Prevalence of neutralizing antibodies against poliovirus 1, 2, and 3 in healthcare professionals aged 20-50 years / Prevalência de anticorpos neutralizantes contra poliovírus 1, 2 e 3 em profissionais de saúde de 20 a 50 anos de idade

ABSTRACT Objective: To describe the prevalence of neutralizing antibodies against poliovirus (PV1, PV2, and PV3) in blood samples of healthcare professionals aged 20 to 50 years. Methods: Health professionals who serve children at Darcy Vargas Children's Hospital and the Department of Pediatrics of Irmandade da Santa Casa de São Paulo. The sample size was calculated at 323 participants. The Mantel-Haenszel chi-square was used to verify differences between groups. The neutralization reaction detected human poliovirus antibodies. For susceptible individuals, vaccination with the inactivated+triple acellular polio vaccine was performed, and neutralizing antibodies were re-dosed after one week. Results: 333 professionals were studied - 92.8% were immune to poliovirus 1, 86.5% to poliovirus 2, and 63.3% to poliovirus 3; 37% had titers less than 1:8 for any serotype, 5;1% had titers below 1:8 for all three. Vaccination with inactivated polio vaccine was performed for susceptible participants, and neutralizing antibodies were dosed after one week, showing increased titers for all polioviruses. Conclusions: Despite the detection of a significant percentage of individuals with low poliovirus antibody titer, the challenge with vaccination demonstrated immune response compatible with poliovirus immunity.

RESUMO Objetivo: Descrever a prevalência de anticorpos neutralizantes contra poliovírus (tipos 1, 2 e 3) em amostra de sangue de profissionais de saúde com idade de 20 a 50 anos. Métodos: Profissionais de saúde que atendem crianças do Hospital Infantil Darcy Vargas e do Departamento de Pediatria da Irmandade da Santa Casa de São Paulo. O tamanho da amostra foi de 323 participantes. Os anticorpos contra poliovírus humanos foram detectados pela reação de neutralização. Para os indivíduos suscetíveis, foram administradas vacina para poliomielite inativada+tríplice e nova dosagem de anticorpos neutralizantes após uma semana. Utilizou-se o teste do qui-quadrado de Mantel-Haenszel para verificar as diferenças entre os grupos. Resultados: Foram estudados 333 profissionais - 92,8% eram imunes ao poliovírus 1; 86,5%, ao poliovírus 2; 63,57%, ao poliovírus 3; 37% apresentaram títulos inferiores a 1:8 para qualquer sorotipo; 5,1% tinham títulos abaixo de 1:8 para os três. Após a vacinação dos suscetíveis, houve elevação dos títulos para todos os poliovírus. Conclusões: Apesar da detecção de percentual significativo de indivíduos com baixo título de anticorpos para poliovírus, o desafio da vacinação demonstrou resposta imune robusta compatível.

Estado actual de la poliomielitis en Latinoamérica

Resumen La vacuna oral contra el poliovirus (OPV) ha sido fundamental en controlar la epidemia de poliomielitis, y destaca por su seguridad, eficacia, facilidad de administración oral y bajo costo. Sin embargo, a pesar de estas ventajas, al tratarse de una vacuna con virus vivos atenuados, existe la posibilidad de mutaciones que confieran neurovirulencia. Por ende, es importante la vigilancia de parálisis flácida aguda (PFA), ya sea asociada a las vacunas atenuadas (VAPP) o a los virus derivados de vacunas (VDPV). En esta revisión presentamos datos importantes de Latinoamérica en los últimos años, donde se revisan los datos de VDPV de transmisión comunitaria, de origen ambiguo y asociadas con inmunodeficiencias. Debido a la presencia de VDPV, es importante fortalecer el sistema de vigilancia epidemiológica por PFA, con datos muy inferiores a los recomendados en estos últimos años en las Américas. Adicionalmente, es fundamental mejorar las coberturas vacunales para reducir la cantidad de lactantes en riesgo de adquirir poliomielitis. En consecuencia, presentamos las tasas de cobertura vacunal con la vacuna inactivada contra el poliovirus (IPV) en la región y analizamos los programas de vacunación contra la poliomielitis en concordancia con las recomendaciones de la Sociedad Latinoamericana de Infectología Pediátrica (SLIPE; mínimo 3 dosis de IPV) y del Grupo de Expertos en Asesoramiento Estratégico (SAGE) sobre Inmunización de la OMS (mínimo 2 dosis de IPV). El estudio concluye con recomendaciones de los autores para el cambio de OPV a uso exclusivo de IPV, para aumentar las coberturas vacunales y para reforzar la vigilancia por PFA en la región.

