Elimination Of Poliomyelitis Research Articles

Guillain-Barre syndrome complicating Neisseria meningitidis infection

Guillain-Barré Syndrome (GBS)-an immune-mediated condition-is the most common cause of acute flaccid paralysis, since the elimination of poliomyelitis. We present a case of GBS as a rare complication of meningococcal meningitis based on clinical features, nerve conduction studies and magnetic resonance imaging (MRI) findings. GBS has rarely been described after meningitis. This case is unique in that our findings show that GBS may be observed after meningococcal meningitis.

Lessons from the elimination of poliomyelitis in Africa.

In August 2020, Africa was declared free of poliomyelitis (polio), bringing to fruition a goal that took more than 30 years to achieve. This Perspective chronicles global, continental, national and community actions taken by diverse stakeholders that finally led to the elimination of transmission of wild poliovirus in Africa. The cascade of events started with the development of polio vaccines and the realization that polio, much like smallpox, could be eradicated. After a 1988 pledge by the World Health Assembly to eradicate polio globally, concerted and deliberate efforts were made in Africa to achieve this goal. This included the use of evidence-based approaches for the harmonization and standardization of public health strategies, using a network of polio laboratories and emergency operation centres and actively pursuing underserved populations. Innovative solutions to counter challenges such as conflict and vaccine hesitancy may be of use in future public health interventions.

New vaccine technologies, adjuvants and delivery system

Immunization represents the most cost-effective means to achieve the prevention of infectious diseases. Vaccines successfully protected humans from serious infections resulting in worldwide eradication of smallpox and regional elimination of poliomyelitis. New technologies continue to provide many effective biological products for disease control. Various techniques including recombinant DNA approaches, peptide synthesis chemistry, and immunomodulation have been applied to the development of new vaccines and improvement of existing vaccines. These technologies have constructed avirulent and attenuated strains to be used as live vaccines, as well as provided more effective manufacturing methods to produce protein antigens. bacterial polysaccharides (PS) and PS-protein conjugate vaccines. Adjuvant is an agent added to biologics that augments specific immune responses to antigens. Adjuvants can be divided into several classes including aluminum salts, surface-active agents, bacterial derivatives and slow-release materials. Nonionic block copolymer as a multiple emulsion, and proteinoid microspheres were also developed for use in various vaccines. The ideal vaccine delivery system depends on the capabilities of the controlled delivery system to achieve optimum concentration of antigens, while maintaining vaccine stability under physiological conditions. Microspheres were used for controlled release of antigens whereas peptides of monoclonal antibodies were applied for enhancement of mucosal IgA antibody formation.

MODERN POSSIBILITIES OF VIROLOGICAL DIAGNOSTICS OF POLIOMYELITIS

The review presents the data from the literature of our and foreign countries devoted to modern virologic diagnostics of poliomyelitis viruses of 1, 2, and 3 types that is especially topical in connection with WHO program on complete poliomyelitis elimination in the world. There is described the role of laboratory virologic investigations in making the diagnosis of poliomyelitis infection. The classical methods of poliomyelitis viruses detection are given in detail.

Poliomyelitis in modern conditions: achievements and prospects

The creation in the middle of the 20th century vaccines against poliomyelitis (PM) – inactivated vaccine (IPV) and live oral vaccine from Sabin strains (OPV) with various properties, advantages and disadvantages, but highly effective, made it possible to implement the idea of elimination of PM. Since 1988, the WHO Global Program of PM eradication has achieved remarkable success: the incidence of PM caused by wild poliovirus (PV) has been reduced by 10 thousand times, the number of endemic countries has been reduced to 3, the circulation of wild PV has been discontinued in 4 regions of the world the wild type 2 of PV has been eradicated, and wild type 3 of PV has not been detected for almost 5 years. Under conditions of a decrease in the incidence of PM caused by wild PV, the known negative properties of trivalent OPV made its further use problematic. These negative properties are: 1) the ability to cause post-vaccination complications and 2) the genetic instability of Sabin strains, especially PV of type 2, and their ability under certain conditions (primarily in conditions of low collective immunity to PV) to quickly restore neurovirulence, transforming into circulating vaccinederived PV (VDPV), capable of causing incidents and outbreaks of PM. In order to reduce the risk associated primarily with type 2 PV, WHO proposed a global switch to the use of bivalent OPV from types 1 and 3, completed in 2016. In 2019, WHO plans to complete eradication of type 1 and 3 PVs, and in 2022 completely abandon the OPV. The precondition for the safety of such tactics is the maintenance of high collective immunity to PM. There are several threats to the security of this strategy. PVs can “silently” circulate in the human population for a long time without clinical manifestations of PM, which, with inadequate epidemiological surveillance can lead to the return of PM. The reintroduction of both wild PV and Sabin strains can occur from institutions that preserve / work with PV. The source of VDPV can be people with primary immunodeficiencies, which continuously excrete PV. It is necessary to maintain surveillance over the PM, expand additional types of surveillance for the PV, strict containment of all PVs. The only way to maintain collective immunity is immunization with trivalent IPV. The current global shortage of IPV poses a significant threat to the world’s epidemiological well-being. The solution to the problem is the development of a new generation of safe and effective vaccines, improving the ways of introducing IPV, developing antiviral drugs.

