AFP polio. Acute flaccid paralysis

One of the most global and expensive initiatives of the World Health Organization (WHO) and health officials of all countries for many years has been the worldwide fight to eliminate the human polio virus. Nowadays this struggle is as far from its goal as it was decades ago.

Opponents and supporters of vaccination have been exchanging arguments about the harmfulness/usefulness of vaccinations in general for more than two hundred years. This material will talk about one specific disease, vaccines against it and the history of medical and near-medical manipulations around it. This disease is human polio.

For further understanding, biological and medical details are indispensable. Hereinafter, only official, “mainstream” medical positions will be presented, unless otherwise stated. So, polio (polio (Greek) - gray, myelos - brain) is an acute viral infection that can affect the nervous system (gray matter of the spinal cord) with the development of peripheral paralysis. The causative agent is an RNA virus of the Picomaviridae family of the Enterovirus genus. There are 3 known serotypes of the virus. The pathogen can infect motor neurons of the gray matter of the spinal cord and the nuclei of the motor cranial nerves. When 40-70% of motor neurons are destroyed, paresis occurs, and over 75% - paralysis.

The only known reservoir and source of infection is humans (patient or carrier). Most cases are asymptomatic (it is unclear from the outside that the person is sick). The infection spreads through the fecal-oral route, through direct or indirect contact with feces. Diseases are recorded at any age, but more often in children under 5 years of age. In children early age observe the so-called abortive form (more than 90% of all cases), characterized by a mild course and absence of damage nervous system. The disease develops 3-5 days after contact and occurs with a slight increase in body temperature, malaise, weakness, headache, vomiting, and sore throat. Recovery occurs after 24-72 hours. In 1% of cases, a more severe, but also not paralytic form develops - temporary inflammation of the meninges (poliomeningitis)

In the paralytic form, the incubation period is 7-21 days (in patients with immunodeficiency - up to 28 days), followed by a pre-paralytic period (1-6 days), which may be absent. At this point, intoxication appears (fever, headache, adynamia, drowsiness), catarrh of the upper respiratory tract, diarrhea, vomiting. Next comes a paralytic period (1-3 days). It manifests itself in low muscle tone (hypotonia), reduced or absent reflexes of the affected muscles and their rapidly developing atrophy - such symptoms are called acute flaccid paralysis (AFP). The paralytic form is difficult from the first days, in 30-35% the so-called. bulbar form (with damage to the muscles responsible for breathing). Actually, the severity of the disease is determined by respiratory failure. And finally, there comes a period during which the affected muscles recover - over the course of several days. In severe cases, recovery can last several months or even years, sometimes full recovery does not occur. Ratios of the number of paralytic and non-paralytic forms of polio in epidemics of the 20th century. in developed countries, according to various sources, from 0.1% to 0.5% (1:200 -1:1000). Those most at risk of developing paralytic poliomyelitis are: patients with immunodeficiency conditions, malnourished and weakened children, those who do not have immunity to poliovirus, and pregnant women.

An important note must be made - from the discovery of poliovirus in 1909 until the mid-20th century, any acute flaccid paralysis (AFP) was considered to be polio. Paradoxically, polio paralysis is considered the only infectious disease, the incidence of which increased sharply in the late 19th and early 20th centuries, and the main epidemics occurred in the 30s, 40s, and 50s of the 20th century. At the same time, in underdeveloped countries, the incidence of AFP remained low, even isolated. For example, outbreaks of paralytic poliomyelitis were observed among American troops in China, Japan and the Philippines, while local children and adults did not get sick. In 1954, there were 246 cases of paralysis, 52 deaths among U.S. military personnel in the Philippines (including families), and no reported cases among Filipinos. Moreover, according to available statistics, AFP more often affected the wealthier segments of the population than the poor. Available “mainstream” hypotheses suggest that due to increased prosperity and improved sanitary and hygienic conditions, people began to become infected with poliovirus later, and, accordingly, to become ill in complicated forms (“hygiene” theory). In this article, I will not consider noteworthy hypotheses about the connection between AFP and smallpox vaccinations, diet, artificial feeding, etc., etc. The fact, however, is that the risk of poliomyelitis in the paralytic form increases from acute diseases suffered immediately before paralysis, and from the already mentioned immunodeficiencies, temporary and permanent.

Be that as it may, acute flaccid paralysis posed a significant threat - the number of cases of AFP at the peak of the epidemic, for example, in the USA alone was about 50,000 cases per year, while the mortality rate in the first epidemics reached 5-10 percent - usually from pneumonia , developing against the background of respiratory failure in the bulbar form of the disease (hereinafter – mortality as a percentage of AFP/paralytic forms of polio). Gradually, doctors achieved a reduction in mortality by changing patient management tactics, including using the so-called. “iron lungs” - ventilators by creating negative pressure on the chest. For example, mortality in New York decreased by 10 times from 1915 to 1955.

It is clear that polio paralysis was at the peak of public attention in developed countries. Hospital halls filled with “iron lungs” with children lying in them have become part of the healthcare system and a typical plot of the mass media. Treatment remained symptomatic. The classic measure for combating epidemic diseases - quarantine - was actively used since 1916, but did not give any effect. Non-paralytic forms of the disease often went unnoticed, and were so widespread that it would have required isolating almost the entire population. Doctors still had one more untapped tool to fight infection: vaccination.

Tremendous efforts have been devoted to developing a vaccine against poliovirus, especially in the United States. John Enders in 1949 developed a method for growing the virus in vitro, in an artificial cell environment. This made it possible to create a virus in large quantities. Before this work, the only reliable source of viruses was the nervous tissue of monkeys infected with it. On the other hand, it was believed that the virus could only multiply in nerve cells, and cultures of these cells were extremely difficult to obtain and maintain. Enders and his collaborators, Weller and Robbins, were able to find conditions under which the poliovirus multiplied well in cell culture of human and monkey embryos. (They received the Nobel Prize for this in 1954).

In 1953, Jonas Salk created his polio vaccine - he stated that he had found a way to inactivate (“kill”) the virus using formaldehyde, heat and changes in acidity, but retain “immunogenicity” - the ability to induce the production of specific antibodies to the poliovirus in humans. These antibodies should, at a minimum, save a person from severe disease in the event of infection. Vaccines of this type, with an inactivated virus, are called IPV (inactivated polio vaccines). Such vaccines theoretically cannot cause disease, and a person vaccinated with them is not infectious. Method of administration: injection into soft tissues.

[It should be noted here that the first chemically inactivated polio vaccine was tested in 1935. The number of dead and maimed children among those who became paralyzed as a result of that experiment was so high in percentage terms that all work was stopped.]

Salk's work to create his vaccine was funded by $1 million from the Roosevelt family's polio research fund. It was believed that US President F.D. Roosevelt suffered polio as an adult, after which he could only move in a wheelchair. Interestingly, today it is believed that Roosevelt was not sick with polio, because... his symptoms differed significantly from classical symptoms.

In 1954, field trials of the Salk vaccine were conducted. These trials were conducted under the leadership of Thomas Francis (with whom Salk had previously developed the influenza vaccine) and are apparently the largest trials of any vaccine to date. They were funded by the private National Foundation for Infantile Paralysis (also known as the March of Dimes), cost $6 million (about $100 million in today's dollars), and involved a huge number of volunteers. The vaccine is believed to have demonstrated 83% effectiveness in trials on 2 million children.

In fact, Francis' report contained the following information: 420,000 children were vaccinated with three doses of a vaccine containing three types of inactivated viruses. The control groups consisted of 200,000 children who received a placebo and 1,200,000 who were not vaccinated. For the bulbar form of paralysis, the effectiveness ranged from 81% to 94% (depending on the type of virus); for other forms of paralysis, the effectiveness was 39-60%; for non-paralytic forms, no difference was found with the control groups. Further, all vaccinated students were in the second grade, and the control groups included children different ages. And finally, those who contracted polio after the first vaccination were counted as unvaccinated!

Finally, in the same year of 1954, the first serious “victory” over polio was achieved. It happened like this: until 1954, the diagnosis of “paralytic poliomyelitis” was made in cases if the patient has had symptoms of paralysis for 24 hours. It was synonymous with AFP. After 1954, for the diagnosis of “paralytic poliomyelitis” it became necessary that the patient symptoms of paralysis were observed in the period from 10 to 20 days from the onset of the disease AND persisted during examination after 50-70 days from the onset of the disease. In addition, since the advent of the Salk vaccine, laboratory testing for the presence of poliovirus in sick people began, which, as a rule, did not happen before. During laboratory studies, it became clear that a significant number of AFPs, previously recorded as “paralytic poliomyelitis,” should be diagnosed as diseases of the Coxsackie virus and aseptic meningitis. In fact, in 1954 there was a complete redefinition of the disease - instead of AFP, medicine began to deal with a newly defined disease with long-term paralysis and caused by a specific virus. From this point on, the incidence rates of paralytic polio went steadily downward, and comparison with the previous period became impossible.

On April 12, 1955, Thomas Francis spoke in Michigan to 500 selected doctors and experts, and his speech was broadcast to another 54,000 doctors in the United States and Canada. Francis declared the Salk vaccine safe, powerful and effective. The audience was delighted. Here is a sample from the Manchester Guardian, April 16 of that year: “Perhaps only the overthrow of communism in the Soviet Union could bring as much joy to the hearts and homes of America as the historic announcement that the 166-year war against polio had almost come to an end.” end." Within two hours of Francis' announcement, the official license was issued and five pharmaceutical companies simultaneously began producing millions of doses. The American government has announced that it wants to vaccinate 57 million people by mid-summer.

