3/19/2015

Polio this week as of 18 March 2015


Polio this week as of 18 March 2015 
  • As per risk assessment criteria set by the International Health Regulations (IHR) Emergency Committee on the international spread of wild poliovirus, Syria and Ethiopia have now been re-classified as countries ‘no longer infected by wild poliovirus, but which remain vulnerable to international spread’, following no detection of wild poliovirus in more than 12 months. More

  • In Pakistan, efforts are continuing to tighten up strategies and ensure implementation of the ‘low season’ emergency operations plan. Strong coordination of activities by Emergency Operations Centres (EOCs) at federal and provincial level is helping to evaluate implementation and enable corrective measures as necessary. See ‘Pakistan’ section below for more. 


        

      Wild poliovirus type 1 and Circulating vaccine-derived poliovirus cases
      Total cases
      Year-to-date 2015
      Year-to-date 2014
      Total in 2014 
      WPV
       cVDPV
       WPV
       cVDPV
       WPV
       cVDPV
      Globally
      20
      0
      37
      5
      359
      54 
      - in endemic countries 
      20
       0
      33
      5
      340
       51
      - in non-endemic countries 
      0
       0
      4
       0
      19
       3
        

      Case breakdown by country

      Countries
      Year-to-date 2015
      Year-to-date 2014
      Total in
       2014
      Onset of paralysis of  most  
       recent case
      WPV
      cVDPV 
      WPV 
      cVDPV
       WPV
      cVDPV 
       WPV
       cVDPV
      Pakistan19029430621 24-Feb-1513-Dec-14 
      Afghanistan132821-Jan-15N/A 
      Nigeria001630 24-Jul-1416-Nov-14 
      Somalia00 0511-Aug-14N/A 
      Equatorial Guinea0 01 05003-May-14N/A 
      Iraq00 02007-Apr-14N/A 
      Cameroon03 0509-Jul-14N/A 
      Syrian Arab Republic001021-Jan-14N/A 
      Ethiopia001005-Jan-14N/A 
      South Sudan 0 0 0 0N/A 12-Sep-14 
      Madagascar 0 0N/A 29-Sep-14 
        Circulating vaccine-derived poliovirus cVDPV: Madagascar is cVDPV1, all others cVDPV2. NA: onset of paralysis in most recent case is prior to 2014. cVDPV is associated with ≥ 2 AFP cases or non-household contacts. VDPV2 cases with ≥ 6 (≥ 10 for type1) nucleotides difference from Sabin in VP1 are reported here.

      Afghanistan

      • No new cases of wild poliovirus type 1 (WPV1) have been reported in the past week. The most recent case had onset of paralysis on 21 January in Reg district of Hilmand province. The total number of WPV1 cases for 2014 remains 28, and 1 for 2015. Most of the cases from 2014 were linked to cross-border transmission with neighbouring Pakistan. 
      • Two WPV1 positive environmental samples were confirmed this week, from Hilmand and Kandahar (dates of collection: 25 and 26 January), confirming ongoing circulation of the virus in the country. 

      Nigeria

      • No new wild poliovirus type 1 (WPV1) cases were reported in the past week. Nigeria’s total WPV1 case count for 2014 remains 6. No cases have been reported in 2015. The most recent case had onset of paralysis on 24 July in Sumaila Local Government Area (LGA), southern Kano state. 
      • No new type 2 circulating vaccine-derived poliovirus (cVDPV2) cases were reported this week. The most recent case had onset of paralysis on 16 November in Barde Local Governmental Area of Yobe state. The total number of cVDPV2 cases for 2014 in Nigeria remains 30. 

      Pakistan

      • Three new wild poliovirus type 1 (WPV1) cases were reported in the past week, one from Khyber in Federally Administered Tribal Areas (FATA) and two from Sindh, bringing the total number of WPV1 cases to 19 in 2015. The most recent case had onset of paralysis on 24 February (from Khyber, FATA). The total number of WPV1 cases in 2014 remains 306. 
      • No new type 2 circulating vaccine-derived poliovirus (cVDPV2) cases were reported in the past week. The most recent case had onset of paralysis on 13 December. The number of cVDPV cases reported in 2014 remains 21. 
      • Efforts are ongoing to strengthen implementation of the ‘low season’ emergency operations plan. 
      • Strong, functional Emergency Operations Centres (EOCs) are now operational both at the federal and provincial. 
      • Strategies are focusing on clearly identifying reasons for missed children, and putting in place area-specific mechanisms to overcome area-specific challenges. 
      • Independent monitoring is strengthened and rolled out across wider geographic areas to provide a clearer assessment of quality and associated gaps. 
      • Activities are focusing on known infected areas, but also areas deemed at high-risk but which have not reported polio cases. Environmental surveillance indicates widespread transmission of the virus, not just in known infected areas but also in areas without cases. Environmental surveillance is proving to be an instrumental supplemental surveillance tool enabling a clearer epidemiological picture.  

