Poliomielitis

Poliomyelitis 
1. DISEASE REPORTING A. Purpose of reporting and surveillance 1. To identify cases of polio. 2. To prevent transmission of polio. 3. To distinguish between wild-type polio and vaccine-associated paralytic polio. B. Legal Reporting Requirements 1. Health care providers: immediately notifiable to local health jurisdiction 2. Health care facilities: immediately notifiable to localhealth jurisdiction 3. Laboratories: Poliovirus, acute, by IgM positivity or PCR positivity immediately notifiable to local health jurisdiction; specimen submission is required – isolate or clinical specimen associated with positive result (2 business days) 4. Local health jurisdictions: immediately notifiable to the Washington State Department of Health (DOH) Communicable Disease EpidemiologySection (CDES) C. Local Health Jurisdiction Investigation Responsibilities 1. Begin the investigation and notify CDES immediately. 2. Facilitate transport of specimens to Washington State Public Health Laboratories (PHL). 3. Implement appropriate infection control measures. 4. Report all confirmed and probable cases (see definitions below) to CDES. Complete the polio investigation form (available athttp://www.doh.wa.gov/notify/forms/polio.pdf) and enter the data into the Public Health Issues Management System (PHIMS). 2. THE DISEASE AND ITS EPIDEMIOLOGY Background Wild polio virus was eliminated from the western hemisphere in 1991 but remains endemic in Nigeria, India, Pakistan and Afghanistan, where control efforts are ongoing. Beginning in 2003, polio re-emerged in many countries in Africa,facilitated by refugee movement. For up-to-date information regarding worldwide polio transmission see: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx A. Etiologic Agent Poliovirus (enterovirus subgroup) is an RNA virus. There are three serotypes (1, 2 and 3), and all can cause paralysis. There is no cross-protective immunity for the serotypes. Clinical poliomyelitis can becaused by wild-type viruses and, rarely, attenuated live (oral) vaccine strains.

Last Revised: January 2011 Page 1 of 7

Washington State Department of Health

Poliomyelitis

Reporting and Surveillance Guidelines

B. Description of Illness The virus infects the throat and intestine, with invasion of local lymph nodes. Up to 95% of polio infections are inapparent or asymptomatic. Somepersons have nonspecific mild illnesses including fever, sore throat, or gastrointestinal symptoms. In rare cases poliovirus infects the spinal cord or brain stem resulting in aseptic meningitis or acute asymmetric flaccid paralysis, which occurs in approximately one of 200 poliovirus infections. Symptoms of paralytic polio typically progress within a few days, achieve a plateau for weeks, and thenresolve partially or fully. Legs are more often affected than arms. Bulbar paralysis affecting the cranial nerves may accompany extremity involvement or can occur as the sole paralysis. C. Polio in Washington The last endemic transmission of wild polio virus infection in the United States was in 1979; the last case of wild virus infection identified in Washington occurred in 1977.Vaccine-associated paralytic polio (VAPP) continued to occur sporadically, including in a Washington resident in 1993 who contracted the virus from a grandchild recently vaccinated with oral polio vaccine (OPV). In 1997, the ACIP recommended routine use of inactivated (IPV) rather than oral polio vaccine to eliminate the risk of vaccineassociated paralytic polio in the United States. In 2000, an all IPV vaccineschedule was implemented which greatly reduced the occurrence of vaccine-associated paralytic polio. However, an unvaccinated Arizona resident contracted VAPP in 2005 during international travel to a polio-endemic area where oral vaccine is in use. D. Reservoir Humans, usually persons with an inapparent infection. E. Modes of Transmission Polio is mainly transmitted by the fecal-oral route...