13 days after the announcement of the safety and effectiveness of the Salk vaccine, the first reports of illnesses among vaccinated people appeared in newspapers. Most of them were vaccinated with the Cutter Laboratories vaccine. Her license was immediately revoked. As of June 23, there were 168 confirmed cases of paralysis among those vaccinated, including six deaths. Moreover, it unexpectedly turned out that among those in contact with the vaccinated there were another 149 cases, and 6 more corpses. But the vaccine was supposed to be “dead”, which means it was not infectious. The Public Health Service conducted an investigation and found that vaccine manufacturers were consistently detecting live virus in prepared batches of the vaccine: the number of lots with live virus reached up to 33%. And this despite the fact that the methods for measuring the activity of the virus were very limited. Apparently "inactivation" didn't work. Lots with live virus were confiscated, but manufacturers did not test all batches in a row, but randomly. By May 14, the polio vaccination program in the United States was stopped.

This story was called the Cutter Incident. Its result was a significant number of victims, and a sharp increase in the number of carriers of various types of polio virus.

After the incident, the IPV production technology was changed - an additional degree of filtration was introduced. This new vaccine was considered safer, but less effective in developing immunity. Clinical trials this vaccine was not carried out at all. Although public confidence was significantly damaged, vaccination with the new Salk vaccine resumed and continued in the United States until 1962 - but in very limited quantities. According to official statistics, from 1955 to 1962. The incidence of paralytic polio in the United States fell 30 times (from 28,000 to 900). Of these 900 cases of paralysis (in fact, this is only reported in half of the states), one in five children received 2, 3, 4 or even 5 IPV vaccinations - and was still paralyzed (remember, under the new accounting rules).

It was in this situation that Dr. Sabin's oral polio vaccine (OPV) was born. Albert Bruce Sabin proved back in 1939 that poliovirus enters the human body not through the respiratory tract, but through the digestive tract. Sabin was convinced that live vaccine, taken orally, will contribute to the development of longer and more reliable immunity. But a live vaccine could only be prepared from viruses that do not cause paralysis. To do this, viruses grown in kidney cells of rhesus monkeys were exposed to formaldehyde and other substances. In 1957, material for vaccinations was prepared: weakened (attenuated) viruses of all three serotypes were obtained.

To test the pathogenicity of the resulting material, it was first injected into the brains of monkeys, and then Seibin and several volunteers tested the vaccine on themselves. In 1957, the first live vaccine was created by Koprowski and was used for some time for vaccination in Poland, Croatia and Congo. Parallel work on the creation of OPV based on the same Seibin viruses was carried out at that time in the USSR under the leadership of Chumakov and Smorodintsev - by this time the polio epidemic had begun in the USSR. Finally, in 1962, OPV was licensed to Sabin and the US Department of Health. As a result, live OPV based on Sabin viruses began to be used throughout the world.

Seibin's OPV showed the following properties: 1) it was believed that after taking three doses the effectiveness reached almost 100%; 2) the vaccine was limitedly virulent (infectious) – i.e. vaccinated people infected unvaccinated people with vaccine strains of the virus, who thus also acquired immunity. In sanitary countries, 25% of contacts became infected. Naturally, in Africa these numbers should have been even higher. The huge advantage of OPV was and still is its low cost and ease of administration - those same “a few drops in the mouth.”

However, a unique feature of Sabin's OPV at that time, known since 1957, was the ability of its strains to turn back into a virus that affects the nervous system. There were several reasons for this:
1) vaccine viruses were weakened from the point of view of the ability to multiply in nervous tissue, but multiplied perfectly on the intestinal walls.
2) The poliovirus genome consists of single-stranded RNA, and, unlike double-stranded DNA viruses, it mutates easily
3) At least one of the strains, namely the third serovariant, was only partially weakened. In fact, it is very close to its wild ancestor - only two mutations and 10 differences in nucleotides.

Due to the combination of these three conditions, one of the vaccine viruses (usually the third serotype) from time to time, when multiplying in the body of a person (vaccinated or the one who became infected from him), turns into a pathogen and leads to paralysis. As a rule, this happens during the first vaccination. According to American statistics, vaccine-associated paralysis, as it was called, occurred once in 700,000 vaccinated people or their contacts after the first dose. This happened extremely rarely during subsequent vaccine administrations - once every 21 million doses. Thus, out of 560 thousand people vaccinated for the first time (remember about 25% of contacts), one polio paralysis developed (paralysis according to the new definition). In the vaccine manufacturers' annotations you will find a different figure - one case per 2-2.5 million doses.

Thus, OPV, by definition, could not defeat polioparalysis while it was in use. Therefore, another replacement was used - it was decided to defeat the wild poliovirus. It was assumed that at a certain level of immunization of the world's population, the circulation of viruses would stop, and the wild virus, which lives only in humans, would simply disappear (as theoretically happened with smallpox). Weak vaccine viruses are not a hindrance to this, since even a sick person, after recovery, completely eliminates the virus from the body after a few months. Therefore, one day, when no one on Earth has a wild virus, vaccinations can be stopped.
The idea of ​​eliminating “wild” polio was taken up by the entire progressive public. Although in some countries (for example, in Scandinavia) not OPV, but improved IPV was used, universal vaccination against polio began in the “civilized” world. By 1979, wild poliovirus had disappeared from the Western Hemisphere. The number of polioparalysis has remained at a constant level.

However, it was necessary to eliminate the “wild” poliovirus throughout the planet, otherwise, if the immunization program was stopped, any visitor from third world countries could reintroduce the virus. The situation was complicated by the fact that for countries in Asia and Africa, polio was far from being a priority health concern. A general immunization program, even with cheap OPV (costs 7-8 cents per dose versus $10 for IPV) would devastate their budget for medical programs. Significant funds were also required to monitor and analyze all cases of suspected polio. Through political pressure, the use of public donations and government subsidies from the West, the World Health Organization managed to gain support. In 1988, at the WHO World Assembly, a policy was proclaimed to eradicate polio by the year 2000.

As we approached the cherished date, the wild virus was found less and less often. WHO officials demanded one final push - and countries held national immunization days, national collection months, and so on. Private and public organizations joyfully collected money to save little African children from disability - not suspecting that little African children had other, more important problems in general and with health in particular. In total, over 20 years, the cost of the polio eradication program was conservatively estimated at about $5 billion (this includes both direct financial costs and estimates of volunteer labor). Of these, 25 percent was allocated by the private sector, especially the Rotary Club, which allocated a total of $500 million, and the Gates Foundation. However, even in the poorest countries, such as Somalia, at least 25-50% of the total costs were borne by local communities and budgets.

But let's return briefly to... macaques. As already mentioned, the viruses for both the Salk and Sabin vaccines were obtained from cultures created from the cells of rhesus monkeys. More precisely, their kidneys were used. In 1959, American doctor Bernays Eddy, who worked in state institute, which was involved, in particular, in licensing vaccines, on its own initiative tested cell cultures obtained from the kidneys of rhesus monkeys for oncogenicity. The experimental newborn hamsters that Eddie used developed tumors after 9 months. Eddy suggested that the monkeys' cells could be infected with some kind of virus. In July 1960, she presented her materials to her superiors. Her superiors ridiculed her, banned her publication, and removed her from testing polio vaccines. But that same year, doctors Maurice Hilleman and Ben Sweet managed to isolate the virus. They called it simian virus 40, or SV40, because it was the 40th virus discovered in the kidneys of rhesus monkeys up to that time.
Initially, it was assumed that only residents would become infected with SV-40 Soviet Union, where at that time vaccination with the live Seibin vaccine was taking place en masse. However, it turned out that the “dead” Salk vaccine is much more dangerous in relation to SV-40 infection: formaldehyde in a solution of 1:4000, even if it neutralized the poliovirus, did not completely “deactivate” SV-40. And subcutaneous injection greatly increased the likelihood of infection. For more later estimates, about a third of all Salk vaccine doses produced before 1961 were contaminated with live SV-40 virus.
The US government has launched a "quiet" investigation. There was no immediate danger to humans from the SV-40 virus at that time, and the government simply required vaccine manufacturers to switch from macaques to African green monkeys. Already released batches of vaccines were not recalled, and the public was not informed. As Hilleman later explained, the government feared that information about the virus would cause panic and jeopardize the entire immunization program. Currently (since the mid-90s), the question of the oncogenicity of the SV-40 virus in humans is acute; the virus has been repeatedly detected in previously rare types of cancer tumors. In laboratory studies, SV-40 has been used for years to cause cancer in animals. According to official estimates, 10-30 million Americans alone have received the vaccine contaminated with the SV-40 virus, and approximately 100 million people worldwide. The SV-40 virus is currently detected in blood and semen healthy people, including those born long after the expected end of use of contaminated vaccines (1963). Apparently this monkey virus is now somehow circulating among humans. There is no information yet about what affects African green monkeys.

The story of SV-40 demonstrated a new danger - infection through polio vaccines by previously unknown pathogens. How is the global immunization program going? As the victorious year 2000 approached, two very unpleasant things began to emerge. And here we come, in fact, to the reasons for the failure of the campaign to eradicate the poliovirus.

First. It turned out that the body of some people vaccinated with live Seibin viruses does not stop releasing them into the environment after a couple of months, as expected, but releases it for years. This fact was discovered by chance during a study of one patient in Europe. Isolation of the virus has been recorded from 1995 to this day. Thus, a practically impossible task arose of finding and isolating all long-term carriers of the virus after the cessation of vaccination. But these were still flowers.

Second. Since the end of the 90s. Strange cases of polio paralysis and meningitis began to be reported from regions declared free of wild polio. These cases occurred in such different geographical regions as Haiti, Dominica, Egypt, Madagascar, and various islands of the Philippines. Children who had previously been “immunized” with a live oral vaccine also got sick. The analysis showed that the paralysis was caused by several new strains of poliovirus, DERIVED from weakened vaccine viruses. The new strains apparently emerged as a result of mutation plus recombination with other enteroviruses, and they are as infectious and dangerous to the nervous system as good old poliovirus. A new column has appeared in WHO statistics: acute flaccid paralysis caused by viruses derived from the vaccine...

