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.
Poliovirus infection is usually asymptomatic. When symptomatic, the most common presentation is a minor gastrointestinal illness.
Acute flaccid paralysis (AFP), or paralytic poliomyelitis, is the hallmark of the major illness. A minority of affected cases with AFP progress to life-threatening bulbar paralysis and respiratory compromise.
Postpoliomyelitis syndrome may occur many years after the initial illness, and consists of weakness and fatigue in muscle groups previously affected in the acute illness.
There is no cure for poliovirus infection or postpoliomyelitis syndrome, and treatment is mainly supportive.
Early physical therapy is key to maximizing and restoring limb function in paralytic poliomyelitis and in postpoliomyelitis syndrome.
The cornerstones of poliomyelitis eradication initiatives are oral vaccines containing attenuated poliovirus (OPV) (Sabin) in disease-endemic, outbreak-affected areas and recently polio-free countries of the world, and inactivated poliovirus vaccine (IPV) (Salk) in the rest of the world, in countries where the risk of vaccination-associated paralytic polio is considered greater than the risk of naturally occurring infection.
Poliomyelitis is contracted through transmission of poliovirus, an enterovirus, usually through gastrointestinal-oral transmission. The condition may manifest as the minor illness, which is usually gastrointestinal, or as the major illness, characterized by acute flaccid paralysis (AFP). Ninety-five percent of poliovirus infections are asymptomatic. The classic clinical syndrome of poliomyelitis involves asymmetric paralysis of the affected limb (usually the lower extremities). There is no specific treatment, nor reservoir in nature, making vaccination and global eradication a major priority for the World Health Organization (WHO). World Health Organization: poliomyelitis Opens in new window
History and exam
Key diagnostic factors
- unimmunized 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
- respiratory muscle atrophy and respiratory distress
- lack of vaccination
- poor sanitation
- area of endemic infection
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
gastrointestinal illness: poliovirus suspected
paralytic poliomyelitis (acute flaccid paralysis)
postpoliomyelitis syndrome (PPS)
- Viral gastroenteritis in adults
- Transverse myelitis
- Guillain-Barre syndrome (GBS)
- Recommended child and adolescent immunization schedule for ages 18 years or younger, United States, 2022
- Post-polio syndrome: EFNS guidelines on post-polio syndrome
DTaP vaccine (diphtheria, tetanus, polio, and pertussis)More Patient leaflets
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