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Differential Diagnosis of Acute Flaccid Paralysis and its Role in Poliomyelitis Surveillance

Centers for Disease Control and Prevention, National Immunization Program, Vaccine-Preventable Disease Eradication Division, Atlanta, GA, USA.
Epidemiologic Reviews (Impact Factor: 7.33). 02/2000; 22(2):298-316. DOI: 10.1093/oxfordjournals.epirev.a018041
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    • "spinal cord, and it may cause temporary or permanent damage of the nerve cells due to the inflammation process (Shibuya and Murray, 2004). According to Marx et al. (2000) as many as 1% of infected individuals develop paralytic disease. Polio usually affects children under 12 months of age (Ebnezar, 2003), but the probability of developing paralytic polio increases with age since paralysis in children occurs in 1/1000 cases, while in adults 1/75 may develop paralysis (Gawne and Halstead, 1995). "
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    ABSTRACT: Osteological changes consistent with neurogenic paralysis were observed in one male and one female skeleton recovered from two Croatian medieval sites – Virje and Zadar. Both skeletons display limb asymmetry typical of neurogenic paralysis that occurs during the childhood. The male skeleton displays atrophy and shortening of the right arm and the right femur, while the female skeleton exhibits identical changes on the right arm and both legs. Additionally, both skeletons exhibit scoliotic changes of the spine, and the female skeleton also displays bilateral hip dysplasia. Differential diagnosis included disorders such as cerebral palsy, poliomyelitis, cerebrovascular accident, and Rasmussen's encephalitis. These are the first cases of neurogenic paralysis (cerebral palsy and/or paralytic poliomyelitis) identified in Croatian archeological series. The Virje skeleton is only the third case of hemiplegia identified from archeological contexts (first with spinal scoliosis), while the Zadar skeleton represents the first case of triplegia reported in the paleopathological literature.
    07/2014; 7:25–32. DOI:10.1016/j.ijpp.2014.06.002
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    • "Most cases are due to enterovirus 39 No. 6 November 2008 70, enterovirus 71, coxsackie A7 and echoviruses (Solomon and Wilson, 2003). Many studies have found GBS to be a leading cause of AFP (Marx et al, 2000). Also known as Acute Inflammatory Demyelinating Polyneuropathy, GBS is an immunologically mediated para-infectious or post-infectious process causing damage to the lower motor neurons in the peripheral nerves or nerve roots. "
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    ABSTRACT: In 1992 surveillance of acute flaccid paralysis (AFP) cases was introduced in Malaysia along with the establishment of a national referral laboratory at the Institute for Medical Research. The objective of this study was to determine the incidence, viral etiology and clinical picture of AFP cases below 15 years of age, reported from 2002 to 2007. Six hundred seventy-eight of 688 reported cases were confirmed as AFP by expert review. The clinical presentation of acute flaccid paralysis in these cases was diverse, the most commonly reported being Guillian-Barre syndrome (32.3%). Sixty-nine viruses were isolated in this study. They were Sabin poliovirus (25), Echovirus (22), Cocksackie B (11), EV71 (5), Cocksackie A (1), and untypable (5). Malaysia has been confirmed as free from wild polio since the surveillance was established.
    The Southeast Asian journal of tropical medicine and public health 12/2008; 39(6):1033-9. · 0.55 Impact Factor
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    ABSTRACT: Routine and mass administration of oral polio vaccine (OPV) since 1961 has prevented many millions of cases of paralytic poliomyelitis. The public health value of this inexpensive and easily administered product has been extraordinary. Progress of the Global Polio Eradication Initiative has further defined the value of OPV as well as its risk through vaccine-associated paralytic poliomyelitis (VAPP) and vaccine-derived polioviruses (VDPV). Although both are rare, once wild poliovirus transmission has been interrupted by OPV, the only poliomyelitis due to poliovirus will be caused by OPV. Poliovirus will be eradicated only when OPV use is discontinued. This paradox provides a major incentive for eventually stopping polio immunization or replacing OPV, but it also introduces complexity into the process of identifying safe and scientifically sound strategies for doing so. The core post eradication immunization issues include the risk/benefits of continued OPV use, the extent of OPV replacement with IPV, possible strategies for discontinuing OPV, and the potential for development and licensure of a safe and effective replacement for OPV. Formulation of an informed post eradication immunization policy requires careful evaluation of polio epidemiology, surveillance capability, vaccine availability, laboratory containment, and the risks posed by the very tool responsible for successful interruption of wild poliovirus transmission.
    Reviews in Medical Virology 09/2003; 13(5):277-91. DOI:10.1002/rmv.401 · 5.76 Impact Factor
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