AFP polio. SanPin

Description:

Acute flaccid syndrome (AFP) occurs as a result of damage to a peripheral nerve anywhere. AFP is a complication of many diseases, including.

Causes of acute flaccid paralysis:

Flaccid paralysis develops due to the action of enteroviruses. Pathology occurs due to damage to neurons spinal cord and plots peripheral nerves.

The most common cause of paralysis is polio.

AFP includes all paralysis accompanied by rapid development. The condition for making such a diagnosis is the development of paralysis within three to four days, no more. The disease occurs in children under 15 years of age as a result of polio, and also in adults for many reasons.

Acute flaccid paralysis does not include:

Paresis of facial muscles;
paralysis acquired at birth as a result of injury;
injuries and damage that provoke the development of paralysis.

There are several types of AFP depending on the cause of nerve damage.

Symptoms of acute flaccid paralysis:

AFP is diagnosed if the following symptoms are present:

Lack of resistance to passive movement of the affected muscle;
pronounced muscles;
absence or significant deterioration of reflex activity.

A specific examination does not reveal disorders of nervous and muscle electrical excitability.

The location of the paralysis depends on which part of the brain is damaged. When the anterior horns of the spinal cord are damaged, paralysis of one leg develops. In this case, the patient cannot move his foot.

With symmetrical spinal cord lesions in cervical spine it is possible to develop paralysis of both the lower and upper extremities at the same time.

Before the onset of paralysis, the patient usually complains of acute excruciating pain in the back. In children, the pathology is accompanied by the following symptoms:

Swallowing dysfunction;
weakness of the muscles of the arms and legs;
trembling in hands;
breathing disorder.

No more than three to four days pass from the appearance of the first symptoms to the development of paralysis. If the disease manifests itself later than four days from the onset of illness, there can be no talk of acute flaccid paralysis.

The pathology is dangerous due to its complications, including:

Reduction in the size of the affected limb or part of the body due to the fact that the muscles are atrophied;
hardening of the muscles in the affected area (contracture);
hardening of joints.

As a rule, in most cases it is impossible to get rid of complications caused by flaccid paralysis. The success of treatment largely depends on the cause of the disorder, as well as timely access to the clinic.

Diagnostics:

The following must be tested for the presence of the virus:

Children under 15 years of age with flaccid paralysis;
- refugees from areas with high risk infections (India, Pakistan);
- patients with clinical signs of the disease and their environment.

Fecal samples are required for analysis. At the beginning of the disease, the concentration of the virus in the patient’s feces reaches 85%.

Patients with polio, or patients suspected of having this disease, should be examined again one day after the initial analysis.

Symptoms of polio:

Fever;
- inflammation of the mucous membrane of the nasopharynx;
- violation motor activity neck muscles and back;
- spasms and muscles;
- muscle pain;
- digestive disorders;
- rare urination.

TO acute symptoms include difficulty breathing and muscle paralysis.

Treatment of acute flaccid paralysis:

Therapy is aimed at restoring the function of peripheral nerves affected by the viral disease. For this purpose, use:

Drug therapy;
physiotherapy;
massage;
folk remedies.

The combination of these methods makes it possible to obtain good therapeutic effect, but only subject to timely treatment. If more than 70% of neurons have died as a result of a viral infection, restoration of mobility and sensitivity of the affected area is impossible.

Drug therapy includes treatment with neurotropic and vasoactive drugs. This therapy is aimed at improving metabolism and conduction of nerve fibers, improving blood circulation and stimulating the activity of the nervous system.

Typically, drugs are administered either intravenously or intramuscularly. It is possible to administer drugs using a dropper in cases of extensive neuronal damage.

Vitamin therapy is required. The introduction of B vitamins is indicated, which stimulate cell renewal and strengthen the nervous system.

During the rehabilitation period, wearing a bandage or orthosis is indicated to fix the limb in a physiologically stable manner. correct position. This measure will avoid visible deformation of the joint due to weakening of the muscles.

Prevention of intestinal infections in children.

Prevention of intestinal infections in children is the most important modern task that guards the health of the younger generation. Acute intestinal infections are an urgent problem in pediatric science, due to the prevalence of a diverse composition of pathogens, as well as the role they play in the formation of pathologies of the child’s gastrointestinal tract. Acute intestinal infections are characterized by high morbidity in all age categories and mortality in children early age V developing countries. Each child experiences approximately 3 episodes of diarrhea per year.

The group of intestinal infections that affect children's bodies is large. It includes pathogens of dysentery, salmonellosis, gastroenteritis and coli infections, both bacterial and viral in nature. Intestinal infections are usually severe. The clinical picture of different infections may be different from one another, but is usually associated with high fever, vomiting and loose stools (diarrhea).

Prevention of intestinal infections in children will be more effective if parents are familiar with the sources of intestinal infections and routes of infection.

Sources of intestinal infections can be both patients and bacteria carriers. Bacteria carriers can be people who are in incubation period and those who had previously had an intestinal infection.

Often the sources can be sick peers of children who, due to undeveloped hygiene skills and the blurred clinical picture of intestinal infection, pollute the environment.

Birds and animals can also serve as sources of intestinal infection. Particularly in this matter, one should be careful in contacts with possible spreaders of salmonellosis (chickens, ducks).

Any acute intestinal infection in its development path undergoes a fecal-oral transmission mechanism of the pathogen. Such diseases are often called “diseases of dirty hands.” The excrement of patients enters the body through the mouth, and thanks to untreated hands after using the toilet, they end up on food or household items, which become sources of infection for patients.

Acute intestinal infections have several routes of infection: household contact, food, and water. Foodborne outbreaks of acute intestinal infection occur when food is infected by patients or carriers of infections, the water route of infection is typical when sources of drinking water are damaged, and the contact and household route of infection is typical when hand hygiene is not observed and household items become infected,

Prevention of all intestinal infections (both viral and bacterial) is frequent and thorough hand washing, using high-quality food and using only baby products when feeding children. Most intestinal diseases are related to food, and their number increases in the summer and autumn due to the increased consumption of vegetables and fruits. It is necessary to take into account that the spread of these infections is facilitated by flies, which can carry pathogens of dysentery, typhoid fever, and paratyphoid fever over a considerable distance. The increase in the number of intestinal diseases in summer and autumn is associated

with increased water consumption and increased population movement.

Propaganda sanitary and hygienic knowledge encounters difficulties due to the fact that the questions raised seem to many to be too elementary, well-known, and familiar. Meanwhile, even such simple hygiene rules as thoroughly washing hands before preparing food, before eating, and after visiting the toilet are not followed by everyone. It would seem that this should not be mentioned, but practice shows that this is precisely what is often forgotten.

