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  • Poliomyelitis( children's paralysis) symptoms

    Poliomyelitis( infantile paralysis of ) is caused by a virus and is a highly contagious viral infection. In the most serious form, poliomyelitis can cause rapid and irreversible paralysis;until the late 1950s, it was one of the most dangerous infectious diseases and often occurred in the form of epidemics. Post-poliomyelitis syndrome or post-poliomyelitis progressive muscular atrophy can occur 30 or more years after the initial infection, gradually leading to muscle weakness, atrophy and pain. Poliomyelitis can be prevented by creating immunity, and it has now virtually disappeared in developed countries;but the danger of the disease still exists. Poliomyelitis is still common in many countries of the world, and there is no way to cure it;therefore, until the polio virus is destroyed, vaccination remains the main method of protection.

    In the summer and early autumn, when poliomyelitis epidemics most often occur, parents first of all recall it when a child falls ill. Disease, like many other infections, begins with a general malaise, fever and headache. Vomiting, constipation or slight diarrhea is possible. But even if your child has all these symptoms and plus all the pain in his legs, one should not rush to conclusions. There are still great chances that it is a flu or a throat. Of course, you call the doctor anyway. If it does not last long, you can calm down this way: if a child can lower his head between his knees or tilt his head forward so that his chin touches his chest, he probably does not have polio.(But even if he does not pass these tests, it is still not evidence of the disease.)


    Despite significant successes in eradicating poliomyelitis in our country, the problem of diseases accompanied by acute flaccid paralysis( AFP) has not lost its relevance. Pediatricians often have to meet with various infectious diseases of the brain and spinal cord, peripheral nerves. The study of the structure of neuroinfections indicates that the lesions of the peripheral nervous system are found in 9.6% of patients, infectious diseases of the spinal cord - in 17.7%.Among the latter, acute infectious myelopathies prevail, whereas acute paralytic vaccine-associated poliomyelitis, acute myelopathy, encephalomyelopolyradiculoneuropathy are much less common. In this regard, in modern conditions, special attention should be given to differential diagnosis of AFP, monitoring of the epidemic situation, which will avoid overdiagnosis, improve the results of treatment, and reduce the frequency of unreasonable registration of post-vaccination complications.

    Acute paralytic poliomyelitis is a group of viral diseases combined according to the topical principle, characterized by flaccid paresis, paralysis caused by defeat of motor cells in the anterior horns of the spinal cord and nuclei of the motor skull nerves of the brainstem.

    Etiology. The etiological structure of infectious diseases of the nervous system is diverse. Among the etiological factors, wild poliovirus types 1, 2, 3, vaccine polioviruses, enteroviruses( ECHO, Coxsackie), herpesviruses( HSV, HHV type 3, VEB), influenza virus, mumps virus, diphtheria bacillus, borrelia, UPF( staphylococci, gram-negative bacteria).

    Spinal paralysis, caused by the "wild" polio virus, belonging to the family of picornaviruses, the genus of enteroviruses, is of particular interest. The causative agent is small in size( 18-30 nm), contains RNA.The synthesis of the virus and its maturation occur within the cell.

    Polioviruses are not sensitive to antibiotics and chemotherapy. When frozen, their activity persists for several years, in the domestic refrigerator - several weeks, at room temperature - several days. At the same time, polioviruses are quickly inactivated by treatment with formaldehyde, free residual chlorine, poorly tolerated drying, heating, ultraviolet irradiation.

    The virus of poliomyelitis has three serotypes - 1, 2, 3. Cultivation of it in the laboratory is performed by infecting various cultures of tissues and laboratory animals.

    Causes of

    • Poliomyelitis is caused by a viral infection of one of three forms of the poliovirus.

    • The virus can be transmitted through contaminated food and water or with infected saliva during coughing or sneezing.