Expanded Programme on Immunization in Bangladesh: A Success Story

Infections are responsible for the majority of loss of life in children and vaccination has made enormous contribution to public health, including the eradication of one dreaded disease, small pox, and elimination of poliomyelitis from all but a handful of countries. Globally, immunization currently averts an estimated 2 to 3 million deaths every year. In Bangladesh it has prevented an estimated 2 million deaths from 1987- 2000, and continues to prevent approximately 200,000 deaths each year. WHO introduced EPI (Expanded Programme on Immunization) in 1977 at Alma-Ata, the capital of Kazakhastan for the underdeveloped countries. Subsequently Bangladesh has launched EPI programme. Recently AD (Auto Disable) syringes and vaccination against Hepatitis B, H. Influenzae, Measles-Rubella (MR) and Pneumococcus has been introduced in vaccination programme. In Bangladesh, immunization coverage of DPT/PENTA3 was only 16% in 1988 increased significantly to 69% in 1990, 81% in 2000, 90% in 2011and 92% in 2013 which was higher than global coverage of 84% in 2013 and comparable to first world countries. In Pakistan fully immunization coverage in 2010 was only 50%.9 Indian national full immunization coverage was 56% in 1990, 59% in 2000, 74% in 2010 and 74% in 2012 whereas in our country it was 52% in 1991, 53% in 2000, 79% in 2010, 80% in 2011and 81% in 2013 which signifies our excellent success for prevention of communicable diseases in successive years. So, EPI in Bangladesh has been recognized for its sustained high coverage and great contribution to the reduction of childhood morbidity and mortality and it received two ‘GAVI best performance award’ in 2009 and 2012.Bangladesh J Child Health 2015; VOL 39 (2) :93-98

Study of Cerebrospinal Fluid (CSF) and Clinical and Electrophysiological Features of Hospitalized Patients with Gullain-Barre´ Syndrome

Background: Since the elimination of poliomyelitis from most part of the world Gullain-Barre' Syndrome (GBS) has been the leading cause of acute flaccid paralysis which leads to substantial morbidity and mortality. Though GBS has received a lot of attention in developed countries, there is a paucity of reports on the GBS from the developing world including Bangladesh.Objective: The objective of the study was to correlate clinical, cerebrospinal fluid (CSF) and electrophysiological findings of hospitalized Gullain-Barre´ syndrome patients for early diagnosis and appropriate management.Materials and Methods: A total of 47 clinically diagnosed GBS patients admitted in Neurology, Medicine and Pediatrics departments of Dhaka Medical College Hospital (DMCH) were included in this quasi-experimental study. Biochemical, cytological and bacteriological studies of CSF of these patients were done. Electrophysiological studies of all subjects were done and values were compared with upper and lower limits of normal.Results: In this study, antecedent event were present in 55.30% cases and upper respiratory infection (23.40%) and gastroenteritis (21.30%) were the commonest antecedent disorders. All the study patients had numbness or paresthesia and limb weakness, and muscle pain was in 44.7% cases, facial weakness in 36.2% cases, ophthalmoplegia or ptosis in 6.4% and bulbar involvement was in 6.4% cases. Most of the patients (95.7%) had deep tendon hypo/areflexia followed by respiratory distress (21.3%), and ataxia (19.1%). Majority of the study patients (57.4%) required one week time to develop maximum deficit. Maximum subjects (70.2%) had motor type GBS followed by sensorimotor type (21.3%), Miller-Fisher type (6.4%) and sensory type (2.1%). Eighty three percent of the study patients had CSF protein concentration >45 mg/dL with mean ± SD of 71.32 ± 20.20 mg/dL (37–112 mg/dL). The cell count in CSF was <5 per mm3 in 95.7% of the study patients with mean ±SD cell count of 3.2 ± 1.80/mm3 (2–15 cells per mm3). The mean ± SD time to perform EMG was 9.4 ± 3.6 days with a range from 5–17 days and the mean ± SD disability grade at that time to EMG was 3.6 ± 0.9 with a range from 2–5. Regarding the electrodiagnostic types, the commonest pattern (40.40%) was found AIDP, AMAN was 29.80%, AMSAN 19.15% and mixed pattern was in 10.65% of the patients.Conclusion: This study reveals that clinical, CSF and electrophysiological findings accurately diagnose the GBS patients along with typing of GBS.J Enam Med Col 2015; 5(3): 145-150