        Central Africa

        • No new wild poliovirus type 1 (WPV1) cases were reported in the last week. In 2014, 10 cases were reported in central Africa: 5 in Cameroon and 5 in Equatorial Guinea. Over 8 months have passed since the last WPV1 case had onset of paralysis in central Africa (in Cameroon, onset of paralysis on 9 July). 
        • National Immunization Days (NIDs) are planned in Chad and Gabon, and Subnational Immunization Days (SNIDs) in Cameroon in March. In April, NIDs are scheduled in Equatorial Guinea and Chad, staggered NIDs in Central African Republic, and a SNID in the Democratic Republic of the Congo.   

        Horn of Africa

        • No wild poliovirus type 1 (WPV1) cases have been reported in the last week. The most recent case, which had onset of paralysis on 11 August 2014, was from Hobyo district of Mudug province, central Somalia. The total number of WPV1 cases that were reported in the Horn of Africa in 2014 was 6: 1 in Ethiopia (date of onset of paralysis on 5 January) and 5 in Somalia. 
        • No cases of type 2 circulating vaccine derived poliovirus (cVDPV2) have been reported in the last week. The most recent case of cVDPV2 had onset of paralysis in South Sudan on 12 September. In 2014, 2 cases were reported in South Sudan. 
        • National Immunization Days (NIDs) are planned in South Sudan from 24 – 27 March. Supplementary Immunization Activities are planned in Somalia and NIDs in Yemen (30 March to 2 April). Subnational Immunization Days (SNIDs) are also planned in Ethiopia and Somalia in March and in Kenya, Sudan and Ethiopia in April. 

        Israel and West Bank and Gaza

        • Wild poliovirus type 1 (WPV1) has not been detected in environmental samples in Israel or the West Bank and Gaza Strip for more than 11 months. The most recent WPV positive sample was collected in southern Israel on 30 March 2014. All environmental samples collected since April have been negative for WPV.

        Middle East

        • No new wild poliovirus type 1 (WPV1) cases have been reported in the last week. Three cases of WPV1 were reported in the Middle East in 2014 - 2 in Iraq and 1 in Syria. 
        • The most recent case reported from Syria had onset of paralysis on 21 January 2014, while the most recent case in Iraq had onset of paralysis in Mada'in district, Baghdad-Resafa province, on 7 April. 
        • Phase III of the Middle East outbreak response is continuing to further strengthen vaccination services for vulnerable populations and to strengthen surveillance for polioviruses across the region. 

        West Africa

        • No wild poliovirus type 1 (WPV1) cases have been reported in the past week. The most recent WPV1 case in the region occurred in Tahoua province, Niger, with onset of paralysis on 15 November 2012. 
        • Even as polio programme staff across West Africa help to control the Ebola outbreak affecting the region, efforts are being made in those countries not affected by Ebola to vaccinate children against polio to create a buffer zone surrounding the affected countries. The Ebola crisis in western Africa continues to have an impact on the implementation of polio eradication activities in Liberia, Guinea and Sierra Leone. Twenty two surveillance medical officers from the National Polio Surveillance Programme (NPSP) in India have been deployed for 3 months to strengthen surveillance systems and data collection for the Ebola response, demonstrating the polio legacy in action. Read more
        • On 10 – 13 April, National Immunization Days (NIDs) are planned in Benin, Burkina Faso, Cote d'Ivoire, Mali, Niger and Senegal. NIDs are planned for the three Ebola-affected countries of Guinea, Liberia and Sierra Leone in April and May.

        - See more at: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx#sthash.cdZ5w3j1.dpuf

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        Erradicación de La poliomielitis

        Polio Tricisilla Adaptada

        March Of Dimes Polio History

        Dr. Bruno

        video

        movie

        movie2

        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