To effectively educate the population of the entire planet on the prevention of acute intestinal infections, experts from the World Health Organization have developed ten “golden” rules for the prevention of food poisoning (infections).

Selecting safe food products. Many foods, such as fruits and vegetables, are consumed raw, while others are risky to eat without pre-cooking. For example, always buy pasteurized milk rather than raw milk. When purchasing food, keep in mind that the purpose of post-processing is to make the food safe and extend its shelf life.

Prepare food thoroughly. Many raw foods, mainly poultry, meat and raw milk, are often contaminated with pathogenic microorganisms. During the cooking process, bacteria are destroyed, but remember that the temperature in all parts of the food product must reach 70 0.

Eat cooked food without delay.

Store food carefully. If you have prepared food for future use or want to store the rest of it after eating, keep in mind that it should be stored either hot (at or above 60 0) or cold (at or below 10 0 C). This is exceptional important rule, especially if you intend to store food for more than 4-5 hours.

It is better not to store food for children at all.

Reheat pre-cooked food thoroughly. This is the best measure of protection against microorganisms that could multiply in food during storage (proper storage inhibits the growth of microbes, but does not destroy them). Once again before eating, thoroughly warm the food (the temperature in its thickness should be at least 70 0 C).

Avoid contact between raw and prepared foods.

Wash your hands often.

Keep the kitchen perfectly clean.

Keep food protected from insects, rodents and other animals. Animals are often carriers of pathogenic microorganisms that cause food poisoning. To reliably protect products, store them in tightly sealed jars (containers).

Use boiled water, boil it before adding to food

products or before use.

Pediatrician: Usenova Zhanat Asylbekovna

I. ACUTE FLACK PARALYSIS (AFP)

During the period of eliminating any infection, it is especially important to obtain and analyze specific and reliable evidence of its complete absence in a specific area. For polio, this means identifying at least one case of acute flaccid paralysis (AFP) per 100 thousand children under 15 years of age.

Under AFP syndrome understand any case of acute flaccid paralysis in a child under 15 years of age, including Guillain-Barré syndrome, or any paralytic disease regardless of age when polio is suspected, as well as all cases of paralytic polio.

Identification of the maximum number of AFP serves as an indicator of the effectiveness of the epidemiological surveillance system and the maintenance of a high level of alertness among health workers regarding polio. Each case of AFP should be considered a potential case of polio requiring immediate epidemiological investigation.

When AFP is detected, it is isolated priority ("hot") cases diseases, which include:

Children with AFP who do not have information about preventive vaccinations against polio;

Children with AFP who do not have a full course of vaccination against polio (less than 3 doses of vaccine);

Children with AFP who arrived from polio-endemic countries (territories);

Children with AFP from migrant families, nomadic population groups;

Children with AFP who communicated with migrants and people from nomadic groups of the population;

Children with AFP who had contact with those arriving from countries (territories) endemic (unaffected) with polio;

Persons suspected of having polio, regardless of age.

Considering the global processes in the world, the blurring of borders, and the intensity of migration flows, the risk of importing the virus from endemic regions has recently increased significantly. Therefore, epidemiological surveillance of diseases associated with AFP will continue until the global eradication of poliomyelitis.

At the beginning of the 21st century, on the way to eradicating polio, outbreaks of diseases with AFP symptoms caused by vaccine-related polioviruses were registered in a number of countries (Dominican Republic, Republic of Haiti, Philippines, Madagascar, Indonesia). Analysis of these outbreaks showed that the main risk factor is a decrease in the level of routine vaccination coverage of children in these countries. According to WHO, countries where polio remains endemic face challenges to achieving the goal of eradicating the infection. These include active military operations and strict restrictions on movement within the territory (Afghanistan), intensive population migration, the inability to conduct reliable monitoring on the ground, lack of support from non-governmental organizations, as well as fragmented immunization activities with low coverage of children with vaccinations associated with religious and national traditions.

It should be noted that in the post-certification period of polio eradication, surveillance of polio becomes especially important. enteroviral infections , since the removal of polioviruses from natural circulation can lead to the activation of the epidemic process of other (“non-polio”) enteroviruses, which, in turn, can cause the development of diseases occurring with the AFP syndrome.

An integral part of epidemiological surveillance of polio and AFP is epidemiological analysis of morbidity. It includes an assessment of morbidity in various age groups according to clinical forms, laboratory confirmation of diagnosis, and vaccination history. The analysis is carried out for the territory as a whole and for individual districts, as well as among urban and rural population. Particular attention is paid to studying the causes of deaths. Important has an analysis of data from the pre-hospital stage: epidemiological history, the state of the child’s health before the disease, the duration of hospitalization from the moment of contacting the health care facility, the initial diagnosis. The epidemiological analysis also includes the results of a laboratory (virological) examination, the timing of collection and delivery of material to the regional center for epidemiological surveillance of polio and AFP, the condition of fecal samples, and the timing of obtaining the results of the study of the material. To conduct an in-depth analysis of morbidity and assess the quality of epidemiological surveillance, it is necessary to use data from epidemiological investigation cards of polio and AFP cases, as well as data from other medical documents.

To monitor diseases with AFP syndrome, at the initial stage of implementation of the Polio Eradication Program in Russia, in accordance with WHO recommendations, the “expected” number of cases of this pathology was calculated for each territory in accordance with the number of children under the age of 15 years. The indicator is adjusted annually because demographic situation in the territories during the implementation of the National Infection Elimination Program was characterized by a significant decrease in the child population. Territories where AFP has not been recorded for a number of years are called “silent”; in these territories, random testing for polioviruses of healthy children attending preschool institutions is carried out. The study includes children who have been vaccinated against polio for at least 1 month.

II. CLINICAL AND LABORATORY FEATURES OF DISEASES WITH AFP SYNDROME

In the Krasnoyarsk Territory over the previous period (1999-2005), 4 cases of vaccine-associated polio (VAPP) were identified. Three children developed vaccine-associated spinal acute paralytic polio in a recipient (after receiving the first dose of the vaccine) and one case of VAPP in a contact of a recipient vaccinated with live polio vaccine.

Since 2005, no cases of VAPP have been registered in the Krasnoyarsk Territory.

The prevalence of diseases occurring with the AFP syndrome in the Krasnoyarsk Territory for the period from 2005 to 2012 ranges from 0.89 to 1.8 per 100 thousand children under 15 years of age, respectively (Table 1).