Abstract Oral poliovirus vaccine (OPV) has been instrumental in controlling the polio epidemic, and stands out for its safety, efficacy, ease of oral administration, and low cost. However, despite these advantages, as it is a live attenuated virus vaccine, there is the possibility of mutations that confer neurovirulence. Therefore, surveillance for acute flaccid paralysis (AFP) is important, whether associated with live vaccines (VAPP) or vaccine-derived viruses (VDPV). In this review we present important data from Latin America in recent years, where data on VDPV of community transmission, of ambiguous origin and associated with immunodeficiencies are reviewed. Due to the presence of VDPV, it is important to strengthen the epidemiological surveillance system for AFP, with data much lower than those recommended in recent years in the Americas. Additionally, it is essential to improve vaccination coverage to reduce the number of infants at risk of acquiring poliomyelitis. Consequently, we present the vaccination coverage rates with the inactivated vaccine against poliovirus (IPV) in the region and analyze the vaccination programs against poliomyelitis in accordance with the recommendations of the Latin American Society of Pediatric Infectious Diseases (SLIPE; minimum 3 doses of IPV) and the WHO Strategic Advisory Expert Group (SAGE) on Immunization (minimum 2 doses of IPV). The study concludes with recommendations from the authors for the change from OPV to exclusive use of IPV, to increase vaccination coverage and to strengthen surveillance for AFP in the region.

A erradicação da poliomielite em quatro tempos / La erradicación de la poliomielitis en cuatro tiempos / Poliomyelitis eradication in four stages

O objetivo deste artigo é rever o "estado da arte" dos avanços, obstáculos e estratégias para atingir a erradicação global da pólio. As ações de controle da poliomielite iniciaram na década de 1960 com o advento das duas vacinas antipoliomielíticas, a vacina oral da pólio (VOP) e a vacina inativada da pólio (VIP). No período de 1985 a 2020, são implementadas estratégias para atingir a meta de erradicação do poliovírus selvagem (WPV). Após o sucesso da interrupção da transmissão autóctone do WPV na região da Américas, foi lançada a meta da erradicação global. Descrevemos o processo de erradicação em quatro tempos: (1) O advento das vacinas VIP e VOP iniciou a era do controle da poliomielite; (2) A utilização massiva e simultânea da VOP teve impacto significativo sobre a transmissão do poliovírus selvagem no final da década de 1970 no Brasil; (3) Políticas públicas (nacionais e internacionais) decidem pela erradicação da transmissão autóctone do poliovírus selvagem nas Américas e definem as estratégias epidemiológicas para interromper a transmissão; e (4) A implantação das estratégias de erradicação interrompeu a transmissão autóctone do WPV em quase todas as regiões do mundo, exceto no Paquistão e Afeganistão, onde, em 2020, cadeias de transmissão do WPV1 desafiam as estratégias de contenção do vírus. Por outro lado, a persistência e a disseminação da circulação do poliovírus derivado da VOP, em países com baixa cobertura vacinal, somadas às dificuldades para substituir a VOP pela VIP constituem, atualmente, os obstáculos para a erradicação a curto prazo. Finalmente, discutimos as estratégias para superar os obstáculos e os desafios na era pós-erradicação.