Global lessons from India’s poliomyelitis elimination campaign

In its history of more than two decades, the Global Polio Eradication Initiative (GPEI), led by national governments and the World Health Organization, has made remarkable headway, punctuated by a few public health riddles. Globally, the number of cases of poliomyelitis (polio) confirmed annually dropped from an estimated 350 000 in 1988 to 1651 in 2008. (1) By 2 December 2009, the number of cases of wild poliovirus (WPV) infection reported by endemic countries had declined somewhat, but the number reported by non-endemic countries had nearly tripled (Fig. 1). Indigenous WPV type 1 (WPV1) and WPV type 3 (WPV3) have been eliminated from all countries except Afghanistan, India, Nigeria and Pakistan, yet in 2008 outbreaks resulting from imported cases were reported by 12 countries, in five of which transmission has lasted for more than 12 months. Furthermore, cases of infection with the vaccine-derived poliovirus still occur, and this virus will continue to circulate and cause outbreaks for as long as oral polio vaccine is used. The time has not yet come when routine vaccination is no longer required, a hallmark that eradication has been achieved. In the midst of these virological considerations, the key lesson that emanates from the Indian experience is that the social determinants of programme implementation are as important as the technical ones--and this lesson has a significant bearing on other disease elimination programmes as well. Polio elimination in India Efforts to eliminate polio in India may provide insights as to the factors that can influence the success or failure of polio elimination strategies and ultimate disease eradication. In India, 659 cases of WPV infection (predominantly with WPV3) and 15 cases of vaccine-derived poliovirus infection had been reported by 4 December 2009, about 80% of them in the state of Uttar Pradesh and 17% in the state of Bihar. Children aged less than 2 years were the most affected group. On the surveillance front, stool collection within 14 days of the onset of paralysis, as mandated by India's National Polio Surveillance Project, has hovered between 84% and 85% of all reported cases of acute flaccid paralysis in 2008 and 2009--figures that maintain the prescribed target of 80% or above. This is a critical component of the polio eradication strategy, since ascertaining that the poliovirus is the cause of a child's paralysis is only possible by examining a stool specimen. However, in the last decade the incidence of nonpolio acute flaccid paralysis in India has increased 10-fold (from the WHO benchmark of at least 1 per 100 000), and in 2009 Bihar reported 29 cases per 100 000 population (based on stool tests conducted in 86% of cases of acute flaccid paralysis). Questions have thus been raised about the robustness of polio surveillance, and there is concern that cases of poliomyelitic acute flaccid paralysis that are reported late may be lurking among suspected cases. Under the GPEI Strategic Plan 2009-2013, the goal is to achieve polio eradication by 2013. With only 66 cases of WPV infection in 2005, India was seemingly at the threshold of eradicating polio; however, the 10-fold rise in cases of infection by WPV observed over the four ensuing years has put the goal beyond reach. There is a need to critically re-examine realities on the ground in India in an effort to understand what has gone wrong. Supplementary immunization activities The current polio elimination strategy has focused primarily on interrupting WPV1 transmission based on the epidemiological argument that WPV1 causes higher rates of paralysis than other wild poliovirus types and is likely to spread to polio-free areas. In 2005, monovalent oral polio vaccine against WPV1 (mOPV1) replaced the trivalent oral polio vaccine (tOPV) in some supplementary immunization rounds. After the WPV1 outbreak in 2006, the mOPV1 was administered to children through several supplementary immunization activities (SIAs). …

Certifying the elimination of poliomyelitis from Europe: advancing towards global eradication.