By 2003, it became clear, as one doctor said, that the very concept of “viral eradication” had to be eliminated. The chances of permanently eradicating all strains of the polio virus are almost negligible. It turned out that it is impossible to stop polio vaccination due to the elimination of the pathogen! Even if cases of polio paralysis suddenly stopped completely, vaccinations would need to continue to protect against circulating viruses. At the same time, the use of live oral vaccine becomes unacceptable - because causes vaccine paralysis and epidemic outbreaks of mutant viruses.

Naturally, this had a very discouraging effect on the campaign's financial donors and health officials. Health officials are now proposing switching the entire vaccination program to IPV, a dead vaccine that currently costs 50 to 100 times more than OPV, subject to the availability of trained personnel. This is impossible without a radical reduction in price; Some African countries will probably stop participating in the existing program - compared to AIDS and other health problems, the problem of combating polio is not at all interesting.

What are the results of half a century of struggle?

Fatal epidemics of acute flaccid paralysis (AFP) in developed countries have ceased as gradually as they began. Was this decline the result of polio vaccination? The exact answer is that although it seems most likely, we don't know. Currently, according to WHO statistics, the incidence of AFP in the world is growing rapidly (three times in ten years), while the number of polio paralysis is falling - which, however, can also be explained by improvements in data collection. In Russia in 2003, 476 cases of AFP were reported, of which 11 were cases of poliomyelitis (vaccine). Half a century ago they would all have been considered polio. In total, according to official data, from five hundred to a thousand children in the world every year become paralyzed as a result of polio vaccination. Three types of wild poliovirus have been eliminated from large geographic areas. Instead, polioviruses derived from the vaccine virus and about 72 viral strains of the same family circulate, causing diseases similar to polio. It is possible that these new viruses have become more active due to changes in the human intestine and general biocenosis caused by the use of vaccines. Many millions of people have been infected with the SV-40 virus. We have yet to learn about the consequences of introducing human body other components of polio vaccines, known and unknown.
Evgeny Peskin, Moscow.

Sources:
1. Paul A. Offit, Addressing Vaccine Safety Concerns. Vaccine Safety: What Does Experience Tell Us? Institute for Continuing Healthcare Education, Dec.22, 2000 (http://www.medscape.com/viewprogram/280_index)
2. Goldman AS, Schmalstieg ES, Freeman DH, Goldman DA Jr, Schmalstieg FC Jr, What was the cause of Franklin Delano Roosevelt’s paralytic illness? Nov, 2003, Journal of Medical Biography (http://www.rsmpress.co.uk/jmbarticle2.pdf); Study raises doubts about FDR's polio, Oct.30, 2003. USA Today;
3. Press release, polio vaccine evaluation results, April 12, 1955 The University of Michigan Information
and News Service (http://www.med.umich.edu/medschool/chm/polioexhibit/press_release.htm)
4. B. Greenberg. Intensive Immunization Programs, Hearings before the Committee on Interstate & Foreign Commerce, House of Representatives, 87th Congress, 2nd Session on H.R. 10541, Washington DC: US ​​Government Printing Office, 1962; pp. 96-97
5. Butel JS, Lednicky JA, Cell and molecular biology of simian virus 40: implications for human infections and disease. J Natl Cancer Inst (United States), Jan 20 1999, 91(2) p119-34
6. Gazdar AF, Butel JS, Carbone M, SV40 and human tumors: myth, association or causality?
Nat Rev Cancer (England), Dec 2002, 2(12) p957-64
7. Butel JS Increasing evidence for the involvement of SV40 in human cancer.
Dis Markers (Netherlands), 2001, 17(3) p167-72
8. William Carlsen, Rogue virus in the vaccine. Early polio vaccine harbored virus now feared to cause cancer in humans. San Francisco Chronicle, July 15, 2001
9. Hilleman MR. Six decades of vaccine development - a personal history. Nat. Med. 1998; 4 (Vaccine Suppl.): 507-14
10. Kris Gaublomme. Polio: the roots of the story. International Vaccination Newsletter, http://www.whale.to/v/gaublomme1.html
11. Polio Eradication: the final challenge. The world health report, 2003. Ch.4. World Health Organization. (http://www.who.int/whr/2003/chapter4/en/)
12. Morbidity and Mortality Weekly Report. March 2, 2001. Outbreak of poliomyelitis"Dominican Republic and Haiti, 2000-2001. U.S. Department of Health & Human Services, Centers for Disease Control and Prevention
13. Morbidity and Mortality Weekly Report. October 12, 2001. Acute Flaccid Paralysis Associated with Circulating Vaccine-Derived Poliovirus - Philippines, 2001. U.S. Department of Health & Human Services, Centers for Disease Control and Prevention (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5040a3.htm)
14. Technical Advisory Group of the World Health Organization on the Global Eradication of Poliomyelitis. "Endgame" issues for the global polio eradication initiative. Clin Infect Dis. 2002;34:72-77.
15. Shindarov LM, Chumakov MP, Voroshilova MK, et al. Epidemiological, clinical, and pathomorphological characteristics of epidemic poliomyelitis-like disease caused by enterovirus 71. J Hyg Epidemiol Microbiol Immunol 1979;23:284-95
16. Chaves, S. S., S. Lobo, M. Kennett, and J. Black. February 24, 2001. Coxsackie virus A24 infection presenting as acute flaccid paralysis. The Lancet 357:605
17. Morbidity and Mortality Weekly Report. October 13, 2000. Enterovirus Surveillance - United States, 1997-1999. U.S. Department of Health & Human Services, Centers for Disease Control and Prevention
18. “Elimination of polio.” Bulletin “Vaccination. News of vaccine prevention", n6 (24), 2002 (http://medi.ru/doc/15b24.htm).
19. Report “Epidemiological surveillance of polio and acute flaccid paralysis in the Russian Federation for January-December 2003”, Coordination Center for Poliomyelitis Eradication, Federal Center for State Sanitary and Epidemiological Surveillance of the Ministry of Health of the Russian Federation, (http://www.fcgsen.ru/21/documents /polio_01_12_2003.html ). The ORP figure according to operational information is given, the number of ORP according to form 1 is 346.
20. Polio case count. Eradication AFP Surveillance, on-line database, World Health Organization.

2. The importance of studying the topic: In accordance with the Global Program for the Elimination of Poliomyelitis by the Year 2000, adopted by WHO, Russia began implementing it on its territory in 1996. Thanks to maintaining a high level of vaccination coverage among children in the 1st year of life (more than 90%), holding national immunization days and additional vaccinations in areas where cases of acute polio are registered, improving epidemiological surveillance The incidence of polio in Russia has decreased. Currently, in conditions of sporadic incidence of polio, in order to tighten control over the infection, a system of epidemiological surveillance of all diseases accompanied by acute flaccid paresis and paralysis in children under 15 years of age has been introduced, since the basis clinical picture Paralytic forms of polio include flaccid paresis and paralysis. The incidence rate of acute flaccid paralysis in Russia averages 0.3 per 100,000 children under 15 years of age, which is significantly lower than in Europe (1.12 per 100,000 children under 15 years of age), which indicates a lack of awareness of our practitioners in approaches to diagnosing this disease.

3. Purpose of the lesson: learn to make a differential diagnosis of diseases accompanied by acute flaccid paralysis syndrome.

A) The student must know:

In 2002, the Russian Federation received a certificate from the World Health Organization (WHO) confirming its status as a “poliomyelitis-free country.”

Endemic countries in which transmission of the wild polio virus continues are: Nigeria, India, Pakistan, Afghanistan. However, the longer it takes to stop transmission of wild poliovirus in remaining endemic countries, the greater the risk of introduction of wild poliovirus into currently polio-free countries.

Currently, the role of not only wild strains of poliovirus, but also vaccine-derived polioviruses that have significantly diverged from the vaccine ancestor (VDPV), has been proven to play a role in the occurrence of polio outbreaks among populations with low immunization coverage. Such strains are capable of prolonged circulation and, under certain conditions, restoration of neurovirulent properties.

In order to improve measures to maintain the polio-free status of the Russian Federation, the “National Action Plan to maintain the polio-free status of the Russian Federation” has been developed and is being implemented.

- Acute polio is an acute infectious disease caused by one of 3 types of virus, polio, and occurs in different clinical forms - from abortive to paralytic.

- Paralytic polio characterized by the development of flaccid paresis and paralysis without impaired sensitivity, pyramidal symptoms and without progression.

- Paralytic forms occur when the virus affects the gray matter located in the anterior horns of the spinal cord and the motor nuclei of the cranial nerves.

- Polio virus is an enterovirus and exists in the form of three antigenic types 1, 2 and 3. All types of the virus can cause a paralytic form of the disease.

Poliomyelitis mainly affects children under 3 years of age, mostly unvaccinated and also not fully vaccinated. Cases of the disease in adults are extremely rare.

- Immunity infection obtained as a result of natural infection (infection with wild virus, including asymptomatic and mild cases of the disease) or a completed course of immunization with live oral polio vaccine persists throughout life. Moreover natural immunity type-specific. Only vaccination can provide immunity against all three types of the virus.

For every case of paralytic polio, there may be more than 100 people with mild and asymptomatic disease.

A suspected polio case is any case of acute flaccid paralysis for which no other cause can be immediately identified. Within 10 days of illness onset, the case must be reclassified as “confirmed” or “rejected.” The physician is required to report any case of acute flaccid paralysis and provide follow-up care.

Polio confirmed based on the following: isolation and identification of the virus, a positive serological test with a four-fold or greater increase in serum poliovirus antibody titre, epidemiological link to another suspected or confirmed case, residual flaccid paralysis 60 days after the onset of the disease.