We studied the structure and clinical and laboratory features of diseases occurring with AFP syndrome in 31 children hospitalized in infectious diseases hospital Municipal Budgetary Institution of the City Children's Clinical Hospital No. 1 of Krasnoyarsk for the period 2007-2012.

Among the observed patients, 58% were residents of Krasnoyarsk and 42% were children from the regions.

Table 1.

Qualitative indicators of epidemiological surveillance of polio and acute flaccid paralysis for the period 2005-2012. in Krasnoyarsk region

Indicators / years
Expected number of AFP cases
AFP cases registered
Incidence rate per 100 thousand children upon graduation. diagnosis
Indicator of timely identification of patients with AFP in the first 7 days from the onset of paralysis (target 80%)
Proportion of AFP cases with 2 stool samples taken at intervals of 24-48 hours (%)
Proportion of AFP cases that were investigated within 48 hours after registration (%)
Proportion of samples collected in the first 14 days from the onset of paralysis (%)
Proportion of samples received by the laboratory within 72 hours of collection (%)
Proportion of AFP cases examined clinically after 60 days (%)
Number of patients with VAPP

The age structure of patients with AFP syndrome was presented as follows: children of the first year of life accounted for 16% (5 people), 1-3 years - 26% (8 people), 4-7 years - 22.6% (7 people). ), 8-10 years - 19.3% (6 people), 11-15 years - 16.1% (5 people).

The presence of AFP was indicated by gait disturbances (paretic, lameness, dragging of a limb or stepping), and in severe cases, the inability to walk or even stand. In the affected limbs, there was a decrease in muscle tone and strength, absence or decrease in tendon reflexes, i.e. peripheral paresis or paralysis was observed. In a number of cases, sensory impairment was noted.

Clinical observation in the hospital was supplemented by laboratory research methods: peripheral blood analysis, virological examination of feces twice with an interval of 24-48 hours, if polio is suspected, serological examination (neutralization reaction in paired sera), lumbar puncture, electromyography, MRI of the brain/spinal cord to exclude a space-occupying process. All patients were consulted by specialized specialists - a neurologist (assessment of neurological status), an ophthalmologist (examination of the fundus). In order to identify residual effects of paresis, all patients were examined by an infectious disease specialist and a neurologist 60 days after the onset of the disease.

The majority of children (80.6% (25 people)) were hospitalized in the first two weeks from the onset of the disease. At the same time, the preliminary diagnosis is prehospital stage indicating the AFP syndrome was established only in 48.4% of patients; the remaining patients had various diagnoses (neuroinfection?, ARVI, myalgia, serous meningitis, chickenpox encephalitis, spinal cord space-occupying process, radicular syndrome).

When studying the vaccination history of the observed patients, three children were identified who were not vaccinated against polio, who were registered as “hot cases”.

In the structure of the final clinical diagnoses of AFP, the largest share was polyradiculoneuropathy (Guillain-Barré syndrome) - 41.9% (13 people), the second place in frequency of occurrence was occupied by mononeuropathy, more often post-traumatic - 38.7% (12 people), less often meningoencephalomyelitis was recorded - 13% (4 people) and myelopolyradiculoneuritis - 6.4% (2 people).

The leading nosological form in the structure of AFP in the patients we observed was polyradiculoneuropathy - Guillain-Barré syndrome (GBS), which is known to be one of the most severe diseases of the peripheral nervous system. A spring-autumn seasonal increase in the incidence of GBS can be observed, with 38.5% (5 people) of patients identified in the spring and 46% (6 people) in the autumn. Among the cases, patients aged 4-10 years predominated (54%), less often GBS was registered among children of the first year of life (7.7%). In most cases (46%), the development of the disease was preceded by ARVI (6 people); in a number of patients (15.4%), the triggering factor for GBS was chicken pox(2 people), intestinal infections (2 people) and even meningococcal infection(1 person).

In all patients, the disease began acutely, more often (84.6%) against the background of normal body temperature, and only in 15.4% of patients at the onset of GBS the temperature increased to low-grade levels. The first symptom of the disease in 61.5% of cases was weakness in the arms and legs, less often the first complaint was pain in the legs (38.5%), gait disturbance (38.5%), and sensory disorders by polyneuritic type (69.2%). Sensory impairment usually extended to the hand and lower forearm, foot, and lower leg. At the same time, the patients did not distinguish between temperature, touch, painful stimuli, and some children also had paresthesia (a crawling sensation in the hands and feet). In all cases, paresis and paralysis were peripheral in nature and were symmetrical, characterized by long period increase (on average 9 days) and an ascending nature of distribution. In 53.8% (7 people) the lower extremities were affected, mainly the distal parts, in 46.2% (6 people) tetraparesis was recorded. In 61.5% (8 people) of patients with GBS, in addition to paresis and paralysis, damage to the III, IV, VI, VII pairs of cranial nerves was noted, in 30.7% (4 people) bulbar disorders were recorded. In a number of cases (30.7%), autonomic disorders were noted in the form of hyperhidrosis of the palms and feet, sinus tachy- or bradycardia, arrhythmia, and decreased blood pressure.

Among patients with post-infectious polyneuropathy (13 people), moderate (61.5%) and severe (30.7%) forms predominated, while light form the disease was registered only in 7.7% of cases.

During a virological study of feces for polioviruses, a vaccine strain of poliovirus type 2 was isolated from one 8-year-old child with GBS, which was regarded as its transient carriage, since clinical data made it possible to completely exclude the paralytic form of poliomyelitis. In the remaining patients with Guillain-Barré syndrome, the results of virological testing of feces for polioviruses were negative.

All patients with post-infectious polyneuropathy underwent a cerebrospinal fluid examination; in 61.5% of cases, protein-cell dissociation was detected. An electromyographic study in all patients with GBS revealed an increase in the time and a decrease in the amplitude and speed of nerve impulse conduction mainly along the small tibial nerves, and these changes were most pronounced in the distal limbs. To exclude a space-occupying process of the spinal cord/brain, MRI was performed in 61.5% (8 people) of patients. Examination of the fundus by an ophthalmologist revealed signs of intracranial hypertension in 30.7% of observed patients.

All patients with post-infectious polyneuropathy were examined by an infectious disease specialist and a neurologist at the infectious diseases hospital over time 60 days from the onset of the disease. Complete restoration of the functions of the affected limbs, without residual effects of paresis, was recorded in 69.2% (9 people) of children; residual effects in the form of muscle hypotonia, hyporeflexia, and gait disturbances 2 months from the onset of paresis were observed in 30.7% (4 people). ) cases.