    The source of the infection is a sick person or carrier. The greatest epidemiological significance is the presence of the virus in the nasopharynx and intestines, from where it is released into the external environment. In this case, the isolation of the virus with feces can last from several weeks to several months. In the nasopharyngeal mucus, the agent of poliomyelitis is 1-2 weeks.

    The main transmission routes are alimentary and airborne.

    In conditions of mass specific prevention, sporadic cases were recorded throughout the year. Mostly children were sick before the age of seven, of them the proportion of patients of early age reached 94%.The index of contagiosity is 0.2-1%.The lethality in the unvaccinated reached 2.7%.

    The World Health Organization in 1988 raised the issue of complete eradication of poliomyelitis caused by a "wild" virus. In this regard, 4 main strategies to combat this infection were adopted:

    1) to achieve and maintain a high level of coverage of the population with preventive vaccinations;

    2) additional vaccinations on national immunization days( NIDs);

    3) creation and functioning of an effective system of epidemiological surveillance of all cases of acute flaccid paralysis( AFP) in children under the age of 15 with compulsory virological examination;

    4) additional "mop-up" immunization in disadvantaged areas.

    At the time of the adoption of the Global Polio Eradication Program, the number of patients in the world was 350,000. However, by 2003, due to ongoing activities, their number had dropped to 784. Three regions of the world are already free of poliomyelitis: American( since 1994)Pacific( since 2000) and European( since 2002).However, poliomyelitis caused by wild poliovirus continues to be recorded in the Eastern Mediterranean, African regions and South-East Asia. Endemic for poliomyelitis are considered to be India, Pakistan, Afghanistan, Nigeria.

    Since December 2009, an outbreak of poliomyelitis caused by poliovirus type 1 has been reported in Tajikistan. It is assumed that the virus came to Tajikistan from neighboring countries - Afghanistan, Pakistan. Taking into account the intensity of migratory flows from the Republic of Tajikistan to the Russian Federation, including labor migration and active trade relations, a "wild" poliovirus virus was imported into our country, polio cases in adults and children were recorded.

    Russia launched the Global Polio Eradication Program on its territory in 1996. Due to the high level of immunization coverage for children of 1 year of life( more than 90%) and the improvement of epidemiological surveillance, the incidence of this infection in Russia declined from 153 cases in 1995up to 1 in 1997. By the decision of the European Regional Certification Commission in 2002, the Russian Federation was granted the status of a territory free of poliomyelitis.

    Prior to switching to the use of inactivated polio vaccine, diseases caused by vaccine polioviruses( 1 to 11 cases per year) were registered in Russia, which usually resulted in the introduction of the first dose of live OPV.

    Diagnosis

    • Medical history and physical examination.

    • Blood tests.

    • Lumbar puncture( spinal puncture).

    Laboratory diagnostics. Only based on the results of virological and serological studies, it is possible to establish a definitive diagnosis in poliomyelitis.

    Virological examination of poliomyelitis in laboratories of regional centers for poliomyelitis / AFP epidemiological surveillance is subject to:

    - sick children under 15 with acute flaccid paralysis;

    - contact children and adults from poliomyelitis and AFP in the case of late( after the 14th day from the time of detection of paralysis) examination of the patient, and also in the presence of patients in the environment of patients from disadvantaged poliomyelitis territories, refugees and internally displaced persons);

    - children under the age of 5 years who have arrived during the last 1.5 months from the Chechen Republic, the Republic of Ingushetia and applied for medical assistance to treatment and prophylactic institutions, regardless of the profile( once).

    Patients with clinical signs of poliomyelitis or acute flaccid paralysis are subject to mandatory 2-fold virological examination. The first test feces take during the day from the moment of diagnosis, the second sample - in 24-48 hours. The optimum volume of feces is 8-10 g. The sample is placed in a sterile special plastic container. If the samples are shipped to the regional polio / AFP surveillance center within 72 hours from the date of sampling, the samples are placed in the refrigerator at a temperature of 0 to 8 ° C and transported to the laboratory at a temperature of 4 to 8 ° C( reverse coldchain).In cases where the delivery of material to the virological laboratory is planned to be carried out at a later date, the samples are frozen at -20 ° C and transported frozen.

