Poliomyelitis in Tajikistan. Protection of Russia from emergence and spread of wild poliomyelitis virus

Problem of emergence and spread of poliomyelitis in Russian Federation and neighboring states is examined. Measures taken in Russian Federation to prevent emergence of poliomyelitis cases caused by wild type virus are discussed, as well as treaties and agreements between Russia, Commonwealth of Independent States, Shanghai Cooperation Organization states regarding epidemiological control of poliomyelitis and acute flaccid paralysis. Measure planned by Federal Service for Surveillance for Protection of Consumers Rights and Human Welfare to prevent emergence of poliomyelitis and acute flaccid paralysis cases in Russian Federation and neighboring countries are presented.     

A mixed epidemic of poliomyelitis and Bornholm's disease (pleurodynia)

Summary During a mixed epidemic of poliomyelitis and Bornholm's disease in the summer of 1951, evidence was obtained of the involvement of at least 6 different immunological types of Coxsackie virus, among which the Albany A₂ type dominated. Poliomyelitis virus was isolated from the stools of 6 out of 20 patients suffering from paralytic poliomyelitis; Coxsackie virus from 1, and both poliomyelitis and Coxsackie virus from 2 out of these 20 patients. During the whole year, Coxsackie virus was recovered from the stools of patients suffering from paralytic poliomyelitis, aseptic meningitis, pleurodynia and summer grippe in approximately equal percentages (11 to 14%), but during the epidemic months from July to October, 25% of the patients with poliomyelitis, and 16% of the patients with pleurodynia gave positive results for Coxsackie virus. The sparing or the enhancing effect of Coxsackie virus infection on the development of paralysis in patients with dual infections is discussed. Aided by a grant from the National Health Research Council T.N.O.     

Induction of mutations in mammalian cells by the action of live vaccinal strains of poliomyelitis virus

The attenuated strains' poliomyelitis virus induces mutagenesis in human and Chinese hamster cultured cells. The mutagenic action of the poliovirus is detected at chromosome and gene levels and directly depends on the multiplicity of cell infection. Possibilities for developing nonmutagenic antivirus vaccines are discussed.     

Virus survival as a seasonal factor in influenza and poliomyelitis

Summary The influence of temperature and humidity on the survival of airborne viruses was studied in a static system. Preliminary experiments with a bacteriophage showed that relative humidity was more important than temperature and absolute humidity. The effect of relative humidity was not dependent on the composition of the medium surrounding the virus particles. The survival of influenza and poliomyelitis virus are sharply influenced by relative humidity but in an opposite way. Influenza virus survives much better at lower humidities, poliomyelitis virus at higher humidities. In countries with moderate climates the period of increasing morbility for influenza, in winter, coincides with indoor conditions of relative humidity which are optimal to virus survival. For poliomyelitis the same is true during summer (Fig. 7). Indoor relative humidity is considered an important “seasonal factor” in the epidemiology of poliomyelitis and influenza and probably of other diseases.     

Possible method of eradication of poliomyelitis as an infection

Problem of poliomyelitis eradication is examined in the review. After the eradication of wild poliovirus, vaccine poliomyelitis virus continues to circulate in the human population. In rare cases it can cause the development of the disease. The authors describe disadvantages of the use of oral and inactivated poliomyelitis vaccines and note that by using oral poliomyelitis vaccine and eradication only of wild poliovirus, eradication of poliomyelitis as an infection will not succeed. As one of the approaches to reach this goal the authors propose the use of various enterovirus interference. Use of live enterovirus vaccine is described and its advantages and disadvantages are examined.     

Distribution of antibodies to poliovirus in the children of a large industrial city

The results of prolonged dynamic observations on the state of herd immunity against poliomyelitis virus in an industrial city are given. The survey covered 1304 children. The data thus obtained, when synchronized according to years, seasons, the age of the surveyed children and the methods used in the survey, indicated that in every age group 20-30% of children had no antibodies to group I poliomyelitis virus and 30% of children had no antibodies to group III poliomyelitis virus. The geometrical mean of antibody titers to different types of the virus fluctuated from 1.8 to 4.6 log2, the lowest value being obtained for the titer of antibodies to type III poliomyelitis virus. During the whole period of immunological control (1974-1978) no mass circulation of poliomyelitis virus and no outbreaks of poliomyelitis were registered despite the fact that a considerable proportion of children having no antibodies to one or several types of the virus was constantly present among the most susceptible part of children.     