Second place in the OVP structure was occupied by traumatic mononeuropathy - 38.7%(12 people). The most common traumatic mononeuropathies are acute traumatic neuritis of the sciatic nerve after intramuscular injection into the gluteus maximus muscle. In our observations, in different age groups, the disease was recorded with approximately the same frequency: in children under one year of age - 25% (3 people), 1-3 years - 16.7% (2 people), 4-7 years - 25% (3 people), over 7 years old - 33.3% (4 people). Clinical manifestations mononeuropathies were represented by peripheral asymmetric paresis of the lower limb with sensory disorders, which in some cases were accompanied by pain. The paresis developed against the background of normal body temperature; there was a history of intramuscular injections in the gluteal region, as well as traumatic falls. During the therapy, all patients with mononeuropathy showed fairly rapid positive dynamics, and by the time of discharge, almost all patients in this group had completely restored the functions of the affected limb. When examined on the 60th day from the moment of development of paresis, no residual effects were detected in any patient with traumatic mononeuropathy.

Thus, in conditions of sporadic incidence of poliomyelitis, the problem of AFP, in particular acute paralytic poliomyelitis of a different or unspecified etiology, remains relevant. One of the important sections at the stage of polio eradication is the conduct of epidemiological surveillance of diseases with the AFP syndrome.

The analysis of diseases accompanied by acute flaccid paralysis syndrome made it possible to develop algorithms for the diagnosis and management of patients with this pathology at the prehospital stage and in the hospital.

III. ALGORITHMS FOR DIAGNOSIS AND MANAGEMENT OF PATIENTS WITH POLIOMYELITIS AND OTHER ACUTE FLAGGED PARALYSIS

Pre-hospital diagnostics

Diagnostic signs of AFP The following complaints are: weakness in the limbs, lameness, inability to walk or even stand. At neurological examination (by an emergency physician, pediatrician alone or together with a neurologist in a clinic) detect: gait disturbance (paretic lameness, dragging of a limb, or stepping), in severe cases - inability to walk, lack of support. In the affected limbs, there is a decrease in muscle tone and strength, absence or decrease in tendon reflexes, i.e. peripheral incision or paralysis is observed. In some cases, sensory disturbances and pelvic disorders may occur.

When collected medical history it is necessary to clarify the date of onset of paresis, the duration of its increase, find out whether the development of paresis was accompanied by an increase in temperature, whether the paresis was preceded by catarrhal or dyspepsia symptoms, infectious diseases, injuries, intramuscular injections suffered within 2-3 weeks.

To figure out epidemiological history: stay over the past 1.5 months in areas affected by polio or contact with residents of these areas; availability of vaccination against polio 4-30 days before the disease or contact with vaccinated people within 6-60 days before the development of paresis.

Specify vaccination history: number of polio vaccinations, timing, vaccines used.

When the above-described data is identified, a topical diagnosis: “Acute paralytic poliomyelitis”, “Acute paralytic poliomyelitis associated with vaccine”, “Post-infectious polyneuropathy”, “Traumatic neuropathy”, “Acute infectious myelitis”. If the doctor finds it difficult to determine the topic of damage to the peripheral nervous system, then the diagnosis is indicated: "Acute flaccid paralysis" or "Acute flaccid paresis."

Tactics of a pediatrician at a clinic

If a pediatrician diagnoses AFP, it is necessary, if there is a neurologist in the clinic, to urgently consult the patient with him, and possibly with a traumatologist or pediatric surgeon

A patient with AFP is immediately, without additional examinations and observations at the site, hospitalized in an infectious diseases hospital

The referral indicates the patient’s complaints, medical history, epidemiological history, vaccinations against polio, identified symptoms, diagnosis

An emergency notification for the emergency department is drawn up and sent to the territorial State Sanitary Service.

After hospitalization of the patient in a hospital, carry out anti-epidemic measures at the source of the disease.

SANITARY-EPIDEMIOLOGICAL (PREVENTIVE) MEASURES AT THE DISEASE SOCIETY

Sanitary and anti-epidemiological (preventive)

activities in the outbreak where a patient with PIO/AFP has been identified

1. A specialist from the territorial body carrying out state sanitary and epidemiological supervision, when identifying a patient with POLIIO/AFP or a carrier of wild poliovirus, conducts an epidemiological investigation, determines the boundaries of the epidemic focus, the circle of people who communicated with the patient with POLIIO/AFP, a carrier of wild poliovirus, and organizes a complex of sanitary- anti-epidemic (preventive) measures.

2. Sanitary and anti-epidemic (preventive) measures in the outbreak of polio/AFP are carried out by medical and other organizations under the control of territorial bodies carrying out state sanitary and epidemiological supervision.

3. In the epidemic focus where a patient with POLI/AFP has been identified, measures are taken in relation to contact children under 5 years of age:

Medical examination by doctors - pediatrician and neurologist (infectious disease specialist);

Taking one fecal sample for laboratory testing (in the cases provided for in paragraph 5);

Single immunization with OPV vaccine (or inactivated polio vaccine - IPV - in the cases provided for in paragraph 4) regardless of previous preventive vaccinations against this infection, but not earlier than 1 month after the last immunization against polio.

4. Children who have not been vaccinated against polio, who have been vaccinated once with the IPV vaccine, or who have contraindications to the use of the OPV vaccine, are vaccinated with the IPV vaccine.

5. Taking one fecal sample from children under 5 years of age for laboratory testing in epidemic foci of Polio/AFP is carried out in the following cases:

Late detection and examination of patients with POLI/AFP (later than 14 days from the onset of paralysis);

Incomplete examination of patients with POLI/AFP (1 stool sample);

If you are surrounded by migrants, nomadic population groups, as well as those arriving from polio-endemic (polio-affected) countries (territories);

When identifying priority ("hot") cases of AFP.

6. Taking fecal samples from contact children under 5 years of age for laboratory testing is carried out before immunization, but not earlier than 1 month after last vaccination against polio with OPV vaccine.

Sanitary and anti-epidemic (preventive)

activities in the outbreak where a polio patient has been identified,

caused by wild strain poliovirus, or carrier

wild poliovirus

1. Measures in the outbreak where a patient with poliomyelitis caused by a wild strain of poliovirus, or a carrier of wild poliovirus, are identified are carried out in relation to all persons, regardless of age, who had contact with them, and include:

Primary medical examination of contact persons by a therapist (pediatrician) and a neurologist (infectious disease specialist);

Daily medical observation for 20 days with registration of observation results in the relevant medical documentation;

A one-time laboratory examination of all contact persons (before additional immunization);

Additional immunization of contact persons against polio as soon as possible, regardless of age and previous preventive vaccinations.

