280 likes | 395 Views
Poliomyelitis. ד"ר אלכס גורי מחלות זיהומיות בילדים, ב"ח קפלן. Introduction. “Polios” = “gray”, “myelos”= “spinal cord” First descriptions Medin (Sweden) 1890 First epidemics – Scandinavia, USA 189* 1950++ regular epidemics 25/100.000 1952 USA 58000 cases, 3145 fatalities, 21269 handicapped.
E N D
Poliomyelitis ד"ר אלכס גורי מחלות זיהומיות בילדים, ב"ח קפלן
Introduction • “Polios” = “gray”, “myelos”= “spinal cord” • First descriptions Medin (Sweden) 1890 • First epidemics – Scandinavia, USA 189* • 1950++ regular epidemics 25/100.000 • 1952 USA 58000 cases, 3145 fatalities, 21269 handicapped
Virology • Enterovirus • 3 serotypes, lifelong specific immunity to each serotype • Humans are only natural host • Wild type, live-attenuated, VDPV (vaccine-derived)
Clinical • Incubation 9-12 (range 5-35) from contact to prodrome, 11-17 day to paralysis
Clinical features • 60-1000/1 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
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
DD • Entero 71 • West Nile virus • Guillain-Barre (symmetrical, ascending, lost of sensation, 1-2 weeks of progress, protein in CSF)
Dx • Isolation (RT-PCR) in stool, rarely in CSF/brain biopsy, serology (no vaccine/wild differentiation)
IPV • Jonas Salk 1955
IPV • High titers of ab, no secretory ab
OPV • Sabin OPV field trials 1955-59 • Monovalent originally • VAPP 1:2.6 million • 25%(VAPP) inimmune deficient (B-cell) Chumakov Mikhail
ב01.09.2013 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