Abstract
Background: While we are inching towards global eradication of polio, the paralysis due to non-polio viruses (NPEV) poses greater challenge. Factors responsible for causing Acute Flaccid Paralysis (AFP) were studied in 3596 AFP patients in 64 districts of Uttar-Pradesh, India, to observe indirect relationship of AFP with wild polio as well as NPEV. A recent study suggests the need to investigate polio virus negative but NPEV positive AFP cases. Methods: The lab results of the stool samples of these children were line listed and analysed to observe the association of various factors with respect to presence of paralysis on 60 follow-up days. Taking zero OPV dose AFP cases as a biological base, we studied the relationship of presence of paralysis at 60 follow-up days to that of presence of NPEV in stool samples while polio virus was present or absent. Results: 70 of the 86 AFP cases (81%) with zero OPV dose and having only NPEV isolated in stool samples were having paralysis at 60 follow-up days. There were 4.54% (162) AFP cases, which did not carry any polio virus but were having NPEV isolated in the stool samples and paralysis at 60 follow-up days. 79% (75/95) of zero OPV dose children, who were having residual weakness at 60 follow-up days, were carrying both polio virus as well as NPEV in their stool samples. Total AFP cases, having residual weakness at 60 follow-up days and having NPEV in stool samples, decreased with increase in OPV doses; a behavior similar to what wild polio viruses (WPV) have to OPV. Conclusions: Maybe polio like NPEV is active for causing severe paralysis in children and is responding to the OPV. As is evident in the studies by M. Margalith, B. Fattal et al. [1] that there is an antibody response to the enteroviruses, we can think of coming out with a vaccine against the enteroviruses. Therefore, enterovirus vaccine can be produced on similar lines to that of OPV, as now we have enough isolates of NPEV. Effective NPEV surveillance system also needs to be in place.
Highlights
While we are inching towards global eradication of polio, the paralysis due to non-polio enteroviruses (NPEV)poses greater challenge
2) 4.5% children (162) with paralysis at 60 days follow-up were though not carrying polio virus but were having NPEV isolated in their stool sample
There appears to be a relation between paralysis caused by the poliovirus and presence of NPEV, making this paralysis more severe i.e. the paralysis was present in majority even after 60 days of follow-up where we were able to isolate both wild polio viruses (WPV) and NPEV in stool samples
Summary
While we are inching towards global eradication of polio, the paralysis due to non-polio enteroviruses (NPEV)poses greater challenge now. The author, while working with polio eradication initiative, found a strange association between paralysis present at 60 follow-up days and presence of NPEV in the stool samples of the affected children. This led the author to investigate deeper into the cause. While we are inching towards global eradication of polio, the paralysis due to nonpolio viruses (NPEV) poses greater challenge. Taking zero OPV dose AFP cases as a biological base, we studied the relationship of presence of paralysis at 60 follow-up days to that of presence of NPEV in stool samples while polio virus was present or absent.
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