2. Additional immunization is organized:

Adults, including medical workers - once, OPV vaccine;

Children under 5 years of age: single immunization with OPV vaccine, regardless of previous preventive vaccinations against this infection, but not earlier than 1 month after the last immunization against polio or with inactivated polio vaccine - IPV - unvaccinated against polio, vaccinated once with IPV vaccine or having contraindications to the use of OPV vaccine;

Children under 15 years of age who arrived from countries (territories) endemic (problematic) for poliomyelitis - once (if there is information about vaccinations received in the territory Russian Federation) or three times (without information about vaccinations, if there are vaccinations carried out in another country) - with the OPV vaccine;

Pregnant women who do not have information about preventive vaccinations against polio or have not been vaccinated against polio - a single dose of IPV vaccine.

3. In the population or in the territory where a patient with poliomyelitis caused by wild poliovirus (a carrier of wild poliovirus) has been identified, an analysis of the state of vaccination is carried out with the organization of the necessary additional anti-epidemic and preventive measures.

4. In the outbreak of poliomyelitis after hospitalization of the patient, current and final disinfection is carried out using disinfectants approved for use in the prescribed manner and having virucidal properties, in accordance with the instructions/guidelines for their use. Organization and conduct of final disinfection is carried out in accordance with the established procedure.

Tactics of a doctor in the emergency room of an infectious diseases hospital (or infectious diseases department of a central district hospital)

An infectious disease doctor finds out:

• medical history

  clarifies the date of onset of the disease, the dynamics of the development of neurological, catarrhal, dyspeptic symptoms

  clarifies infectious diseases suffered within 2 - 3 weeks

  determines the presence of injuries, intramuscular injections, vaccination against polio 4 - 30 days before the disease or contact with vaccinated people in the last 4 - 60 days

  establishes vaccination history

  clarifies the epidemiological history (pay attention to the patient’s stay over the last 1.5 months in the Caucasus, Chechnya, Ingushetia, Central Asia, the presence of patients with enterovirus infection in the environment).

During an objective examination and filling out the objective status, the infectious disease specialist describes in detail the following neurological data:

gait (paretic, lameness, dragging of the leg, stepping)

checks how the patient walks (on toes and heels), jumps, whether the gait changes after physical activity, or the patient does not walk, does not stand, does not sit at all

checks the volume of active movements in the vertical and horizontal planes, muscle strength and tone, tendon reflexes, sensitivity (possibly a disturbance of the “socks”, “golf”, “stockings”, “gloves” type, which is not typical for polio)

performs anthropometry of the affected limb

pays attention to autonomic disorders (sweating, decreased temperature of the extremities, Trousseau spots), trophic disorders (bedsores, ulcers), pathological reflexes (Babinsky, Gordon)

Preliminary diagnosis by the emergency room doctor(according to ICD X)

"Polio" (if clinical signs indicate damage to the anterior horns of the spinal cord):

asymmetric flaccid paresis

rapid dynamics of increase in paresis or paralysis

symptoms of intoxication

no sensory impairment.

« Acute infectious myelitis":

signs of flaccid paresis, possibly symmetrical

pyramidal symptoms

The presence of sensory disorders of the segmental type

monoparesis with decreased muscle tone

« Post-infectious polyneuropathy »:

symmetrical flaccid paralysis

sensitivity disorder of the polyneuritic type

pelvic and trophic disorders

Possible pelvic dysfunction

history of an infectious disease within 2 - 3 weeks

"Traumatic neuropathy of the sciatic nerve":

history of intramuscular injection preceding paralysis

acute development of flaccid monoparesis

Sensory impairment of the mononeuritic type

no symptoms of intoxication

"Acute flaccid paralysis"

there are difficulties in determining the source of damage to the peripheral nervous system

examination of the patient:

2-fold virological examination of feces with an interval of 24 - 48 hours for polio and enteroviruses

in case of clinical suspicion of poliomyelitis, a serological examination is prescribed (2 blood serum samples of 5 ml each with an interval of 2 - 3 weeks)

lumbar puncture (cell-protein dissociation indicates the possibility of poliomyelitis; protein-cell dissociation indicates post-infectious polyneuropathy, a space-occupying process; the normal composition of the cerebrospinal fluid is characteristic of traumatic neuropathy)

electromyography.

The emergency room doctor prescribes treatment for the patient:

strict bed rest (10 - 14 days)

antiviral therapy

non-steroidal anti-inflammatory drugs

dehydration therapy (Lasix, furosemide)

potassium preparations

painkillers

GCS (for paralysis and post-infectious polyneuropathy)

Tactics of management and observation of a patient in an infectious diseases hospital (or department)

In the first 3 days of the patient’s stay in the hospital, a commission examination is required with the participation of an infectious disease specialist, neurologist, epidemiologist, and hospital administration.

Purpose of inspection: clarification of the topical diagnosis and differentiation with poliomyelitis.

The neurologist evaluates:

• range of motion of the upper and lower limbs in the proximal and distal sections

  muscle tone and strength (in points) of the upper and lower extremities

  volume of the limbs in the proximal and distal sections ( in cm.)

  tendon and skin reflexes: carporadial, knee, Achilles, plantar, abdominal

  pathological reflexes (Babinsky, Oppenheim, Gordon, etc.)

  sensitivity

  dysfunction of the pelvic organs.

Repeated consultations with a neurologist are carried out at intervals of 7 - 10 days.

Upon receipt of the results of a virological study (after 1 month if negative and after 3 months if viruses are detected), a second commission examination is carried out with a discussion of the diagnosis.

The topical diagnosis is supplemented by deciphering the etiology of the disease:

in case of acute flaccid spinal paralysis and isolation of the “wild” polio virus, diagnosis : “Acute paralytic spinal poliomyelitis caused by “wild” (imported, local) polio virusI (II, III) type"

when a vaccine-related strain of poliovirus is isolated from a patient with acute flaccid spinal paralysis and has a history of vaccination against polio, 4 to 30 days in advance diagnosis : "Acute paralytic spinal poliomyelitis associated with vaccine in a recipient"

If a picture of acute flaccid spinal paralysis develops in a child who has been in contact with someone vaccinated against polio in the period from 4 to 60 days and the vaccine strain is isolated, a diagnosis: “Vaccine-associated spinal paralytic poliomyelitis in contact with the recipient”(VAPP)

If a topical diagnosis of polio is made, a virological examination is carried out completely and in a timely manner (before the 14th day of illness), but the polio virus has not been isolated, then diagnosis: “Acute paralytic poliomyelitis of another, non-polio etiology”

if the examination is incomplete and late (later than the 14th day from the moment of illness), if the polio virus is not detected, you should put diagnosis : "Acute paralytic poliomyelitis of unspecified etiology."

upon discharge from the hospital, it is necessary to describe the neurological status in detail, to identify whether there are residual effects of paresis.