El objetivo de este artículo es revisar el "estado de la cuestión" de los avances, obstáculos y estrategias para alcanzar la erradicación global de la polio. Las acciones de control de la poliomielitis se iniciaron en la década de 1960, con el advenimiento de las dos vacunas antipoliomielíticas, la vacuna oral de la polio (VOP) y la vacuna inactivada de la polio (VIP). En el período de 1985 a 2020, se implementan estrategias para alcanzar la meta de la erradicación del virus de la polio salvaje (WPV). Tras el éxito de la interrupción de la transmisión autóctona del WPV en la región de las Américas, se lanzó la meta de la erradicación global. Describimos el proceso de erradicación en cuatro tiempos: (1) El advenimiento de las vacunas VIP y VOP inició la era del control de la poliomielitis; (2) La utilización masiva y simultánea de la VOP tuvo un impacto significativo sobre la transmisión del virus de la polio salvaje, al final de la década de 1970, en Brasil; (3) Políticas públicas (nacionales e internacionales) deciden la erradicación de la transmisión autóctona del virus de la polio salvaje en las Américas y definen las estrategias epidemiológicas para interrumpir la transmisión; y (4) La implantación de las estrategias de erradicación interrumpió la transmisión autóctona del WPV en casi todas las regiones del mundo, excepto en Paquistán y Afganistán, donde, en 2020, cadenas de transmisión del WPV1 desafían las estrategias de contención del virus. Por otro lado, la persistencia y la diseminación de la circulación del virus de la polio, derivado de la VOP, en países con baja cobertura de vacunas, sumadas a las dificultades para substituir la VOP por la VIP constituyen, actualmente, los obstáculos para la erradicación a corto plazo. Finalmente, discutimos las estrategias para superar los obstáculos y los desafíos en la era poserradicación.

This article's objective is to review the "state of the art" in the progress, obstacles, and strategies for achieving global polio eradication. Poliomyelitis control measures began in the 1960s with the advent of two vaccines, the oral polio vaccine (OPV) and the inactivated polio vaccine (IPV). From 1985 to 2020, strategies were implemented to reach the goal of eradication of wild poliovirus (WPV). Following the success with the interruption of indigenous WPV transmission in the Americas, the goal of global eradication was launched. We describe the process of eradication in four historical stages: (1) The advent of the inactivated and oral polio vaccines launched the age of poliomyelitis control; (2) The massive and simultaneous use of OPV had a significant impact on WPV transmission in the late 1970s in Brazil; (3) Domestic and international public policies set the goal of eradication of indigenous WPV transmission in the Americas and defined the epidemiological strategies to interrupt transmission; and (4) The implementation of eradication strategies interrupted indigenous WPV transmission in nearly all regions of the world except Pakistan and Afghanistan, where in 2020 the WPV1 transmission chains have challenged the strategies for containment of the virus. Meanwhile, the persistence and dissemination of circulation of OPV-derived poliovirus in countries with low vaccination coverage, plus the difficulties in replacing OPV with IPV, are currently the obstacles to eradication in the short term. Finally, we discuss the strategies for overcoming the obstacles and challenges in the post-eradication era.

Nota Histórica / Historical Note

Resumen Una de las grandiosas experiencias a nivel mundial ha sido la vacunación contra la poliomielitis así como también lo fue en su momento la vacunación contra la viruela. Posiblemente con la ayuda de mejores condiciones sanitarias de las poblaciones (al ser una enfermedad de transmisión oral-fecal) estamos en las puertas de la erradicación, pero sobre todo gracias a la intervención con las vacunas contra la polio, tanto la inactivada como la oral. No serán tratados los temas técnicos de las vacunas utilizadas, ambas han sido extraordinarias herramientas para llegar a este momento. No puede ser más oportuna la cita de William Shakespeare: "el pasado es el prólogo", colocada en un mármol a la entrada de un edificio público en Washington DC.