Main transmission mechanism is fecal-oral, but transmission of the virus through the respiratory route is possible. Man is the only reservoir and source of infection.

- Incubation period 7-14 days, ranges from 4 to 30 days.

- Main clinical forms polio are paralytic and non-paralytic.

PARALYTIC includes: spinal, bulbar, mixed (bulbo-spinal, ponto-spinal) forms.

NON-PARALYTIC POLIOMYELITIS can occur in the form of meningeal and abortive forms. The forms of poliomyelitis are closely related to the phases of the pathogenesis of the infection.

- For paralytic polio Characterized by a cyclical course with alternating preparalytic, paralytic, recovery and residual periods.

- During the preparalytic period fever, intoxication and meningo-radicular syndrome are noted.

With polio they develop flaccid (peripheral) paralysis, asymmetric, rapidly progressing with predominant localization in proximal parts, without loss of sensitivity.

A differential diagnosis with paralytic poliomyelitis requires flaccid paresis and paralysis, peripheral paresis facial nerve, bulbar syndrome. With non-paralytic polio: serous meningitis, unclear febrile illnesses from the environment of a patient with a paralytic form of acute polio.

The tactics and volume of treatment are determined by the form and period of the disease. There is no specific treatment, that is, medications that block the polio virus. The administration of large doses of gamma globulin does not produce a therapeutic effect.

The rapid development of paralysis limits possibilities specific treatment, even if it existed. In this regard, the prevention of polio (full vaccination) is of great importance.

B) The student must be able to:

1) identify complaints (fever, pain in the limbs, muscle weakness, headache, repeated vomiting);

2) collect anamnesis - finding out the dynamics of the disease (cyclical course with a change in the preparalytic and paralytic periods);

3) find out the vaccination history (vaccinations and their usefulness) and epidemiological history (existence of contact with a patient, vaccinations 6-30 days before the onset of the disease or contact with a recently vaccinated child, keeping in mind the possibility of vaccine-associated poliomyelitis);

4) conduct an objective examination of a child with suspected polio, detect “morning” paralysis in the proximal limbs, suppression of tendon reflexes, general hyperesthesia, determine meningeal and encephalitic symptoms, etc.;

5) suspect, diagnose polio and formulate a diagnosis in accordance with the classification, carry out a differential diagnosis;

6) order an examination to confirm the diagnosis and know the technique of performing a lumbar puncture, staging serological reactions. Interpret the results: possible changes in the cerebrospinal fluid, results of serological reactions;

7) treat the patient in accordance with the form and period of the disease, taking into account the premorbid background;

8) rehabilitate a patient who has suffered a paralytic form of polio;

9) carry out anti-epidemic measures in the polio outbreak;

10) carry out specific prevention - polio vaccination.

C) The student must have an idea of:

1) Modern to regional peculiarities– polio,

2) a system of measures aimed at eradicating polio carried out in the region.

5. Questions of basic disciplines necessary for mastering this topic:

1) Microbiology- properties of the pathogen, methods for diagnosing viral infections.

2) Propaedeutics of childhood diseases- methodology for examining a patient, semiotics.

3) Pathological physiology- pathogenesis of the main syndromes.

4) Nervous diseases- methods of neurological examination, semiotics.

5) Pharmacology- characteristics, mechanism of action and doses of drugs used for treatment.

6. Topic content structure:

The World Health Assembly in 1988 decided to eradicate polio by the year 2000. Eradication means that there will be no new cases of polio caused by a wild virus and no wild polio viruses will circulate in nature for at least three years. Currently, the situation with the circulation of poliovirus in 6 territories of WHO-defined regions is as follows:

Regions certified by WHO as polio-free are the Americas (there has been no circulation of polioviruses since 1990), the Western Pacific region (since 1997), Europe and Russia since 2002.

African, Eastern Mediterranean, South Asian regions (India, Nepal, Pakistan, Afghanistan) - polio remains a common disease.

Currently, in conditions of sporadic incidence of polio, to tighten infection control, a system of epidemiological surveillance of all diseases accompanied by acute flaccid paresis and paralysis in children under 15 years of age has been introduced, since the basis of the clinical picture of paralytic forms of polio is flaccid paresis and paralysis.

At high quality epidemiological surveillance, the frequency of detection of acute flaccid paralysis should be at least 1 case per 100,000 children under the age of 15 years, while in at least 80% of cases of the disease, 2 fecal samples should be taken with an interval of 24-48 hours for virological testing.

The main measures to maintain the status of the Russian Federation as a polio-free country at the present stage are:

Maintaining the level (at least 95%) of preventive vaccination coverage of the population through routine immunization and additional mass immunization (SubNDI, “clean-up”, “clean-up plus” operations);

Maintaining the quality of surveillance for polio and acute flaccid paralysis;

Improving the quality of laboratory virological diagnosis of each case of polio and AFP;

Conducting additional surveillance of the circulation of the polio virus using the virological method of studying materials from environmental objects (wastewater) and from children at risk (children from refugee families, forced migrants, nomadic groups, children from orphanages and other closed children's institutions);

Surveillance of enteroviral infections;

Safe laboratory storage of wild poliovirus (containment).

Under acute flaccid paralysis syndrome understand any case of acute flaccid paralysis (paresis) in a child under 15 years of age, including Guillain-Barré syndrome, or any paralytic disease, regardless of age, with suspected polio.

According to the ICD 10th revision (1995), to Acute flaccid paralysis includes:

Acute paralytic poliomyelitis caused by wild imported or local (endemic) poliovirus, or associated with vaccine virus,

Polyneuropathy,

Mononeuropathies (neuritis of the facial nerve, etc.),

Myelitis,

Acute paralytic poliomyelitis of other or unspecified etiology, which was previously called “poliomyelitis-like diseases”.

A suspected polio case is any case of acute flaccid paralysis for which the cause cannot be immediately determined. It must be deciphered within 10 days from the onset of the disease, based on laboratory (virological and serological), epidemiological (contact) data and monitoring of patients over time (preservation of paralysis 60 days after the onset of the disease).

If signs of flaccid paresis (limited movements, hypotonia, hyporeflexia) or flaccid paralysis (lack of movements, atony, areflexia) are detected in a child, a topical diagnosis (poliomyelitis, Guillain-Barré syndrome, neuropathy or myelitis) is first made. Also allowed as a preliminary diagnosis: “acute flaccid paresis (paralysis).” The topical diagnosis must be confirmed or made after 2-3 days of the patient’s stay in the hospital after a commission clinical examination (the commission includes an infectious disease specialist, a neurologist, and the head of the department) and obtaining the results of a cerebrospinal fluid study.

Acute polio can occur in the form of paralytic and non-paralytic forms. PARALYTIC POLIOMYELITIS includes spinal, bulbar, pontine and mixed (bulbo-spinal, ponto-spinal) forms, NON-PARALYTIC - meningeal and abortive.

In pathogenesis There are three phases of acute polio, which correspond to clinical variants of the infection:

a) initial accumulation of the virus in the nasopharynx and intestines,

b) penetration of the virus into the blood,

c) penetration of the virus into the nervous system with the development of:

Inflammatory process in the meninges and then

Damage to large motor cells of the gray matter of the spinal cord and brain stem.

The pathological process in acute poliomyelitis can be interrupted at any stage of the disease development, depending on this, various clinical forms:

a) if the virus multiplies in the intestines, but does not enter the blood and nervous system - this corresponds to VIRUS CARRIAGE;

b) when the virus penetrates only into the blood, a short febrile illness without neurological symptoms- ABORTION FORM;

c) when the virus penetrates from the blood into the nervous system, damage may occur only to the meninges MENINGEAL FORM;

d) if the virus penetrates the spinal cord and brain stem, then large motor cells located in the gray matter of the anterior horns are affected. Clinically, this is expressed by the development of the PARALYTIC FORM OF POLIOMYELITIS.

Acute flaccid paralysis occurs as a result of damage to the peripheral nerve anywhere. AFP is a complication of many diseases, including polio.

Flaccid paralysis develops due to the action of enteroviruses. Pathology occurs due to damage to neurons of the spinal cord and areas of peripheral nerves.

A common cause of development is polio.

AFP includes all paralysis accompanied by rapid development. The condition for making such a diagnosis is the development of pathology within three to four days, no more. The disease occurs in children under 15 years of age as a result of polio, and also in adults for many reasons.

Acute flaccid paralysis does not include:

• paresis of facial muscles;
• paralysis acquired at birth as a result of injury;
• injuries and damage that provoke the development of paralysis.

There are several types of AFP depending on the cause of nerve damage.

Symptoms

AFP is diagnosed if the following symptoms are present:

• lack of resistance to passive movement of the affected muscle;
• pronounced muscle atrophy;
• absence or significant deterioration of reflex activity.

A specific examination does not reveal disorders of nervous and muscle electrical excitability.

The location of the paralysis depends on which part of the brain is damaged. When the anterior horns of the spinal cord are damaged, paralysis of one leg develops. In this case, the patient cannot move his foot.

With symmetrical damage to the spinal cord in the cervical region, paralysis of both lower and upper extremities may develop simultaneously.

Before the onset of paralysis, the patient complains of acute excruciating pain in the back. In children, the pathology is accompanied by the following symptoms:

• swallowing dysfunction;
• weakness of the muscles of the arms and legs;
• trembling in hands;
• breathing disorder.

No more than three to four days pass from the appearance of the first symptoms to the development of paralysis. If the disease manifests itself later than four days from the onset of illness, there can be no talk of an acute flaccid form.

The pathology is dangerous due to its complications, including:

• reduction in the size of the affected limb or part of the body due to the fact that the muscles are atrophied;
• hardening of the muscles in the affected area (contracture);
• hardening of joints.

