Thanks to the Global Polio Eradication Initiative (GPEI), led by governments and WHO, the dreaded disease polio has been stopped. But there are still countries in the world where the pathogen continues to infect people.

What kind of disease is polio? Why is there still a chance of catching this virus at this time? Do adults get this disease? Can a vaccinated person become infected with polio? Let's find out everything about this disease.

The causative agent of polio

The causative agent of polio, poliovirus hominis, was isolated in 1909 from the spinal cord of a sick person. The virus is highly resistant - it dies at room temperature only after 3 months, tolerates drying well, low temperatures, withstands the action of human digestive juices. Heating to 56 degrees and exposure disinfectants with ultraviolet it destroys it in half an hour.

What is the insidiousness of the polio pathogen? These are the duration of the period of virulence (the ability to infect) and the ease of transmission.

Routes of transmission of polio

How does polio spread? The disease is transmitted in two ways.

The predominant route of entry of the virus into the body is airborne. It settles in the area of ​​the lymph nodes of the pharynx and begins to multiply. This is a turning point in the onset of the disease.

In general, susceptibility to the polio pathogen is low. Among children infected with the virus, only 0.2–1% get sick. Until what age is the polio virus dangerous? The highest percentage of patients (80%) occurs between the ages of one and five years. Newborns rarely get sick. Older children often experience hidden forms diseases, as a result of which they receive lasting immunity and do not get sick again.

Clinical features

Symptoms of polio in children depend on protective factors in the region of the lymphopharyngeal ring and the amount of virus ingested. If the immune system is weak, the pathogen enters the bloodstream and viremia occurs. More often it strives for nerve cells. Although it can also affect other organs: lungs, bronchi, tonsils, heart.

The incubation period for polio is a minimum of five days, a maximum of up to a month, and an average of two weeks. The further course of the disease will depend on the person’s immunity. The virus can cause five different conditions.

Attention: yes characteristic features paralytic form of polio - the so-called tripod symptom - the patient cannot touch his knees with his lips. Sits, slightly leaning forward with emphasis on both hands.

Paralysis occurs suddenly, usually due to a drop in temperature. This is a period of mass death of nerve cells, often in the area of ​​the anterior horns of the spinal cord, less often in the cells of the brain stem and cerebellar nuclei. Complete paralysis is characterized by the death of a quarter or even a third of nerve cells. Muscle death occurs. The muscles of the legs and deltoid atrophy more often. Less commonly - the torso and respiratory muscle groups. The prognosis for the paralytic form is disappointing: the legs fail, the person is forever bedridden.

Death from polio is possible if the virus reaches the medulla oblongata. Here are located important centers life support. Deaths are more common in adults than in children. Also, the cause of death can be bacterial complications - severe pneumonia, sepsis. Up to 10% of those sick with the paralytic form die from paralysis of the respiratory muscles.

Complications after polio

The consequences of polio are the replacement of dead cells with another type of tissue (glial). A scar appears in their place. The absence of nerve cells leads to loss of vital functions. Depending on where it leaked inflammatory process, the following options are distinguished:

• spinal - flaccid paralysis of the limbs, neck, torso;
• bulbar - swallowing, speech, breathing are impaired - this is a very dangerous complication of polio;
• damage to the facial nerve;
• brain damage.

In many ways, the outcome of the disease is determined by the extent of the lesion, timely treatment and serious attitude to rehabilitation. If persistent paralysis develops, this can lead to disability.

Treatment of polio

All patients with suspected disease are hospitalized mandatory. To date, there are no specific drugs to treat polio. Antiviral agents are ineffective and antibiotics are useless. Treatment is limited to relieving symptoms during the acute period.

More time should be devoted to the rehabilitation period. First, in order to limit paralysis, physical activity is reduced to a minimum. Then, as recovery progresses, therapeutic exercises, electrical stimulation of paralyzed muscles, massage and hydrotherapy have a good effect. The goal of therapy: to develop and strengthen neighboring areas of the brain so that they take on some of the lost functions.

The following medications are appropriate during this period:

• stimulating the conduction of nerve impulses;
• trophic, to improve nutrition;
• hormones.

Preventive measures

If polio is suspected, the patient is immediately isolated, and everyone who came into contact with him is subject to observation for 21 days.

Of course, the best way to prevent polio is vaccination. To date, they have not yet come up with anything better than such prevention of polio.

Vaccination measures to prevent the disease are strictly mandatory. Vaccinations begin from the first months of a child’s life. It is included in the list of mandatory childhood vaccinations and is therefore free.

There are two types of vaccine:

• inactivated (IPV) with killed viruses - injection form;
• oral live vaccine(OPV) in the form of dragees or liquid solution.

Parents should know everything about the polio vaccine - when it is done, how to behave after it, what complications are possible.

Vaccination against polio

The first wave of vaccination takes place in three stages:

• at 3 months;
• at 4 months;
• at 5 months.

The next wave of vaccination occurs at 18 months, six years and ends at 14 years. The second wave of revaccination can be carried out in conjunction with vaccines against whooping cough, tetanus and diphtheria ().

What is the polio vaccine called?

Single-component vaccines:

• Russian polio vaccine types 1,2,3 (per os) - in the form of drops;
• French vaccine "Imovax Polio" - solution for intramuscular administration;
• Belgian inactivated vaccine "Poliorix" - intramuscular injection.

Multicomponent vaccines:

Within an hour after the administration of the live vaccine, you should not feed or water the child.

If we consider polio in adults, from the point of view of infection and complications, then the need for vaccination becomes obvious, because adults also suffer from this disease. For adults, vaccination is necessary if a person did not receive it in childhood and when traveling to hazardous areas. this disease: Pakistan, Afghanistan, etc. Revaccination is carried out every 5–10 years.

Thanks to universal vaccination efforts, polio is extremely rare in pregnant women. Previously, the incidence among pregnant women was high, the disease was more severe than in other people. There were frequent cases of spontaneous abortion. If intrauterine infection occurred, the fetus had various types of paralysis. The mortality rate for such children was close to 25%.

Let's summarize. Poliomyelitis affects the most vulnerable age of 4-5 year old children. When a child strives to know and explore everything. The death of nerve cells at this age will be difficult to restore even with the longest rehabilitation. The virus is also dangerous for adults. Medicines are useless during a polio outbreak, and each new case will contribute to the transmission of the virus. And as long as there is at least one infected child in the world, all children will be at risk of contracting polio, so the best way to prevent the disease is vaccination.

Poliomyelitis is an infectious inflammatory disease that affects the central nervous system. Breeds in motor neurons, which leads to their further death. The first signs in children appear in more late stages. Distributed throughout to the globe, children under seven years of age are more susceptible.