Seronegativity to polio viruses among previously immunized adult candidates to solid organ transplantation

ABSTRACT In the current effort to eliminate polio from the world, it is important to recognize and vaccinate susceptible groups, especially immunocompromised patients living in countries where attenuated polio vaccine is still used. In this report, we describe the frequency of protective antibodies in a small sample of adult SOT candidates in whom previous vaccination could be ascertained. Patients included in this report were selected among the participants of an ongoing prospective study carried out at the Reference Center for Special Immunobiologicals of the Evandro Chagas National Institute of Infectious Diseases in Rio de Janeiro, Brazil. Among the first 100 patients enrolled in this study, only seven adult SOT candidates had proven polio vaccination at childhood. Three of these seven patients (43%) had no protective antibody titers to one or more poliovirus subtype before solid organ transplant. Proven childhood vaccination against polio does not reliably provide lifelong protective antibody titers for adult SOT candidates and should not be used as a criterion to analyze the need for vaccination in this population.

Health related quality of life in Turkish polio survivors: impact of post-polio on the health related quality of life in terms of functional status, severity of pain, fatigue, and social, and emotional functioning / Qualidade de vida relacionada com a saúde em sobreviventes turcos da pólio: impacto pós-pólio na saúde relacionada com a qualidade de vida em termos de estado funcional, gravidade da dor, fadiga e funcionamento social e emocional

ABSTRACT Objective: To determine the impact of postpolio-syndrome on quality of life in polio survivors. Methods: Forty polio survivors were included in the study. Twenty-one patients fulfilling the Halstead's postpolio-syndrome criteria participated in postpolio-syndrome group. The remaining nineteen patients formed non-postpolio-syndrome group. Control group was composed of forty healthy subjects. Quality of life was evaluated by Nottingham Health Profile, depression by Beck Depression Scale and fatigue by Fatigue Symptom Inventory. Isometric muscle strength was measured by manual muscle testing. Results: Total manual muscle testing score was 26.19 ± 13.24 (median: 29) in postpolio-syndrome group and 30.08 ± 8.9 (median: 32) in non-postpolio-syndrome group. Total manual muscle testing scores of non-postpolio-syndrome group were significantly higher than that of postpolio-syndrome group. Patients with postpolio-syndrome reported significantly higher levels of fatigue and reduced quality of life in terms of physical mobility, pain and energy when compared with patients without postpolio-syndrome and control group. It was not reported a statistically significant difference in social and emotional functioning and sleep quality between postpolio-syndrome, non-postpolio-syndrome and control groups. Also it was not found any statistically significant difference in Beck Depression Scale scores among the groups. Conclusions: Postpolio-syndrome has a negative impact on quality of life in terms of functional status, severity of pain and energy. The identification, early recognition and rehabilitation of postpolio-syndrome patients may result in an improvement in their quality of life.

RESUMO Objetivo: Determinar o impacto da síndrome pós-pólio na qualidade de vida nos sobreviventes da pólio. Métodos: Quarenta sobreviventes da pólio foram incluídos no estudo. Participaram do grupo de síndrome pós-pólio 21 pacientes que atenderam aos critérios de síndrome pós-pólio de Halstead. Os 19 restantes formaram o grupo não síndrome pós-pólio. O grupo controle foi composto por 40 indivíduos saudáveis. A qualidade de vida foi avaliada pelo Nottingham Health Profile, a depressão pela Escala de Depressão de Beck e a fadiga pelo Inventário de Sintomas de Fadiga. A força muscular isométrica foi medida por teste muscular manual. Resultados: O escore total do teste muscular manual foi 26,19 ± 13,24 (mediana: 29) no grupo de síndrome pós-pólio e 30,08 ± 8,9 (mediana: 32) no grupo não síndrome pós-pólio. Escores totais de teste muscular manual de grupo não síndrome pós-pólio foram significativamente maiores do que os do grupo de síndrome pós-pólio. Os pacientes com síndrome pós-pólio relataram níveis significativamente maiores de fadiga e qualidade de vida reduzida em termos de mobilidade física, dor e energia quando comparados com pacientes sem síndrome pós-pólio e grupo controle. Não se relatou uma diferença estatisticamente significativa no funcionamento social e emocional e na qualidade do sono entre grupos de síndrome pós-pólio, não síndrome pós-pólio e controle. Além disso, não se encontrou diferença estatisticamente significativa nos escores da Escala de Depressão de Beck entre os grupos. Conclusões: A síndrome pós-pólio tem um impacto negativo na qualidade de vida em termos de estado funcional, gravidade da dor e energia. A identificação, o reconhecimento precoce e a reabilitação dos pacientes com síndrome pós-pólio podem resultar em uma melhoria da qualidade de vida.

