May 22, 2012

Poliomyelitis



Filed under: Infectious Diseases
 Polio is a contagious viral illness that in its most severe form causes paralysis, difficulty breathing and sometimes death.
In the U.S., the last case of wild polio — polio caused naturally, not by a vaccine containing live virus — occurred in 1979. Today, despite a concerted global eradication campaign, wild poliovirus continues to affect children and adults in Afghanistan, India, Nigeria and Pakistan.
The Centers for Disease Control and Prevention (CDC) advises taking precautions to protect against polio if you're traveling anywhere there's a risk of polio. If you're a previously vaccinated adult who plans to travel to an area where polio is occurring, you should receive a booster dose of inactivated poliovirus. Immunity following a booster dose lasts a lifetime.
Although polio can cause paralysis and death, the vast majority of people who are infected with the poliovirus don't become sick and are never aware they've been infected with polio.

Nonparalytic polio
. Some people who develop symptoms from the poliovirus contract nonparalytic polio — a type of polio that doesn't lead to paralysis (abortive poliomyelitis). This usually causes the same mild, flu-like signs and symptoms typical of other viral illnesses.
Signs and symptoms, which generally last two to 10 days, include:
                Fever
                Sore throat
                Headache
                Vomiting
                Fatigue
                Back pain or stiffness
                Neck pain or stiffness
                Pain or stiffness in the arms or legs
                Muscle spasms or tenderness
                Meningitis
Paralytic polio
. Fewer than 1 percent of people infected with poliovirus develop paralytic polio, the most serious form of the disease. Initial signs and symptoms of paralytic polio, such as fever and headache, often mimic those of nonparalytic polio. Between one and 10 days later however, signs and symptoms specific to paralytic polio appear, including:
                Loss of reflexes
                Severe muscle aches or spasms
                Loose and floppy limbs (acute flaccid paralysis), often worse on one side of the body
The onset of paralysis may be sudden.
Classifications of paralytic polio
Paralytic polio has historically been divided into several types, depending primarily on which part of the body is affected. These classifications aren't rigid, and overlap may occur among the different forms.
                Spinal polio. This most common form of paralytic polio attacks certain nerve cells (motor neurons) in your spinal cord and may cause paralysis of the muscles that control breathing and those in your arms and legs. Sometimes the neurons are only damaged, in which case you may recover some degree of muscle function. But if the neurons are completely destroyed, the paralysis is irreversible, although you still retain your sense of feeling, unlike after many spinal cord injuries.
                Bulbar polio. In this severe type of polio, the virus affects the motor neurons in your brainstem, where the centers of the cranial nerves are located. These nerves are involved in your ability to see, hear, smell, taste and swallow. They also affect the movement of muscles in your face and send signals to your heart, intestines and lungs. Bulbar polio can interfere with any of these functions but is especially likely to affect your ability to breathe, speak and swallow and can be fatal without respiratory support.
                Bulbospinal polio. A combination of both bulbar and spinal paralytic polio, this form can lead to paralysis of your arms and legs and may also affect breathing, swallowing and heart function.
Post-polio syndrome. 

Affecting some people who have recovered from polio, post-polio syndrome is a cluster of disabling signs and symptoms that appears decades — an average of 30 to 40 years — after the initial illness. Common signs and symptoms include:
                Progressive muscle or joint weakness and pain
                General fatigue and exhaustion after minimal activity
                Muscle atrophy
                Breathing or swallowing problems
                Sleep-related breathing disorders, such as sleep apnea
                Decreased tolerance of cold temperatures
When to see a doctor
. Be sure to check with your doctor for polio vaccination recommendations before traveling to a part of the world where polio may still occur naturally or where oral polio vaccine (OPV) is still used, such as Central and South America, Africa and Asia. In countries that use the OPV — vaccine made with live, but weakened (attenuated) polio virus — the risk of paralytic polio to travelers is extremely low, but not zero.
Additionally, call your doctor if:
                Your child hasn't completed the series of polio vaccinations
                Your child experiences an allergic reaction after receiving polio vaccine
                Your child has problems other than a mild redness or soreness at the vaccine injection site
                You have questions about adult vaccination or other concerns about polio immunization
                You had polio years ago and are now experiencing unexplained weakness and fatigue
The poliovirus resides only in humans and enters the environment in the feces of someone who's infected. Poliovirus spreads primarily through the fecal-oral route, especially in areas where sanitation is inadequate.
Poliovirus can be transmitted through contaminated water and food or through direct contact with someone infected with the virus. Polio is so contagious that anyone living with a recently infected person is likely to become infected too. Although people carrying the poliovirus are most contagious seven to 10 days before and after signs and symptoms appear, they can spread the virus for weeks in their feces.
You're at greatest risk of polio if you haven't been immunized against the disease. In areas with poor sanitation and sporadic or nonexistent immunization programs, the most vulnerable members of the population — pregnant women, the very young and those with weakened immune systems — are especially susceptible to poliovirus.
These factors also increase your risk if you haven't been vaccinated:
                Travel to an area where polio is common or that has recently experienced an outbreak
                Living with or caring for someone who may be shedding poliovirus
                Handling laboratory specimens that contain live poliovirus
                A compromised immune system, such as occurs with HIV infection
                Having had your tonsils removed (tonsillectomy)
                Extreme stress or strenuous physical activity after being exposed to poliovirus, both of which can depress your immune system
Paralytic polio can lead to temporary or permanent muscle paralysis, disability, and deformities of the hips, ankles and feet. Although many deformities can be corrected with surgery and physical therapy, these treatments may not be options in developing nations where polio is still endemic. As a result, children who survive polio may spend their lives with severe disabilities.
Doctors often recognize polio by symptoms such as neck and back stiffness, abnormal reflexes, and difficulty swallowing and breathing. To confirm the diagnosis, a sample of throat secretions, stool or cerebrospinal fluid — a colorless fluid that surrounds your brain and spinal cord — is checked for the presence of poliovirus.
Because no cure for polio exists, the focus is on increasing comfort, speeding recovery and preventing complications. Supportive treatments include:
                Bed rest
                Antibiotics for secondary infections (none for poliovirus)
                Analgesics for pain
                Portable ventilators to assist breathing
                Moderate exercise (physiotherapy) to prevent deformity and loss of muscle function
                A nutritious diet 

