ACUTE FLACCID PARALYSIS Kanishk Deep Sharma definition Sudden onset of weakness or paralysis over a period of 15 days in a patient aged less than 15 years age Ddx poliomyelitis Non enveloped, positive stranded RNA virus Genus ENTEROVIRUS family PICORNAVIRIDAE 3 antigenically distinct serotypes:-1,2,3 pathogenesis •Entry into mouth. •Replication in pharynx, GI tract, Local Lymphatic. •Hematologic spread to lymphatic and central nervous system. •Viral spread along nerve fibers. •Destruction of motor neurons Immunity Initially protected by maternal antibodies for first few weeks of life Types Asymptomatic Abortive Polio Non-paralytic Paralytic Spinal Bulbar Bulbospinal Cf- asymptomatic • Accounts for approximately 95% of cases • Virus stays in intestinal tract and does not attack the nerves • Virus is shed in the stool so infected individual is still able to infect others Cf-abortive •Does not lead to paralysis •Mild symptoms seen such as sore throat, fever, n/v, diarrhea, constipation ( Minor illness) •Most recover in <1><5><4days />95% immune after 3 doses Immunity probably lifelong Inactivated polio vaccine Humoral immunity and to some extend pharyngeal immunity Duration of immunity not known with certainty Strategies for polio eradication Global Polio Eradication Initiative launched in 1988 Polio cases have decreased by over 99% 1988 - >125 countries In 2010 - 4 countries The remaining countries are Afghanistan, India, Nigeria and Pakistan Core strategies High infant immunization coverage with four doses of oral poliovirus vaccine (OPV) in the first year of life Supplementary doses of OPV to all children under five years of age during national immunization days AFP surveillance among children under fifteen years of age Targeted “mop-up” campaigns once wild poliovirus transmission is limited to a specific focal area. Immunisation in india Polio Vaccination under UIP OPVº birth OPV1 6 wks OPV2 10 wks OPV3 14 wks OPV4 16-24 Months Pulse Polio Immunization (PPI) The supplementary immunization activities (SIAs) in India launched in 1995 Irrespective of the immunisation status Usually Dec & Jan – Peak transmission aim Providing additional OPV doses to every child aged <5><15 years who have had the onset of flaccid paralysis within the preceding 60 days All cases that are found are investigated immediately, with collection of two stool specimens before administration of OPV.

1. ACUTE
FLACCID
PARALYSIS
KANISHK DEEP SHARMA
ROLL NO. 50

2. DEFINITION
Sudden onset of weakness or paralysis over a period of 15
days in a patient aged less than 15 years age

3. DDX

5. POLIOMYELITIS
Non enveloped, positive stranded RNA virus
Genus ENTEROVIRUS
family PICORNAVIRIDAE
3 antigenically distinct serotypes:-1,2,3

6. •Entry into mouth.
•Replication in pharynx, GI tract, Local Lymphatic.
•Hematologic spread to lymphatic and central nervous
system.
•Viral spread along nerve fibers.
•Destruction of motor neurons
PATHOGENESIS

7. IMMUNITY
•Initially protected by maternal antibodies for first few weeks
of life

8. TYPES
• Asymptomatic
• Abortive Polio
• Non-paralytic
• Paralytic
• Spinal
• Bulbar
• Bulbospinal

9. CF- ASYMPTOMATIC
• Accounts for approximately 95% of cases
• Virus stays in intestinal tract and does not attack the nerves
• Virus is shed in the stool so infected individual is still able
to infect others

10. CF-ABORTIVE
•Does not lead to paralysis
•Mild symptoms seen such as sore throat, fever, n/v, diarrhea,
constipation ( Minor illness)
•Most recover in <1 week

11. CF- NON PARALYTIC
( Major illness)
– Occurs in 1-2% of polio infections
– Symptoms are stiffness in the neck, back, and/or legs
– Increased or abnormal sensations can occur
– Complete recovery after 2-10 days of symptoms

