Relato de um caso de reação à vacina oral contra a poliomielite tratado com homeopatia / Report of a case of reaction to oral polio vaccine treated with homeopathy

Este estudo relata um caso de paresia flácida assimétrica após administração da vacina oral contra poliomielite, com acometimento do membro inferior esquerdo. A primeira dose de medicamento homeopático foi prescrita no 20º dia após o início dos sintomas. Evoluiu com desaparecimento da paresia e normalização do padrão de marcha nos 40 dias subsequentes. Pode-se considerar a homeopatia como escolha terapêutica em casos de paresias agudas. (AU)

We report a case of asymmetric flaccid paresis which developed following intake of oral polio vaccine affecting the left lower limb. Homeopathic treatment was started 20 days after the onset of symptoms. Paresis disappeared and the gait pattern became normal along the following 40 days. Homeopathy might be considered for treatment of acute paresis. (AU)

Double Whammy the Great Switch and a Complex Endgame

In 1988 the world health assembly resolved to eradicate poliomyelitis.The Live attenuated oral polio vaccine was the captain against the fight to eradicate poliomyelitis.It had indeed many advantages in the fight to eradicate polio.But despite its many advantages it has a risk for occurrence of rare cases of paralytic poliomyelitis among immunologically normal OPV recipients and additional risk of emergence of Vaccine derived polio virus(VDPVs).Poliovirus being an RNA virus are notorious for mutation.India is a polio free country since 2011 however endemicity of its neighbours are a detterent against dropping guard.This article reviews the introduction of Bivalent oral polio vaccine instead of trivalent oral polio vaccine and rationale of addition of Inactivated Polio vaccine on the road to the—Endgame Strategy

India’s Last Battle in the War Against Polio.

Type 2 vaccine virus is the predominant cause of Vaccine-derived poliovirus and Vaccine-associated paralytic poliomyelitis. Therefore, World Health Organization recommends global synchronized switching from trivalent to bivalent Oral polio vaccine. To prevent the risk of type 2 poliovirus re-emergence, atleast one dose of Inactivated polio vaccine is recommended at 14 weeks of age in routine immunization, before the switch. To protect immunocompromised children and those under 14 weeks of age, an additional dose must be given at 6 weeks of age. Mass campaigns of Injectable polio vaccine in states with poor Routine immunization coverage, before the trivalent to bivalent Oral polio vaccine switch, will reduce risk of Vaccine-derived poliovirus by covering all under-immunized pockets. The additional costs are justified as it is our ethical obligation to eliminate any iatrogenic risk.

Assessment of cold-chain maintenance in vaccine carriers during Pulse Polio National Immunization Day in a rural block of India.

India was certified polio free on 27 March 2014. Supplementary immunization activities, in the form of national immunization days, is one of the core strategies for eradication, where oral polio vaccine is administered to children aged under 5 years throughout the country. Oral polio vaccine is heat sensitive and requires maintenance of a stringent cold chain. Therefore, vaccine carriers with ice packs are used in the Pulse Polio Immunization (PPI) programme. This study assessed whether the cold chain is maintained during National Immunization Day in Beed district. A cross-sectional study was conducted at six randomly selected booths, one each from six primary health centres in Georai block of Beed district in Maharashtra. Electronic data loggers, configured to measure half-hourly temperatures, were kept in vaccine carriers throughout the day of PPI. The vaccine carrier temperature was below 8 °C at all six booths; minimum temperature recorded was –9.5 °C, while the maximum was 4.5 °C. The vaccine vial monitor did not reach discard point in any booth. A vaccine carrier with four ice packs very effectively maintains the cold chain required for oral polio vaccine.

Caution needed in using oral polio vaccine beyond the cold chain: Vaccine vial monitors may be unreliable at high temperatures.