In most cases, it is impossible to get rid of complications caused by flaccid paralysis. The success of treatment largely depends on the cause of the disorder and timely access to the clinic.

Types of flaccid paralysis

There are several types of pathology, depending on the cause of its development:

• polio;
• myelitis;
• polyneuropathy;
• mononeuropathy.

Paralysis in children develops due to polio caused by a virus, as well as with a disease of unspecified etiology.

Inflammation of the spinal cord (myelitis) causes a disruption in the connections between the central nervous system and the PNS, which causes paralysis and impaired sensitivity in some parts of the body.

Flaccid paralysis also accompanies poly- and mononeuropathy. These diseases are characterized by damage to areas of the peripheral nervous system. With polyneuropathy, multiple lesions caused by viruses or infections are diagnosed. Mononeuropathy is characterized by damage to one nerve, usually the disorder affects the radial or ulnar nerve, causing paralysis of the corresponding part of the body.

Paralytic polio

Poliomyelitis is dangerous disease which can lead to the development of paralysis in children. Diagnosed in childhood up to 15 years, however, there are often cases of delayed complications of polio several decades after the disease.

The disease is accompanied by damage to the motor neurons of the anterior horns of the spinal cord, which is responsible for the development of flaccid paralysis in polio.

The routes of infection with the polio virus are from person to person and through household contact, when the patient’s saliva gets on food or utensils. At room temperature, the virus that causes this disease remains dangerous for several days.

The virus persists on the mucous membranes of the nasopharynx for up to two weeks, which makes it highly likely that infection will occur from a sick person.

There is only one way to protect yourself from the virus – through vaccination. In rare cases, the live vaccine also causes paralysis.

Virological examination

The following must be tested for the presence of the virus:

• children under 15 years of age with flaccid paralysis;
• refugees from areas with a high risk of infection (India, Pakistan);
• patients with clinical signs of the disease and their environment.

Fecal samples are required for analysis. At the beginning of the disease, the concentration of the virus in the patient’s feces reaches 85%.

Patients with polio, or patients suspected of having this disease, should be examined again one day after the initial analysis.

Symptoms of polio:

• fever;
• inflammation of the mucous membrane of the nasopharynx;
• impaired motor activity of the neck muscles and back;
• muscle spasms and cramps;
• muscle pain;
• indigestion;
• infrequent urination.

TO acute symptoms include difficulty breathing and muscle paralysis.

AFP in polio

The disease is characterized by rapid development, symptoms rapidly increase within 1-3 days. On the fourth day, flaccid paralysis is diagnosed. To make a diagnosis it is necessary to confirm:

• sudden onset of paralysis;
• sluggish nature of the disorder;
• asymmetrical damage to the body;
• absence of pathologies from the pelvic organs and sensitivity.

The first week before paralysis develops, there is fever, lethargy, pain, and muscle spasms. Then paralysis rapidly develops, the severity of which depends on the characteristics of the damage to the spinal neurons. With pathology, the general symptoms of polio usually subside. A gradual restoration of motor function is observed a week after the development of paralysis. The prognosis depends on which part of the neurons is affected. If 70% or more of neurons have died due to disease, motor function the affected part of the body is not restored.

The prognosis for recovery can be judged 10 days after the development of paralysis. If during this period voluntary movements of the muscles of the affected part of the body begin to appear, there is a high probability of complete restoration of mobility over time. The peak of recovery occurs in the first three months after the illness. Residual symptoms may persist for up to two years. If after 24 months the motor function of the affected limb has not been restored, residual effects cannot be treated. After polio, deformities of the limbs, impaired joint mobility, and contracture are observed.

AFP in children

Thanks to compulsory vaccination, polio in a child in our country does not pose such a danger as in India or Pakistan. But polio is not the only cause of flaccid paralysis in children. Pathology develops under the influence of various enteroviruses. There are various neurotropic viruses that attack the nervous system and cause severe paresis with subsequent muscle atrophy. Entoroviruses of non-poliomyelitis nature are particularly dangerous.

Treatment of AFP

Therapy is aimed at restoring the function of peripheral nerves affected by the viral disease. For this purpose, use:

• drug therapy;
• physiotherapy;
• massage;
• folk remedies.

The combination of these methods makes it possible to obtain good therapeutic effect, but only subject to timely treatment. If more than 70% of neurons have died as a result of a viral infection, restoration of mobility and sensitivity of the affected area is impossible.

Drug therapy includes treatment with neurotropic and vasoactive drugs. Therapy is aimed at improving metabolism and conduction of nerve fibers, improving blood circulation and stimulating the activity of the nervous system.

The drugs are administered either intravenously or intramuscularly. It is possible to administer drugs using a dropper in cases of extensive neuronal damage.

Vitamin therapy is required. The introduction of B vitamins is indicated, which stimulate cell renewal and strengthen the nervous system.

During the rehabilitation period, wearing a bandage or orthosis is indicated to fix the limb in a physiologically correct position. This measure will avoid visible deformation of the joint due to weakening of the muscles.

Physiotherapy and massage

Physiotherapeutic methods of treatment help to speed up the restoration of motor activity and restore sensitivity. For paralysis, methods of electrical stimulation - galvanization, balneotherapy - are successfully used. Such therapeutic methods improve the conductivity of nerve fibers, accelerate regeneration and cell restoration. A course of such treatment is carried out only after the underlying disease that led to paralysis has been relieved.

To normalize muscle activity and to prevent the development of atrophy, massage is used. Patients are prescribed an intense massage, with prolonged kneading of damaged muscles and strong rubbing.

When performing a massage, it is important to remember that muscles constrained by paralysis should not be subjected to traumatic effects. The massage should be intense, but without excessive effort. Traumatic effects on the affected muscles can have the opposite effect.

To restore muscle activity, a long course of massage is indicated, up to six months. With regular procedures, the result will become noticeable after the first 5 sessions.

In addition to classic massage, good results are achieved by applying targeted pressure to painful nodes of the human body. In this case, you also cannot act directly on the stiff muscle. This technique improves metabolic processes in muscle fibers, stimulating the rapid restoration of mobility and sensitivity. The maximum effect is achieved by using two techniques simultaneously, alternating.

Folk remedies for a speedy recovery

Traditional methods can be supplemented with treatment, but only after consultation with your doctor. It is not possible to cure paralysis on your own using folk methods alone. Often, patients, preferring herbal treatment, ignore the doctor’s instructions, which leads to a worsening of the situation and the impossibility of further recovery with medications.

1. Make a decoction of a tablespoon of rose hip root with the addition of the same amount of berries and 500 ml of water. After cooling, the decoction is diluted with 5 liters of water and used as a bath for paralyzed limbs.
2. Peony evasive is used to speed up recovery. To do this, you need to prepare a decoction from the rhizome of the plant, at the rate of 1 spoon of dry root per 600 ml of boiling water. After the decoction has infused and cooled, it should be taken three times a day before each meal, one small spoon.
3. Fresh leaves of dye sumac are poured with a glass of boiling water and left for 2 hours in a warm place. After cooling, take the decoction in a small spoon every 5 hours, regardless of meals.

Before starting such treatment, you should make sure that there is no allergic reaction on recipe ingredients.

Prevention and prognosis

The prognosis largely depends on the degree of damage to spinal cord neurons. With moderate neuronal death, it is possible to achieve restoration of motor activity, but treatment will be long-term, up to several years. In the treatment of paralysis important role plays a timely visit to the clinic and correct diagnosis Problems.

Preventive measures include timely treatment of any infectious and viral disease. The presence of any source of infection in the body is dangerous due to its spread throughout the body through the bloodstream, which may result in the development of inflammatory damage to the peripheral nerves.

When the first symptoms of developing paralysis appear (muscle weakness, cramps, muscle and back pain), you should immediately consult a specialist.

Resolution of the Chief State Sanitary Doctor of the Russian Federation dated July 28, 2011 N 107
"On approval of SP 3.1.2951-11 "Prevention of polio"

2. Put into effect the specified sanitary and epidemiological rules from the date of entry into force of this resolution.

3. From the moment of the introduction of SP 3.1.2951-11, the sanitary and epidemiological rules SP 3.1.1.2343-08 “Prevention of polio in the post-certification period”, approved by the Decree of the Chief State Sanitary Doctor of the Russian Federation 03/05/2008 N 16, are considered invalid (registered with the Ministry of Justice Russian Federation 04/01/2008, registration N 11445), put into effect by the specified resolution from 06/01/2008.

G. Onishchenko

New sanitary and epidemiological rules regarding the prevention of polio have been developed.

Acute poliomyelitis is an infection of viral etiology. It is characterized by a variety of clinical forms - from abortive to paralytic.

The source of infection is a person, a patient or a carrier. Poliovirus appears in nasopharyngeal secretions 36 hours later and in feces 72 hours after infection.

The incubation period for acute polio ranges from 4 to 30 days. Most often it lasts from 6 to 21 days.

The pathogen is transmitted by water, food and household routes, as well as by airborne droplets and airborne dust.

The disease is recorded mainly in children who are not vaccinated against polio or are vaccinated inappropriately. preventive vaccinations.

It is detected during requests for and provision of medical care, examinations, examinations, and active epidemiological surveillance.

A patient with suspected disease should be hospitalized in an infectious diseases hospital. When such a patient is identified, 2 fecal samples are taken for laboratory virological testing with an interval of 24-48 hours. They must be taken as soon as possible, but no later than 14 days from the onset of paresis/paralysis.

At least 95% of the total number of children to be vaccinated at the age of 12 months must be vaccinated and the same number at the second revaccination at the age of 24 months.

Sanitary and epidemiological rules come into force from the date the resolution comes into force. From this moment SP 3.1.1.2343-08 “Prevention of polio during the post-certification period” loses its force.