Diagnosis and differential diagnosis of poliomyelitis; the management of patients in the hospital admitting room

Because of the great variety of early symptoms of poliomyelitis and their similarity to the symptoms of a number of other diseases, in times of epidemic many patients are admitted to hospital on suspicion of poliomyelitis. At such times the prime purpose of the hospital admitting room staff is to distinguish between patients with poliomyelitis (or other diseases requiring immediate treatment) and those who may be referred into other channels. This presentation (1) points out the superficial similarities of the clinically observable signs and symptoms and of laboratory data in poliomyelitis and in other diseases, and (2) discusses the more occult dissimilarities which aid in differentiation.     

Enteroviruses in the XX and XXI centuries

The modern view of the role of enteroviruses in the eradication of poliomyelitis is presented. Enteroviruses were discovered in the XX century. In the 1950s they caused great epidemics of poliomyelitis and serous meningitis in many countries of the world. The introduction of oral poliomyelitis vaccine (OPV) into medical practice made it possible to eliminate the epidemics of poliomyelitis in a short time. Poliomyelitis morbidity was reduced to sporadic cases and in a number of regions disappeared. OPV produced non-specific influence also on the epidemics of serous meningitis, as well as on a case incidence. The eradication of poliomyelitis viruses and the cessation of immunization with OPV will not result in eradication of paralytic diseases. Paralytogenic viruses of 20 serotypes circulate in nature, and some of these viruses are capable of causing the outbreaks of severe paralytic diseases. The authors propose either to retain immunization with OVP as tour immunizations with monovaccine of type 2, or to create new live enterovirus vaccines on the basis of avirulent enterovirus strains.     

Outside Europe. Is poliomyelitis a serious problem in developing countries?--the Danfa experience.

Children were examined for lameness in the Danfa Project district of rural Ghana to assess the impact of endemic poliomyelitis and to test a widely held hypothesis that paralytic poliomyelitis is relatively rare in such districts (less than 1 per 1000 children affected). The observed prevalence of lameness attributable to poliomyelitis was 7 per 1000 school-aged children, and the annual incidence is estimated to be at least 28 per 100 000 population. Although no evidence for an epidemic was found, these rates are comparable with those in the USA and Europe during the years of severe epidemics and indicate that a high price is being paid in the Danfa district for the natural acquisition of immunity. As a result, immunisation against poliomyelitis has been given high priority. A teacher questionnaire was also tested for use in postal surveys as a rapid means of estimating the prevalence of lamenes attributable to poliomyelitis in countries with a reasonable network of primary schools.     

Poliomyelitis in MuLV-infected ICR-SCID mice after injection of basement membrane matrix contaminated with lactate dehydrogenase-elevating virus

The arterivirus lactate dehydrogenase-elevating virus (LDV) causes life-long viremia in mice. Although LDV infection generally does not cause disease, infected mice that are homozygous for the Fv1(n) allele are prone to develop poliomyelitis when immunosuppressed, a condition known as age-dependent poliomyelitis. The development of age-dependent poliomyelitis requires coinfection with endogenous murine leukemia virus. Even though LDV is a common contaminant of transplantable tumors, clinical signs of poliomyelitis after inadvertent exposure to LDV have not been described in recent literature. In addition, LDV-induced poliomyelitis has not been reported in SCID or ICR mice. Here we describe the occurrence of poliomyelitis in ICR-SCID mice resulting from injection of LDV-contaminated basement membrane matrix. After exposure to LDV, a subset of mice presented with clinical signs including paresis, which was associated with atrophy of the hindlimb musculature, and tachypnea; in addition, some mice died suddenly with or without premonitory signs. Mice presenting within the first 6 mo after infection had regions of spongiosis, neuronal necrosis and astrocytosis of the ventral spinal cord, and less commonly, brainstem. Axonal degeneration of ventral roots prevailed in more chronically infected mice. LDV was identified by RT-PCR in 12 of 15 mice with typical neuropathology; positive antiLDV immunolabeling was identified in all PCR-positive animals (n = 7) tested. Three of 8 mice with neuropathology but no clinical signs were LDV negative by RT-PCR. RT-PCR yielded murine leukemia virus in spinal cords of all mice tested, regardless of clinical presentation or neuropathology.     

