Copyright � The Korean Academy of Medical Sciences
Vaccine-associated Paralytic Poliomyelitis
: A Case Report of Flaccid Monoparesis after Oral Polio Vaccine
This report describes a case of acute flaccid paralysis after administration of oral polio vaccine (OPV). A 4 month-old male patient with the decreased movement of left lower extremityfor 1 month was transferred to the Department of Pediatrics. He received OPV with DTaP at 2 months of age. Flaccid paralysis was detected 4 weeks after OPV immunization. Attempts to isolate Sabin-like viruses in the two stool and CSF samples failed because those specimens were collected more than 2 month after the onset of paralysis. Hypotonic monoparesis (GIV/V), hypotonia and atrophy on the leftlower extremity, and ipsilateral claw foot persisted for more than 18 months, while we followed him with rehabilitation therapy. This is the first case of officially approved, recipient vaccine-associated paralytic poliomyelitis in Korea.
Sun Jun Kim, Sung Han Kim*, Young Mee Jee*, Jung Soo Kim
Department of Pediatrics, Chonbuk National University, Medical School, Jeonju; Division of Entericand Hepatitis Viruses*, National Institute of Health, Seoul, Korea Received : 22 July 2005 Accepted : 13 December 2005
Address for correspondence
Sun Jun Kim, M.D. Department of Pediatrics, Chonbuk National University Hospital, 638-18 Keumam-dong, Dukjin-gu, Jeonju 561-712, Korea Tel : +82.63-250-1799, Fax : +82.63-250-1464 E-mail : firstname.lastname@example.org
Key Words : Poliovirus vaccine,Poliomyelitis
Although Poliomyelitis caused by wild-type poliovirus has been almost eradicated, especially in developed countries, vaccine-associated paralytic poliomyelitis (VAPP) cases still continue to occur in most of developed and developing countries. In Korea, the last indigenously acquired cases of poliomyelitis caused by wild poliovirus were reported in 1983, and theeradication of wild poliomyelitis in Korea was certified in October 2000. Korea is now in the midst of maintaining polio-free status. Live attenuated oral polio vaccine (OPV) has been successfully used to control wide-type poliomyelitis over the past 30 yr. Although it has several advantages such as low cost, ease of use, and high efficacy rate with herd immunity (1), OPV has a drawback of causing a rarebut serious complication of vaccine associated paralysis. Furthermore, VAPP cases cannot be distinguished clinically from the wide-type poliomyelitis (1). In India a report described 181 VAPP cases among 125 million children less than 5 yr of age in one year, of 1.45 per million children per year, or seven cases per million birth cohorts (2, 3). Assuming an annual average of 45 cases in LatinAmerica, the total in Latin America and India experienced 226 cases a year. The annual incidence of VAPP in European countries, according to the WHO, is 0.4-3.0 per million vaccinated children (1). In the U.S.A., an estimated
risk for VAPP ranged from 1 case per 2.5 million doses of OPV distributed in 1980-89 (4) to 1 case per 3.2 million doses distributed in 1973-84 (5). In Korea, OPV wasintroduced in 1962, about 4 yr after the first implementation of IPV, and has been used alone since 1975 for the prevention of poliomyelitis. As the statistics from the WHO show, it is apparent that as long as OPV is in use, there is always the risk of VAPP to occur regardless of where it is used. The over all risk for VAPP is approximately one case in 2.4 million doses of OPV vaccine with a firstdose risk of one in 750,000. When considering the birth cohort and the amount of OPV distributed in Korea, an occurrence of 0.5-2 cases of VAPP a year can be expected. Unfortunately, however, since the day of OPV administration started in Korea, there has not been any VAPP case reported so far. This is the first case of a recipient VAPP confirmed in December 2003 by the (Korean) National Committee...