Resolution of the Chief State Sanitary Doctor of the Russian Federation dated July 28, 2011 N 107 “On approval of SP 3.1.2951-11 “Prevention of polio”

Registration N 22378

This resolution comes into force 10 days after the day of its official publication

Poliomyelitis (infantile paralysis) is caused by a virus and is highly contagious viral infection. In its most serious form, polio can cause rapid and irreversible paralysis; until the late 1950s, it was one of the most dangerous infectious diseases and often occurred in epidemics. Post-polio syndrome or post-polio progressive muscular atrophy can occur 30 years or more after the initial infection, gradually leading to muscle weakness, wasting, and pain. Polio can be prevented by building immunity and is now virtually extinct in developed countries; however, the risk of disease still exists. Polio is still common in many countries around the world, and there is no way to cure it; therefore, until the polio virus is eradicated, vaccination remains the main method of protection.

In summer and early autumn, when polio epidemics most often occur, parents first of all remember about it when their child gets sick. The disease, like many other infections, begins with general malaise, fever and headache. Vomiting, constipation, or mild diarrhea may occur. But even if your child has all these symptoms, plus leg pain, you should not rush to conclusions. There's still a good chance it's the flu or a sore throat. Of course, you call a doctor anyway. If he is away for a long time, you can reassure yourself this way: if the child can lower his head between his knees or tilt his head forward so that his chin touches his chest, he probably does not have polio. (But even if it fails these tests, it is still not proof of disease.)
Despite significant progress in eradicating polio in our country, the problem of diseases accompanied by acute flaccid paralysis (AFP) has not lost its relevance. Pediatricians often encounter various infectious diseases of the brain, spinal cord, and peripheral nerves. The study of the structure of neuroinfections indicates that lesions of the peripheral nervous system occur in 9.6% of patients, infectious diseases of the spinal cord - in 17.7%. Among the latter, acute infectious myelopathies predominate, while acute paralytic vaccine-associated poliomyelitis, acute myelopathy, enceare much less common. In this regard, in modern conditions it is necessary to pay special attention differential diagnosis AFP, monitoring the epidemic situation, which will avoid overdiagnosis, improve treatment results, and reduce the frequency of unfounded registration of post-vaccination complications.

Acute paralytic poliomyelitis - group viral diseases, united according to the topical principle, characterized by flaccid paresis, paralysis caused by damage to motor cells in the anterior horns of the spinal cord and the nuclei of the motor cranial nerves of the brain stem.

Etiology. Etiological structure infectious diseases The nervous system is diverse. Among the etiological factors are “wild” polioviruses type 1, 2, 3, vaccine polioviruses, enteroviruses (ECHO, Coxsackie), herpesviruses (HSV, HHV type 3, EBV), influenza virus, mumps virus, diphtheria bacillus, borrelia, UPF (staphylococci, gram-negative bacteria).

Of particular interest is spinal paralysis caused by the “wild” polio virus, which belongs to the picornavirus family, a genus of enteroviruses. The pathogen is small in size (18-30 nm) and contains RNA. Virus synthesis and maturation occur inside the cell.

Polioviruses are not sensitive to antibiotics and chemotherapy. When frozen, their activity persists for several years, in a household refrigerator for several weeks, and at room temperature for several days. At the same time, polio viruses are quickly inactivated when treated with formaldehyde, free residual chlorine, and do not tolerate drying, heating, or ultraviolet irradiation.

The polio virus has three serotypes - 1, 2, 3. Its cultivation in the laboratory is carried out by infection different cultures tissues and laboratory animals.

Causes

Poliomyelitis is caused by a viral infection with one of three forms of the polio virus.

The virus can be transmitted through contaminated food and water or through contaminated saliva during a cough or sneeze.

The source of infection is a sick person or carrier. The greatest epidemiological significance is the presence of the virus in the nasopharynx and intestines, from where it is released in external environment. In this case, the release of the virus in feces can last from several weeks to several months. The nasopharyngeal mucus contains the polio pathogen for 1-2 weeks.

The main routes of transmission are nutritional and airborne.

Under conditions of mass specific prevention, sporadic cases were recorded throughout the year. Mostly children under seven years of age were ill, of whom the proportion of young patients reached 94%. The infectiousness index is 0.2-1%. Mortality among unvaccinated people reached 2.7%.

In 1988, the World Health Organization raised the question of the complete eradication of polio caused by the “wild” virus. In this regard, 4 main strategies have been adopted to combat this infection:

1) achieving and maintaining a high level of population coverage with preventive vaccinations;

2) carrying out additional vaccinations on national immunization days (NDIs);

3) creation and operation of an effective epidemiological surveillance system for all cases of acute flaccid paralysis (AFP) in children under 15 years of age with mandatory virological examination;

4) carrying out additional “cleaning up” immunization in disadvantaged areas.

At the time of the adoption of the Global Polio Eradication Program, the number of patients in the world was 350,000. However, by 2003, thanks to ongoing activities, their number dropped to 784. Three regions of the world are already free from polio: American (since 1994), Western Pacific (since 2000) and European (since 2002). However, polio caused by wild poliovirus continues to be reported in the Eastern Mediterranean, African and South-East Asia regions. India, Pakistan, Afghanistan, and Nigeria are considered endemic for polio.

Since December 2009, an outbreak of polio caused by type 1 poliovirus has been registered in Tajikistan. It is assumed that the virus came to Tajikistan from neighboring countries - Afghanistan, Pakistan. Taking into account the intensity of migration flows from the Republic of Tajikistan to the Russian Federation, including labor migration and active trade relations, the “wild” polio virus was imported into the territory of our country, and cases of polio in adults and children were registered.

Russia began implementing the Global Polio Eradication Program on its territory in 1996. Thanks to maintaining a high level of vaccination coverage among children in their first year of life (more than 90%) and improving epidemiological surveillance, the incidence of this infection in Russia has decreased from 153 cases in 1995. up to 1 - in 1997. By decision of the European Regional Certification Commission in 2002, the Russian Federation received the status of a polio-free territory.

Before the transition to the use of inactivated polio vaccine, diseases caused by vaccine polioviruses were recorded in Russia (1 - 11 cases per year), which usually occurred after the first dose of live OPV was administered.

Diagnostics

Medical history and physical examination.

Blood tests.

Lumbar puncture (spinal tap).

Laboratory diagnostics. Only based on the results of virological and serological studies can a final diagnosis of polio be made.

The following are subject to virological testing for polio in the laboratories of regional centers for epidemiological surveillance of polio/AFP:

- sick children under 15 years of age with symptoms of acute flaccid paralysis;

- contact children and adults from foci of poliomyelitis and AFP in the case of late (later than the 14th day from the moment of detection of paralysis) examination of the patient, as well as if there are people around the patient who arrived from areas unfavorable for poliomyelitis, refugees and internally displaced persons (one-time) ;

- children under the age of 5 years who arrived during the last 1.5 months from the Chechen Republic, the Republic of Ingushetia and sought medical care in medical institutions, regardless of the profile (one time).

Patients with clinical signs of poliomyelitis or acute flaccid paralysis are subject to mandatory 2-fold virological examination. The first fecal sample is taken within 24 hours from the moment of diagnosis, the second sample - after 24-48 hours. The optimal volume of feces is 8-10 g. The sample is placed in a sterile special plastic container. If the delivery of collected samples to the regional polio/AFP surveillance center will be carried out within 72 hours from the date of collection, then the samples are placed in a refrigerator at a temperature of 0 to 8 ° C and transported to the laboratory at a temperature of 4 to 8 ° C (reverse cold). chain). In cases where the material is planned to be delivered to the virology laboratory at a later date, the samples are frozen at a temperature of -20 °C and transported frozen.

The frequency of virus isolation in the first two weeks is 80%, in the 5th-6th week - 25%. No permanent carriage was detected. Unlike the Coxsackie and ECHO viruses, the polio virus is isolated extremely rarely from the cerebrospinal fluid.

In case of death, material is collected from the cervical and lumbar extensions of the spinal cord, the cerebellum and the contents of the colon. With paralysis lasting 4-5 days, it is difficult to isolate the virus from the spinal cord.

The following are subject to serological examination:

— patients with suspected polio;

- children under the age of 5 years who arrived during the last 1.5 months from the Chechen Republic, the Republic of Ingushetia and sought medical care in medical institutions, regardless of their profile (one time).

For serological testing, two samples of the patient’s blood (5 ml each) are taken. The first sample must be taken on the day of placement primary diagnosis, the second - after 2-3 weeks. Blood is stored and transported at a temperature of 0 to +8 °C.

RSC detects complement-fixing antibodies to the N- and H-antigens of poliovirus. On early stages Only antibodies to the H-antigen are detected, after 1-2 weeks - to the H- and N-antigens, in those who have recovered - only N-antibodies.

During the first infection with poliovirus, strictly type-specific complement-fixing antibodies are formed. Upon subsequent infection with other types of polioviruses, antibodies are formed predominantly to heat-stable group antigens, which are present in all types of polioviruses.

PH detects virus-neutralizing antibodies in the early stages of the disease; it is possible to detect them during the hospitalization of the patient. Virus-neutralizing antibodies can be detected in urine.

RP in agar gel reveals precipitins. Type-specific precipitating antibodies can be detected during the recovery period and circulate long time. To confirm the increase in antibody titers, paired sera are examined with an interval of 3-4 weeks; a dilution of the serum that is 3-4 times or more higher than the previous one is taken as a diagnostic increase. Most effective method is an ELISA that allows one to quickly determine a class-specific immune response. It is mandatory to carry out PCR to detect RNA viruses in individual feces and cerebrospinal fluid.

Symptoms

Fever.

Headache and sore throat.

Stiff neck and back.

Nausea and vomiting.

Muscle pain, weakness or cramps.

Difficulty swallowing.

Constipation and urinary retention.

Bloated belly.

Irritability.

Extreme symptoms; muscle paralysis; difficulty breathing.

