Poliomyelitis (pediatric spinal paralysis, Heine-Medina disease) is an acute and severe infectious disease that is caused by the poliovirus that affects the gray matter of the anterior horns of the spinal cord and other parts of the central nervous system.
Poliomyelitis mainly affects children and adolescents. The danger of the disease is the development of paralysis.
Specific prevention is a vaccine against polio. There are 2 types of polio vaccines:
- live vaccine Sebina (OPV – contains live attenuated viruses)
- inactivated (IPV – contains polioviruses of all three serotypes killed by formalin).
OPV is vaccinated in children from 2 months of age by instilling 2-4 drops (depending on the concentration of the vaccine) on the lymphoid tissue of the pharynx in infants and on the surface of the tonsils in older children.
The first vaccination is carried out for 3, 4, 5 and 6 months, then revaccination is required at 18, 20 months and at the age of 14.
After the OPV vaccination, the child cannot be fed and nourished for an hour, since the vaccine will be washed off with food and water in the stomach. If the child burped, you must repeat the vaccination (for the same reason).
Before vaccination and immediately after it, no new products can be introduced into the child’s diet, since allergic reactions may appear that have been mistaken for the side effects of the vaccine.
On the eve of vaccination, one should make sure that there are antipyretic and antiallergenic drugs in the first-aid kit.
Precautions after OPV vaccination: Do not kiss the baby on the lips and wash your hands after washing the baby.
Contraindications for OPV vaccination:
- children with congenital immunodeficiency or HIV (it is also impossible if family members have the same problems);
- the presence of pregnant women in the child’s environment;
- pregnancy or planning it;
- unusual reaction to previous vaccination;
- allergic to neomycin, streptomycin and polymyxin B (included in the vaccine);
- acute infectious diseases (vaccination after recovery).
IPV vaccination is carried out
- children (weakened, having a pregnant mother and / or intestinal disorders)
- adults (health care workers who have close contact with patients, a trip to endemic areas, unvaccinated people).
IPV is administered subcutaneously or intramuscularly:
- children: primary vaccination at 2, then at 4 months, then revaccination at 6-18 months and at 4-6 years;
- adults: first vaccination (0.5 ml), repeat after 4-8 weeks, and administering a third dose after 6-12 months.
Side effects of vaccination:
Possible side effects that do not require emergency medical intervention:
- temperature increase to 38.5 ° C,
- pain at the injection site,
- nausea, single vomiting, or diarrhea.
Seek immediate medical attention if:
- adynamic and lethargic child;
- shortness of breath, shortness of breath;
- temperature above 39 ° C .;
- urticaria, itching;
- swelling of the face, eyes;
- difficulty swallowing.
After IPV vaccination, walking and bathing a child are not prohibited.
First of all, unvaccinated people are threatened with polio with all the ensuing consequences.
In addition, in case of refusal from vaccination, they are prohibited from traveling to countries requiring vaccination against poliomyelitis and temporarily (for the period of the epidemic) are not employed in educational and health institutions.
The following forms of polio are distinguished:
1. Typical poliomyelitis with CNS lesion:
- non-paralytic: meningeal and abortive;
- paralytic: spinal and bulbar;
2. Atypical forms – erased and asymptomatic.
3. By severity:
- moderately severe;
To establish the severity, the severity of intoxication and motor impairment are evaluated.
4. By character:
- smooth flow (without complications);
- uneven course (with complications, with the addition of a secondary infection, with exacerbation of chronic diseases).
The incubation period lasts 8-12 days, but can vary from 5 to 35 days.
Acute poliomyelitis occurs in various clinical forms, and the symptoms of the disease are represented by the following syndromes:
- intoxication syndrome;
- syndrome of catarrhal phenomena;
- syndrome of disorders of the digestive tract;
- syndrome of neurological disorders.
Poliomyelitis begins at the preparative stage:
- sudden rise in temperature
- a runny nose, sore throat, cough,
- as well as diarrhea or constipation,
- abdominal pain, vomiting.