    The frequency of virus isolation in the first two weeks is 80%, at 5 - 6th week - 25%.There was no permanent carrier. Of the cerebrospinal fluid, unlike Coxsackie and ECHO viruses, the polio virus is extremely rare.

    For lethal outcomes, the material is taken from the cervical and lumbar spinal cord, cerebellum and colon contents. With paralysis lasting 4-5 days - the virus from the spinal cord is difficult to isolate.

    Serological examination should include:

    - patients with suspected poliomyelitis;

    - children under the age of 5 years who arrived during the last 1.5 months from the Chechen Republic, the Republic of Ingushetia and applied for medical assistance to medical and preventive institutions, regardless of their profile( once).

    For serological examination, take two samples of the patient's blood( 5 ml each).The first test should be taken on the day of the initial diagnosis, the second - after 2-3 weeks. The blood is stored and transported at a temperature of 0 to +8 ° C.

    DSC reveals complement-binding antibodies to the N- and H-antigens of the poliovirus. In the early stages, only antibodies to H-antigen are detected, after 1-2 weeks - to H- and N-antigens, in those who have recovered - only N-antibodies.

    At the first infection with poliovirus, strictly type-specific complement-binding antibodies are formed. Upon subsequent infection with other types of poliovirus, antibodies are formed predominantly to the thermostable group antigens that are available in all types of polioviruses.

    PH reveals viral neutralizing antibodies in the early stages of the disease, it is possible to identify them at the stage of hospitalization of the patient. Viral neutralizing antibodies can be detected in urine.

    RP in the agar gel reveals precipitin. Type-specific precipitating antibodies can be detected during the recovery period, circulate for a long time. To confirm the growth of antibody titers, paired sera are examined at intervals of 3-4 weeks, serum dilution exceeding the previous 3-4 times or more is taken as a diagnostic increase. The most effective method is ELISA, which allows in a short time to determine the class-specific immune response. It is mandatory to carry out PCR in order to detect RNA viruses in some feces, cerebrospinal fluid.

    Symptoms of

    • Fever.

    • Headache and sore throat.

    • Fixed neck and back.

    • Nausea and vomiting.

    • Muscle pain, weakness, or spasms.

    • Difficulty in swallowing.

    • Constipation and retention of urine.

    • Swollen abdomen.

    • Irritability.

    • Extreme symptoms;muscle paralysis;difficulty breathing.

    Pathogenesis of .The entrance gates of infection in poliomyelitis are the mucosa of the gastrointestinal tract and upper respiratory tract. Reproduction of the virus occurs in the lymphatic formations of the posterior pharyngeal and intestinal walls.

    Overcoming the lymphatic barrier, the virus penetrates the bloodstream and is transmitted throughout the body. Fixation and multiplication of the causative agent of poliomyelitis occurs in many organs and tissues - lymph nodes, spleen, liver, lungs, heart muscle and, especially, in brown fat, which is a kind of virus depot.

    The penetration of the virus into the nervous system is possible through the endothelium of small vessels or along the peripheral nerves. Distribution within the nervous system occurs through the dendrites of the cells and, possibly, through the intercellular spaces. When the virus interacts with the cells of the nervous system, the most profound changes develop in motoneurons. The synthesis of polioviruses occurs in the cytoplasm of the cell and is accompanied by the suppression of the synthesis of DNA, RNA and host cell proteins. The latter dies at the same time. Within 1-2 days, the virus titer in the central nervous system increases, and then begins to fall and soon the virus disappears.