The main cause of polio in a child is the penetration of the poliovirus into the body. It quickly dies at high temperatures, ultraviolet irradiation and in environments with a minimum amount of liquid. The source of the pathogen is a sick person in an asymptomatic stage or a carrier. The route of entry is airborne droplets and when particles with the virus enter the mouth. The greatest peak in the spread of the disease occurs in late summer or autumn. The microorganism penetrates through lymphatic system into the blood and reaches the spinal cord, where important stages its development.

Factors predisposing to the occurrence of pathology are non-compliance with personal hygiene and insufficient control over the cleanliness of children’s hands and surrounding objects, large crowds of people, neglect specific prevention, reduced immunity due to congenital pathologies or acquired chronic infections.

Classification

According to the form, typical and atypical poliomyelitis are distinguished. The first occurs with damage to the central nervous system and includes the non-paralytic type (meningeal) and paralytic (spinal, bulbar, pontine and mixed). Atypical does not affect brain structures; it is divided into inapparatus and abortive types.

Meningeal poliomyelitis is similar to the picture of ordinary meningitis, affecting the gray matter of the brain to a greater extent.

Spinal, the most common type of disease, affects the gray matter of the spinal cord, namely those areas that are responsible for motor activity person. Paralysis of the muscles of the upper and lower extremities develops.

Bulbar poliomyelitis is a pathological process in the medulla oblongata.

Pontine type is characterized by damage to the nuclei of the facial nerve, which results in paralysis facial muscles.

The hardware form does not show itself enough for a long time, but the person becomes a carrier of the virus and is able to infect other people.

Abortive is the most dangerous in terms of epidemiology, since it has nonspecific symptoms, for example, disorders of the gastrointestinal tract, it is easily confused with any other infection, and the likelihood of infecting a healthy population increases significantly.

The pathology is divided into mild, moderate and severe poliomyelitis. The main criterion for making a diagnosis is the level of intoxication and the severity of dysfunction of the musculoskeletal system.

By nature, the disease is divided into groups with a smooth course and non-smooth course, which means the presence of complications and the addition of secondary pathogenic microflora.

Symptoms

Signs differ depending on the form and stage of development of the pathology. Highlight:

• incubation period;
• preparalytic period (initial stage);
• paralytic period;
• recovery period (convalescence period);
• period of residual effects.

The incubation period, depending on the state of the immune system of the body of children, passes differently. For some it may take only ten days, for others about a year or more. Sometimes, as in the case of innate polio, the disease does not go beyond the incubation period.

In the initial stage, it begins to form clinical picture. With polio, symptoms in children include stomach and intestinal disorders and the disease is more similar to either ARVI or poisoning. It all starts acutely, with a rapid increase in body temperature to 38.0-39.0°C. Accompanied by increased sweating, chills, and decreased appetite. Nausea and vomiting often occur, loose stool. The heart rate and breathing rate increases. The nervous system is gradually affected - the child is lethargic, weakened, and inactive. May complain of pain in the joints and muscles of the limbs, which intensifies when trying to stand up or roll over to the other side. Convulsions develop. Sometimes the muscles of the diaphragm are affected, which leads to complications in the form of difficult intermittent inhalation or exhalation. Next, urination disorders, skin rash or redness appear, especially in the joint area, and swelling of some parts of the body. The preparalytic period lasts about seven days.

The paralytic stage is characterized separately for each form of pathology and has its own characteristics.

Spinal shape

Body temperature declines, becoming either normal or subfebrile (37.0°C). Appear motor signs polio, the baby cannot sit or stand without additional support from his arms. Increased sweat production is preserved, which indicates a violation of the autonomic nervous system. The adductor, abductor, flexor and extension muscles of the arms and legs fail, paralysis and paresis are formed, and they differ in the depth of damage to the nervous tissue. Without proper tension, muscle fibers atrophy in the second or third week of the disease. The process is practically irreversible, the child remains disabled.

Bulbar and pontine form

The disease affects twelve pairs of cranial nerves, namely their nuclei located in the medulla oblongata of the brain. These departments are responsible for the main functions: sensory organs, movement of limbs, control of facial expressions, orientation in space, breathing, heartbeat, and so on. A more severe form of the disease, since the symptoms of polio in children are not limited to impaired muscle contraction. Affected cardiovascular system, arrhythmias, blockades of nerve impulses, increased or depressed heartbeat, and surges in blood pressure may develop. Shortness of breath appears, even to the point of suffocation. The amount of oxygen carried in the blood decreases, as evidenced by the bluish appearance of the skin. Babies are in a state of fear, anxiety, and constantly cry. The condition quickly worsens and occurs one by one. Likely death.

The pontine form is the so-called bulbar subtype, since the nuclei of the seventh pair of cranial nerves are affected. The face looks like a mask, without movement of facial muscles, the baby is unable to smile or express surprise or disappointment.

Meningeal form

The exact clinical picture of meningitis in the first stages of inflammation. Children are more likely to experience headaches and an inability to flex their spine. cervical spine due to spasm of the back muscles. Everything is accompanied by a prolonged fever, which can alternate with normal body temperature. By the fourth week, all symptoms disappear; if treatment is not timely, migraine is typical as a complication. rare case mental disorders.

Abortive and in-apparatus form

The inapparate form does not develop; the pathogen can only be identified during laboratory research.

The abortive form has the most favorable outcome, everything ends in complete recovery. The clinical picture does not develop beyond the preparalytic stage.

The recovery period lasts about one year. In addition to muscle atrophy, the development of osteoporosis and osteochondrosis is possible. The affected limb is stunted in growth, its functions do not return to their original healthy state.

Period of residual effects - final stage polio, where all the results of damage to the nervous tissue by the pathogen are visible. From time to time you may experience cramps and paresis, pain in the arms and legs, clubfoot and deformation of the feet.

Diagnostics

The diagnosis of poliomyelitis is made primarily on the basis of the patient’s complaints and an objective examination. The neurologist is obliged to check reflexes, sensitivity of the skin, if necessary, measure heart rate, blood pressure, and pay attention to the nature of breathing.

Standard directions for delivery are issued general analyzes blood, urine and feces. Sometimes the level of leukocytes increases, the erythrocyte sedimentation rate increases, which indicates inflammation. The microorganism can be detected in feces, but this entails some difficulties, since not all hospitals are equipped with certain equipment, and the methods of collecting and transporting biological material are constantly violated.