Tactics for managing the patient after discharge from the hospital:

• After 60 and 90 days from the onset of the disease, fecal samples are taken for virological examination, the results are entered into the child’s medical records.

  After 60 days, the patient is examined by a neurologist at a hospital or clinic to identify residual symptoms of paresis

  Medical history and outpatient card a patient with AFP syndrome is submitted to the Regional Expert Council for the Prevention of Poliomyelitis and Enteroviral Diseases to approve the final diagnosis, verify the correctness of treatment and observation.

  Dispensary observation of children who have suffered AFP is carried out by a neurologist, an infectious disease specialist and a pediatrician at the clinic (4 groups of dispensary observation, as for polio).

IV. SCHEME FOR WRITING THE ILLNESS HISTORY OF A PATIENT WITH ACUTE PARALYTIC POLIOMYELITIS AND OTHER ACUTE FLAGGED PARALYSIS (PARESIS)

Complaints. If complaints are detected, pay attention to weakness in the legs, pain, paresthesia, changes in sensitivity in the limbs, lameness, inability to walk and even stand or sit.

History of the disease. Indicate the date of onset of the disease, initial symptoms (there may be fever, catarrhal phenomena, intestinal dysfunction, the development of paralysis against the background of full health is possible), the date of onset of paresis, the presence or absence of intoxication, the duration of the increase in paresis, the severity of pain, changes in sensitivity, the presence pelvic disorders.

Specify the date of application for medical help, the initial diagnosis, the period of examination by a neurologist, the date of submission emergency notice and where the patient is referred. Ask about possible traumatic injuries to the limbs, spine, injections in the gluteal area, as well as previous viral and bacterial diseases over the past month.

Epidemiological anamnesis. Find out contacts with polio patients and visitors from polio-prone areas, with people arriving from war zones, with the nomadic gypsy population. Find out if the child has traveled to polio-prone areas over the past 1.5 months.

Determine whether the child received a live vaccine 4 - 30 days before the disease, and whether the child was in contact with a person vaccinated with a live polio vaccine 6 - 60 days before the development of paresis.

Anamnesis of life. Find out your vaccination history against polio, at what age vaccination began, what drugs (live, killed vaccine), timing of vaccination, how many doses of the vaccine you received, the date of the last vaccination. Indicate previous diseases.

Objective status. Estimate severity of condition the patient according to the depth, prevalence of paralysis and the presence of bulbar disorders.

When describing skin pay attention to increased humidity and coldness of the affected limbs, to the presence of other disorders of the autonomic nervous system (Trousseau's spots).

Looking around musculoskeletal system, assess the condition of the joints (deformation, swelling, pain, hyperemia), the presence of muscle pain.

On palpation lymph nodes determine their size, density, pain.

Describing respiratory system, note the nature of breathing through the nose (free, difficult), breathing rhythm, excursion chest, the presence or absence of a cough, the nature of the sputum. Perform percussion and auscultation.

From the authorities of cardio-vascular system determine pulse rate, evaluate heart sounds, heartbeat, presence of murmurs, measure blood pressure.

Inspect digestive organs: muscle soreness and tension abdominal wall when palpating the abdomen, the size of the liver and spleen, indicate the frequency and nature of stool. Describe the condition of the oropharyngeal mucosa (hyperemia, granularity, vesicular rashes on the arches, hyperemia and tuberosity back wall pharynx).

Note whether there is pathology on the part genitourinary system.

Describe in detail neurological status. Assess the patient's consciousness.

Describe the condition of the cranial nerves, paying particular attention to possible lesions facial nerve(smoothness of the nasolabial fold, drooping of the corner of the mouth, asymmetry of the grin, incomplete closure of the palpebral fissure when closing the eyes and in sleep). Possible damage to the glossopharyngeal and vagus nerve(impaired swallowing, phonation, choking, nasal voice, sagging soft palate and lack of reflex on the affected side, deviation of the uvula, absence or reduction of the palatine and pharyngeal reflexes), hypoglossal nerve (deviation of the tongue, dysarthria).

Assess the motor sphere: gait (paretic, lameness, dragging of a limb, stepping, cannot walk or stand), the ability to walk on tiptoes and on heels, stand and jump on the left and right legs. Check motor activity in your hands.

In case of doubtful paresis, check the gait after physical activity (the phenomena of paresis may be more clearly visible). Assess the muscle tone of each limb in the proximal and distal sections (hypotonia, atony, hypertension, dystonia, plastic type). With the patient lying down, check the volume of passive and active movements (in the vertical and horizontal plane). Assess muscle strength in the proximal and distal sections on a five-point scale. Determine the presence of muscle atrophy and wasting. Measure the volume of the right and left limbs at three symmetrical levels (upper 1/3, middle, lower 1/3 of the limb). Check tendon reflexes from the arms (triceps and biceps brachii, carporadial) and legs (knee, Achilles), assess their symmetry. Indicate the presence of pathological reflexes (carpal - Rossolimo, Zhukovsky; foot - Babinsky, Rossolimo, Oppenheim and Gordon).

Assess the presence and severity of tension symptoms (Lassegue, Nery symptoms), pain along the nerve trunks, along the spine.

Determine skin reflexes: abdominal (upper, middle, lower), cremasteric, plantar.

Check superficial sensitivity: pain, tactile. A disorder of the neuritic type is possible: a decrease or increase in sensitivity of the “socks”, “golf”, “stockings”, “tights”, “short gloves”, “long gloves” type. Check deep sensitivity (muscle-joint feeling). Determine the presence of autonomic disorders (sweating, cold extremities), trophic disorders (bedsores, ulcers).

Determine the presence of meningeal symptoms.

Note whether there are pelvic disorders (urinary and fecal retention or incontinence).

Preliminary diagnosis and its rationale.

If signs of flaccid paresis (limited movements, hypotonia, hyporeflexia) or flaccid paralysis (lack of movements, atony, areflexia) are detected in a child, a topical diagnosis (poliomyelitis, Guillain-Barre syndrome, neuropathy, myelitis) is first made. Also allowed as a preliminary diagnosis: “Acute flaccid paresis (paralysis).” The topical diagnosis must be confirmed or made after 2-3 days of the patient’s stay in the hospital after a commission clinical examination (the commission includes an infectious disease specialist, a neurologist, and the head of the department) and receipt of research results cerebrospinal fluid.