RELATION OF A STREPTOCOCCUS TO EPIDEMIC POLIOMYELITIS-Studies in Etiology,Diagnosis and Specific Treatment

The production in 1915 of herpes zoster or "posterior" poliomyelitis in animals with a streptococcus led to further research on the etiologic importance of streptococci in "anterior" poliomyelitis.A specific streptococcus was demonstrated consistently in persons with poliomyelitis and in well persons having contact with them or merely inhabiting an area in which poliomyelitis was epidemic. That the organism was not present in areas remote from contact with the disease was likewise demonstrated.The streptococcus has been isolated from filtrates of poliomyelitis virus and from the tissues and exudates which harbor the virus. It appears in the spinal fluid in the preparalytic stage of poliomyelitis and disappears from the spinal fluid during the severe stage of the disease. Antibody and antigen prepared from the streptococcus were used to determine the presence of antigen and antibody indicative of streptococcal infection in many patients with poliomyelitis and in well persons. The intensity of reaction indicating specific streptococcal antigen was directly proportional to the degree of paralysis in patients; the reaction was greater in persons whose age, sex and previous isolation from the disease would normally indicate greater susceptibility. The test for antibody gave opposite results. Specific agglutinins for the streptococcus and neutralizing antibody for the virus were present consistently in the serum of persons and monkeys during recovery from poliomyelitis. Virus produced in vitro from the associated streptococcus caused all the clinical and pathologic features of poliomyelitis in monkeys inoculated with it, and the animals that recovered from the disease thus induced were proved to be immune thereafter to the natural virus. Antistreptococcic serum prepared in horses was used to treat poliomyelitis. In a group of monkeys inoculated with the virus of the disease, 6 per cent of those receiving the serum before inoculation died of the disease; of the control group, 82 per cent. In a series of poliomyelitis patients treated with the serum the mortality rate was 8 per cent; in a control series, 21 per cent. In a series treated in all stages of the disease by the author, 10 per cent died; of those who did not receive the serum, 25 per cent. An antibody has been prepared from the streptococcus which appears to prevent paralysis and otherwise mitigate poliomyelitis and to provide immunization from the disease.The conclusion is reached that the virus of poliomyelitis is a form of the specific streptococcus, which is the agent in primary infections and in the development of the immunizing antibody.     

State of collective immunity to poliomyelitis in Moscow donors

Immunity induced by immunization with oral poliomyelitis vaccine has long been considered to last for life, similarly to immunity developing after infection with wild poliomyelitis virus. Vaccine virus cannot circulate among the immune population for a long time. The vaccination of children against poliomyelitis, carried out in the course of many years, has made it possible to suggest that a considerable number of immune persons were present among the adult population. The examination of 1,030 Moscow donors has revealed that antibodies to poliomyelitis virus of types 1, 2 and 3 were detected in 47.3%, 45.5% and 76.4% of the examinees respectively, the values of the average geometric titers being low. It is known that passages of poliomyelitis vaccine virus through nonimmune persons may result in emergence of revertant viruses with increased neurovirulence. The nonimmune adult population, especially the mothers of vaccinated and revaccinated children, may serve as favorable environment for the circulation of vaccine viruses and the appearance of revertant viruses.     

The level of postvaccinal immunity to diphtheria, tetanus and poliomyelitis in relation to the number of inoculations]

The work was aimed at the comparative study of the intensity of immunity to diphtheria, tetanus and poliomyelitis, depending on the number of injections of adsorbed diphtheria-pertussis-tetanus (DPT) vaccine and poliomyelitis vaccine, for the purpose of finding out the possibility of reducing the antigenic load given to children without diminishing the intensity of immunity. To determine the level of immunity to diphtheria and tetanus, 1900 children under school age were serologically studied by the micromethod in the passive hemagglutination test. The intensity of immunity to poliomyelitis virus was studied in 333 children by means of the neutralization test. The immunogenic properties of the diphtheria component of adsorbed DPT vaccine were found to be less pronounced than those of the tetanus component of the vaccine, which made it impossible to reduce the antigenic load by decreasing the number of vaccinations against diphtheria. The results of the study of postvaccinal immunity to poliomyelitis suggest that during the first and second year of life the course of vaccination against poliomyelitis may be reduced to 3 injections.     

Congenital absence of the gallbladder; case report

The virus of human poliomyelitis has been demonstrated in excretions before onset of the disease, during the disease, and in convalescence. It may be confused with different viruses likely to be found in the same sources in clinical conditions resembling poliomyelitis.Immunologic differences between strains of poliomyelitis virus have been detected so that three types are now evident. The distribution of these types and their importance as causes of epidemics are not known. This multiplicity of immunologic types is an important factor in considering immunization of humans. Commercial manufacture of vaccines faces many technical problems. Recently the Coxsackie virus has been demonstrated in humans with a disease closely resembling poliomyelitis.     