The main guideline for identifying the pathogen is the result of laboratory tests. A swab is taken from the mucous membrane of the mouth or nasopharynx and submitted to microscopic examination. Plays an important role in diagnosis enzyme immunoassay(ELISA) and complement fixation reaction (CFR). Both methods make it possible to determine the titer of antibodies in the patient’s blood serum. In case of any difficulties or doubts, it is possible to carry out a polymerase chain reaction (PCR), based on reading the genome of the pathogen.

It is used for differential diagnosis, in which liquor fluid flows through a tube under high pressure, from which one can judge the patient’s condition. It is practically not carried out in children.

Electromyography is a modern method that allows you to determine the activity of transmission of nerve impulses to muscle fibers and provides an accurate description of the state of the nervous system.

Treatment

Treatment of polio in children is carried out in inpatient conditions under the supervision of doctors. Complete rest, isolation from healthy people, diet with high content nutrients and strict bed rest. If you are unable to feed yourself little patient a feeding tube is inserted. In severe cases, artificial ventilation is necessary.

Therapy is mainly symptomatic and immunomodulatory. Taking B vitamins is important ascorbic acid in higher doses. At high temperatures, antipyretics (paracetamol), painkillers (ketorol, rarely analgin), and anti-inflammatory drugs (ibuprofen, aspirin) are recommended. If the child is hyperexcitable, sedatives (seduxen) are needed.

During the preparalytic period, it is important to restore circulating blood volume (CBV) and water-electrolyte balance. This is done using intravenous drip administration of glucose, solutions of potassium salts, sodium, calcium and other minerals.

During the recovery phase, physiotherapy, massage and physical therapy are indicated. Greatest effect provides UHF, electrical stimulation of the musculoskeletal system, warm salt baths and paraffin treatment of joints.

Atypical forms disappear without leaving a trace and do not require additional therapy.

IN at a young age, as the body grows, it is possible to straighten deformed limbs, treat scoliosis using plaster casts or surgery.

Rehabilitation after acute period takes about three years. Throughout the entire period, sick children should be examined by a neurologist, an orthopedist and a therapist.

Prevention

Now a specific one has been developed, based on the rules for routine immunization of children.

There are two types of vaccines. The first implies the presence of living, but weakened or damaged pathogens, while the second contains dead microorganisms. Greater preference is given to the live vaccine, since it more strongly stimulates the immune system, humoral mechanisms are activated, and antibodies appear in the blood.

Preventive measures are carried out starting from the age of three months. Three vaccinations are given at intervals of one month. Further, to maintain the immune status of children, it is necessary to be revaccinated at one and a half years, the next time at two years, and the last at six years. The main contraindications to immunization are weakened immunity due to a recently cured disease and a possible allergic reaction. In the first case, after the baby’s condition improves, it is recommended to get vaccinated.

Nonspecific prevention includes compliance with sanitary and hygienic standards and teaching children how to comply with them.

Poliomyelitis is an infectious disease that affects the nervous system. Mostly children are affected.

If the virus enters the central nervous system, it leads to the death of neurons and the child becomes disabled. The disease is hidden, asymptomatic, but highly contagious.

How does polio manifest itself in children, what are the symptoms at the onset of the disease, and what are the signs of pathology in children under one year old, 2 years old and older, and how to treat a dangerous disease? Find answers to these and other questions in our material.

What is it

Childhood polio is a viral disease The causative agent of which is poliovirus (a type of enterovirus).

The pathology is also called “infantile spinal paralysis”. According to ICD 10, the pathology has code A.80 - acute poliomyelitis.

The disease has been known since the times of Ancient Greece. Steles and drawings depicting people with twisted limbs have been discovered. Hippocrates has a description of the pathology.

In the 19th century, doctors believed that polio was a consequence of poor sanitation. But later these judgments were abandoned, as massive outbreaks of the virus were recorded, in which children from different walks of life were sick.

Many famous scientists began to study the disease: Yakov Heine, A. Ya. Kozhevnikov, K. Medina. The viral nature of the disease was revealed.

The polio vaccine began to be developed at the beginning of the 20th century by Konstantin Levatidi.

In the 40-50s. In the 20th century, the incidence of polio took on the scale of a national disaster. Thousands of children died from the disease and became disabled.

In the photo below you can see sick children with symptoms of polio:

Widespread use of the vaccine began in the mid-20th century, the number of cases was significantly reduced, and in the USSR, the disease was completely eliminated.

At first, a natural virus was used for vaccinations, and in 2002, its synthetic analogue was synthesized.

Currently, cases of the virus are emerging in countries in Asia and Africa due to lack of vaccinations.

Classification

In medicine, there are two types of diseases: acute and vaccine-associated.

Acute in severity has the following forms:

• Typical. The central nervous system is affected. It is divided into paralytic and non-paralytic types.
• Atypical. It occurs without damage to the central nervous system. It has inapparant and abortive forms.

Abortive flow is absent typical symptoms. There are signs characteristic of many diseases: weakness, gastrointestinal disorders, temperature.

This is the most unfavorable type of disease from an epidemiological point of view, since it is diagnosed late, and the child has time to infect others.

The non-paralytic form occurs as meningitis. In paralytic forms, the muscles of the legs, arms, and face are affected. The most dangerous thing is damage to the diaphragmatic muscle. It leads to respiratory arrest.

The paralytic form is of the following types:

• spinal (limbs, neck are paralyzed);
• bulbar (characterized by disturbances in swallowing, speech, and heart function);
• pontine (facial nerve paralysis, leading to loss of facial expressions or facial distortion);
• mixed (combines characteristics of all types of virus).

In terms of severity, the disease is classified into mild, moderate and severe. The course of the disease can be smooth or unsmooth, accompanied by complications and exacerbations of other diseases.

A separate group includes a vaccine-associated type of pathology, which is usually characteristic of unvaccinated children with immunodeficiency (HIV, AIDS).

Causes of illness in a child

The causative agent of polio- poliovirus from the enterovirus family of the picornavirus subgroup. There are three types of poliovirus, the most dangerous is the first.

It accounts for 85% of cases of the paralytic form of the disease. The virus is resistant to external influences, even to freezing and drying.

Remains viable for up to 100 days in water and up to 60 days in feces. Perishes under the influence of high temperatures, ultraviolet radiation and chlorine.

Children are very susceptible to the virus, especially babies from 3 months to a year. Newborn babies practically do not get sick, as they have placental immunity. You can become infected both from a sick person and from a virus carrier.

The disease is transmitted through household contact and by airborne droplets: through toys, dishes, food, unwashed hands. Sources of infection are any human biological fluids.

Reasons for the spread of polio:

• poor hand hygiene;
• unfavorable sanitary conditions;
• crowding of people;
• lack of vaccination.

