Poliovirus infection
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.
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
Other diagnostic factors
- age <36 months
- gastrointestinal prodrome
- fever
- malaise
- respiratory muscle atrophy and respiratory distress
Risk factors
- lack of vaccination
- poor sanitation
- poverty
- area of endemic infection
- immunosuppression
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
Treatment algorithm
gastrointestinal illness: poliovirus suspected
paralytic poliomyelitis (acute flaccid paralysis)
post-poliomyelitis syndrome (PPS)
Contributors
Authors
Omar A. Khan, MD, MHS, FAAFP
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.
Differentials
- Viral gastroenteritis in adults
- Transverse myelitis
- Guillain-Barre syndrome (GBS)
More DifferentialsGuidelines
- Recommended child and adolescent immunization schedule for ages 18 years or younger, United States, 2022
- Post-polio syndrome: EFNS guidelines on post-polio syndrome
More GuidelinesPatient leaflets
DTP vaccine (diphtheria, tetanus, polio)
6-in-1 vaccine (diphtheria, hepatitis B, Haemophilus influenzae type B, polio, tetanus, whooping cough)
More Patient leaflets
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