Is poliomyelitis a serious problem in developing countries? The Vellore experience

Progress towards global polio eradication

Twelve years after the global polio eradication goal was set, polio cases have declined by more than 95% world-wide. Polio immunization campaigns have been conducted in every endemic country with as many as 470 million children immunized per year. Intense wild poliovirus transmission is now limited to South Asia and sub-Saharan Africa. To achieve eradication at the earliest possible date, immunization campaigns are being intensified in the remaining endemic countries. Major programmatic challenges include reaching vulnerable children in areas with armed conflict and ensuring full financial and political support for the initiative. With global eradication imminent, WHO is preparing for post-eradication issues: containment of polioviruses, certification of eradication, and stopping immunization.

Paralytic poliomyelitis in children under 6 years in Pondicherry: a community survey

STUDY OBJECTIVES

To assess the amount of poliomyelitis and its epidemiological features including risk factors.

DESIGN

This was a retrospective study of cases of paralytic poliomyelitis among children 0-6 years of age.

SETTING

Pondicherry, India, 1983-89.

SUBJECTS

A total of 47,960 children aged less than 6 years.

MEASUREMENTS AND MAIN RESULTS

In 1989, 469 field workers undertook a door to door survey of children 0-6 years old to identify those with limb paralysis. This was followed by clinical examination to establish the cause, supplemented by case notes held by the Child Development Services. Altogether 203 cases of limb paralysis were identified, 188 of which were judged a result of paralytic poliomyelitis. The prevalence of poliomyelitis in 1989 was 3.9/1000 among children below 6 years of age. There was a male preponderance with a male:female ratio of 1.4:1. The prevalence was least in infants (1/1000) and highest in children aged 2 to 3 years (6.4/1000). The age at onset was less than 12 months in 42% of cases and less than 3 years in 98%. The median age at onset was 13.4 months. Time series analysis showed a high occurrence of cases from May to September between 1983 and 1989. The legs were affected in 97%. About 41% of children had received three doses of oral polio vaccine. There was a history of intramuscular injection, possibly provoking a paralytic attack, in 54% of cases.

CONCLUSION

This retrospective community study involving the staff of the Integrated Child Development Services provided valid data about poliomyelitis with little additional cost and minimum training. Because the study covered a whole population of children under 6 years, rather than a sample, the data will help in monitoring and surveillance of poliomyelitis and also in planning strategies for effective control.

Paralytic poliomyelitis in Addis Ababa: follow-up survey of registered children

A survey was carried out of children resident in Addis Ababa with paralytic poliomyelitis who had been registered at a weekly-held multidisciplinary "polio clinic" at the Ethio-Swedish Children's Hospital. The children were physically examined and traced to their homes, where a questionnaire was completed yielding demographic data, initial disease presentation and subsequent treatment. A total of 557 (90%) children were traced, of whom 80% were between the ages of 5 and 16 years. The pattern of disease with predominantly lower limb involvement was similar to that in previous reports. Contractures were frequent, 50% having contractures both at initial presentation and on follow-up. Standard treatment protocols were offered. Initially, 70% of the patients required a walking aid. Follow-up showed poor compliance, with only half the children using the walking aid. Forty-seven per cent of the patients had not attended the clinic for over 2 years, those with moderate disability being more likely to attend. The survey suggested that poor compliance may be related to a poor understanding of the disease and benefits of rehabilitation, lack of transport and financial constraints. During the past 4 years a further 305 children from the city presented to the clinic with poliomyelitis. Rehabilitation of handicapped children is a problem in all developing countries and the lessons learned from this study may be useful to others planning rehabilitation programmes.