The syndrome of neurological disorders is characterized by
- lethargy, fatigue,
- increased sensitivity of the skin,
- pains in the spine and extremities.
This stage lasts for 5 days. Then the disease passes into the paralytic stage:
- temperature decreases
- muscle aches disappear,
- paresis and paralysis occur.
The lower limbs are more often involved in the process, less frequently the muscles of the trunk, the abdominals, the respiratory muscles.
After 7-14 days, muscular atrophies and dislocations of the joints develop.
The recovery stage lasts 4-6 months, then the healing process slows down, while muscle atrophies and contractures (muscle contractions) remain.
Residual phenomena or residual stage is characterized by the presence of persistent paralysis, contractures, deformity and shortening of the limbs, spinal curvature. Residual effects lead to lifelong disability.
During outbreaks of poliomyelitis, the mortality rate of patients reaches 2-5% of respiratory failure due to paralysis of the respiratory muscles.
When making a diagnosis, it is necessary to consider clinical and epidemiological, serological and virological data:
- spinal puncture (increased pressure of cerebrospinal fluid, leukocytes – neutrophils , high protein content);
- complete blood count (signs of inflammation: leukocytosis, increased ESR);
- throat swabs and culture;
- seeding analysis of faeces;
- blood culture and CSF on a nutrient medium;
- definition in the serum of antibodies (not less than fourfold increase in antibody titers in paired sera taken in the acute stage of the disease and after 1 – 3 weeks);
- electroencephalogram and MRI (give nonspecific results and have only relative value for diagnosis).
Poliomyelitis is treated by an infectious disease physician in a hospital setting.
Patients are isolated in boxing for 40 days.
There is no specific treatment for the disease –
- symptomatic therapy (antipyretic, painkillers, sedatives),
- Gammaglobulin and vitamin therapy (vitamins C, B1, B 12, B6), amino acids are prescribed.
Patients in the acute stage of the disease are shown strict bed rest (2-3 weeks). With paralysis of the respiratory muscles – artificial ventilation of the lungs.
Paralyzed limbs require special attention. The positions of the legs, arms and spine must be correct. The legs are laid in parallel, slightly bending at the knee and hip joints using planted rollers. The feet should be perpendicular to the shins (they are fixed by putting a thick cushion under the soles). Hands bred to the sides and bent at the elbow joints at an angle of 90 °.
To improve neuromuscular conduction, prozerin, neuromidine, and dibazole are prescribed. Treatment in the infection department takes 3-4 weeks.
Rehabilitation treatment begins in the hospital and continues on an outpatient basis. Physical therapy is prescribed, classes are conducted with an orthopedist, water procedures (exercises under water), physiotherapy (UHF, electrical stimulation, applying hot moist compresses on sore muscles). Further sanatorium treatment (sea, sulfur baths, mud) is shown.
Poliomyelitis can cause the development of respiratory and cardiovascular insufficiency due to paralysis of the intercostal and diaphragmatic muscles. Therefore, patients should be monitored with vital signs. Possible death due to paralysis of the respiratory muscles.
After vaccination against poliomyelitis, it is possible to develop (very rarely) vaccine-associated polio.
The causative agent of polio is a poliovirus of three types. The source of infection is the sick and virus carriers.
The virus is transmitted by the fecal-oral and airborne routes.
In tropical countries, cases are recorded throughout the year, in countries with a temperate climate, more often in summer and autumn.
Factors contributing to the spread of the virus:
- non-compliance with personal hygiene (dirty hands);
- unsatisfactory removal of feces;
- poor sewage;
- contaminated food (unwashed vegetables and fruits) and water (including bathing in polluted water);
- home flies.
The prognosis is favorable for non-paralytic polio.
After paralytic poliomyelitis, contractures, muscle atrophy, and paresis of the limbs (disability) are formed.