2/23/2015

Somalia Polio Free for 6 Months - UN Welcomes As a Breakthrough but Vaccinations to Continue


Somalia has been polio free for six months but UN says vaccination campaigns must continue as risks remain
JOINT PRESS RELEASE
Somalia is marking six months since the last polio case was seen in the country following an outbreak that affected 199 people, mostly children.
Polio was detected in Somalia in May 2013,for the first time in six years,after the parents of a two-year-old girl in Mogadishu found she was unable to walk. The virus, which can cause paralysis or even death, spread quickly affecting 194 people in 2013. However the number was contained to just five cases in 2014, one of them an adult who died, all in the remote Mudug region of Puntland, north-eastern Somalia. The last case was reported in Hobyo district,Mudug on 11 August 2014.
Since the outbreak began, the authorities, with the support of the United Nations Children's Fund, UNICEF and the World Health Organization(WHO) have targeted more than2 million children under the age of five for vaccinations as well as children aged from five to 10 and adults in some areas. The vaccination campaigns began as soon as the news of the first case came out as at the time Somalia was home to the largest pool of unvaccinated children in the world with over half a million children unvaccinated for more than five years.
Despite the news,the authorities and the UN are taking a cautious approach since the task of eradication is not finished yet. Polio continues to threaten the lives of Somali children and the campaigns to eradicate polio will continue in 2015.
"It is a breakthrough that the polio outbreak has been curbed. No new cases of polio have been reported over the past six months. The vaccination campaigns have been a massive undertaking from the community level upwards and we must keep up the momentum until we are sure polio has been completely wiped out," said the Humanitarian Coordinator for Somalia, Philippe Lazzarini.
Somalia reported its last indigenous Wild Poliovirus (WPV) case in 2002. In 2005, the country experienced an importation of WPV of Nigerian origin, which resulted in an explosive outbreak all over the country and a total of 228 polio cases. With an intensified polio immunization response, Somalia was able to stop the circulation and reached polio free status again in 2007.
"We have defeated polio before and we will do it again," said UNICEF Somalia Representative Steven Lauwerier. "This is an important milestone, but there is no room for complacency. We will continue to support the Somali health authorities with the vaccination campaigns until we are certain that no more children will suffer from this highly infectious disease."
The routine immunization coverage rate in Somalia is extremely low and during the polio vaccination campaigns, the vaccinators have painstakingly gone house to house to administer the vaccine which consists of two drops in the mouth.
"The tremendous effort of Government of Somalia and its partners in containing the outbreak is highly commendable. But polio has not yet been stopped for good, and efforts must continue to ensure polio free status for children in Somalia," said Dr. Ghulam Popal, WHO Somalia Representative. "Care and vigilance are crucial to ensure that children all over Somalia are vaccinated, despite the challenges posed by inaccessibility and insecurity. In addition, strengthening surveillance systems so that polio cannot continue to be transmitted undetected, is a crucial component of moving towards polio free Somalia."
Sanitation is poor in many areas of Somalia. The polio virus is quickly transmitted through water or food contaminated with human waste from an infected person. Proper sanitation is one way to prevent it spreading.
There is no cure for polio and the vaccineis safe and effective. Children should be vaccinated several times to ensure they are protected for life and adults too can carry the virus.
Post Polio Litaff, Association A.C _APPLAC Mexico

The Polio Crusade

THE POLIO CRUSADE IN AMERICAN EXPERIENCE A GOOD VIDEO THE STORY OF THE POLIO CRUSADE pays tribute to a time when Americans banded together to conquer a terrible disease. The medical breakthrough saved countless lives and had a pervasive impact on American philanthropy that ... Continue reading..http://www.pbs.org/wgbh/americanexperience/polio/

Erradicación de La poliomielitis

Polio Tricisilla Adaptada

March Of Dimes Polio History

Dr. Bruno

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A 41-year-old man developed an acute illness at the age of 9 months during which, following a viral illness with headache, he developed severe weakness and wasting of the limbs of the left side. After several months he began to recover, such that he was able to walk at the age of 2 years and later was able to run, although he was never very good at sports. He had stable function until the age of 18 when he began to notice greater than usual difficulty lifting heavy objects. By the age of 25 he was noticing progressive difficulty walking due to weakness of both legs, and he noticed that the right calf had become larger. The symptoms became more noticeable over the course of the next 10 years and ultimately both upper as well as both lower limbs had become noticeably weaker.