For "Acute paralytic poliomyelitis, spinal form" characteristic:

damage to young children - mainly under 3 years of age

development of flaccid paresis or paralysis after a preparalytic period lasting 3-6 days

the appearance of paralysis due to elevated temperature

short (up to two days) period of increasing paralysis

Predominantly affecting the lower extremities

asymmetric paresis or paralysis

greater severity of lesions in the proximal limbs

presence of pain and tension symptoms

autonomic disorders (sweating and decreased temperature in the extremities)

lack of sensitive, trophic skin lesions and pyramidal signs in the limbs

in case of vaccine-associated polio in the recipient, there is a history of an anti-polio vaccination received 4-30 days before the development of the disease, and in case of vaccine-associated polio in a contact - contact with a person vaccinated against polio 6-60 days before the disease

serous inflammation in the cerebrospinal fluid with cell-protein dissociation in the acute period of the disease, then after 10 days protein-cell dissociation is detected

For "Post-infectious polyneuropathy (Guillain-Barré syndrome)" characteristic:

development of the disease in children over 5 years of age

the occurrence of flaccid paralysis against a background of normal temperature

1-3 weeks before the development of paralysis, various infectious diseases are observed

long (from 5 to 21 days) period of increasing paralysis

symmetrical nature of paralysis (paresis)

Predominant damage to the distal extremities

mild sensitivity disorder of the neuritic type (hypo- or hyperesthesia of the “gloves”, “socks”, “long gloves”, “golf” type, paresthesia)

pronounced protein-cell dissociation in the cerebrospinal fluid (protein increases to 1500-2000 mg/l with lymphocytic cytosis of no more than 10-20 cells)

At "Traumatic neuropathy" unlike polio:

there is an indication of injury

no symptoms of intoxication

flaccid paresis is accompanied by a sensitivity disorder of the neuritic type

there are no inflammatory changes in the cerebrospinal fluid

At "Infectious myelitis":

flaccid paralysis of the limbs is accompanied by the presence of pyramidal signs

there are gross sensory disorders of the conduction type

There is no pain or tension symptoms in the affected limbs

pelvic disorders are observed (retention or incontinence of urine and feces)

development of bedsores is typical

in the acute period of the disease, a moderate increase in protein content (up to 600-1000 mg/l) and two to three-digit lymphocytic pleocytosis are observed in the cerebrospinal fluid.

Examination plan:

Clinical blood test.

General urine analysis.

Feces for I/Gl., scraping for enterobiasis.

Virological examination of feces upon admission twice with an interval of 24 hours.

Serological examination (RN, RSC) of blood and CSF in paired sera, with an interval of 2-3 weeks. Diagnostic value has an increase in antibody titer over the course of the disease by 4 times or more. A sharper increase in antibody titer occurs to the serovar that caused the disease.

Determination of poliovirus antigen in feces and CSF using ELISA (type-specific antibodies IgM, IgG, IgA are determined)

Lumbar puncture twice with an interval of 10 days (in the CSF, a change from cell-protein dissociation to protein-cell dissociation is determined).

Examination by a neurologist, ophthalmologist.

Electromyography.

Study of electrical excitability of muscles.

NMR of the spinal cord.

Clinical diagnosis and its rationale.

A clinical diagnosis is made after receiving the results of virological (no earlier than 28 days after collecting fecal samples) and serological studies.

A case of acute flaccid spinal palsy in which wild poliovirus is isolated is classified as "Acute paralytic poliomyelitis caused by wild imported poliovirus (type 1, 2 or 3)" or "Acute paralytic poliomyelitis caused by wild local (endemic) poliovirus (type 1, 2 or 3)."

A case of acute flaccid spinal paralysis that occurred no earlier than 4 and no later than 30 days after taking live polio vaccine, in which the vaccine-derived polio virus was isolated, is classified as "Acute paralytic poliomyelitis associated with vaccine in a recipient."

A case of acute flaccid spinal paralysis that occurs no later than 60 days after contact with a vaccinated person in which vaccine-derived poliovirus is isolated is classified as "Acute paralytic poliomyelitis associated with a vaccine in a contact."

A case of acute flaccid spinal paralysis, in which virological examination was carried out correctly (before the 14th day of illness, twice), but the polio virus was not isolated, is regarded as "Acute paralytic poliomyelitis of other non-polio etiology".

A case of acute flaccid spinal paralysis, in which a virological examination was not carried out or there are defects in the examination (material collection later than the 14th day of illness, a single study) and the polio virus was not isolated, is classified as "Acute paralytic poliomyelitis of unspecified etiology."

With established topical diagnoses (post-infectious polyneuropathy, myelitis, traumatic mononeuropathy), the absence of isolation of the polio virus from the patient allows us to exclude acute paralytic polio.

Examples of clinical diagnoses:

"Post-infectious polyneuropathy, severe form"

"Traumatic neuropathy of the sciatic nerve on the right."

The diagnoses of “Acute paralytic poliomyelitis caused by the wild polio virus” or “Acute paralytic poliomyelitis associated with the vaccine” are finally confirmed when examining the patient 60 days from the onset of paralysis if residual effects of paralysis or paresis are preserved by this time.

Diary. Before writing the diary, the day of illness and the day the patient was in the hospital are indicated. The date, heart rate and breathing rate are displayed in the fields. The diary should reflect the dynamics of symptoms of flaccid paresis - muscle tone, tendon reflexes, symptoms of tension, pain, range of motion, muscle strength, volume of limbs. The presence and dynamics of meningeal symptoms are assessed. The condition of the cranial nerves is noted.

At the end of the diary, a conclusion is written based on the results of laboratory tests, changes in the treatment of the patient are justified.

Stage epicrisis. A staged epicrisis is written once every 10 days according to the generally accepted scheme.

Discharge summary written according to the generally accepted scheme. Recommendations are given for further observation and treatment of the patient, for further vaccination against polio.

Acute flaccid paralysis occurs as a result of damage to the peripheral nerve anywhere. AFP is a complication of many diseases, including polio.

Flaccid paralysis develops due to the action of enteroviruses. Pathology occurs due to damage to neurons of the spinal cord and areas of peripheral nerves.

A common cause of development is polio.

AFP includes all paralysis accompanied by rapid development. The condition for making such a diagnosis is the development of pathology within three to four days, no more. The disease occurs in children under 15 years of age as a result of polio, and also in adults for many reasons.

Acute flaccid paralysis does not include:

• paresis of facial muscles;
• paralysis acquired at birth as a result of injury;
• injuries and damage that provoke the development of paralysis.

There are several types of AFP depending on the cause of nerve damage.

