Advertisement
Case Report| Volume 47, ISSUE 1, P82-84, July 2003

Provocation poliomyelitis: vaccine associated paralytic poliomyelitis related to a rectal abscess in an infant

      Abstract

      Objective. To describe a case of vaccine associated paralytic poliomyelitis (VAPP) and relate this to current UK immunization policy.
      Method. A case report in which the clinical course and factors leading to the diagnosis are described and then related to reports of paralytic poliomyelitis in the literature.
      Results. The child in this case was left severely disabled by paralytic poliomyelitis. The pathological process was related to a pararectal abscess needing urgent drainage shortly after immunisation.
      Conclusion. The skeletal muscle damage due to the presence of the pararectal abscess may have acted as the ‘provocation’ in the development of poliomyelitis. Adoption of a policy of initial vaccination by the parenteral route as in the USA and European countries has been shown to greatly reduce this risk. The UK could adopt this policy which would minimise the risk of VAPP, as all recorded paralytic poliomyelitis in the UK in the last decade has been vaccine related.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Infection
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Freiderich F.
        Neurologic complications associated with oral poliovirus vaccine and genomic variability of the vaccine strains after multiplication in humans.
        Acta Virol. 1998; 42: 187-195
        • Nkowane B.M.
        • Wassilak S.G.F.
        • Orenstein W.A.
        • et al.
        Vaccine-associated paralytic poliomyelitis.
        JAMA. 1987; 257: 1335-1340
        • Joce R.
        • Wood D.
        • Brown D.
        • Begg N.
        Paralytic poliomyelitis in England and Wales.
        BMJ. 1992; 305: 69-70
        • Gromier M.
        • Wimmer E.
        Mechanism of injury-provoked poliomyelitis.
        J Virol. 1998; 72: 5056-5060
        • Mahadevan S.
        • Ananthakrihnan S.
        • Srinivasan S.
        • et al.
        Poliomyelitis: 20 years—the Pondicherry experience.
        J Trop Med Hyg. 1989; 92: 416-421
        • Strebel P.M.
        • Ion-Nedelcu N.
        • Baughman A.L.
        • Sutter R.W.
        • Cochi S.L.
        Intramuscular injections within 30 days of immunization with oral poliovirus vaccine—a risk factor for vaccine associated paralytic poliomyelitis.
        N EJM. 1995; 332: 500-506
        • Wyatt H.V.
        Provocation of poliomyelitis by multiple injections.
        Trans R Soc Trop Med Hyg. 1985; 79: 355-358
        • Wyatt H.V.
        Provocation poliomyelitis and entry of poliovirus to the CNS.
        Med Hypothesis. 1976; 2: 269-274
      1. Salisbury D.M. Begg N.T. 1996 Immunisation against Infectious Disease. HMSO, London1996: 26
      2. Salisbury D.M. Begg N.T. 1996 Immunisation against Infectious Disease. HMSO, London1996: 20
        • Finn A.
        • Bell F.
        Polio vaccine: is it time for a change?.
        Arch Dis Child. 1998; 78: 571-574