    Depending on the condition of the macroorganism, the properties and the dose of the pathogen, the pathological process may stop at any stage of viral aggression. In this case, various clinical forms of poliomyelitis are formed. Most infected children, due to the active reaction of the immune system, eliminate the virus from the body and recover. Thus, with an inpatient form, there is an alimentary phase of development without viremia and invasion of the central nervous system, in the abortive form - the alimentary and hematogenous phases. For clinical variants accompanied by defeat of the nervous system, a consistent development of all phases with motoneuron damage at different levels is characteristic.

    Pathomorphology of the .Morphologically for acute poliomyelitis, the most common lesion is the large motor cells located in the anterior horns of the spinal cord and the nuclei of the motor cranial nerves in the brainstem. In addition, the motor region of the cerebral cortex, the nucleus of the hypothalamus, and the reticular formation can be involved in the pathological process. In parallel with the damage to the spinal cord and the brain, the pathological process involves the soft meninges, in which acute inflammation develops. In this case, the quantity of lymphocytes and the protein content increase in the cerebrospinal fluid.

    Macroscopically, the spinal cord looks edematous, the boundary between gray and white matter is smeared, in severe cases, a graying of gray matter occurs in the transverse section.

    Microscopically, in addition to swollen or completely decayed cells, unchanged neurons occur. This "mosaic" lesion of nerve cells is clinically manifested by an asymmetric, erratic distribution of paresis and paralysis. On the site of the dead neurons, neuronophagic nodules are formed, followed by the growth of glial tissue.

    Classification of

    According to modern requirements, the standard definition of poliomyelitis and acute flaccid paralysis( ORP) is based on the results of clinical and virological diagnostics( Appendix 4 to Order No. M3 of the Russian Federation No. 24 of 25.01.99) and is presented as follows:

    - acute flaccid spinal paralysis,which isolated the "wild" poliomyelitis virus, is classified as acute paralytic poliomyelitis( according to ICD 10 revision A.80.1, A.80.2);

    - acute flaccid spinal paralysis that occurred not earlier than the 4th and not later than the 30th day after receiving a live poliomyelitis vaccine, in which a vaccine virus of poliomyelitis is isolated, is classified as acute paralytic poliomyelitis associated with the vaccine in the recipient( ICD 10 revisionA.80.0);

    - acute flaccid spinal paralysis that occurred not later than the 60th day after contact with the vaccine, in which a vaccine virus of poliomyelitis is isolated, is classified as acute paralytic poliomyelitis associated with the vaccine at the contact( according to ICD 10 revision A.80.0).Isolation of a vaccine-derived poliomyelitis virus in the absence of clinical manifestations is not diagnostic;

    - acute flaccid spinal paralysis, in which the test was not performed completely( virus not isolated) or not at all, but residual flaccid paralysis is observed by the 60th day from the time they occur, classified as acute paralytic poliomyelitis, unspecified( ICD 10 revisionA.80.3);

    - acute flaccid spinal paralysis, in which a complete adequate examination was performed, but the virus was not isolated and no diagnostic increase in antibodies was obtained, is classified as acute paralytic poliomyelitis of another, non-poliomyelitis etiology( ICD 10 revision A80.3).

    Isolation of a "wild" virus strain from a patient with catarrhal, diarrheal or meningeal syndromes without the appearance of flaccid paresis or paralysis is classified as acute non-paralytic poliomyelitis( A.80.4.)

    Acute flaccid spinal paralysis with the release of other neurotropic viruses( ECHO, Coxsackie, herpesvirus) refers to the diseases of another, non-polio etiology.

    All these diseases, based on the topical principle( defeat of the anterior horn of the spinal cord) appear under the general name "Acute polio".

