1. Dr.Indrajeet kumar
Tutor, P.S.M Department
M.G.M Medical College
Jamshedpur
An acute viral infection caused by an rna (entero virus).
Primarily an infection of the human alimentary tract.
CNS involvement in about 1% of cases.
World Problem:
In India:
1954 : Polio vaccine started.
13.01.2011 Last case ..Howrah (W.B)
Endemic in :
25.02. 2012 –declared – non endemic
Afghanistan
Pakistan
Nigeria**
2014 Expected to be declared polio
free.

2. EPIDEMIOLOGY
 AGENT
: an entero-virus of rna group
: 3 serotypes type 1
type 2
type 3
: survival in external environment is long.
in water – 4 month
in faeces – 6 month
: inactivated by common disinfectants and boiling.
EPIDEMIOLOGY agent contd.
RESERVOIR: only human cases.
: most of the cases are sub-clinical.
clinical : sub-clinical = 1 : 1000 (in children)
PERIOD OF COMMUNICABILITY: 7 – 10days before and after the onset of
symptoms.
INFECTIVE MATERIAL : Faeces and
oropharyngeal secretions

3. Epidemiology contd.
HOST FACTOR :
AGE : disease of infancy & childhood.
: 50% cases are infants.
: most vulnerable age group *6m – 5yrs.
SEX:
m:f=3:1
IMMUNITY: one attack gives life long immunity.
: no cross protection for other serotype.
RISK or PROVOCATIVE FACTORS for paralytic polio:
fatigue
trauma
i.m injection
surgery & imm. agents particularly alum containing DPT.
Epidemiology cont.
ENVIRONMENTAL FACTORS:
: more in rainy season.
: poor sanitation.
: over crowding.
MODE OF TRANSMISSION:
1. Faecal – oral:
2. Droplet infection:
INCUBATION PERIOD:
7 – 14 days

4. CLINICAL SPECTRUM
 95% case are sub-clinical.
 less than 1% Paralytic polio.
 Characteristic feature of Paralytic polio
LMN, asymmetrical flaccid paralysis.
:- descending paralysis.
:- DTR diminished or lost
:- no sensory loss
:-signs of meningial irritation.
TREATMENT
 nursing care and rest during acute phase.
 physiotherapy after the acute phase is over.

5. PREVENTION
 AT SOURCE LEVEL: not possible
:- no specific treatment
:- large number of sub-clinical cases.
:- infectious in incubation period.
 AT TRANSMISSION LEVEL:
by personal and community hygiene.
•
AT HOST LEVEL: by active immunization.
POLIO VACCINE
INACTIVATED (Salk) POLIO VACCINE
IPV
1.
ORAL (Sabin) POLIO VACCINE
OPV
Killed vaccine
Live vaccine
2. Given s.c or i.m
Given orally
3. Provides only systemic immunity.
Both systemic and local immunity.
4. Prevents only paralysis (CNS
invasion).
Prevents both paralysis and intestinal
re-infection.
5.
Useful in controlling epidemic.
Not useful in controlling epidemics.
6. Dosing: 4 doses.
Dosing: 0 – 6 – 10 - 14 wks – 16 to 24month
total 5 doses.

6. PULSE POLIO
 “ Sudden simultaneous mass administration of OPV on a single day to
all children of 0-5yrs of age regardless of previous immunization.”
 Started : on 9th December 1995
 Target age group : 0 to 5 yrs of age.
 Vaccine used : 2 drops of trivalent OPV. 2doses six weeks apart.
: a supplementary dose.
•
Types of PP: NID (National imm. day)
SNID (Sub national imm.day)
•
IPP (Intensive Pulse Polio): 1st day vaccination at booth.
Followed by “mop up round”
•

7. DIFFERENTIAL DIAGNOSIS OF AFP
1. Infective polyneuronitis (Guillain Barre syndrome):
ascending and symmetrical paralysis.
2.
Severe hypokalemia: reversal after giving potassium and there will be
3.
Transverse myelitis: history of trauma in spinal region. Initially there is a
history of diarrhoea or vomiting.
stage of shock which appears like lmn paralysis. Deep reflexes are preserved.
4. Trauma : usually after taking an intramuscular injection.