May 20, 2012

Why can’t influenza vaccines be like polio vaccines

A Flu Shot For Life

Why do flu shots only protect us for a single season? Why can’t influenza vaccines be like polio vaccines: get them in childhood and be done with them? Wouldn’t that be the best way to prepare ourselves for the next pandemic?
These are among the questions that will be addressed at next month’s World Science Festival. To lay the groundwork, I’ve written a blog post at the festival web site on where we stand on the road to a universal flu vaccine. At this point, we have good reason to believe that such a vaccine could be invented. Which makes it all the more urgent that we do so. Check it out.

México a la vanguardia en el Síndrome de Post Polio

May 15, 2012

The WHO document on polio prepared for the WHA



México a la vanguardia en el Síndrome de Post Polio

May 13, 2012

Why Polio Isn't Going Away?

As the number of cases of the paralytic disease fall, world health officials have to grapple with a vexing problem: a component of the most widely used polio vaccine now causes more disease than the virus it is supposed to fight | May 14, 2012 | 5

CONTINUED TOLLAlthough polio has disappeared from the Western Hemisphere and Europe, the virus still permanently cripples children in Africa and Asia every year.Image: Joao Henriques/Redux Pictures

In Brief

  • The global campaign to eradicate polio began in 1988. Since then, naturally occurring cases worldwide have dropped to, at last count, around 650 in 2011.
  • Completely eliminating polio requires a change in the current vaccination program because one component in the most widely used vaccine now causes more cases of polio than it prevents.
  • The World Health Assembly is expected to approve a plan this May that should decrease the number of vaccine-linked cases of polio and may speed up overall eradication efforts.
  • Yet questions have arisen over the safety of making the change rapidly. If health officials do not manage this transition correctly, polio could continue to cripple children for years to come.
The shadows lengthen in a guesthouse cafeteria on the sprawling campus of christian Medical College, Vellore, in India. Wrapped up as he is in an issue that has possessed him for years, T. Jacob John notices neither the dying light nor the gathering mosquitoes. He is talking about the oral polio vaccine.
A slight man who speaks and moves with a speed that belies his 76 years, John is one of India’s leading polio experts. Trained as a pediatrician, virologist and microbiologist, he is also a longtime critic of the continued reliance on the oral polio vaccine—OPV in polio speak—used by the nearly 25-year-old international campaign to rid the planet of the paralyzing and sometimes fatal disease. The vaccine is at once an excellent and an imperfect tool. Inexpensive and easy to administer (each dose consists of a few drops of serum on the tongue), it has brought the world to the point where polio eradication is visible on the horizon. Indeed, the World Health Organization announced this past January that there have been no cases of naturally occurring polio in India for a year. But if the distribution of the vaccine is not choreographed with exquisite care, its continued use—at least as it is currently formulated—could actually keep the world from eliminating polio.
Today John is talking with a reporter about a problem raised by a specific component of the oral vaccine, which uses weakened viruses to elicit immunity against the three strains of polio—known as types 1, 2 and 3. (An expensive, alternative vaccine, popular in wealthy nations, consists of an injected formulation that is made up of completely inactivated, or “killed,” viruses; it is known as IPV.) The issue: type 2 poliovirus no longer exists in nature; the last case stemming from naturally circulating virus was reported 13 years ago.
Ongoing vaccination against type 2 would not be worrisome if the viruses in the oral vaccine were perfectly benign. In rare cases, however, the weakened viruses from the vaccine can revert to disease-causing pathogens and provoke the very illness they are meant to prevent. In places where wild polioviruses are still a threat, the risk from natural infection is greater than the small hazard the vaccine poses. But if the only risk of paralysis from type 2 polio comes from the strain in the vaccine itself, then that strain’s continued usage could well be considered unproductive at best and quite possibly unethical. As long as the oral vaccine contains the type 2 virus, however, children in more than 100 countries around the globe must—paradoxically—be vaccinated against type 2 polio to protect them from the type 2 virus in the vaccine.
In 2004 John wrote a letter to the medical journal the Lancet, urging the international community to remove the type 2 component from the oral vaccine, thus making it a “bivalent” vaccine that would protect against types 1 and 3 polioviruses. Like other complaints John has made about the oral polio vaccine, however, the suggestion went nowhere—until now.
The Global Polio Eradication Initiative—a partnership of the WHO, UNICEF, Rotary International and the Centers for Disease Control and Prevention—is marshalling support for an initiative to drop the type 2 component from the oral vaccine. The proposal is part of a substantial overhaul of the plan to eventually phase out the oral polio vaccine altogether once all types of wild polioviruses are demonstrated to have been extinguished. The WHO’s governing council, the World Health Assembly, will be asked to approve the early withdrawal of the oral vaccine’s type 2 component at its annual meeting in May.
If the policy change passes—and the assembly is expected to vote in its favor—the move would eliminate an ethical problem that has been bedeviling the eradication effort for years. It could also speed the job of wiping out the remaining two strains of polio in the three countries where they remain endemic (Afghanistan, Pakistan and Nigeria); a 2010 Lancet study showed that the two-target vaccine is at least 30 percent more effective than the one that has to protect against three strains of polio. And yet the poliovirus has a nasty habit of eluding efforts to contain it. Last year, for example, China reported its first cases—genetic tests traced their origin to Pakistan—in more than a decade. Adjusting the oral polio vaccine, some fear, could have unintended consequences and thus disrupt an eradication campaign that is already 12 years past its original deadline and counting. Read More 
México a la vanguardia en el Síndrome de Post Polio

