. Chumakov Institute of Poliomyelitis and Viral Encephalitis, Russian Academy of Medical Sciences, Moscow The paper deals with the history of discovery of poliomyelitis virus by K. Landsteiner and E. Popper in 1908, the identification of three immunological types of the virus in 1949, the discovery of viral multiplication in the cultures of non-nerve cells with a cytopathogenic effect by A. Anders in 1949, the development of new diagnostic techniques, the design of inactivated poliovirus vaccine by D. Salk in 1953 and its live vaccine by A. Sabin in 1957. The advantages and disadvantages of these vaccines and the prospects for further poliomyelitis control are discussed. The characteristics and role of nonpoliomyelitis enteroviruses are considered. The most important scientific discoveries made in the study of enteroviruses are noted.

Estimation of true incidence of polio: overcoming misclassification errors due to stool culture insensitivity

The diagnosis of polio dependents on culturing the virus in stool samples of children with AFP. Using data obtained under the "Right to Information Act" of instances where only one of the two samples was positive for polio, it was possible to estimate the sensitivity of the system to detect cases of polio. The calculations suggest that there were 1625 (95% CI 1528 to 1725) cases of polio in India in 2006 rather than the 674 reported widely!

Vaccine-associated paralytic poliomyelitis: a case report of flaccid monoparesis after oral polio vaccine

This report describes a case of acute flaccid paralysis after administration of oral polio vaccine (OPV). A 4 month-old male patient with the decreased movement of left lower extremity for 1 month was transferred to the Department of Pediatrics. He received OPV with DTaP at 2 months of age. Flaccid paralysis was detected 4 weeks after OPV immunization. Attempts to isolate Sabin-like viruses in the two stool and CSF samples failed because those specimens were collected more than 2 month after the onset of paralysis. Hypotonic monoparesis (GIV/V), hypotonia and atrophy on the left lower extremity, and ipsilateral claw foot persisted for more than 18 months, while we followed him with rehabilitation therapy. This is the first case of officially approved, recipient vaccine-associated paralytic poliomyelitis in Korea.