Pathogenesis. The entry point for infection in polio is the mucous membrane of the gastrointestinal tract and upper respiratory tract. The virus multiplies in the lymphatic formations of the back wall of the pharynx and intestines.

Overcoming the lymphatic barrier, the virus penetrates the blood and is carried throughout the body by its current. Fixation and reproduction of the polio pathogen occurs in many organs and tissues - lymph nodes, spleen, liver, lungs, heart muscle and, especially, in brown fat, which is a kind of virus depot.

Penetration of the virus into the nervous system is possible through the endothelium of small vessels or along peripheral nerves. Distribution within the nervous system occurs along cell dendrites and possibly through intercellular spaces. When the virus interacts with cells of the nervous system, the most profound changes develop in motor neurons. The synthesis of polioviruses occurs in the cytoplasm of the cell and is accompanied by suppression of the synthesis of DNA, RNA and proteins of the host cell. The latter dies. Within 1-2 days, the titer of the virus in the central nervous system increases, and then begins to fall and soon the virus disappears.

Depending on the state of the macroorganism, the properties and dose of the pathogen pathological process can stop at any stage of viral aggression. In this case, various clinical forms of poliomyelitis are formed. In most infected children, due to an active reaction immune system the virus is eliminated from the body and recovery occurs. Thus, with the inapparant form, there is a nutritional phase of development without viremia and invasion into the central nervous system, with the abortive form, there are nutritional and hematogenous phases. Clinical variants accompanied by damage to the nervous system are characterized by the sequential development of all phases with damage to motor neurons on different levels.

Pathomorphology. Morphologically, acute poliomyelitis is most characterized by damage to large motor cells located in the anterior horns of the spinal cord and the nuclei of the motor cranial nerves in the brain stem. In addition, the pathological process may involve the motor area of ​​the cerebral cortex, the nuclei of the hypothalamus, reticular formation. In parallel with damage to the spinal cord and brain, the soft meninges are involved in the pathological process, in which acute inflammation develops. At the same time, the number of lymphocytes and protein content in the cerebrospinal fluid increase.

Macroscopically, the spinal cord appears swollen, the border between the gray and white matter is blurred, and in severe cases, the cross section shows retraction of the gray matter.

Microscopically, in addition to swollen or completely disintegrated cells, unchanged neurons are found. This “mosaic” nature of the lesion nerve cells clinically manifested by an asymmetric, random distribution of paresis and paralysis. In place of dead neurons, neuronophagic nodules are formed, followed by the proliferation of glial tissue.

Classification

According to modern requirements, the standard definition of polio and acute flaccid paralysis (AFP) is based on the results of clinical and virological diagnostics (Appendix 4 to Order M3 of the Russian Federation No. 24 dated January 25, 1999) and is presented as follows:

- acute flaccid spinal paralysis, in which the “wild” polio virus is isolated, is classified as acute paralytic poliomyelitis (according to ICD 10 revision A.80.1, A.80.2);

- acute flaccid spinal paralysis that occurred no earlier than the 4th and no later than the 30th day after taking the live polio vaccine, in which the vaccine-derived poliovirus was isolated, is classified as acute paralytic polio associated with the vaccine in the recipient (according to ICD 10 revision A .80.0);

- acute flaccid spinal paralysis that occurs no later than the 60th day after contact with a vaccinated person in which vaccine-derived poliovirus is isolated is classified as acute paralytic poliomyelitis associated with a vaccine in a contact (according to ICD 10 revision A.80.0). Isolation of vaccine-derived poliovirus in the absence of clinical manifestations does not have diagnostic value;

- acute flaccid spinal paralysis, in which the examination was not carried out completely (the virus was not isolated) or was not carried out at all, but residual flaccid paralysis is observed by the 60th day from the moment of their onset, is classified as acute paralytic poliomyelitis, unspecified (according to ICD 10 revision A .80.3);

- acute flaccid spinal paralysis, in which a full adequate examination was carried out, but the virus was not isolated and no diagnostic increase in antibodies was obtained, is classified as acute paralytic poliomyelitis of another, non-poliomyelitis etiology (according to ICD 10 revision A.80.3).

Isolation of a “wild” strain of the virus from a patient with catarrhal, diarrheal or meningeal syndromes without the occurrence of flaccid paresis or paralysis is classified as acute non-paralytic poliomyelitis (A.80.4.)

Acute flaccid spinal paralysis with the release of other neurotropic viruses (ECHO, Coxsackie viruses, herpes viruses) refers to diseases of a different, non-poliomyelitis etiology.

All these diseases, based on the topical principle (damage to the anterior horns of the spinal cord), appear under the general name “Acute poliomyelitis”.

Classification of polio

Forms of polio	Phases of virus development
Without CNS damage
1. Inapparant	Alimentary phase of virus development without viremia and invasion into the central nervous system
2. Abortive form	Alimentary and hematogenous (viremia) phases
Forms of poliomyelitis with damage to the central nervous system
!. Nonparalytic or meningeal form	Sequential development of all phases with invasion into the central nervous system, but subclinical damage to motor neurons
2. Paralytic forms: a) spinal (up to 95%) (with cervical, thoracic, lumbar localization of the process; limited or widespread); b) pontine (up to 2%); c) bulbar (up to 4%); d) pontospinal; e) bulbospinal; e) pontobulbospinal	Sequential development of all phases with damage to motor neurons at different levels

Based on the severity of the process, mild, moderate and severe forms of polio are distinguished. The course of the disease is always acute, and the nature can be smooth or non-smooth, depending on the presence of complications (osteoporosis, fractures, urolithiasis disease, contracture, pneumonia, bedsores, asphyxia, etc.).

Clinic. The incubation period for polio is 5-35 days.

The spinal form of polio in children occurs with greater frequency than other paralytic forms. In this case, more often the pathological process develops at the level of the lumbar thickening of the spinal cord.

During the course of the disease, there are several periods, each of which has its own characteristics.

The preparalytic period is characterized by an acute onset of the disease, deterioration of the general condition, an increase in body temperature to febrile levels, headache, vomiting, lethargy, adynamia, meningeal signs. General infectious, cerebral and meningeal syndromes can be combined with catarrhal or dyspeptic symptoms. In addition, it is noted positive symptoms tension, complaints of pain in the back, neck, limbs, pain on palpation of nerve trunks, fasciculations and horizontal nystagmus. The duration of the preparalytic period is from 1 to 6 days.

The paralytic period is marked by the appearance of flaccid paralysis or paresis of the muscles of the limbs and torso. The main diagnostic signs of this stage are:

- sluggish nature of paralysis and its sudden appearance;

- rapid growth movement disorders for a short time (1-2 days);

- damage to proximal muscle groups;

- asymmetrical nature of paralysis or paresis;

— no disturbances of sensitivity and function pelvic organs.

At this time, changes in the cerebrospinal fluid occur in 80-90% of patients with poliomyelitis and indicate the development of serous inflammation in the soft meninges. With the development of the paralytic stage, general infectious symptoms fade away. Depending on the number of spinal cord segments affected, the spinal form can be limited (monoparesis) or widespread. The most severe forms are those accompanied by impaired innervation of the respiratory muscles.

The recovery period is accompanied by the appearance of the first voluntary movements in the affected muscles and begins on the 7-10th day after the onset of paralysis. If 3/4 of the neurons responsible for the innervation of any muscle group die, the lost functions are not restored. Over time, atrophy increases in these muscles, contractures, joint ankylosis, osteoporosis, and limb growth retardation appear. Particularly active restorative the period is running during the first months of the disease, then it slows down somewhat, but continues for 1-2 years.

If after 2 years the lost functions are not restored, then they speak of a period of residual effects (various deformities, contractures, etc.).

The bulbar form of poliomyelitis is characterized by damage to the nuclei of 9, 10, 12 pairs of cranial nerves and is one of the most dangerous options diseases. In this case, there is a disorder of swallowing, phonation, pathological secretion of mucus in the upper respiratory tract. Of particular danger is the localization of the process in the medulla oblongata, when damage to the respiratory and cardiovascular centers poses a threat to the patient’s life. Harbingers of an unfavorable outcome in this case are the occurrence of pathological breathing, cyanosis, hyperthermia, collapse, and impaired consciousness. Damage to the 3rd, 4th, 6th pairs of cranial nerves in polio is possible, but less common.

The pontine form of polio is the most mild, but the cosmetic defect can remain with the child for life. The clinical characteristic of this form of the disease is damage to the nucleus of the facial nerve. In this case, immobility of the facial muscles on the affected side suddenly occurs and lagophthalmos, Bell's symptoms, “sails”, and pulling of the corner of the mouth to the healthy side when smiling or crying appear. The pontine form of polio most often occurs without fever, general infectious symptoms, or changes in the cerebrospinal fluid.

The meningeal form of poliomyelitis is accompanied by damage to the soft meninges. The disease begins acutely and is accompanied by a deterioration in general condition, an increase in body temperature to febrile levels, headache, vomiting, lethargy, adynamia, and meningeal signs.

Symptoms characteristic of the meningeal form of poliomyelitis are pain in the back, neck, limbs, positive symptoms of tension, pain on palpation of the nerve trunks. In addition, fasciculations and horizontal nystagmus may be observed. The electromyogram reveals subclinical damage to the anterior horns of the spinal cord.

When conducting spinal tap The cerebrospinal fluid usually flows out under pressure and is transparent. His research reveals:

— cell-protein dissociation;

— lymphocytic pleocytosis (the number of cells increases to several hundred per 1 mm3);

- normal or slightly increased protein content;

- increased sugar content.

