Polio (Children's spinal paralysis, Heine-Medina disease) - an acute and severe infectious disease which caused by poliovirus that affects the gray matter of the spinal cord anterior horn and other parts of central nervous system.
Polio mainly affects children and adolescents. Risk of the disease is the development of paralysis.
Vaccination against polio
Specific prevention - is vaccination against poliomyelitis. There are 2 types of polio vaccine:
- Sebino live vaccine (OPV - contains live attenuated viruses)
- inactivated (IPV - contains all three poliovirus serotypes killed with formalin).
vaccine OPV
OPV vaccinations conducted children starting at 2 months of age, 2-4 by instillation of drops (in Depending on the concentration of the vaccine) in lymphoid tissue in the throat and tonsil infants surface at older children.
The first vaccination is 3, 4, 5 and 6 months, and then required revaccination at 18, 20 months and 14 years.
After vaccination, OPV child for an hour can not feed and water as food and water will wash off in the vaccine stomach. If a child srygnul, vaccination should be repeated (for the same reason).
Before vaccination and immediately after it can not be administered in the child's diet, new products, as may cause allergic reactions, mistakenly taken for the side effects of the vaccine.
On the eve before vaccination should make sure you have antipyretic and anti-allergy drugs in the home medicine cabinet.
Precautions after vaccination with OPV not kiss the child on the mouth and wash your hands after cleaning the baby.
Contraindications for vaccination OPV:
- children with congenital immunodeficiency or HIV (also impossible, if family members have the same problem);
- the presence of pregnant women surrounded the child;
- pregnant or planning it;
- breast-feeding;
- an unusual reaction to a previous vaccination;
- allergy to neomycin, streptomycin and polymyxin B (included in the vaccine);
- acute infectious diseases (vaccination after recovery).
IPV vaccine
IPV vaccination is carried out
- children (weakened with pregnant mother and / or bowel disorders)
- adults (health care workers who have close contact with patients, a trip to endemic areas, unvaccinated people).
IPV is injected subcutaneously or intramuscularly:
- children: the primary vaccination at 2, then 4 months, then a booster dose 6-18 months and 4-6 years;
- adults: first vaccination (0.5 ml) was repeated after 4-8 weeks, and the third dose after 6-12 months.
Side effects of the vaccination:
Possible side effects that do not require emergency medical attention:
- nervousness,
- raising the temperature to 38,5 ° C,
- swelling,
- pain at the injection site,
- nausea, vomiting or diarrhea single.
Seek immediate medical attention if:
- adynamic and listless child;
- labored breathing, shortness of breath;
- temperature above 39C .;
- convulsions;
- hivesItching;
- drowsiness;
- swelling of the face, eyes;
- difficulty swallowing.
After vaccination IPV walks and bathing the child is not prohibited.
Refusal of vaccination
First of all unvaccinated people polio threatens with all its consequences.
In addition, in case of failure to vaccinate them prohibit travel to countries requiring vaccination polio and temporarily (for the period of the epidemic) do not take a job in education and health institutions.
types of infections
There are the following forms of poliomyelitis:
Type:
1. Typical polio CNS:
- nonparalytic: meningeal and abortive;
- Nerve: Spinal and bulbar;
2. Atypical forms - worn and asymptomatic.
3. Severity:
- easy;
- average weight;
- heavy.
In order to establish the severity of intoxication and estimated severity of motor disorders.
4. The nature:
- for smooth (without complications);
- During non-smooth (with complications accession secondary infection, with acute exacerbation of chronic diseases).
symptoms
The incubation period lasts 8-12 days, but can vary from 5 to 35 days.
Acute polio occurs in different clinical forms of the disease and the symptoms presented by the following syndromes:
- intoxication syndrome;
- catarrhal symptoms syndrome;
- syndrome of gastrointestinal tract disorders;
- syndrome of neurological disorders.