Background & objectives: Stabilized live attenuated oral polio vaccine (OPV) is used to immunize children up to the age of five years to prevent poliomyelitis. It is strongly advised that the cold-chain should be maintained until the vaccine is administered. It is assumed, that vaccine vial monitors (VVMs) are reliable at all temperatures. VVMs are tested at 37°C and it is assumed that the labels reach discard point before vaccine potency drops to >0.6 log10. This study was undertaken to see if VVMs were reliable when exposed to high temperatures as can occur in field conditions in India. Methods: Vaccine vials with VVMs were incubated (10 vials for each temperature) in an incubator at different temperatures at 37, 41, 45 and 49.5°C. Time-lapse photographs of the VVMs on vials were taken hourly to look for their discard-point. Results: At 37 and 41°C the VVMs worked well. At 45°C, vaccine potency is known to drop to the discard level within 14 h whereas the VVM discard point was reached at 16 h. At 49.5°C the VVMs reached discard point at 9 h when these should have reached it at 3 h. Conclusion: Absolute reliance cannot be placed on VVM in situation where environmental temperatures are high. Caution is needed when using ‘outside the cold chain’ (OCC) protocols.

Polio / Polio

Polio continúa endémica en: Nigeria, Afganistán Pakistán e India. La iniciativa global de erradicación de polio de la OMS estableció que para 2013 no debe haber ningún niño paralítico en el mundo por el virus salvaje o por el virus derivado de la vacuna. En esta revisión se describen ambas vacunas contra el polio, la oral y la inactivada, su inmunogenicidad, seguridad y las condiciones a cumplir por un paíspara que cambie su esquema de vacunación de polio oral a inactivada. La vacuna polio oral ha permitido la erradicación de la enfermedaden varios continentes incluyendo América; sin embargo conlleva riesgos, tales como polio paralítica asociada a vacuna (VAP-siglas en inglés-) y parálisis producida por polio virus derivado de la vacuna (VDP-siglas en inglés-). La Vacuna Polio Inactivada (VPI) es segura e inmunogénica, puede ser administrada en combinaciones vacunales. Para que un país cambie a VPI debe tener cobertura y esquemaóptimo de esta vacuna, 90% de, cobertura de DTP3, vigilancia adecuada de parálisis flácida, no estar próximo en la actualidad o recientemente a un país con polio endémico. Altas coberturas vacunales son esenciales par asegurar una inmunidad adecuada de lapoblación

Polio remains endemic in Nigeria, Afghanistan, Pakistan, India. Strategic plan of Global Poliomyelitis Eradication Initiative (GPEI) of the WHO is that by 2013 no child will be paralyzed by a wild or vaccine derived poliovirus. This paper describes both oral and inactivated vaccine, safety concerns with the use of OPV, immunogenicity of IPV and the conditions to be full filled in order for a country to deliverIPV as a regular vaccine schedule. Oral polio vaccine has successfully contributed to global polio eradication in several continents including America. However, it carries risks, such as Vaccine Derived Poliovirus (VDP) and Vaccine Associated Paralytic Polio (VAPP). Inactivated Poliovirus Vaccine (IPV) is safe and immunogenic; it may be administered as monovalent or in a combined shot. Countries opting to switch from OPV to IPV should have: optimal IPV coverage and schedule, 90% of DTP 3 coverage, good surveillance of flaccid paralysis cases, and should not be near a country with endemic polio recently or at the present time. Are neither currently or were notrecently polio endemic nor has close contacts with such areas. High immunization coverage is essential to ensure adequate populationimmunity

Eradicating Polio: It's Feasibility in Near Future.

Continuous wild poliovirus transmission despite 12 years of intensive surveillance has raised serious questions about the feasibility of polio eradication programme with current strategy in near future. At present most of the cases are confined to four endemic countries, which are causing sporadic outbreaks in non-endemic areas. India has experienced a significant increase in number of cases reported in 2006 compared to previous year. Outbreaks originated in western UP which was due to the accumulation of susceptibles between the last outbreak in 2002 and early 2006. Substantial improvement has been observed in strategies of polio eradication but still there are gaps in the programme implementation which needs immediate attention so that goal of polio eradication can be achieved at the earliest opportunity. Even though there are many issues but there are also many factors, which favour polio eradication. These factors include new tool in form of m OPV, natural immunity due to recent outbreak, limiting international spread of polio, new researches to guide programme in right direction, political commitments from endemic countries, etc. 2008 presents the best opportunity ever to interrupt wild polio virus transmission which will lead to global eradication of Polio. Since global eradication is within sight, it is scientifically possible to eradicate the disease in near future.