Seroprevalencia de anticuerpos a virus del sarampión, rubeola, parotiditis, hepatitis B y los tres serotipos de poliovirus, en niños de Quindío, Colombia / Seroprevalence of antibodies to measles, rubella, mumps, hepatitis B viruses and all three poliovirus serotypes among children in Quindío, Colombia

Objetivo Determinar la seroprevalencia de anticuerpos a virus de sarampión, rubeola, parotiditis, hepatitis B y los tres serotipos de poliovirus en población infantil del Departamento del Quindío, Colombia. Métodos Se colectaron muestras de sangre de 170 niños en edades comprendidas entre los cinco y nueve años de nueve departamentos del Quindío. Se determinó la presencia de anticuerpos tipo IgG para sarampión, rubeola y parotiditis mediante un ELISA indirecto comercial. La inmunidad contra la poliomielitis se determinó por la presencia de anticuerpos neutralizantes a poliovirus según los métodos recomendados por OMS. Resultados De los 170 niños estudiados, 169 (99,41 %), 170 (100 %), and 167 (98,2 %) fueron seropositivos a poliovirus 1, poliovirus 2, y poliovirus 3, respectivamente. El título promedio geométrico de anticuerpos fue 178 para poliovirus tipo 1, 120 para el tipo 2 y 56 para el tipo 3. De los 170 niños, el 96,47 % estuvo protegido contra parotiditis y rubeola y el 86,47 % contra sarampión. Se demostró respuesta serológica positiva contra el virus de la hepatitis B solamente en el 62,35 % de las muestras. Conclusiones El programa de inmunización en el Quindío permitió la seroprotección contra los tres serotipos de la polio, rubeola y parotiditis. Sin embargo, la población infantil no está completamente protegida contra la infección con sarampión y virus de la hepatitis B.(AU)

Objective The main goal of this research was to assess the seroprevalence of antibodies against measles, rubella, mumps, hepatitis B and all three poliovirus serotypes among children in the Quindío Department, Colombia. Methods Blood samples were obtained from 170 healthy children aged 5-9 years from nine municipalities in Quindío. The presence of serum IgG antibodies against measles, rubella, mumps and Hepatitis B were determined using commercial indirect ELISA kits. Immunity to poliomyelitis was assessed through the presence of neutralizing antibodies following the method recommended by the World Health Organization. Results Among the 170 children enrolled, 169 (99.41%), 170 (100 %), and 167 (98.2 %) were seropositive to poliovirus 1, poliovirus 2, and poliovirus 3, respectively. The average reciprocal antibody titers were 178 for poliovirus type 1, 120 for type 2 and 56 for type 3. Of the 170 children, 96.47 % were protected against mumps and rubella, and 86.47 % against measles. Only 106 (62.35 %) of the studied subjects were proved to be seropositive to hepatitis B. Conclusion The immunization program in Quindío has provided seroprotection against all three poliomyelitis serotypes, rubella and mumps. However, the child population is not fully protected against measles and hepatitis B virus infections.(AU)

Una batalla ganada: la eliminación de la poliomielitis en Cuba / A battle won: the elimination of poliomyelitis in Cuba