    Poliomyelitis classification

    Forms of poliomyelitis Phases of development of the
    virus Without CNS damage
    1. Inpatient Alimentary phase of the virus development without viralemia and invasion of the central nervous system
    2. Abortive form Alimentary and hematogenous( viremia) phases
    Forms of poliomyelitis with CNS damage
    !.Non-paralytic or meningeal form Consistent development of all phases with CNS invasion, but subclinical lesion of
    motoneurons 2. Paralytic forms:

    a) spinal( up to 95%)( with cervical, thoracic, lumbar localization of the process, limited or widespread);

    b) pontine( up to 2%);

    c) bulbar( up to 4%);D) pontospinal;

    e) bulbospinal;

    e) pantobulbospinal

    Sequential development of all phases with motoneuron damage at different levels of

    The severity of the process distinguishes between light, moderate and severe forms of poliomyelitis. The course of the disease is always acute, and the nature can be smooth or nonsmooth, depending on the presence of complications( osteoporosis, fractures, urolithiasis, contracture, pneumonia, bedsores, asphyxia, etc.).

    Clinic .The duration of the incubation period for poliomyelitis is 5-35 days.

    The spinal form of poliomyelitis in children occurs more frequently than other paralytic forms. In this case, more often the pathological process develops at the level of lumbar thickening of the spinal cord.

    During the course of the illness, several periods are singled out, each of which has its own peculiarities.

    Preparalytic period is characterized by acute onset of the disease, worsening of the general condition, fever to febrile figures, headache, vomiting, lethargy, adynamia, meningeal signs. General infectious, cerebral and meningeal syndromes can be combined with catarrhal or dyspeptic phenomena. In addition, there are positive symptoms of tension, complaints of pain in the back, neck, limbs, tenderness in palpation of nerve trunks, fasciculation and horizontal nystagmus. Duration of the preparative period from 1 to 6 days.

    The paralytic period is marked by the appearance of flaccid paralysis or paresis of the muscles of the limbs and trunk. The main diagnostic features of this stage are:

    - flaccid paralysis and their sudden appearance;

    - rapid growth of motor disorders in a short time( 1-2 days);

    - affection of proximal muscle groups;

    - asymmetric nature of paralysis or paresis;

    - absence of sensitivity and pelvic function disorders.

    At this time, changes in cerebrospinal fluid occur in 80-90% of patients with poliomyelitis and indicate the development of serous inflammation in the soft meninges. With the development of the paralytic stage, general infectious symptoms fade. Depending on the number of affected segments of the spinal cord, the spinal form may be limited( monoparesis) or common. The most severe forms occur, accompanied by a violation of the innervation of the respiratory musculature.

    The recovery period is accompanied by the appearance of the first voluntary movements in the affected muscles and begins on the 7th-10th day after the onset of paralysis. With the death of 3/4 neurons responsible for the innervation of any muscle group, the lost functions are not restored. Over time, these muscles increase atrophy, there are contractures, ankylosis of the joints, osteoporosis, lagging behind the limb in growth. The recovery period is especially active during the first months of the disease, then it slows down somewhat, but lasts for 1 -2 years.

    If in 2 years the lost functions are not restored, then they speak about the period of residual phenomena( various deformations, contractures, etc.).

    Bulbar form of poliomyelitis is characterized by damage to the nuclei of 9, 10, 12 pairs of cranial nerves and is one of the most dangerous variants of the disease. At the same time there is a disorder of swallowing, phonation, pathological secretion of mucus in the upper respiratory tract. The localization of the process in the region of the medulla oblongata is especially dangerous, when, due to the defeat of the respiratory and cardiovascular centers, there is a threat to the life of the patient. Harbinger of an unfavorable outcome in this case is the occurrence of pathological respiration, cyanosis, hyperthermia, collapse, and consciousness disturbance. The defeat of 3, 4, 6 pairs of cranial nerves in poliomyelitis is possible, but is less common.

    The pontic form of poliomyelitis proceeds most easily, however, a cosmetic defect can persist in a child for life. The clinical characteristic of this form of the disease is the defeat of the nucleus of the facial nerve. At the same time, immobility of mimic muscles on the affected side occurs suddenly and lagophthalmus, Bell symptoms, "sails" appear, pulling the corner of the mouth to a healthy side during a smile or crying. The pontic form of poliomyelitis often occurs without raising body temperature, general infection symptoms, changes in cerebrospinal fluid.

