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Epidemiology of Poliomyelitis

Epidemiology of Poliomyelitis. Contents Slide No. Introduction 3 Magnitude of problem 3 World Scenario 4 SEAR Scenario 9 Nepal Scenario 15 Epidemiology 20 Agent factors 20 Host factors 21 Environment factors 21 Incubation period 21

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Epidemiology of Poliomyelitis

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  1. Epidemiology of Poliomyelitis

  2. Contents Slide No. Introduction 3 Magnitude of problem 3 World Scenario 4 SEAR Scenario 9 Nepal Scenario 15 Epidemiology 20 Agent factors 20 Host factors 21 Environment factors 21 Incubation period 21 Mode of transmission 21 Clinical features 22 Laboratory diagnosis 24 Complication 24 Treatment 24 Prevention and control 25 Polio eradication effort 26 References 34

  3. Poliomyelitis is an acute viralinfection caused by Polio virus (RNA virus) which is primarily an infection of alimentary tract but may infect the central nervous system in a very small percentage of cases resulting in varying degrees of paralysis and possibly death. • Magnitude of problem • Many Developed Countries got rid of Poliomyelitis • It is still existing as a problem in Eastern- Mediterranean, Africa and South East Asia. • In Nepal, it is occurring Sporadically. • In Nepal,6 (all WPV1)cases have appeared till now in 2010 Introduction

  4. World Trend of AFP, Polio cases *Data as of 19th-Nov-2010

  5. SAARC Trend of AFP, Polio cases *Data as of 19th -Nov-2010 * Out of 48 cases in SEAR in 2010,42 cases from India and 6 cases from Nepal

  6. Nepal Trend of AFP, Polio cases *Data as of 19th-Nov-2010

  7. Acute Flaccid Paralysis (AFP) Cases, Nepal, 2010 AFP cases = 471 Wild Polio cases= 6 District with AFP cases = 68 Data as of 01 Oct 2010 WHO-IPD

  8. Epidemiology Agent Factors Causative Agent:- Polio virus Type 1,2 & 3 (More commonly type 1 causes paralytic Polio) Reservoir:- Human being Source of infection:- Oropharyngeal secretion, faece Period of communicability: 7-10 days before and after onset of symptoms

  9. Host factors:- Age:- Mainly 6 months to 3 years age group Sex:- Male: Female 3:1 Immunity:- Immunity for only that type after attack Risk factors:-Fatigue, trauma, IM injections, tonsillectomy, precipitate an attack of polio Environment factors:- • Poor waste Management • Rainy season • Overcrowding • contaminated water, food and fly Incubation period: 7-14 days Mode of transmission • Faeco-oral transmission • Droplet Infection

  10. Clinical Features 4 types of Polio • Inapparrent (subclinical) Infection • 95% cases are without signs and symptom • Detected only by laboratory test • Abortive polio or Minor Illness • Occurs among about 4-8%casses, • Appearance of general signs and symptoms like fever, headache, weakness • Signs and symptoms disappear in few days • Non Paralytic Polio • Occurs among about 1% cases, • Appearance of Pain and stiffness on neck and back of body • Signs and symptoms disappear in 2-10days

  11. 4. Paralytic Polio • Occurs among less than 1% cases • Virus invades CNS and causes paralysis • Asymmetrical flaccid paralysis • Pain and stiffness on neck and back muscle • Tripod sign may be present • Kerning’s sign positive • If respiratory muscle paralysis, respiratory failure and may be death • If cranial nerve affected, • Diplopia • Dysphasia • Facial muscle weakness

  12. Laboratory diagnosis:- Virus isolation from faecal and oropharyngeal specimen Complication:- Paralysis Treatment • No specific Treatment: • Good nursing care • If respiratory distress, artificial respiration • If paralysis, physiotherapy • Referral to hospital

  13. Prevention and control 1. Immunization • Routine Immunization:-Sabin Polio Vaccine 2-3 drop orally ; 3 doses at 6,10 and 14 weeks of age(consecutive doses a least 1 month apart) • Supplementary Immunization:- Sabin Polio Vaccine Oral Immunization of 0-5 years of children in NID,SNID and mopping -Up immunization programmes 2. Proper disposal of faece, sputum, saliva etc. of patients 3. Immediate referral of suspected AFP cases to Hospital or IPD center 4. Regular surveillance 5. Health education

  14. Polio eradication effort • In pre-vaccination era, Polio was found all the world • Extensive use of Polio vaccine since 1954 has eliminated Polio in developed countries • In 1988, world health resolved to eradicate polio globally • Nepal is one of the signatories of the polio eradication initiative and Polio Eradication is a priority program of Government of Nepal

  15. Contd… • Nepal is conducting NIDs since FY 2053/54 • In 2061/62(2005 Technical Consultative Group (TCG) recommended that Nepal need not to continue with NID • Nepal didn't conduct NIDs in 2061/62 (2005) and 2062/63 • Besides NID, Nepal has been conducting mop up activities in response to each detected wild polio cases

  16. Progress to Polio eradication in Nepal • Nepal didn’t detect any Poliomyelitis case due to wild virus from 2001 till 2004 • In 2005, 4 cases were detected in Sarlahi and Rautahat district • Then onwards, Polio cases have been detected sporadically

  17. Polio is eradicable because • Man is the only host • Half life of excreted virus in sewage is only 24 hours spread occur only during this period • A long term carrier state is not known to occur • Availability of an easy and effective intervention i.e. Oral Polio vaccine • Diagnostic tools with sufficient reactivity and specificity to detect level of infection

  18. Basic strategies for eradicating polio 1. Immunization • Routine immunization:- Sabin Polio Vaccine 2-3 drop orally ; 3 doses at 6,10 and 14 weeks of age (consecutive doses one month apart) b. Supplementary immunization i. National immunization days(NIDs):- • Immunization campions all over the country on the same date • All 0-5 years children receive 2 extra dose of OPV on 2 days separated by 4-6 weeks irrespective of previous immunization

  19. Contd…… ii. Sub- National immunization days(NIDs): Immunization of All 0-5years children with same dose and same schedule in high risk districts c. Mopping-Up • Last stage in polio eradication • Door to door immunization in high risk districts where wild polio virus is suspected to exist 2. Surveillance of Acute Flaccid Paralysis(AFP) • To know polio endemic zone • To know target population to give vaccine • To identify all reservoir of wild polio transmission

  20. Polio Epidemic:- Appearance of 2 or more local cases caused by same type of virus within 4 weeks period is known as Polio Epidemic.

  21. References • Park. K,Textbook of Preventive and social Medicine.18th edition, BanarasidasBhanot Publishers, Jabalpur-India • K.C. Saroj, Applied Epidemiology in Nepalese Context; A.K. Books & Educational Enteprises, Nepal 2007 • Annual Report;Department of Health Services, 2005/6- 2008/9 • Class-notes • http://www.who.int • www.searo.who.int

  22. Feedback and Suggestion are welcome

  23. Thank you

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