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Poliomyelitis case confirmation: characteristics for use by national eradication programmes.

Abstract：

:Highly sensitive case definitions were first introduced by national poliomyelitis eradication programmes to avoid missing true cases of the disease, though false-positive diagnostic errors could still occur owing to low specificity. Extensive data from all 1620 cases of acute, flaccid paralysis reported in Brazil during 1987-88 provided an opportunity to study the characteristics of confirmed poliomyelitis cases and epidemiologically to evaluate potential case definitions that maximized both sensitivity and specificity. Cases that had been confirmed by wild poliomyelitis virus isolation were compared with those that had been rejected (non-polio cases). To guarantee the consistency of clinical, epidemiological and laboratory investigations, only cases less than 10 years of age that had been investigated within 15 days of the onset and with complete laboratory specimens were included. No single practical case definition combining both high sensitivity and high specificity emerged from the study. However, the results showed that poliomyelitis endemic countries with limited resources should give priority to the investigation of cases in less than 5-year-olds, cases with prodromal fever, cases without involvement in all four limbs, cases without progression greater than 3 days after the onset, and cases occurring in areas where poliomyelitis had recently been confirmed. In countries without laboratory resources, cases of acute, flaccid paralysis with initial involvement in one or both lower limbs and residual neurological sequelae at 60 days should be confirmed. Countries that are close to eradication may selectively reject any cases lacking laboratory confirmation, despite adequate specimen collection, if they do not have initial involvement in one or both lower limbs and residual neurological sequelae at 60 days. :In Sao Paulo, Brazil, physicians followed 85 full term, healthy, breast fed infants born between March 1986-September 1988 monthly for 1 year to compare their immunologic response to immunization with trivalent oral poliovirus vaccine (TOPV). They either received doses 1 day after birth and at 2, 4, and 9 months (group A) or at 2, 4, and 6 months (group B). They analyzed blood samples from the mother at childbirth, from the umbilical cord, and from the infant at 2, 4, 6, 9, and 12 months to measure poliovirus neutralizing antibodies. All but 1 infant had passively transferred antibodies at birth. Group A had higher polio antibodies during the 1st few months, greater seropositivity, and a lower proportion of susceptible infants than group B. In fact, at the end of 12 months, only 3.7% of infants in group A were susceptible to all 3 poliovirus types compared to 25.9% in group B. Seroconversion rates were considerably higher in group A infants from the 3rd dose forward (96.3-100%) than for those in group B (74.1-100%). The response for polioviruses 1 and 2 were essentially the same in both groups at 12 months (96.3-100%). The immunological response to poliovirus type 3 in group A was superior to that of group B at the end of 1 year (96.3% vs. 74.1%), however. Yet group B infants received their 1st dose of the vaccine at 2 months with a higher level of poliovirus 3 type (500,000 TCID50/dose) than group A infants received at birth (300,000 TCID50/dose). Thus immunization of newborns with TOPV provided more protection against polio than a higher vaccine concentration administered to infants beginning at months. This finding is especially relevant since polio type 3 was responsible for the polio outbreak in 1986 in northern Brazil.

journal_name

Bull World Health Organ

journal_title

Bulletin of the World Health Organization

authors

Biellik RJ,Bueno H,Olive JM,de Quadros C

subject

Has Abstract

pub_date

1992-01-01 00:00:00

pages

79-84

issue

eissn

0042-9686

issn

1564-0604

journal_volume

pub_type

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Poliomyelitis case confirmation: characteristics for use by national eradication programmes.