La poliomielitis fue introducida en Cuba a finales del siglo XIX por norteamericanos residentes en Isla de Pinos. Las primeras epidemias ocurrieron en 1906 y 1909, aumentaron en intensidad entre 1930-1958. El objetivo del artículo es reconstruir la historia de la enfermedad y sus epidemias en Cuba hasta 1961, de la primera Campaña Nacional de Vacunación Antipolio (1962) y de sus resultados, bien como analizar la continuidad de las campañas anuales de vacunación hasta la certificación de su eliminación (1994). Se siguió el método histórico lógico; se revisaron documentos de archivos, las estadísticas del Ministerio de Salud Pública sobre morbilidad y mortalidad hasta el 2000. Se calcularon tasas brutas de morbilidad y mortalidad. Se realizaron entrevistas a personajes claves.

Poliomyelitis was introduced in Cuba in the late nineteenth century by American residents in Isla de Pinos. The first epidemics occurred in 1906 and 1909 and increased in intensity between 1930 and 1958. The scope of the paper is to reconstruct the history of the disease and its epidemics in Cuba prior to 1961, the first National Polio Vaccination Campaign (1962) and its results, as well as analyze the ongoing annual vaccination campaigns through to certified elimination of the disease (1994). The logical historical method was used and archival documents and statistics from the Ministry of Health on morbidity and mortality through 2000 were reviewed. Gross morbidity and mortality rates were calculated and interviews with key figures were conducted.

Políticas sanitarias locales puestas a prueba: consultores, expertos, misiones internacionales y poliomielitis en España, 1950-1975 / Local health policies under the microscope: consultants, experts, international missions and poliomyelitis in Spain, 1950-1975

Este trabajo analisa las misiones de expertos de organismos sanitarios internacionales en España destinadas a informar sobre la situación, las actividades realizadas y las intervenciones necesarias en la lucha contra la discapacidad física de los niños. El Plan España-23 fue el instrumento utilizado por la OMS y otras agencias para poner en marcha el proceso de cambio en un país en transformación durante la larga etapa de vigencia de la dictadura franquista. El trabajo utiliza como fuentes informes inéditos de expertos de la OMS, que fueron resultado de visitas realizadas al país entre 1950 y 1975. El abordaje metodológico consistió en un análisis del discurso que se encuentra en las fuentes y su contextualización en los marcos historiográficos pertinentes.

One of the main focuses of analysis of this paper concerns the missions of international health agency experts to Spain to report on the situation, the activities in the fight against physical disabilities in children and on the actions taken to cope with the problem. The Spain-23 Plan was the instrument used by WHO and other agencies to start the process of change in a country undergoing a period of transformation under the enduring Franco dictatorship. As key sources, the paper uses unpublished reports of WHO experts on the subject, which resulted from visits to the country between 1950 and 1975. The methodological approach consists of an analysis of discourses from primary sources within the historiographical framework.

Hacia la erradicación de la poliomielitis: logros y retos en México

Desde la implementación de las estrategias globales de erradicación, la incidencia de parálisis poliomielítica ha disminuido dramáticamente. Cuatro estrategias han contribuido notablemente: a) Altas coberturas de inmunización con vacuna oral de polio (VOP), b) Inmunización suplementaria durante los Días Nacionales de Vacunación, c) Vigilancia epidemiológica efectiva de casos de parálisis flácida aguda (PFA), y d) Bloqueos vacunales en zonas de alto riesgo. Sólo quedan tres países polioendémicos, no obstante, cualquier país corre el riesgo potencial de importación del virus de algunas de estas áreas, de la liberación accidental del virus resguardado en laboratorios de diagnóstico clínico o investigación, o de la presencia de virus circulantes derivados de vacuna en el medio ambiente. Este documento pretende exponer los antecedentes históricos que hicieron posible la eliminación de la enfermedad en México, así como los retos para lograr un mundo libre de poliomielitis.