First signs and symptoms, stages

Symptoms of the disease depend on the type of virus. In hardware form clinical manifestations are absent, the presence of the virus can be detected using laboratory tests.

Symptoms of the abortive type are similar to the clinical picture of other viral diseases:

• high temperature;
• headaches;
• abdominal pain;
• diarrhea;
• weakness.

Recovery occurs in 5-7 days, there are no signs of central nervous system damage.

The meningeal type occurs like meningitis and is accompanied by headaches, fever, and weakness of the neck muscles. The patient recovers in 3-4 weeks.

The paralytic form is the most severe. It has several stages:

• Pre-paralytic. General infectious symptoms are observed: fever, rhinitis, sore throat, tracheitis. Then pain in the limbs, spine, confusion, and convulsions are added.
• Paralytic. Comes in 3-6 days. The patient suddenly develops paralysis of the limbs with preservation of sensitivity. Paralysis is usually asymmetrical and uneven. The most dangerous are paresis of the diaphragm and respiratory muscles, leading to the death of the patient. After 14 days, muscle atrophy begins.
• Restorative. Tendon reflexes and motor functions are gradually restored. Some muscles are restored in a mosaic pattern, which leads to delayed limb growth and the development of osteoporosis (if bone tissue is damaged).
• Residual. Residual symptoms of the disease persist in the form of clubfoot, hallux valgus deformity foot, scoliosis, kyphosis.

Incubation period

The virus penetrates through the mucous membranes of the mouth, nose, and intestines, then it spreads throughout the body through the bloodstream.

In most cases immune system destroys pathogens.

A person is a virus carrier for 7 days, but does not get sick himself.

Approximately 2% of patients develop stage 2 disease.

The polyvirus penetrates the nervous tissue and causes the death of brain neurons. If 30% of neurons die, then paralysis, paresis, and muscle atrophy develop.

Defeats internal organs doesn't happen. A child who has recovered from the disease develops lifelong immunity.

Diagnosis in childhood

Making a diagnosis has great value because many viral diseases have a similar clinical picture. The primary diagnosis is made by a pediatrician and neurologist based on the patient’s complaints and external manifestations.

Diagnostic signs of the disease:

• Progressive paralysis, developing over several days.
• High temperature in the first days, then it normalizes.
• Asymmetrical descending paralysis.
• Weakness of the leg muscles.
• Decreased tendon reflexes.
• Back pain with preservation of sensitivity.

For differential diagnosis, the child is prescribed the following studies:

• ELISA - enzyme immunoassay of blood. Detects specific antibodies to the virus.
• PCR - polymerase chain reaction is prescribed to determine the type of virus.
• If there are difficulties with diagnosis, a lumbar puncture is performed. IN cerebrospinal fluid is discovered increased concentration protein and glucose.
• Electromyography helps determine damage to the anterior horns of the spinal cord.

How to treat: basic treatment methods

Treatment of childhood polio is carried out strictly in a hospital. There are no specific drugs against the virus. Therefore, therapy is symptomatic and restorative in nature.

To alleviate the patient's condition, the following medications are used:

• Painkillers (Analgin, Baralgin).
• Dehydrating agents (Furosemide, Ethocric acid). Restore osmotic pressure.
• Breath stimulants (analeptics). They influence the respiratory center of the brain, normalize the frequency and depth of breathing. This group includes: Etimizole, Cititon, Lobelin.
• Vitamins C, group B.

Bed rest and a high-calorie diet are required for the child. To prevent bedsores and deformities of the limbs, massage is performed.

If breathing is impaired, the patient is connected to a ventilator and parenteral nutrition is prescribed.

After the acute period is over, restorative procedures are carried out:

• UHF, paraffin therapy, electrical stimulation.
• Therapeutic exercise.
• Massage.
• Mud baths.

To prevent contracture from developing, the child is given plaster casts , it is recommended to wear orthopedic shoes.

For complications of the disease in the form of paresis and paralysis, it is used surgery: plastic surgery of tendons, joints, resection bone tissue, osteotomy.

Considering viral nature and the severity of the disease, traditional methods and home treatment are excluded.

Complications

If diagnosed light form disease, it goes away without a trace.

Paralytic types of the virus provoke serious complications:

• persistent irreversible paralysis;
• damage to bone tissue;
• curvature of the spine;
• lethal outcome.

Most of these patients remain disabled. Paralytic forms occur only in unvaccinated children.

Prevention

The only one preventative measure While vaccination remains according to the vaccination calendar.

Use live (Bivak Polio) and inactivated vaccines(Poliorix).

If a child is prone to allergies, it is better to use an inactivated vaccine.

You can give complex vaccines: Infarnix, Pentaxim.

If a child is suspected of having polio, he or she must be isolated. All contact with other children is stopped.

The premises and personal belongings are being disinfected.

Persons in contact with the sick person are being monitored dynamically.

All children attending kindergarten and school must be vaccinated against polio.

But not all parents consent to vaccination.

According to the law, lack of vaccination is not a basis for refusing to admit a child to child care institutions.

However, unvaccinated children are a potential risk for the spread of the disease.

Read more about whether you can get infected from vaccinated and unvaccinated children.

Find out even more useful information about polio and the vaccine against this dangerous disease from the video:

Childhood polio is deadly dangerous disease . It can make a child disabled for life.

To avoid danger, you should not refuse - it provides an almost one hundred percent guarantee of protection against disease.

(Heine-Medina disease, or epidemic infantile paralysis) - infectious disease, caused by the poliovirus with localization pathological process in the anterior horns of the spinal cord.

Poliomyelitis is: acute unspecified, acute non-paralytic, acute paralytic poliomyelitis, other and unspecified; acute paralytic caused by a wild natural virus; acute paralytic, caused by a wild introduced virus; vaccine-associated acute paralytic; acute polio.

Until recently, this disease was widespread throughout the planet. Both isolated, unrelated cases and epidemics have been recorded. Polio was a serious threat - especially to children.

After World War II, incidence rates increased: 71% in Sweden and 37.2% in the United States. In Russia, the rise was not so high, but still significant: in 1940 to 0.67% and in 1958 to 10.7%. In the fight against this serious illness made it possible to achieve the Salk vaccine and the live Sabin vaccine (abbreviated as LVS), which appeared in the late 50s and early 60s of the last century.

After Russia began vaccinating VDV, the incidence rate dropped by more than 100 times. Since 1997, no cases of polio caused by wild strains have been recorded in Russia. Thanks to universal vaccination, the disease was defeated.

The source and carrier of polio infection is humans. The virus is isolated from the nasopharynx and intestines, and therefore can be transmitted by airborne droplets or food. Despite the fact that the wild polio virus has been eradicated, vaccine strains are still active and are associated with 10-15 cases of polio throughout Russia every year.