Polio preparaliticheskoy begins with the steps of:
- sudden onset of fever,
- the appearance of the common cold, sore throat, cough,
- as well as diarrhea or constipation,
- abdominal pain, vomiting.
neurological disorders syndrome is characterized by
- headache,
- lethargy, fatigue,
- increased sensitivity of the skin,
- drowsiness,
- tremor,
- convulsions,
- pain in the spine and extremities.
This phase lasts for 5 days. Then, the disease becomes paralytic stage:
- reduced temperature,
- muscle aches disappear,
- paresis and paralysis occur.
Most often, the process involved the lower limbs, at least the torso muscles, abdominal, respiratory muscles.
7-14 days develop muscle atrophy and joint sprains.
Regenerative stage lasts 4-6 months, then the healing process is slowed down, thus remain contractures and muscle atrophy (muscle contraction).
Residual effects or residual stage characterized by persistent paralysis, contractures, deformation and shortening of limbs, curvature of the spine. Residual effects lead to lifelong disability.
During outbreaks of poliomyelitis mortality reaches 2-5% of patients of respiratory failure due to paralysis of the respiratory muscles.
Diagnostics
When the diagnosis must take into account the clinical and epidemiological, serological and virological data:
- spinal tap (cerebral spinal fluid pressure is increased, leukocytes - neutrophil, Increased protein content);
- complete blood count (signs of inflammation: leukocytosis, increased erythrocyte sedimentation rate);
- swabs from the throat and culture on a nutrient medium;
- analysis of feces with the sowing;
- blood cultures and CSF to the culture medium;
- determination of antibodies in blood serum (not less than four-fold increase in antibody titer in paired sera taken during the acute stage of disease and after 1 - 3 weeks);
- electroencephalogram and MRI (give nonspecific findings and have only a relative value for the diagnosis).
polio treatment
Polio Treatment is an infectious disease physician in a hospital.
Patients are isolated in a box for 40 days.
Specific treatment against the disease does not exist -
- being symptomatic therapy (antipyretics, analgesics, sedatives)
- assigned gammaglobulin and vitamin (vitamin C, B1, B12, B6), amino acids.
The patients in the acute stage of the disease is shown strict bed rest (2-3 weeks). Paralysis of respiratory muscles - mechanical ventilation.
Special attention should be paralyzed limbs. The provisions of the feet, hands and spine must be correct. Feet are placed parallel, slightly bending the knee and hip joints using a padded roller. The feet should be perpendicular to the tibia (they were fixed by putting a thick cushion under the sole). Hand plant in hand and bend the elbow at an angle of 90 °.
To improve the neuromuscular conduction designate Neostigmine, neuromidin, Dibazolum. Treatment in the infectious department takes 3-4 weeks.
Reductive treatment starts and continues in a hospital outpatient. Appointed physiotherapy, classes with an orthopedist, hydrotherapy (exercises under water), physiotherapy (UHF, electrostimulation, attachment of hot moist compresses diseased muscles). Subsequently shown sanatorium treatment (sea, sulfur baths, mud).
complications
Polio can cause the development of respiratory and circulatory failure due to paralysis of the intercostal and diaphragmatic muscles. Therefore, patients should be to conduct monitoring of vital functions. Possible death due to respiratory muscle paralysis.
After vaccination against poliomyelitis may develop (rarely) vaccine-associated poliomyelitis.
Causes
Polio is a three poliovirus types. The source of infection are patients and virus carriers.
The virus is transmitted by the fecal-oral and airborne paths.
In tropical countries, cases are recorded throughout the year in temperate climates often in summer and autumn.
Factors contributing to the spread of the virus:
- failure to comply with rules of personal hygiene (dirty hands);
- poor removal of excrement;
- poor sanitation;
- contaminated food (unwashed vegetables and fruit) and water (including bathing in polluted waters);
- houseflies.
The prognosis for the treatment of polio
Weather favorable with non-paralytic poliomyelitis.
After paralytic poliomyelitis formed contractures, muscle atrophy, limb paresis (disability).