May 11, 2012

Southeast Asia approaches Polio-free certification?


Bangkok, May 11 : With India entering the final stages of eliminating polio and closing to earn itself the coveted 'polio-free status certificate' in next two years, the global community has sought renewed commitment in the crusade against the dreaded disease, calling for further resource mobilization and renewed fund support.

This was conveyed at the 103rd Rotary International Convention held in Thailand that was attended by more than 35,000 Rotarians from 23 countries, Royal Princess of Thailand Chulabhorn and other dignitaries.

"India, once the world's largest global exporter of polio cases, will become the last country in Southeast Asia to be certified polio-free if it remains polio-free for three years. This will be a major achievement as more focussed strategy can be adopted towards battling resurgence threats from wild polio virus," said Kalyan Banerjee, Chairman, Rotary International.

Amidst celebration, speakers reminded the festive assembly that the work is far from complete, because the ultimate goal is yet to be reached as three countries continues to remain polio endemic and the Global Polio Eradication Initiative (an alliance of WHO, CDC, Rotary and UNICEF) was facing a significant funding shortfall of over USUSD 1 billion for activities in 2012-2013.

Bruce Aylward, Assistant Director-General for Polio, Emergencies and Country Collaboration, World Health Organization, said India's removal from the polio-endemic list is "perhaps the most important milestone ever on the long road to eradication."

But an upsurge in cases of paralysis from polio in Nigeria, Pakistan, and Afghanistan and recent polio outbreaks in China, the Congo, and Tajikistan have also prompted what he called an "unprecedented push" to finally end the disease.

He said 192 ministers of health will meet soon and declare polio a public health emergency.

Calling corporates to play more active role in community service, Rajashree Birla, Chairperson, Aditya Birla Centre for Community Initiatives and Rural Development, said, "Corporate indirectly stimulate their own business development if they push their energies and help resolve social sector issues through engagement. There is much to be gained when business leaders take giving to heart, and set the mandate of making a difference by caring for people in their community."

The three day convention also witnessed Princess Chulabhorn representing King Bhumibol Adulyadej at the opening ceremony and thanking Rotarians for their work around the world.

Other dignitaries present on the occasion included Sukhumbhan Boribhat, Bangkok Governor; Hugh Evans, Anti-poverty crusader and Cofounder of the Global Poverty Project; Gillian Sorensen, Senior Adviser and national advocate at the United Nations Foundation; Angelique Kidjo, UNICEF Goodwill Ambassador; Leymah Gbowee, Nobel Peace Prize laureate, and Microcredit pioneer Muhammad Yunus also a Nobel Peace Prize laureate.

The Rotary International convention in Bangkok is estimated to inject more than USD 100 million into the Thai economy. (IBNS)

México a la vanguardia en el Síndrome de Post Polio

May 9, 2012

Does the polio scare really exist today?



México a la vanguardia en el Síndrome de Post Polio

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