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Vaccine-Related Poliomyelitis

Vaccine-Related Poliomyelitis Abstract Immunization has virtually eliminated wild-type poliovirus in this country, but polio still occurs as an iatrogenic disease from the oral trivalent vaccine.1 The risk is small—about one paralytic case per 3 to 4 million units of live vaccine distributed, or less than 20 cases yearly. History of exposure may be unknown or forgotten, since most cases occur in nonimmune adults who contact the virus from oral secretions or the stool of vaccine recipients. Unwary physicians trained in the postvaccine era may misdiagnose polio as the Guillain-Barré syndrome. Clinical features that should argue against Guillain-Barré syndrome are absence of sensory symptoms, prominent meningeal signs, fever at onset of paralysis, and pleocytosis of greater than 50 cells.2 Electrodiagnostic tests also are useful in this differentiation. In polio, sensory nerve conduction velocities are normal, and motor conductions are either normal or, in severe cases, absent because of segmental anterior horn cell References 1. Schonberger LB, Sullivan-Bolyai JZ, Bryan JA: Poliomyelitis in the United States. Adv Neurol 1978;19:217-227. 2. Asbury AK: Diagnostic considerations in Guillain-Barré syndrome. Ann Neurol 1981;9( (suppl) ):1-5.Crossref 3. Brooks DM, Russell WR: Discussion: Anterior poliomyelitis. Proc R Soc Med 1954;47:265-274. 4. Minor TE, Helstrom PB, Nelson DB, et al: Counterimmunoelectrophoresis test for immunoglobulin M antibodies to group B coxsackievirus. J Clin Microbiol 1979;9:503-506. 5. Olsson JE, Pettersson B: A comparison between agar gel electrophoresis and CSF serum quotients of IgG and albumin in neurological disease. Acta Neurol Scand 1976;53:308-322.Crossref 6. Salk J, Salk D: Control of influenza and poliomyelitis with killed virus vaccines. Science 1977;195:834-847.Crossref 7. Melnick JL: Advantages and disadvantages of killed and live poliomyelitis vaccines. Bull WHO 1978;56:21-38. 8. Poliomyelitis vaccine: Killed or live? Lancet 1982;1:84-85. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Vaccine-Related Poliomyelitis

Abstract

Abstract Immunization has virtually eliminated wild-type poliovirus in this country, but polio still occurs as an iatrogenic disease from the oral trivalent vaccine.1 The risk is small—about one paralytic case per 3 to 4 million units of live vaccine distributed, or less than 20 cases yearly. History of exposure may be unknown or forgotten, since most cases occur in nonimmune adults who contact the virus from oral secretions or the stool of vaccine recipients. Unwary physicians trained...
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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1982.00340220031004
Publisher site
See Article on Publisher Site

Abstract

Abstract Immunization has virtually eliminated wild-type poliovirus in this country, but polio still occurs as an iatrogenic disease from the oral trivalent vaccine.1 The risk is small—about one paralytic case per 3 to 4 million units of live vaccine distributed, or less than 20 cases yearly. History of exposure may be unknown or forgotten, since most cases occur in nonimmune adults who contact the virus from oral secretions or the stool of vaccine recipients. Unwary physicians trained in the postvaccine era may misdiagnose polio as the Guillain-Barré syndrome. Clinical features that should argue against Guillain-Barré syndrome are absence of sensory symptoms, prominent meningeal signs, fever at onset of paralysis, and pleocytosis of greater than 50 cells.2 Electrodiagnostic tests also are useful in this differentiation. In polio, sensory nerve conduction velocities are normal, and motor conductions are either normal or, in severe cases, absent because of segmental anterior horn cell References 1. Schonberger LB, Sullivan-Bolyai JZ, Bryan JA: Poliomyelitis in the United States. Adv Neurol 1978;19:217-227. 2. Asbury AK: Diagnostic considerations in Guillain-Barré syndrome. Ann Neurol 1981;9( (suppl) ):1-5.Crossref 3. Brooks DM, Russell WR: Discussion: Anterior poliomyelitis. Proc R Soc Med 1954;47:265-274. 4. Minor TE, Helstrom PB, Nelson DB, et al: Counterimmunoelectrophoresis test for immunoglobulin M antibodies to group B coxsackievirus. J Clin Microbiol 1979;9:503-506. 5. Olsson JE, Pettersson B: A comparison between agar gel electrophoresis and CSF serum quotients of IgG and albumin in neurological disease. Acta Neurol Scand 1976;53:308-322.Crossref 6. Salk J, Salk D: Control of influenza and poliomyelitis with killed virus vaccines. Science 1977;195:834-847.Crossref 7. Melnick JL: Advantages and disadvantages of killed and live poliomyelitis vaccines. Bull WHO 1978;56:21-38. 8. Poliomyelitis vaccine: Killed or live? Lancet 1982;1:84-85.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Sep 1, 1982

References