    The meningeal form of poliomyelitis is accompanied by the defeat of the soft meninges. The disease begins acutely and is accompanied by deterioration of the general condition, fever to febrile figures, headache, vomiting, lethargy, adynamia, meningeal signs.

    Symptoms characteristic of the meningeal form of the polio are pain in the back, neck, extremities, positive symptoms of tension, tenderness in palpation of nerve trunks. In addition, fasciculations and horizontal nystagmus can be observed. On an electromyogram subclinical lesion of the anterior horns of the spinal cord is detected.

    When carrying out spinal puncture, the liquor usually flows out under pressure, transparent. His research reveals:

    - cell-protein dissociation;

    - lymphocytic pleocytosis( the number of cells increases to several hundred in 1 mm3);

    - normal or slightly increased protein content;

    - increased sugar content.

    The nature of changes in cerebrospinal fluid depends on the timing of the disease. So, the growth of the cytosis may be delayed and in the first 4-5 days from the onset of the disease the composition of the cerebrospinal fluid remains normal. In addition, sometimes, in the initial period there is a short-term predominance of neutrophils in the cerebrospinal fluid. After 2-3 weeks from the onset of the disease, protein-cell dissociation is detected. The course of the meningeal form of poliomyelitis is favorable and results in complete recovery.

    The inaparant form of poliomyelitis is characterized by the absence of clinical symptoms with simultaneous isolation of the "wild" strain of the virus from the feces and the diagnostic increase in the titre of antiviral antibodies in the serum.

    For the abortive form or small disease is characterized by an acute onset, the presence of general infectious symptoms without involvement in the pathological process of the nervous system. Thus, children may have fever, mild lethargy, decreased appetite, headache. Often, these symptoms are combined with catarrhal or dyspeptic phenomena, which is the basis for the erroneous diagnosis of acute respiratory viral or intestinal infections. Usually, the abortive form is diagnosed when the patient is hospitalized from the outbreak and positive virological examination results are obtained. The abortive form proceeds benignly and ends with complete recovery within a few days.

    The development of vaccine-associated poliomyelitis is associated with the use of live oral vaccine for mass immunization and the possibility of reversion of the neurotropic properties of individual clones of vaccine strains of viruses. In this regard, in 1964, the WHO Special Committee defined the criteria by which cases of paralytic poliomyelitis can be attributed to vaccine-associated:

    - onset of the disease not earlier than the 4th and not later than the 30th day after vaccination. For those who are in contact with the vaccinated, this period is extended to the 60th day;

    - development of flaccid paralysis and paresis without disturbance of sensitivity with persistent( after 2 months) residual events;

    - absence of disease progression;

    - the release of a similar antigenic characterization from the vaccine virus of poliomyelitis and at least 4-fold increase in type-specific antibodies.

    Treatment of

    • Rest in bed is necessary until symptoms subside.

    • Anesthetics may be used to reduce fever, pain and muscle spasms.

    • Your doctor may prescribe betanecol to fight urinary retention, and antibiotics to treat an associated bacterial urinary tract infection.

    • A urinary catheter, a thin tube connected to a urine collection bag, may be required if bladder control has been lost due to paralysis.

    • Artificial respiration may be required if breathing is difficult;in some cases, an operation to open the throat( tracheotomy) may be required.

    • Physiotherapy is necessary in cases of temporary or permanent paralysis. Mechanical devices such as bands, crutches, wheelchairs and special shoes can help walk.

    • A combination of professional and psychological therapy can help patients adapt to the limitations imposed by the disease.

    Treatment of poliomyelitis in an acute period should be etiotropic, pathogenetic and symptomatic.

