POLIOVIRUS INFECTION, PARALYTIC

Wisconsin Division of Public Health Disease Surveillance Manual (EpiNet, February 2005)

I. IDENTIFICATION

A. CLINICAL DESCRIPTION: Acute onset of flaccid paralysis of one or more limbs with decreased or absent tendon flexes in the affected limbs, without other apparent cause, and without sensory or cognitive loss (as reported by a physician).

B. REPORTING CRITERIA: Clinical diagnosis.

C. LABORATORY CRITERIA FOR CONFIRMATION:

• Isolation of poliovirus from stool samples, CSF or oropharyngeal secretions in cell culture systems.
• Presumptive diagnosis may be made by fourfold or greater changes in neutralizing antibody level.

D. WISCONSIN CASE DEFINITION: A case that meets the clinical description and in which the patient has a neurologic deficit 60 days after onset of initial symptoms, has died, or has unknown follow-up status.

NOTE: All suspected cases of paralytic poliomyelitis are reviewed by a panel of expert consultants before final classification occurs.

II. ACTIONS REQUIRED / PREVENTION MEASURES

A. WISCONSIN DISEASE SURVEILLANCE CATEGORY I: Report IMMEDIATELY BY TELEPHONE to the patient's local health officer upon identification of a case or suspected case. Complete and mail an Acute and Communicable Disease Case Report (DPH 4151) to the local health officer within 24 hours.

B. EPIDEMIOLOGY REPORTS REQUESTED:

• Acute and Communicable Diseases Case Report (DPH 4151).
• Suspected Polio Case Worksheet (CDC 1168p 0000A ).

C. PREVENTION MEASURES:

• Routine vaccination with inactivated polio vaccine is recommended at 2,4,6-18 months and 4-6 years of age.
• Polio vaccine is recommended at 2, 4, 12-18 months and 4-6 years of age. Recommended sequential series consists of two doses of Inactivated Polio Vaccine (IPV) at 2 and 4 months, and two doses of OPV at 12-18 months and 4-6 years of age. Alternate schedules using all OPV or all IPV are also acceptable.
• Polio vaccine recommended for previously non-immunized adults traveling to polio-endemic countries; members of communities in which poliovirus is present; laboratory workers handling specimens containing poliovirus; and health care workers who may be exposed to patients excreting wild-type poliovirus.

D. PUBLIC HEALTH INTERVENTIONS:

• Immediately notify Regional Immunization Program Representative.
• Actively search for other cases that may have been initially diagnosed as Guillian-Barre Syndrome, polyneuritis, transverse myelitis, etc.
• If evidence suggests transmission of wild poliovirus, provide Oral Polio Vaccine (OPV) within the epidemic area to all persons, except those for whom OPV is contraindicated because of immunodeficiency, regardless of previous OPV vaccination status.
• If evidence suggests vaccine-associated poliovirus, no vaccination plan need be developed because no outbreaks associated with vaccine-associated poliovirus strains have been documented in the US to date.

III. CONTACTS FOR CONSULTATION

A. BCDP / IMMUNIZATION PROGRAM: (608) 266-3031.

B. REGIONAL STAFF: See Epinet Introduction: “REGIONAL OFFICE CONTACTS”.

C. WSLH / VIROLOGY: (608) 262-1021.

 

 IV. RELATED REFERENCES

1. Heymann DL, ed. POLIOMYELITIS, ACUTE. Control of Communicable Diseases Manual. 18 th ed. Washington , DC : American Public Health Association, 2004:425-432.

2. Pickering LK, ed. Poliovirus Infections. In: Red Book: 2003 Report of the Committee on Infectious Diseases. 26 th ed. Elk Grove Village , IL : American Academy of Pediatrics, 2003:505-509.

3. Poliomyelitis Prevention in the United States , MMWR 2000; 49 (RR-05):1-22..

 IV. DISEASE TRENDS

The Western Hemisphere was certified as free of indigenous wild poliovirus in 1994. In Wisconsin , the last three cases of wild virus-associated poliovirus were reported in 1979; the last case of vaccine-associated paralytic poliomyelitis was reported in 1988.