Congenital Absence of the Gallbladder: Case Report

The virus of human poliomyelitis has been demonstrated in excretions before onset of the disease, during the disease, and in convalescence. It may be confused with different viruses likely to be found in the same sources in clinical conditions resembling poliomyelitis.Immunologic differences between strains of poliomyelitis virus have been detected so that three types are now evident. The distribution of these types and their importance as causes of epidemics are not known. This multiplicity of immunologic types is an important factor in considering immunization of humans. Commercial manufacture of vaccines faces many technical problems.Recently the Coxsackie virus has been demonstrated in humans with a disease closely resembling poliomyelitis.     

Immunoprophylaxis of poliomyelitis in Ukraine with the use of inactivated vaccine

In connection with the cessation of the circulation of "wild" poliovirus on the territory of the European region, including Ukraine, the strategy of the vaccinal prophylaxis of poliomyelitis is reviewed. Its main aims are the creation of a high level of the specific protection of the population, the prophylaxis of vaccine-associated paralytic poliomyelitis and a decrease in the intensity of the circulation vaccine polioviruses. These aims may be achieved only by the inclusion of vaccinations with inactivated poliomyelitis vaccine (IPV) into the immunization schedule. IPV "Imovax Polio" produced by the firm "Aventis Pasteur" (France) has been shown to have low reactogenicity and high effectiveness, especially with respect to type 3 poliovirus, under the conditions of Ukraine. On the basis of our studies all children, starting from the age of 3 months, are recommended to be vaccinated first with two injections of IPV, followed by further immunization with oral vaccine.     

The molecular epidemiology of poliomyelitis: the characteristics of the strains isolated from patients in Moscow in 1973-1986

Eleven virus strains isolated from poliomyelitis patients in Moscow in 1973-1986 were analyzed by the method of oligonucleotide mapping of RNA. The genome of the isolates showed considerable similarity to the genomes of Sabin's vaccine strains and mainly to the vaccine strain of antigenic type 2. The conclusion was made that the sporadic cases of poliomyelitis registered in this region were etiologically linked with the vaccine strains of poliomyelitis virus. Only in one case the disease appeared in the recipient of the vaccine, in all other cases the patients were infected through contacts.     

A poliomyelitis survey the simple way: the Tanzanian experience.

A simple cost effective survey to assess the need for a rehabilitation service for individuals disabled by poliomyelitis was carried out making the maximum use of the existing government administration. The field team consisted solely of a medical officer and a health officer. The prevalence rate for paralytic poliomyelitis in the Mbeya region of Tanzania was 2.95/1000 persons. The rate for children under 10 years was 1.15/1000, suggesting that the expanded immunisation programme started in 1977 was being successful. With approximately 4000 cases of paralytic poliomyelitis in the Mbeya region a rehabilitation service would seem to be justified. If poliomyelitis surveys are required for rehabilitation purposes they must include all age groups. In this survey, had only school children been considered, as recommended by the World Health Organisation, two thirds of the cases would have been excluded, thereby hardly justifying a rehabilitation service.     

Is poliomyelitis a serious problem in developing countries?--lameness in Ghanaian schools.

A postal survey of lameness in schools throughout Ghana showed an estimated prevalence of lameness attributable to poliomyetitis of 5-8 per 1000 school-aged children and an estimated mean annual incidence of paralytic poliomyelitis of 23 per 100 000 population. Official reported incidence rates range from 0-1 to 2-1 per 100 000 population, indicating that at least 90% of cases are not reported. No evidence of epidemics was found to account for these high rates. These suggest that mean annual incidence rates in tropical endemic countries have always been as great, if not greater, than those experienced by temperate countries during epidemic periods in the twentieth century and that the total number of cases of paralytic poliomyelitis occurring in the world each year has been reduced by only 25% since the advent of polio vaccine. Immunisation against poliomyelitis must have a high priority in Ghana and other tropical countries where the disease is endemic.     

In Memoríam

The mortality rate of poliomyelitis may be reduced by early measures to prevent anoxia and its subsequent complications. Constant nursing care, early tracheotomy, the giving of oxygen, proper use of the respirator and positive pressure equipment are essential in the proper management of patients with poliomyelitis who have respiratory involvement.