    The development of clinical variants of poliomyelitis with the defeat of the nervous system requires mandatory, as early as possible hospitalization of the patient, ensuring thorough care and constant monitoring of vital vital functions. A strict orthopedic regimen should be observed. Affected limbs are given a physiological

    position with the help of gypsum langets, bandages. The diet should meet the child's age requirements in the main ingredients and provide for the exclusion of sharp, fatty, fried foods. Particular attention should be paid to feeding children with bulbar or bulbospinal forms, because of a violation of swallowing a real threat of the development of aspiration pneumonia. It is possible to avoid this terrible complication by probing the baby.

    With regard to drug treatment, the important point is the maximum limitation of intramuscular injections, which contribute to the deepening of neurological disorders.

    As an etiotropic agent for meningeal and paralytic forms, it is necessary to use antiviral drugs( plexonil, isoprinosine pranobex), interferons( viferon, roferon A, reaferon-EC-lipint, leukinferon) or inductors of the latter( neovir, cycloferon), immunoglobulins for intravenous administration.

    Pathogenetic therapy of acute period includes the inclusion in the complex therapy:

    - glucocorticoid hormones( dexamethasone) in severe forms for vital signs;

    - vasoactive neurometabolites( trental, actovegin, instenon);

    - nootropics( gliatilin, pyracetam, etc.);

    - vitamins( A, B1, B6, B12, C) and antioxidants( vitamin E, mexidol, mildronate, etc.);

    - diuretics( diacarb, triampur, furosemide) in combination with potassium-containing preparations;

    - infusion therapy for the purpose of detoxification( 5-10% solutions of glucose with electrolytes, albumin, infukola);

    - inhibitors of proteolytic enzymes( gordoks, amben, countercrack);

    - non-narcotic analgesics( with severe pain syndrome);

    - physiotherapy methods( paraffin or ozocerite applications on the affected limbs, UHF on the affected segments).

    The appearance of the first movements in affected muscular groups marks the onset of an early recovery period and is an indication for the appointment of anticholinesterase drugs( proserine, galantamine, ubretide, oxazil).As pain relief is used, exercise therapy, massage, UHF, electrophoresis, electromyostimulation with pulse current, hyperbaric oxygenation are used.

    After discharge from the infectious disease department, the course treatment with the medicines described above continues for 2 years. The optimal solution should be considered the treatment of convalescent poliomyelitis in specialized sanatoriums.

    It is not yet known whether an infection can be stopped if it has started. On the other hand, many infected children are not paralyzed. Many paralyzed for a time then completely recover. Most of those who are not completely recovering, achieve significant improvement.

    If after an acute phase of the disease slight paralysis is observed, the child should be under the constant supervision of a doctor. Treatment depends on many factors. At each stage the decision is made by the doctor, and there are no general rules. If paralysis persists, various operations are possible, restoring the mobility of members and preventing them from deforming.

    Prevention

    When there are cases of poliomyelitis in your district, parents start asking how to protect the baby. Your doctor who knows the local conditions will give you the best advice. It makes no sense to panic and deprive children of any contact with others. If there are cases of illness in your area, it is prudent to keep children away from crowds, especially in enclosed places, such as shops and cinemas, and away from the swimming pools that many people use. On the other hand, as far as we now know, it is not at all necessary to prohibit a child from meeting with close friends. If you will take care of it all your life, you will not even let me cross the street. Doctors suspect that hypothermia and fatigue increase susceptibility to this disease, but it is more reasonable to avoid both at any time. Of course, the most common case of hypothermia in the summer is when the child spends too much time in the water. When he begins to lose blush, he should be called out of the water - before his teeth clatter.
    • There are a number of vaccines that are recommended to be given at the age of two months, then again at four and 18 months, and also revaccinate when the child goes to school( between the ages of four and six).