Patients with erased or undeveloped forms of the disease are dangerous in terms of infecting others. The virus is excreted in the feces not only during the disease, but also after recovery - for several weeks or months. It can be detected in the nasopharynx after the onset of the disease (within 1-2 weeks), especially the first 3, 4 or 5 days. IN last days During the incubation period, patients are also “contagious.” The infection can be picked up through toys, unwashed hands, and contaminated foods.

Despite the fact that anyone can become infected with polio, children under 7 years of age are most susceptible to the disease. In the first 2-3 months of life, children practically do not suffer from this infection. After a person has suffered from the disease, stable humoral immunity appears and resistance of the cells of the intestinal mucosa to the homologous type of virus is noted. Recurrent illnesses almost never occur.

What provokes / Causes of Poliomyelitis in children:

Three types of viruses have been identified: Brunnhilde, Lansing, Leon, which differ in antigenic properties. Polioviruses belong to the picornavirus family, a genus of enteroviruses containing RNA.

The source of the spread of infection is sick and healthy carriers of the virus, who secrete the infection with nasopharyngeal and intestinal contents. The latter determines the possibility of alimentary and airborne transmission of infection. In the first 7-10 days of illness, the virus can be isolated from pharyngeal washings. Over a longer period (6 weeks, sometimes several months), the virus is isolated from fecal matter. The disease can be transmitted through dirty hands, food products, toys. There is evidence of the widespread distribution of enteroviruses, including polio, in the external environment and food.

Poliomyelitis is a seasonal infection, most often occurring in the summer-autumn period. Acute polio is different high level contagiousness (infectivity) can cover all segments of the population, but children under 7 years of age suffer the most (70-90%). The paralytic form of polio is rare.

Enteroviruses cannot be destroyed with the help of zymic therapeutic drugs and antibiotics. The virus is inactivated by formaldehyde or free residual chlorine (required concentration 0.3-0.5 mg/l). Also helps kill infection ultraviolet irradiation, drying, heating to a temperature of 50 ˚С. The virus can be stored frozen for many years. For example, in an ordinary household refrigerator it can live for 2-3 weeks or more. At room temperature, the virus remains active for several days.

Pathogenesis (what happens?) during Poliomyelitis in children:

The entry points for the virus are the upper respiratory tract and gastrointestinal tract. The virus multiplies in lymphatic structures back wall pharynx and intestines, then viremia occurs (the spread of the virus throughout the body through the bloodstream). During this period, the virus can be isolated from the patient's blood.

When the virus interacts with cells of the nervous system, the most intense changes are experienced by motor neurons, in which the process of neuronophagy occurs (destruction and removal of damaged or degeneratively changed nerve cells) is significantly expressed already at early stage diseases.

Virus penetration polio into the nervous system can occur in various ways: through the endothelium of small vessels, choroidal plexuses, ventricular ependyma.

Characteristic feature The poliomyelitis process is the uneven intensity of cell damage. The most profound changes occur in the area of ​​the anterior horns (especially in the lumbar segments). The process may involve the brain stem and pia mater. By the 6-8th day of illness, the increase in pathological changes usually ends. The severity of the course depends on the properties of the pathogen.

The course of the disease is influenced by the age of the patients: paralytic forms of polio are observed more often in older children and young people, they have a more common bulbar form. Injuries, surgical interventions, pregnancy, stress, and physical activity contribute to a more severe course of polio. It is believed that the administration of drugs or vaccines during the incubation period of poliomyelitis can serve as a provoking factor in the development of paralytic forms of poliomyelitis.

Symptoms of Poliomyelitis in children:

Highlight non-paralytic(asymptomatic, abortive, mepingeal) and paralytic forms of polio, which are characterized by the manifestation of different symptoms.

Non-paralytic forms

In-hardware, or asymptomatic, the form of polio is not clinically manifested. Children with the inapparant form are dangerous to others; they excrete the polio virus in their feces, and their blood contains high concentration specific antibodies. It should be emphasized that the frequency of the inapparent form is quite high.

Abortive form has a number of symptoms: acute onset with elevated temperature bodies, catarrhal phenomena, moderate headache. Gastrointestinal disorders (abdominal pain, nausea, frequent, loose stools) are often observed, especially in young children. This form proceeds favorably, usually after 3-7 days recovery occurs. It should be noted that the diagnosis of inapparant and abortive forms of polio is quite difficult and is carried out only on the basis of epidemiological and laboratory data.

Meningeal the form of polio occurs as serous meningitis: it has an acute onset, high body temperature, severe headache, and repeated vomiting. Patients have stiff neck muscles, Brudzinski's, Kernig's symptoms, spontaneous pain in the arms, legs and back, skin hyperesthesia, positive symptoms of tension in the roots and nerve trunks (Nery, Lasègue, Wasserman symptoms), pain on palpation along the nerve trunks, in some muscle groups may experience fasciculations (short-term involuntary contraction muscle fibers, which manifest themselves as subcutaneous flutter).

With a lumbar puncture, a clear, colorless fluid is usually obtained; the pressure may be increased, cytosis, and the amount of glucose in the cerebrospinal fluid may be increased. Course of the meningeal form polio usually favorable, recovery occurs after 3-4 weeks, normalization of cerebrospinal fluid begins in the 3rd week.

Paralytic forms

Among the paralytic forms of poliomyelitis, spinal, pontine, bulbar, and bulbospinal are distinguished.

Spinal The form of poliomyelitis is divided into 4 periods: preparalytic, paralytic, restorative, residual. The clinical picture of the disease develops after an incubation period that lasts 10 days. During this period, the polio virus is present in the body and can be detected in fecal matter before the first symptoms of the disease. The onset of the disease is acute, the temperature rises to 38-40 ° C, often with a twofold rise over the course of 5-7 days. Patients suffer from headaches frequent vomiting, pain in the limbs and back. Neurological symptoms often appear on the second rise in temperature: stiff neck (resistance to performing passive movements), positive Brudzinski, Ksrnig symptoms, tension in the roots and nerve trunks. Fasciculations may be observed in individual muscle groups, and sweating is pronounced. The duration of the preparalytic period is 6 days, but in some patients paralysis develops from a clear preparalytic period. Paralysis usually occurs at the end of the febrile period or in the first hours after the temperature drops. The spinal form can be localized in the cervical, thoracic, and lumbar regions, depending on which part of the spinal cord the motor cells of the anterior horns are affected. The paralysis is flaccid, marked by hypo- or areflexia; later, from the 2-3rd week, muscle atrophy occurs with a change in electrical excitability (degeneration reaction). The most severe forms are spinal, affecting the diaphragm and respiratory muscles. chest. Breathing falls on inhalation and rises on exhalation; auxiliary muscles are included in breathing. The duration of the period is several days, sometimes the increase in paralysis occurs within several hours, but it can take up to 2 weeks. The restoration processes of impaired functions begin in the 2nd and 3rd weeks. The most affected muscle groups are involved in the recovery process in more late dates, sometimes the pathological process does not reverse, and atrophy increases. Subsequently, joint contracture, trophic disorders, osteoporosis develop, and limbs may lag in growth. The recovery period usually lasts throughout the year, especially active in the first months of the disease, then a period of residual effects begins. In 80-90% of patients with the spinal form of acute polio, there are changes in the cerebrospinal fluid, initially the same as in the meningeal form, and then, in the 2-3rd week, protein-cell dissociation can be observed.