On examination there was wasting of the muscles of upper and lower limbs on the left, and massively hypertrophied gastrocnemius, soleus and tensor fascia late on the right. The calf circumference on the right exceeded that on the left by 10 cm (figure1). The right shoulder girdle, triceps, thenar eminence and small muscles of the hand were wasted and there was winging of both scapulae. The right quadriceps was also wasted. The wasted muscles were also weak but the hypertrophied right ankle plantar flexors had normal power. The tendon reflexes were absent in the lower limbs and present in the upper limbs, although the right triceps was reduced. The remainder of the examination was normal.

Figure 1

The patient's legs, showing massive enlargement of the right calf and wasting on the left

Questions

1
What is that nature of the acute illness in infancy?
2
What is the nature of the subsequent deterioration?
3
What investigations should be performed?
4
What is the differential diagnosis of the cause of the progressive calf hypertrophy?

Answers

QUESTION 1

An acute paralytic illness which follows symptoms of a viral infection with or without signs of meningitis is typical of poliomyelitis. Usually caused by one of the three polio viruses, it may also occur following vaccination and following infections with other enteroviruses.1 Other disorders which would cause a similar syndrome but with upper motor neurone signs would include acute vascular lesions, meningoencephalitis and acute disseminated encephalomyelitis.

QUESTION 2

A progressive functional deterioration many years after paralytic poliomyelitis is well known, although its pathogenesis is not fully understood.2 It is a diagnosis of exclusion; a careful search for alternative causes, for example, orthopaedic deformities such as osteoarthritis or worsening scoliosis, superimposed neurological disorders such as entrapment neuropathies or coincidental muscle disease or neuropathy, and general medical causes such as respiratory complications and endocrinopathies.3

QUESTION 3

Investigations revealed normal blood count and erythrocyte sedimentation rate and normal biochemistry apart from a raised creatine kinase at 330 IU/l (normal range 60–120 IU/l), which is commonly seen in cases of ongoing denervation. Electromyography showed evidence of denervation in the right APB and FDI with polyphasic motor units and complex repetitive discharges, no spontaneous activity in the left calf and large polyphasic units in the right calf consistent with chronic partial denervation. Motor and sensory conduction velocities were normal. A lumbar myelogram was normal. Magnetic resonance imaging (MRI) scan of the calves is shown in figure2.

Figure 2

Axial T1 weighted MRI scan (TR 588 ms, TE 15 ms) of the calves, showing gross muscle atrophy and replacement by adipose tissue on the left, and hypertrophy of the muscles on the right, with only minor adipose tissue deposition

QUESTION 4

The differential diagnosis of the progressive calf hypertrophy is given in the box.

Causes of calf muscle hypertrophy

Chronic partial denervation

  • radiculopathy

  • peripheral neuropathy

  • hereditary motor and sensory neuropathy

  • spinal muscular atrophy

  • following paralytic poliomyelitis

    Neuromyotonia and myokymia

  • Isaac's syndrome

  • generalised myokymia

  • neurotonia

  • continuous muscle fibre activity due to: chronic inflammatory demyelinating polyradiculopathy, Guillain Barre syndrome, myasthenia gravis, thymoma, thyrotoxicosis, thyroiditis

    Muscular dystrophies

    Myositis

    Infiltration

  • tumours

  • amyloidosis

  • cysticercosis

    Link here