    Immunization of children is the basis of a strategy for eradicating poliomyelitis, with vaccination coverage for routine immunization should be at least 95% among children of the decreed ages, in accordance with the Schedule of Prophylactic Inoculations.

    National immunization days are the second important component in the polio eradication strategy. The purpose of these campaigns is to stop circulating the "wild" poliovirus by immunizing as quickly as possible( within a week) all children belonging to the age group with the highest risk of the disease( usually children under three years old).

    In Russia, National Immunization Days against poliomyelitis with a coverage of about 4 million children under the age of 3 years( 99.2-99.5%) were conducted for 4 years( 1996-1999).Immunization was carried out in two rounds, with an interval of one month live oral poliomyelitis vaccine( OPV), with immunization coverage of at least 95% of the number of children of the specified age groups in the territory.

    The main preventive drug in our country and all over the world is the live Sabin vaccine( HIV), recommended by WHO.In addition, imported vaccines Imovax Polio( Sanofi Pasteur, France), Tetrakok( Sanofi Pasteur, France) have been registered in Russia. The Pentaxim vaccine( Sanofi Pasteur, France) is under registration. The vaccines listed are classified as inactivated by lyophilic vaccines. Vaccines are stored at a temperature of 2-8 ° C, for 6 months. The vial should be used within two working days.

    Currently OPV - oral types 1, 2 and 3( Russia), IPV - Imovax Polio - inactivated reinforced( types 1, 2, 3) and Pentaxim( Sanofi Pasteur, France) are used to immunize children against poliomyelitis.

    Vaccination begins at the age of 3 months three times with an interval of 6 weeks IPV, revaccination at 18 and 20 months, and at 14 years OPV.

    The dose of a live vaccine of domestic production - 4 drops per reception. It is administered by mouth an hour before meals. Drink, take food and drink within an hour after vaccination is not allowed. When regurgitation should give a second dose.

    Contraindications to vaccination of HPV are:

    - all types of immunodeficiency;

    - neurological disorders for previous vaccination with HPV;

    - the presence of acute diseases. In the latter case, the vaccination is performed immediately after recovery.

    Not severe diseases with a rise in body temperature to 38 ° C are not a contraindication for vaccination of HPV.In the presence of diarrhea, the vaccination is repeated after the normalization of the stool.

    Oral vaccine against poliomyelitis is considered to be the least reactogenic. However, when it is used, the possibility of an adverse postvaccinal event is not ruled out. The greatest degree of risk is observed with primary vaccination and with contact infection of non-immune children.

    To prevent the occurrence of vaccine-associated poliomyelitis in children, especially from at-risk groups( IDS, born from HIV-infected mothers, etc.), one can use inactivated poliomyelitis vaccine for initial vaccination or by conducting a full course of immunization.

    Additional immunization is provided for epidemics. It is carried out regardless of previous preventive vaccinations against poliomyelitis, but not earlier than 1 month after the last immunization. Children who are less than 5 years old( the age composition of children may be changed) who have been in epidemic outbreaks with poliomyelitis, diseases accompanied by acute flaccid paralysis, who are suspected of these diseases in the family, apartment, home, preschool and medical-prophylactic institution, as well as communicating with arrivals from polio-prone areas.

    Nonspecific prevention of poliomyelitis infection involves hospitalization and isolation of the patient, establishment of observation for 20 days for contact children under the age of 5 years. According to the epidemiological evidence, a single virological examination of the contact is carried out. In the epidemic focus of POLIO / ORP after the hospitalization of the patient, the final disinfection is carried out.

    • For adults, polio vaccination is recommended only before traveling to places where poliomyelitis is common.

    • Consult a doctor immediately if you or your child feel polio symptoms or if you may have been infected with a virus and have not yet been vaccinated.

    • Contact your doctor to get a polio vaccine if you have not been vaccinated and are about to travel where poliomyelitis often occurs.

    • Attention! Call an "ambulance" if someone experiences difficulty breathing or has limb paralysis.