Pontine form of polio. The polio virus infects the nucleus of the facial nerve located in the pons. As a rule, one side suffers. The function of facial muscles is impaired. The eyelids stop closing, it is impossible to wrinkle the forehead or puff out the cheeks. The corner of the mouth becomes motionless, the brow reflex decreases or is lost.

Bulbar form Poliomyelitis occurs with damage to the nuclei of the IX, X, XII cranial nerves, which leads to disorders of swallowing, phonation, and pathological secretion of mucus. A sharp deterioration in the condition of patients is observed with damage to the respiratory and vasomotor centers with disruption of vital functions. Breathing becomes periodic and arrhythmic, then the function of the respiratory center fades, and vasomotor disorders develop. The patient's agitation gives way to somnolence, coma. If death does not occur, then after 2-3 days the process stabilizes, and in the 2-3rd week the recovery period begins.

With bulbospinal form polio The clinical picture shows a combination of bulbar symptoms with paresis and paralysis of the muscles of the trunk and limbs. A condition in which, along with damage to the respiratory center, paresis and paralysis of the respiratory muscles develops is especially dangerous for the patient’s life. When the nucleus of the facial nerve, located in the pons of the brain, is damaged, the pontine form develops. The latter is characterized by paralysis of facial muscles in the absence of lacrimation, taste disturbances, and impaired pain sensitivity. An increase in body temperature, the development of intoxication often does not occur, and there is a complete or partial loss of facial movements on one half of the face. The palpebral fissure does not close, the corner of the mouth is lowered. Sometimes there is a bilateral lesion with varying depths of disturbance of the facial muscles. During an epidemic, the initial formation of the process can develop in the pontospinal form, which is characterized by a severe course in combination with damage to the respiratory, vasomotor centers and paralysis of the respiratory muscles.

Diagnosis of Poliomyelitis in children:

It should be emphasized that for setting accurate diagnosis It is necessary to note not only the presence of the above-mentioned clinical symptoms, but also the results of laboratory tests.

Laboratory diagnostics polio includes virological(detection of virus in clinical biomaterial) and serological methods ( studying antibodies or antigens in blood serum) research. The virus is isolated in the first week of the disease from nasopharyngeal swabs and feces. Serological analysis is carried out 2 times with an interval of 2-3 weeks. A result with a 4-fold increase in antibody titer is considered diagnostically significant. In the peripheral blood of polio, there is usually moderate neutrophilic leukocytosis in the first days, then the levels normalize. Changes in the cerebrospinal fluid, characteristic of the meningeal and spinal forms, were noted above. In the pontine form, cerebrospinal fluid levels may remain within normal limits.

Depending on clinical form polio is carried out differential diagnosis(diagnosis of a person’s condition based on certain objective or subjective symptoms), for example, the meningeal form of polio is differentiated from other serous meningitis: mumps, enterovirus, tuberculosis, from which it differs by the presence pain syndrome, pain in the nerve trunks during palpation, symptoms of tension in the nerve trunks and roots.

Differential diagnosis spinal form of poliomyelitis is carried out with diseases of the osteoarticular system, myelitis, polyradiculoneuritis and poliomyelitis-like diseases. Pain during passive movements in the joints, lack of change in muscle tone and reflexes, normal indicators cerebrospinal fluid testify in favor of diseases of the osteoarticular system. With myelitis, central paralysis, pathological signs, conduction disturbances of sensitivity, and pelvic disorders are often observed.

Treatment of Poliomyelitis in children:

Treatment of acute polio in children determined by the period of the disease and the nature of the course. Compliance required bed rest sick, and during the period of increasing paralysis, absolute rest is necessary. For headaches and vomiting, dehydration therapy is performed. Important has the use of diacarb, which reduces the activity of carbonic anhydrase in the choroid plexuses of the ventricles of the brain and in brain neurons. Diacarb is prescribed orally (it is well absorbed into the intestines), 1 time per day, every other day, together with sodium bicarbonate. When prescribing Diacarb, severe hypokalemia may develop with general and muscle weakness, convulsions. calf muscles, cardiac dysfunction. Diacarb should not be taken concomitantly with potassium-sparing diuretics (amiloride and triamterene) due to possible severe systemic acidosis.

For meningoradicular syndrome, analgesics (analgin, etc.) and B vitamins are prescribed, vitamin B12 is of particular importance.

For menigoradicular syndrome, from the 2nd week of treatment, thermal procedures (paraffin, hot wrap) are prescribed. In the early recovery period UHF, diathermy, electrophoresis with novocaine, therapeutic exercises and massage are prescribed. During the period of increasing paralysis with the development of cerebral edema and collapse, corticosteroid hormones can be prescribed; Antibiotics are used only for bacterial complications. With the development of breathing disorders, the patient is transferred to artificial ventilation of the lungs (ALV); in case of bulbar paralysis, a tracheotomy is performed and, only after suctioning out the mucus from respiratory tract, use mechanical ventilation.

During the recovery period, drugs are used that improve neuromuscular transmission: galantamine, proserin, dibazol in successive courses for 3-4 weeks, administered 15-20 minutes before classes therapeutic exercises which is carried out taking into account the functional state of the muscles. After 6 months From the onset of the disease, resort treatment is possible: mud applications, sea bathing, baths. During the period of residual effects, if there is persistent paresis, bone deformities, prosthetics and orthopedic measures are carried out.

The prognosis for recovery depends on the type of polio and the nature of its course. When diagnosed with the meningeal form, the prognosis is favorable; with the paralytic form, 20-40% of patients can be restored. Bulbar, bulbospinal and spinal forms with respiratory failure can be fatal on the 3-6th day of the paralytic period. For the pontine form, the prognosis is favorable for life, but with residual effects.

