Poliovirus infection

Last reviewed: 6 Sep 2022
Last updated: 09 Aug 2022
09 Aug 2022

Vaccine derived poliovirus (VDPV) detected in New York, London, and Jerusalem

The Global Polio Laboratory Network has confirmed the isolation of type 2 VDPV in environmental samples in London, New York and Jerusalem, and one case of paralytic polio has been reported in an unvaccinated individual in New York. Analysis of the type 2 VDPV isolated from the patient and the isolates detected in the environmental samples confirms they are genetically linked.

VDPV arises from oral attenuated poliovirus vaccine (OPV). The attenuated poliovirus replicates in the intestine stimulating an immune response; however, over time it can evolve and lose its attenuating mutation, causing disease just as wild poliovirus does. OPV has not been used in the US since 2000 and the UK since 2004, and so it is likely that the recently-detected VDPV originated from an individual who arrived from a country where OPV has been used for immunisation campaigns.

Genetic and epidemiological investigations are ongoing to determine possible spread of the virus and potential associated risk.

See Epidemiology

Original source of update

Summary

Definition

History and exam

Key diagnostic factors

  • unimmunised status
  • residence or travel in endemic area
  • decreased tone and motor function of affected limb
  • decreased tendon reflexes of affected limb
  • muscle atrophy of affected limb
More key diagnostic factors

Other diagnostic factors

  • age <36 months
  • gastrointestinal prodrome
  • fever
  • malaise
  • respiratory muscle atrophy and respiratory distress
Other diagnostic factors

Risk factors

  • lack of vaccination
  • poor sanitation
  • poverty
  • area of endemic infection
  • immunosuppression
More risk factors

Diagnostic investigations

Investigations to consider

  • virus culture from stool, CSF, or pharynx
  • CSF analysis
  • serum antibodies to poliovirus
  • MRI of spinal cord
  • electromyelogram (EMG) of affected limb
More investigations to consider

Treatment algorithm

INITIAL

gastrointestinal illness: poliovirus suspected

ACUTE

paralytic poliomyelitis (acute flaccid paralysis)

ONGOING

post-poliomyelitis syndrome (PPS)

Contributors

Authors

Omar A. Khan, MD, MHS, FAAFP
Omar A. Khan

President and CEO

Delaware Health Sciences Alliance

Physician Leader, Partnerships & Academic Programs

Christiana Care Health System

Associate Professor

Department of Family & Community Medicine

Sidney Kimmel Medical College of Thomas Jefferson University

Newark

DE

Disclosures

OAK is an author of a number of references cited in this topic.

David L. Heymann, MD, DTM&H

Professor of Infectious Disease Epidemiology

London School of Hygiene and Tropical Medicine

University of London

Head

Centre on Global Health Security - Chatham House

London

UK

Disclosures

DLH is an author of a number of references cited in this topic.

Peer reviewers

Javed M. Gilani, MD, FRCP, FACP

Assistant Clinical Professor

Jefferson Medical College

Philadelphia

PA

Disclosures

JMG declares that he has no competing interests.

Gregory Pappas, MD, PhD

The Nordin M. Thobani Professor and Chairman

Department of Community Health Sciences

Aga Khan University

Karachi

Pakistan

Disclosures

GP declares that he has no competing interests.

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