The nature of changes in the cerebrospinal fluid depends on the timing of the disease. Thus, the increase in cytosis may be delayed and in the first 4-5 days from the onset of the disease the composition of the cerebrospinal fluid remains normal. In addition, sometimes, in the initial period, a short-term predominance of neutrophils in the cerebrospinal fluid is observed. After 2-3 weeks from the onset of the disease, protein-cell dissociation is detected. The course of the meningeal form of poliomyelitis is favorable and ends full recovery.

The inapparent form of polio is characterized by the absence of clinical symptoms with the simultaneous isolation of a “wild” strain of the virus from feces and a diagnostic increase in the titer of antiviral antibodies in the blood serum.

The abortive form or minor disease is characterized by an acute onset, the presence of general infectious symptoms without involvement of the nervous system in the pathological process. Thus, children may experience fever, moderate lethargy, decreased appetite, and headache. Often the listed symptoms are combined with catarrhal or dyspeptic symptoms, which serves as the basis for the erroneous diagnosis of acute respiratory viral or intestinal infections. Typically, the abortive form is diagnosed when a patient is hospitalized from the outbreak and receives positive results of a virological examination. The abortive form proceeds benignly and ends with complete recovery within a few days.

The development of vaccine-associated poliomyelitis is associated with the use of live oral vaccines for mass immunization and the possibility of reversing the neurotropic properties of individual clones of vaccine virus strains. In this regard, in 1964, a special WHO committee determined the criteria by which cases of paralytic poliomyelitis can be classified as vaccine-associated:

- onset of the disease no earlier than the 4th and no later than the 30th day after vaccination. For those who have been in contact with a vaccinated person, this period is extended to the 60th day;

- development of flaccid paralysis and paresis without impaired sensitivity with persistent (after 2 months) residual effects;

— absence of progression of the disease;

- isolation of a polio virus similar in antigenic characteristics to the vaccine virus and at least a 4-fold increase in type-specific antibodies.

Treatment

Rest in bed is necessary until severe symptoms subside.

Painkillers may be used to reduce fever, pain, and muscle spasms.

Your doctor may prescribe betanekol to combat urinary retention and antibiotics to treat associated bacterial infection urinary canal.

A urinary catheter, a thin tube connected to a bag to collect urine, may be needed if bladder control has been lost due to paralysis.

Artificial respiration may be needed if breathing is difficult; In some cases, surgery to open the throat (tracheotomy) may be necessary.

Physiotherapy is necessary in cases of temporary or permanent paralysis. Mechanical devices such as bandages, crutches, wheelchair and special shoes can help you walk.

A combination of occupational and psychological therapy can help patients adjust to the limitations imposed by the disease.

Treatment of polio in the acute period should be etiotropic, pathogenetic and symptomatic.

The development of clinical variants of polio with damage to the nervous system requires mandatory, as early as possible hospitalization of the patient, providing careful care and constant monitoring of basic vital functions. A strict orthopedic regimen must be followed. Affected limbs are given physiological

position with the help of plaster splints and bandages. The diet must meet the child’s age-related needs for basic ingredients and includes the exclusion of spicy, fatty, and fried foods. Particular attention should be paid to feeding children with bulbar or bulbospinal forms, since due to impaired swallowing there is a real threat of developing aspiration pneumonia. Tube feeding of the child allows you to avoid this dangerous complication.

As for drug treatment, an important point is to limit intramuscular injections as much as possible, which contribute to the worsening of neurological disorders.

As etiotropic agents for meningeal and paralytic forms, it is necessary to use antiviral drugs(pleconaril, isoprinosine pranobex), interferons (viferon, roferon A, reaferon-ES-lipint, leukinferon) or inducers of the latter (neovir, cycloferon), immunoglobulins for intravenous administration.

Pathogenetic therapy of the acute period involves the inclusion of complex therapy:

— glucocorticoid hormones (dexamethasone) in severe forms for health reasons;

- vasoactive neurometabolites (trental, actovegin, instenon);

— nootropic drugs (gliatilin, piracetam, etc.);

— vitamins (A, B1, B6, B12, C) and antioxidants (vitamin E, mexidol, mildronate, etc.);

- diuretics (diacarb, triampur, furosemide) in combination with potassium-containing drugs;

— infusion therapy for the purpose of detoxification (5-10% solutions of glucose with electrolytes, albumin, infucol);

- inhibitors of proteolytic enzymes (Gordox, Ambien, Contrical);

- non-narcotic analgesics (for severe pain);

- physiotherapeutic methods (paraffin or ozokerite applications on the affected limbs, UHF on the affected segments).

The appearance of the first movements in the affected muscle groups marks the beginning of early recovery period and is an indication for the prescription of anticholinesterase drugs (proserin, galantamine, ubretide, oxazil). As cupping progresses pain syndrome They use exercise therapy, massage, UHF, then electrophoresis, pulsed current electromyostimulation, hyperbaric oxygenation.

After discharge from the infectious diseases department, the course of treatment with the medications described above continues for 2 years. The optimal solution should be considered the treatment of polio convalescents in specialized sanatoriums.

It is not yet known whether the infection can be stopped once it has started. On the other hand, many infected children do not suffer from paralysis. Many who are temporarily paralyzed then make a full recovery. Most of those who do not recover permanently make significant improvement.

If after acute phase mild paralysis is observed, the child should be under constant medical supervision. Treatment depends on many factors. At each stage, the decision is made by the doctor, and there are no general rules. If paralysis persists, various operations are possible to restore the mobility of the limbs and protect them from deformation.

Prevention

When there are cases of polio in your area, parents start asking how to keep their child safe. Your local doctor will give you the best advice. There is no point in panicking and depriving children of all contact with others. If there are cases of the disease in your area, it is wise to keep children away from crowds, especially indoor areas such as shops and cinemas, and away from swimming pools that are used by many people. On the other hand, as far as we now know, it is not at all necessary to prohibit a child from meeting close friends. If you take care of him like this all your life, you won’t even allow him to cross the street. Doctors suspect hypothermia and fatigue increase susceptibility to the disease, but both are wise to avoid at all times. Of course, the most common case of hypothermia in the summer is when a child spends too much time in the water. When he begins to lose his color, he should be called out of the water - before his teeth chatter.
. There are a number of vaccines that are recommended to be given at two months of age, then again at four and 18 months, and a booster dose when the child starts school (between four and six years of age).

Immunization of children is the basis of the polio eradication strategy, and the level of vaccination coverage during routine immunization should be at least 95% among children of decreed ages in accordance with the Preventive Vaccination Calendar.

National immunization days are the second important component of the polio eradication strategy. The goal of these campaigns is to stop the circulation of wild poliovirus by immunizing as quickly as possible (within a week) all children in the age group at highest risk of disease (usually children under three years of age).

In Russia, National Polio Immunization Days covering about 4 million children under 3 years of age (99.2-99.5%) were held for 4 years (1996-1999). Immunization was carried out in two rounds, with an interval of one month, with live oral polio vaccine (OPV), with vaccination coverage of at least 95% of the number of children indicated age groups located in this territory.

Main prophylactic drug both in our country and throughout the world there is the Seibin live vaccine (LSV), recommended by WHO. In addition, registered in Russia imported vaccines Imovax Polio (Sanofi Pasteur, France), Tetracok (Sanofi Pasteur, France). The Pentaxim vaccine (Sanofi Pasteur, France) is under registration. The listed vaccines are inactivated polio vaccines. Vaccines are stored at 2-8 °C for 6 months. An opened bottle should be used within two working days.

Currently, for immunization of the child population against polio, OPV is used - oral types 1, 2 and 3 (Russia), IPV - Imovax Polio - inactivated enhanced (types 1, 2, 3) and Pentaxim (Sanofi Pasteur, France).

Vaccination begins at the age of 3 months three times with an interval of 6 weeks with IPV, revaccination at 18 and 20 months, and at 14 years with OPV.

The dose of domestically produced live vaccine is 4 drops per dose. It is administered orally an hour before meals. It is not allowed to drink the vaccine, eat or drink within an hour after vaccination. If regurgitation occurs, a second dose should be given.

Contraindications to VPV vaccination are:

- all types of immunodeficiency;

— neurological disorders due to previous VPV vaccinations;

- presence of acute diseases. IN the latter case The vaccination is carried out immediately after recovery.

Non-severe illnesses with an increase in body temperature up to 38 °C are not a contraindication for VPV vaccination. If diarrhea is present, vaccination is repeated after stool normalization.

The oral polio vaccine is considered the least reactogenic. However, when using it, the possibility of an adverse post-vaccination event cannot be excluded. The greatest degree of risk is observed during primary vaccination and during contact infection of non-immune children.

It is possible to prevent the occurrence of vaccine-associated polio in children, especially from risk groups (IDF, born from HIV-infected mothers, etc.), using inactivated polio vaccine for initial vaccination or by completing a full course of immunization.

According to epidemiological indications, additional immunization is carried out. It is carried out regardless of previous preventive vaccinations against polio, but not earlier than 1 month after the last immunization. Children under the age of 5 years are subject to a single immunization with OPV (the age composition of children can be changed), who communicated in epidemic foci with patients with polio, diseases accompanied by acute flaccid paralysis, if these diseases are suspected in the family, apartment, house, preschool educational and medical -preventive institution, as well as those who communicated with those arriving from polio-prone areas.

Nonspecific prevention of polio infection involves hospitalization and isolation of the patient, establishing observation for 20 days of contact children under the age of 5 years. According to epidemiological indications, a one-time virological examination of contacts is carried out. IN epidemic focus After hospitalization of the patient, final disinfection is carried out with POLI/ORP.

In adults, polio vaccination is recommended only before traveling to areas where polio is common.

Contact your doctor immediately if you or your child experience symptoms of polio or if you may have been infected with the virus and have not yet been vaccinated.

Contact your doctor to get the polio vaccine if you have not been vaccinated and plan to travel to areas where polio is common.

Attention! Call " ambulance” if someone is having difficulty breathing or has paralysis of a limb.