Since the strategies to eradicate polio were implemented, the incidence of paralytic polio has dropped dramatically. Four main strategies have greatly contributed: a) High immunization coverage rate with oral polio vaccine (OPV), b) Supplementary immunization activities during the National Immunizations Days c) An effective epidemiological surveillance system for acute flaccid paralysis (AFP) and d) Intensified immunization activities in high risk areas. Three countries remain polio endemic, nevertheless, any country has a potential risk of the virus importation from one of these endemic areas; an accidental release of poliovirus from a research or clinical laboratory, or from having a circulating vaccine-derived poliovirus in the environment. The present document aims to provide an historical background that made possible the disease elimination in Mexico. Moreover, we discuss the challenges that every country needs to face in order to achieve a polio-free world.

Coverage and causes of non immunization in national immunization days for polio; a consumer and provider perspective study in Peshawar

Polio is a viral disease that may cause paralysis and infant death. Despite ongoing efforts, polio has not been eradicated from Pakistan. The purpose of this survey is to estimate the coverage of polio vaccine during National Immunization Days and to determine the factors associated with lack of immunization. A Cross-sectional survey was conducted in Peshawar, Pakistan, from 1[st] June to 9[th] June 2010. Confidence level of 95% and confidence interval of 4 was used to derive the sample size [for a population more than 20,000]. Parents of 600 children under 5 years were asked about immunization during NIDs of January - May 2010 [5 NIDs]. Questions regarding demographics, income, education, occupation, accessibility to health centers and frequency of visits from health workers was inquired. Knowledge and views on immunization were also asked. 40 health personnel involved in immunization were also interviewed and they were asked about hurdles faced in immunization. 83.7% children were vaccinated in all National Immunization Days, while 94.7% had at least, taken polio vaccine once. 5.3% had not taken polio vaccine during National immunization Days of 2010. Main reasons for not vaccinating were; Vaccinator absent/not visiting home/vaccine not available [63.36%], no awareness [17.4%], Child ill [5.8%], family problem/mother busy [3.3%] and wrong ideas/sterility [3.3%]. Many health personnel [32.5%] considered lack of awareness among people and low accessibility to vaccine as the main hurdles in immunization, besides the poor salaries and incentives. Polio vaccination during National Immunization Days 2010 was a partial success because some pockets of poor children and afghan refugees were poorly vaccinated. In order to eradicate polio, they must be vaccinated

Vigilancia epidemiológica de las parálisis flácidas agudas / Epidemiologic surveillance of acute flaccid paralysis

Las parálisis flácidas agudas (PFA) constituyen un complejo síndrome con una amplia gama de posibles etiologías, entre las cuales se encuentran la poliomielitis y el síndrome de Guillain-Barré (SGB). Su vigilancia tiene una gran importancia en salud pública, debido a la iniciativa mundial de erradicar la poliomielitis y a los posibles efectos adversos de la vacunación masiva contra la influenza A(H1N1), la cual pudiese estar asociada al SGB. Durante los años 2009 y 2010 no se reportaron casos de poliomielitis en nuestro país ni en la región de las Américas. Sin embargo, dada la situación epidemiológica mundial de esta enfermedad resulta fundamental mantener buenas coberturas de vacunación y un sistema de vigilancia adecuado. En relación a la vigilancia del SGB posterior a la implementación de la vacunación masiva contra la influenza A(H1N1), no se observó un aumento significativo de casos en niños y tampoco se logró establecer asociación entre la inmunización y la aparición de esta enfermedad en adultos.

Acute flaccid paralysis constitutes a complex syndrome with a wide spectrum of possible etiologies, among whom are poliomyelitis and Guillain-Barré syndrome. Its surveillance has great importance to public health due to the polio eradication world initiative and the possible adverse effects of mass vaccination against influenza A(H1N1). During 2009 and 2010, no poliomyelitis cases were reported in our country nor American region. However, given the world epidemiologic situation ofthis disease, it is essential to maintain adequate vaccination coverage and surveillance system. Related to Guillain-Barré syndrome surveillance after influenza A(H1N1) mass vaccination implementation, no significant increase in cases among children was observed, and no association between immunization and adult disease occurrence could be established.