Indigenous wild polioviruses have been virtually eliminated from the 51 countries of the European Region of the World Health Organization (WHO), an achievement that is of critical importance to the global initiative to eradicate poliomyelitis by the year 2000. An international commission has been established to certify the elimination of poliomyelitis from this region. European countries have recently been requested to establish National Certification Committees to review and submit the necessary documentation and surveillance data. In some Western European countries where polio has not been reported for many years, the challenge will be to produce robust evidence demonstrating both the current absence of wild poliovirus and the means to promptly detect and respond to possible importations of wild poliovirus for the next several years, up to global eradication and the cessation of polio vaccination. 1. laboratory-based surveillance with collection of faecal specimens is necessary to demonstrate the absence of indigenous wild poliovirus 2. certification can only occur after all countries have demonstrated the absence of indigenous wild polioviruses for at least 3 years and have the means to detect and respond to importations of wild poliovirus for several years into the future 3. any single case of poliomyelitis in Europe now requires an immediate public health response which includes virological investigation and prompt notification to the World Health Organization.

IMMUNIZATION: Past Successes, Future Challenges

Global eradication of smallpox, elimination of poliomyelitis in the Western Hemisphere, and a 90% decrease in Haemophilus influenzae meningitis in the Western Hemisphere mark some of the achievements of immunization programs around the world. Yet many serious problems continue to exist, particularly in the developing world. Advances in biotechnology and the renewed interest by industry, governments, and the World Health Organization in vaccine development and delivery in the field provide an exciting prospect for major advances in immunization in the next few decades.

Eradication of poliomyelitis

China and the other countries of the Western Pacific Region have a goal of eradication of wild poliovirus by the end of 1995. In this report we examine the progress made toward eradication through the end of 1993. We examined the information about poliomyelitis and wild poliovirus based on the acute flaccid paralysis surveillance system. The number of reported poliomyelitis cases decreased from 4623 cases in 1989 and 5065 cases in 1990, which occurred during a large nationwide poliomyelitis epidemic, to 538 cases in 1993. Mass supplemental immunization sessions were conducted during the 1991 to 1992 and 1992 to 1993 winters. After the two rounds of supplemental immunizations in the 1992 to 1993 winter, wild poliovirus was not detected for the subsequent 21 months in 22 contiguous provinces in central and northern China, in which 980 million persons reside. In 1993 wild poliovirus was detected in only 5 provinces in southern China and in 2 provinces in the remote Western region; these provinces have only 14% of the total population in China. China is close to achieving its 1995 poliomyelitis elimination goal. Mass supplemental immunizations in children 0 to 3 years old can rapidly eliminate wild poliovirus from large, very densely populated areas, low income rural areas and remote mountainous areas. There appears to be no technical obstacle, even in the most difficult areas, to achieving global eradication of wild poliovirus by the year 2000.

Control of Poliomyelitis in Kuwait

The use of oral poliovirus vaccine (OPV) in the early 1960s marked the beginning of the State's effort in controlling poliomyelitis in Kuwait. During the next two decades, despite the vaccine's availability and use, the disease continued to cause disability and death. However, with the massive and sustained use of the trivalent OPV since 1963G and the introduction of neonatal supplementary immunization with monovalent type 1 (MOPV) in 1976G along with strengthening of the surveillance activities against poliomyelitis, the incidence of the paralytic disease began declining and by the mid-eighties it disappeared altogether. With no cases of paralytic poliomylelitis reported in Kuwait since 1986G, the disease is largely controlled. The epidemiology of poliomyelitis in Kuwait has been examined here in retrospect. The paper profiles about 3 1/2 decades (1958G to 1992G) of efforts that led to this impressive virtual elimination of poliomyelitis. In order to maintain this status and eventually achieve the goal of eradication without the rare occurrence of vaccine-associated paralysis, it is, in our opinion, necessary to adopt an approach of combined vaccination with the inactivated polio vaccine (IPV), preferably in the neonatal age, followed by OPV. Simultaneously, monitoring the presence and circulation of wild poliovirus in the environment and continuous surveillance should be carried out for timely intervention.

The Guillain-Barré syndrome.

WITH the virtual elimination of poliomyelitis, Guillain—Barre syndrome has become the most common cause of acute generalized paralysis, with an annual incidence of 0.75 to 2 cases per 100,000 population. Several clinical variants of this demyelinating polyneuropathy have been described, the electrophysiologic aspects better understood, and the immunologic basis clarified, but the diagnosis is still made by clinical acumen and experience. The eponym derives from the description in 1916 by G. Guillain and J.A. Barre, then French army neurologists, and A. Strohl, who performed the electrophysiologic recordings1; it remains useful because of uncertainty about the cause and pathogenesis of . . .