Currently, the problem of progression of muscle disorders in patients with residual effects of poliomyelitis is of particular relevance. A peculiar clinical condition- post-polio syndrome (PPMS), which develops in some individuals many years after acute polio. PPMS is manifested by progressive weakness of both atrophic muscles and muscles that were not previously affected, muscle fatigue, paresthesia, muscle spasm, fasciculations; postpolio atrophy develops. Diagnosis and treatment of PPMS are under development.

Prevention of Poliomyelitis in children:

Prevention of polio includes isolating the patient for 3 weeks, monitoring contacts for 21 days, disinfecting the premises and belongings, and vaccination with a live vaccine. Administration of liquid trivalent (type I, II and III) vaccine is carried out at the ages of 2, 3, 5 months, 1 year; revaccination at 2 and 7 years.

The following vaccines have been registered and are being used in Russia:

• oral polio vaccine types I, II and III (OPV), made in Russia;
• Tetrakok company "Sapofi Pasteur", made in France;
• Imovax D.T. Full of Sapofi Pasteur, made in France.

Since 1997, thanks to universal prevention with vaccines, not a single strain of the polio virus has been isolated in Russia. That is why the WHO European Bureau has certified the country as one that has defeated polio.

I would like to dedicate my material to the problem of one of the serious illnesses, found in childhood. We're talking about polio. The relevance of the issue is due to the fact that in Russia cases of detection of this terrible disease. According to media reports, they were all brought from abroad, but, however, this does not make the problem any less.

The authority to monitor and register all cases of dangerous infections, including polio, belongs to World Organization health (WHO). They are also actively working to reduce morbidity and, if possible, completely eradicate diseases from the world. According to them, in Russia (until May 2010) the situation with polio was quite favorable and had the status of a polio-free country. Achieving this status was not easy. This required many years of mass vaccination and the work of many laboratories and groups of scientists. We won’t burden you with historical aspects, we’ll just find out why this disease is dangerous and why they are trying to destroy it on the territory of individual states and the world as a whole.

Poliomyelitis (polio (Greek) - gray, myelos - brain) is a disease caused by viruses. There are several types of them - the so-called enteroviruses, that is, intestinal viruses. They are very common and surrounding nature and can easily get to the child. In addition to polio, this group causes a lot of other diseases, such as hepatitis A, Coxsackie and ECHO viral infections.

However, polio of all of them leaves the most severe consequences for the future, characterized by inflammatory diseases mucous membrane of the oral cavity and intestines. But the most important thing is that polio very often affects the baby’s nervous system, causing flaccid or atrophic paralysis, making him disabled for the rest of his life. Probably the most famous example consequences of polio is the crippled President of the United States of America, Franklin Roosevelt. He was chained to wheelchair due to leg paralysis. During the pre-vaccination era, there were hundreds of thousands of such examples; polio was epidemic in nature and left behind thousands of crippled children.

What is the danger of these viruses? Firstly, these are viruses that feel very good in the external environment for about 3-4 months; they can remain active for a long time in wastewater and feces, on vegetables and fruits, in dairy products; at body temperature, viruses live and multiply up to six months. The only way to fight them is to treat them with high temperatures and disinfectants.

How can a child become infected with polio?

Most often, polio occurs in the warm season, because this time is the most optimal for the life and reproduction of viruses - they are warm and have a place to multiply. There are several ways to get the virus - it gets into the soil with feces and wastewater, which means it can get to the baby from dirty hands if the baby digs in the ground. A child can also get the virus through personal contact if there are virus carriers or sick people in the house. In modern conditions of vaccination coverage, this is unlikely, however, given the importation of polio into Russia from neighboring countries, it is not completely ruled out.

There is a food route. When consuming dairy products or fruits and vegetables contaminated with viruses. But the most main route of entry of the virus for children still remains the airborne route - when talking, sneezing, coughing, kissing, many viruses enter the air and the baby can inhale them and thus become infected. Children of any age, and even adults, can get sick. But still, polio is most dangerous for preschool children under 5-6 years of age, and it is especially dangerous for infants.

The polio virus multiplies on the baby's intestinal mucosa, then penetrates through the lymphatic vessels into the baby's intestines. intestinal lymph nodes and into the blood. It spreads through the blood to all organs and systems, mainly to spinal cord, affecting it at different levels and affecting the nerves that arise from it. The polio virus can also penetrate the brain.

Symptoms of polio.

During the course of polio, there are several stages that resemble many other diseases in nature, so it is very difficult to recognize immediately. This is the danger - patients are especially infectious already in the last days of the incubation period and the first days of the disease. And taking into account the child’s age and the child’s attendance at children’s groups, you can yourself assess the degree of danger, also taking into account the fact that many parents now often and, sometimes unreasonably, refuse to vaccinate their children.

The disease begins with an incubation period - during this period the child looks no different, he looks healthy, but the virus actively multiplies in his intestines. This stage usually lasts 10-12 days, decreasing to a minimum of 5 days or increasing to 35 days.

Next, the clinical picture of poliomyelitis itself develops. This is not always paralysis of the muscles of the limbs (“paralysis” from the Greek paralysis to relax) - a disorder of motor functions in the form of a complete absence of voluntary movements, due to a disruption in the transmission of nerve signals to the corresponding muscles.

Polio has several forms of the disease. In the best case, the disease will proceed like a severe acute respiratory viral infection or flu, it develops acutely and is manifested by severe headaches, vomiting, screaming and restlessness of the baby, high temperature. The second variant of the course may be a type of intestinal infection - with vomiting, diarrhea, fever and general malaise of the baby.

A meningeal variant of the course of the disease is possible - it develops as an acute respiratory disease, manifested by severe headaches. Vomiting, meningeal phenomena against the background of an increase in temperature to 39-40 degrees C. There may also be a two-wave course. During the first wave, the clinical picture of the disease is similar to ARVI, the temperature drops for 2-3 days. But after 2-5 days normal temperature a second wave of fever appears with the development of serous meningitis (non-purulent inflammation meninges), while the baby also experiences pain in the limbs, neck and back.

These are the so-called non-paralytic forms of polio.
The classic manifestation of polio is the paralytic variant. It is divided into several types, which we will describe in detail below. This disease occurs in stages, which significantly complicates the work of a pediatrician or pediatric infectious disease specialist in the matter of early diagnosis polio. There are preparalytic, paralytic, recovery and residual periods, or scientifically, residual.

Forms of paralytic poliomyelitis.

