Paralytic poliomyelitis in slums of Bombay

A systematic review of the worldwide prevalence of survivors of poliomyelitis reported in 31 studies

BACKGROUND

Accurate prevalence figures estimating the number of survivors of poliomyelitis (disease causing acute flaccid paralysis) following poliovirus infection are not available. We aim to undertake a systematic review of all literature concerning the prevalence of survivors of poliomyelitis.

METHODS

Electronic databases were searched from 1900 up to May 2016 for peer-reviewed studies using a population-based approach witha defined denominator and some form of diagnostic or clinical verification of polio. Exclusion criteria were any prevalence data that were unable to be extracted or calculated and studies reporting on incidence only. The quality of each included study was assessed using an existing tool modified for use in prevalence studies. Average crude prevalence rates were used to calculate worldwide estimates.

RESULTS

Thirty-one studies met criteria with 90% of studies conducted in low-income to lower middle-income countries. Significant variability in the prevalence of survivors of poliomyelitis was revealed, in low- income to lower middle-income (15 per 100 000 in Nigeria to 1733 in India) and upper-middle to high-income countries (24 (Japan) to 380 per 100 000 (Brazil). The total combined prevalence of survivors of poliomyelitis for those studies at low to moderate risk of bias ranged from 165 (high-income countries) to 425 (low-income to lower middle-income countries) per 100 000 person-years. Historical lameness surveys of children predominated, with wide variation in case definition and assessment criteria, and limited relevance to current prevalence given the lack of incidence of poliovirus infection in the ensuing years.

CONCLUSIONS

These results highlight the need for future epidemiological studies of poliomyelitis to examine nationally representative samples, including all ages and greater focus on high-income countries. Such efforts will improve capacity to provide reliable and more robust worldwide prevalence estimates.

Impact of annual immunisation programme with oral polio vaccine on the prevalence of paralytic poliomyelitis

Lameness survey was conducted in a rural community development block of Haryana in 1985. Enumerators contacted school teachers, anganwadi workers and several key informants in the community to identify lame children in 1-11 years age-group. Physician verified 219 lame cases to be due to poliomyelitis. Prevalence of poliomyelitis lameness was 7.3/1000 children born in 1974-76, 7.7/1000 children born in 1977-1980 and 2.3/1000 children born in 1981-1984 (expected to increase to 3.1/1000 when all children born in 1981-84 cross 5th year of life). Immunisation coverage with 3 doses of oral polio vaccine (OPV) was less than 10% during 1974-80 when immunisation was a clinic based activity. Coverage increased from 50 to 80% during 1981-85 when OPV was given in annual immunisation campaign. The results indicate that prevalence of paralytic poliomyelitis dropped at least by 60% after giving OPV in annual immunisation campaigns.