12. CF- PARALYTIC
Paralytic Polio Fewer than 1% of those infected develop this
type
Acute flaccid paralysis seen.
Initially focal but spreads over 3 – 4 days
Headache, neck/back stiffness, unusual sensations,
increased sensitivity to touch
Tripod sign + Descending paralysis
Asymmetrical patchy paralysis
Deep tendon reflex lost before onset of paralysis

13. SPINAL POLIO
Most common form of paralytic
79% –Attacks motor neurons and causes paralysis of
muscles of respiration and muscles of extremities
Children <5 years most likely to become paralyzed in one
leg
Adults are most commonly paralyzed in both arms and legs
Those affected still retain sensation in extremities

16. BULBAR POLIO
• Accounts for 2% of paralytic polio
• Virus attacks motor neurons in brainstem
•Affects cranial nerve function
•Primarily inhibits ability to breathe, speak, and swallow
effectively Facial asymmetry present

17. BULBOSPINAL POLIO
•Accounts for 19% of paralytic cases
• Affects extremities and cranial nerves
• Leads to severe respiratory involvement

18. DDX
CHARACTERISTICS
•Asymmetric AFP
•Fever & muscle pain at onset
•Rapid progress, from onset to max. paralysis in <4days
•Intact sensory function
•Residual weakness/paralysis after 60 days

19. TREATMENT IN PAST
Iron Lung
a sealed chamber with an electrically driven bellows that
regulates breathing.

21. PRESENT TREATMENT
• Antibiotics for infection
• Analgesics for pain
• Portable Ventilators for breathing problem
• Moderate Exercise
• Nutritional Diet

22. PREVENTION

23. •Oral polio vaccine
• Formed by sabin
• Produces both Humoral & local immunity Contributes to
herd immunity
• 50% immune after 1 dose
• >95% immune after 3 doses
• Immunity probably lifelong

24. •Inactivated polio vaccine
• Humoral immunity and to some extend pharyngeal immunity
• Duration of immunity not known with certainty

25. STRATEGIES
FOR POLIO
ERADICATION

26. Global Polio Eradication Initiative launched in 1988
Polio cases have decreased by over 99%
1988 - >125 countries
In 2010 - 4 countries
The remaining countries are Afghanistan, India, Nigeria and
Pakistan

27. CORE STRATEGIES
1. High infant immunization coverage with four doses of
oral poliovirus vaccine (OPV) in the first year of life
2. Supplementary doses of OPV to all children under five
years of age during national immunization days
3. AFP surveillance among children under fifteen years of
age
4. Targeted “mop-up” campaigns once wild poliovirus
transmission is limited to a specific focal area.

28. IMMUNISATION IN
INDIA

29. POLIO VACCINATION
UNDER UIP
OPVº birth
OPV1 6 wks
OPV2 10 wks
OPV3 14 wks
OPV4 16-24 Months

30. PULSE POLIO
IMMUNIZATION (PPI)
The supplementary immunization activities (SIAs) in India
launched in 1995
Irrespective of the immunisation status
Usually Dec & Jan – Peak transmission

31. AIM
Providing additional OPV doses to every child aged <5 years
at intervals of 4-6 weeks during National Immunization Days
(NIDs) & sub-National Immunization Days (SNID's)
“Flood” the community with OPV within a very short period
of time, thereby interrupting transmission of virus
throughout the community.
Intensification : house-to-house “search and vaccinate”
component.

32. OUTBREAK RESPONSE
IMMUNIZATION (ORI)
House-to-house immunization following the AFP case
investigation and stool specimen collection

33. ACTIVE CASE SEARCH
Where an AFP case resides – or where an AFP case has
visited during the incubation period for polio (4-25 days
before paralysis onset)
Carried out immediately along with ORI
A search is conducted for any children aged <15 years who
have had the onset of flaccid paralysis within the preceding
60 days
All cases that are found are investigated immediately, with
collection of two stool specimens before administration of
OPV.