– spinal form. This is what classical sources describe – damage to the limbs with the development of paralysis. Usually, during the first 2-3 days, the disease manifests itself with general nonspecific manifestations - an increase in temperature accompanied by loose stools, a slight runny nose or redness of the throat. After about three days, headaches, vomiting, pain in the baby’s legs and arms, neck and back appear. If the baby is examined by a doctor at this moment, he will note the characteristic “meningeal symptoms” - the “tripod” symptom - the sick baby is forced to rely on outstretched arms when moving from a lying position to a sitting position and the “potty” symptom - the child sits on the potty only with support from floor with your hands behind your back. Disorders of the autonomic nervous system will also be noted - increased sweating, palpitations, decreased blood pressure, marbling of the skin, twitching of the neck and certain muscle groups of the child. This is the preparalytic period of polio.
It is followed by a paralytic period - it will continue from the moment of the appearance of paralysis (complete damage to a group of muscles of the limbs or other parts of the body) and paresis (partial restriction of muscle movement), and will end when signs of restoration of impaired functions appear. The main signs of polio infection are their sudden onset against the background of either sharp decline temperature. Or on a new wave of growth. The muscles of the baby’s legs and, less often, the arms and body fail; they have a symmetrical and “mosaic” arrangement; the muscles atrophy, but their structure is not damaged. Atrophy occurs at 2-3 weeks of the disease and gradually intensifies and progresses.
The recovery period for a baby can last approximately six months to a year. But if during this period there are no signs of recovery in the paralyzed muscles. Then the process is considered irreversible, and this already passes into the residual period and the child remains disabled.

Bulbar form - the virus affects the nuclei special departments brain - cranial nerves. Cranial nerves are highly specialized areas of the nervous system, there are 12 pairs of them, they differ in function - from the cells of the light receptors of the eye to the cells of the tongue that determine taste. These nerves often carry both sensory and motor signals and act without any input from the person. Cranial nerves exit directly from the brain, then travel to their destination organs.
This form The course is difficult, the preparalytic period in children is either very short or non-existent, the temperature rises, and disorders of swallowing, sound pronunciation, and speech appear. The child cannot eat normally, he constantly chokes, and liquid food gets into his nose. It is difficult for babies to cough up sputum, but the disease is most severe. when the brain stem, where the respiratory and vasomotor centers are located, is damaged, arrhythmias develop. Dyspnea. Increased blood pressure and blueness of the face and limbs. Kids are in a state of fear, crying, restless. The baby's condition may quickly deteriorate and a coma may develop.

Pontine form is special shape polio, when the seventh is specifically affected or in another way facial nerve. This is manifested by the baby’s inability to wrinkle his forehead, close his eye or bare his teeth.

The mixed form of polio is the most severe, because in addition to damage to the brain stem, where part of the cranial nerves are located, paresis and paralysis of the muscles of the limbs occur. This form leads to more deaths - the baby may develop respiratory arrest due to disruptions in the functioning of the respiratory center, which is located in the brain stem.

Do they write a lot in the press and on the Internet that polio can occur after vaccination? Is this true? All previously described types of polio develop when a child is infected with “wild” viruses. However, there is a so-called vaccine-associated polio (hereinafter VAP). Let us dwell on it separately, because it is precisely with this that many disputes and issues within the framework of vaccine prevention are associated.
VAP can only develop with live oral vaccination (i.e. administered by mouth) polio vaccine. These are droplets that drip into babies' mouths. When this vaccine is administered, the virus contained in the composition is activated in the intestines. The virus begins to multiply in the baby's intestines, causing activation immune defense and causing the formation of immunity, which neutralizes the introduced virus. This virus is weakened and does not harm children who receive vaccine drops.

But how then can VAPP develop? There can be two options: the first option is the development of polio in a child who at the time of vaccination had an immunodeficiency that had not previously manifested itself. Then the viruses, although weakened, can, in the absence of sufficient resistance from the immune system, reach the nervous system and cause paralysis. However, we immediately note the fact that immunodeficiencies are very rare in childhood, no more than 1 in 500,000 children. Therefore, the risk is minimal, and only when the oral vaccine is administered.
The second option is a spontaneous mutation of the virus introduced into the baby’s body and the emergence of aggressive properties in it, which will allow it to cause a polio clinic. But even if we assume that the virus undergoes mutation, not all people who become ill with the real virus develop paralysis; approximately 5-20% develop paralysis. From the above it follows that the risk of developing VAPP is less than 1 per million cases of oral polio vaccine.
Warning against the joyful exclamations of opponents of vaccination, I would immediately like to clarify some points. You might think from the previous words that if a child is not vaccinated, then the risk of VAPP is reduced to zero. But this is not so, dear parents, if your child communicates with children vaccinated with OPV, who release vaccine viruses, and from the vaccinated body they are released into the external environment and infect others. Actually, the vaccine was developed, among other things, with such an effect of indirect collective immunization and revaccination in mind. However, in this way the mutant virus can also enter the body of someone for whom OPV vaccination is contraindicated, i.e. children with immunodeficiencies, or those who have not yet been vaccinated or are not fully vaccinated (with the same OPV). And then the development of VAPP is possible according to the mechanisms described above.

How does VAPP occur? The disease can develop 4-6 days after the start of vaccination, but no later than 30 days from the date of vaccination. If the baby has been in contact with a baby vaccinated with the OPV vaccine, the time frame may extend to 60 days. The process begins with an increase in temperature, and by about the 20th day, first an increase in muscle tone develops, and then a rare decrease in muscle tone up to paralysis. Moreover, the sensitivity of the arms and legs does not suffer. But, in order to prove that this is vaccine-associated polio, it is necessary to isolate a virus from a sick baby, which will be similar in its properties to the vaccine that either the baby himself or those with whom he came into contact and presumably became infected were vaccinated.

How are sick people treated and what is done at the point of detection? At the slightest suspicion, and even more so if there are manifestations of any type of polio, the baby will be immediately placed in a separate boxed department of the infectious diseases hospital. And in the house where the sick person was identified, disinfection measures are carried out by specialists from the SES.
There are no specific anti-polio drugs - the baby is treated depending on the type of lesion and degree. The baby is discharged no earlier than 40 days from the moment of illness, or as it disappears clinical symptoms.
All children under 15 years of age who have been in contact with a sick child and adults, if they work in children's groups or food enterprises, are quarantined for 20 days from the moment of contact. All children who do not have vaccinations or who do not know how many and when they were are urgently vaccinated, and children under 4 years of age are also given immunoglobulin. Immunoglobulin is a drug made from the blood of a person who has been ill or vaccinated against a particular infection and has developed antibodies - protective proteins against the causative agent of infection.

Prevention of the disease is carried out through vaccination, carried out within the framework of the national vaccination calendar of Russia. Vaccination will be discussed in detail in a separate material.