Elimination of Poliomyelitis in Finland

Elimination of Poliomyelitis in Finland

Elimination of Poliomyelitis in Finland

In Finland paralytic poliomyelitis has disappeared after immunization programs carried out exclusively with inactivated poliovirus vaccine (IPV). A sharp decrease in the number of patients with poliomyelitis occurred after mass vaccination in 1960-1961, when 51% of the population had received the complete primary vaccination. Immunity is maintained by continuous vaccination of infants, whose vaccination rate is close to 98%. Intensive poliovirus surveillance in 1972-1974 revealed that dissemination of the virus has also virtually ceased. Serologic surveys indicate that greater than or equal to 90% of individuals older than 15 years of age possess antibodies to all viral types, but in the younger age groups the proportion with antibodies to types 1 and 3 is lower, a finding that is alarming, especially in the case of type 3. Revaccination of seronegative children and conscripts has induced rapid booster-like responses, indicating that fully vaccinated individuals, although without demonstrable antibodies, are protected against poliomyelitis. The new, improved IPV developed in Holland induces satisfactory antibody titers in all vaccinees, with two injections--or perhaps even one--leading to long-lasting immunity.

Strategies for elimination of poliomyelitis in different parts of the world with use of oral poliovirus vaccine.

Since its first mass use in 1960, oral polio vaccine ( OPV ) has largely eliminated paralytic poliomyelitis from temperate-climate and subtropical regions of the world that have good health services and a combined total population of almost 2,000 million people. The various strategies used in these countries have been highly successful even where, as in the USA, large numbers of children received no vaccine or only a single dose of OPV . During the period of 1981-1982, only 2.8 cases per 100 million total population per year were reported in the USA. The main challenge in the present era is the economically undeveloped tropical and subtropical regions with inadequate health services that are inhabited by more than half of the world population, where recent surveys for residual paralysis due to poliomyelitis have shown that the incidence of the disease has been higher than it was in the USA and other predominantly temperate-climate countries before the vaccine era. The problem in these countries is that the majority of children receive no vaccine and that the extensive year-round dissemination of virulent polioviruses requires a different strategy of vaccination from that used in the temperate-climate countries. The special point about the annual mass vaccinations with OPV for all children younger than three, four, or five years of age-which have proven highly successful in Cuba (for the past 20 years), in Brazil (during the past three years), and recently also in Mexico-is that all the children are usually vaccinated within one or two days, which quickly breaks the chain of transmission of the virulent viruses, and the annual campaigns create and maintain the maximum number of children with resistant intestinal tracts.

Paralytic poliomyelitis can be eliminated.

Since the introduction and widespread use of inactivated and oral poliovirus vaccines, there has been a continued and increasing commitment to worldwide poliomyelitis control. The eradication of poliomyelitis in certain countries, smallpox eradication worldwide, the World Health Organization's (WHO) Expanded Programme on Immunization, and advances in poliovirus vaccine production augur well for worldwide elimination within the next few decades. The success of any such program rests firmly upon scientific feasibility, intensive epidemiologic surveillance, and economic justification. The development of a variety of disease-specific control/prevention programs worldwide have improved communicable disease reporting in many countries and established health-care infrastructure as well. Equally important has been the emergence of the concept of epidemiologic surveillance. The success of poliomyelitis elimination in large parts of the world, the WHO commitment, and the tragic, visible effects of poliomyelitis are sufficiently strong arguments to persuade the countries of the world to make the necessary effort to eliminate poliomyelitis within the next generation.

Selective primary health care: strategies for control of disease in the developing world. IX. Poliomyelitis.

Poliomyelitis is an acute viral disease primarily afflicting children. It can be very mild, permanently crippling, or fatal. In the developed nations, poliomyelitis is controlled by the use of trivalent vaccines: killed virus administered by injection and/or attenuated virus administered orally. The latter is cheaper. A combination of the two may be required in some tropical countries. In many developing nations poliomyelitis remains endemic and prevalent, especially in children; 37,747 cases were reported to the World Health Organization in 1979, but greater than 200,000 cases probably occurred. Socioeconomic improvement and public health measures (i.e., immunizations) remain the major strategies for control. While global eradication may be a more distant goal, poliomyelitis could be controlled better. Effective programs for control include safe, efficacious, and inexpensive vaccines; methods for successful management of vaccine delivery systems; commitment and training of health personnel; public education; commitment of funds; and research to improve vaccines and their delivery. The major obstacle to control of poliomyelitis is failure to immunize an adequate number of susceptible children. Development of strategies for immunization is crucial to elimination of poliomyelitis as a major world health problem.