Symptoms

AFP is diagnosed if the following symptoms are present:

• lack of resistance to passive movement of the affected muscle;
• pronounced muscle atrophy;
• absence or significant deterioration of reflex activity.

A specific examination does not reveal disorders of nervous and muscle electrical excitability.

The location of the paralysis depends on which part of the brain is damaged. When the anterior horns of the spinal cord are damaged, paralysis of one leg develops. In this case, the patient cannot move his foot.

With symmetrical damage to the spinal cord in the cervical region, paralysis of both lower and upper extremities may develop simultaneously.

Before the onset of paralysis, the patient complains of acute excruciating pain in the back. In children, the pathology is accompanied by the following symptoms:

• swallowing dysfunction;
• weakness of the muscles of the arms and legs;
• trembling in hands;
• breathing disorder.

No more than three to four days pass from the appearance of the first symptoms to the development of paralysis. If the disease manifests itself later than four days from the onset of illness, there can be no talk of an acute flaccid form.

The pathology is dangerous due to its complications, including:

• reduction in the size of the affected limb or part of the body due to the fact that the muscles are atrophied;
• hardening of the muscles in the affected area (contracture);
• hardening of joints.

In most cases, it is impossible to get rid of complications caused by flaccid paralysis. The success of treatment largely depends on the cause of the disorder and timely access to the clinic.

Types of flaccid paralysis

There are several types of pathology, depending on the cause of its development:

• polio;
• myelitis;
• polyneuropathy;
• mononeuropathy.

Paralysis in children develops due to polio caused by a virus, as well as with a disease of unspecified etiology.

Inflammation of the spinal cord (myelitis) causes a disruption in the connections between the central nervous system and the PNS, which causes paralysis and impaired sensitivity in some parts of the body.

Flaccid paralysis also accompanies poly- and mononeuropathy. These diseases are characterized by damage to areas of the peripheral nervous system. With polyneuropathy, multiple lesions caused by viruses or infections are diagnosed. Mononeuropathy is characterized by damage to one nerve, usually the disorder affects the radial or ulnar nerve, causing paralysis of the corresponding part of the body.

Paralytic polio

Poliomyelitis is a dangerous disease that can lead to paralysis in children. Diagnosed in childhood up to 15 years, however, there are often cases of delayed complications of polio several decades after the disease.

The disease is accompanied by damage to the motor neurons of the anterior horns of the spinal cord, which is responsible for the development of flaccid paralysis in polio.

The routes of infection with the polio virus are from person to person and through household contact, when the patient’s saliva gets on food or utensils. At room temperature, the virus that causes this disease remains dangerous for several days.

The virus persists on the mucous membranes of the nasopharynx for up to two weeks, which makes there a high probability of infection from a sick person.

There is only one way to protect yourself from the virus – through vaccination. In rare cases, the live vaccine also causes paralysis.

Virological examination

The following must be tested for the presence of the virus:

• children under 15 years of age with flaccid paralysis;
• refugees from areas with a high risk of infection (India, Pakistan);
• patients with clinical signs of the disease and their environment.

Fecal samples are required for analysis. At the beginning of the disease, the concentration of the virus in the patient’s feces reaches 85%.

Patients with polio, or patients suspected of having this disease, should be examined again one day after the initial analysis.

Symptoms of polio:

• fever;
• inflammation of the mucous membrane of the nasopharynx;
• impaired motor activity of the neck muscles and back;
• muscle spasms and cramps;
• muscle pain;
• indigestion;
• infrequent urination.

Acute symptoms include difficulty breathing and muscle paralysis.

AFP in polio

The disease is characterized by rapid development, symptoms rapidly increase within 1-3 days. On the fourth day, flaccid paralysis is diagnosed. To make a diagnosis it is necessary to confirm:

• sudden onset of paralysis;
• sluggish nature of the disorder;
• asymmetrical damage to the body;
• absence of pathologies from the pelvic organs and sensitivity.

The first week before paralysis develops, there is fever, lethargy, pain, and muscle spasms. Then paralysis rapidly develops, the severity of which depends on the characteristics of the damage to the spinal neurons. With pathology, the general symptoms of polio usually subside. A gradual restoration of motor function is observed a week after the development of paralysis. The prognosis depends on which part of the neurons is affected. If 70% or more of the neurons are lost due to the disease, motor function of the affected part of the body is not restored.

The prognosis for recovery can be judged 10 days after the development of paralysis. If during this period voluntary movements of the muscles of the affected part of the body begin to appear, there is a high probability full recovery mobility over time. The peak of recovery occurs in the first three months after the illness. Residual symptoms may persist for up to two years. If after 24 months the motor function of the affected limb has not been restored, residual effects cannot be treated. After polio, deformities of the limbs, impaired joint mobility, and contracture are observed.

AFP in children

Thanks to mandatory vaccination, polio in a child in our country does not pose such a danger as in India or Pakistan. But polio is not the only cause of flaccid paralysis in children. Pathology develops under the influence of various enteroviruses. There are various neurotropic viruses that attack the nervous system and cause severe paresis with subsequent muscle atrophy. Entoroviruses of non-poliomyelitis nature are particularly dangerous.

Treatment of AFP

Therapy is aimed at restoring the function of peripheral nerves affected by the viral disease. For this purpose, use:

• drug therapy;
• physiotherapy;
• massage;
• folk remedies.

The combination of these methods makes it possible to obtain a good therapeutic effect, but only with timely treatment. If more than 70% of neurons have died as a result of a viral infection, restoration of mobility and sensitivity of the affected area is impossible.

Drug therapy includes treatment with neurotropic and vasoactive drugs. Therapy is aimed at improving metabolism and conduction of nerve fibers, improving blood circulation and stimulating the activity of the nervous system.

The drugs are administered either intravenously or intramuscularly. It is possible to administer drugs using a dropper in cases of extensive neuronal damage.

Vitamin therapy is required. The introduction of B vitamins is indicated, which stimulate cell renewal and strengthen the nervous system.

During the rehabilitation period, wearing a bandage or orthosis is indicated to fix the limb in a physiologically correct position. This measure will avoid visible deformation of the joint due to weakening of the muscles.

Physiotherapy and massage

Physiotherapeutic methods of treatment help to speed up the restoration of motor activity and restore sensitivity. For paralysis, methods of electrical stimulation - galvanization, balneotherapy - are successfully used. Such therapeutic methods improve the conductivity of nerve fibers, accelerate regeneration and cell restoration. A course of such treatment is carried out only after the underlying disease that led to paralysis has been relieved.

To normalize muscle activity and to prevent the development of atrophy, massage is used. Patients are prescribed an intense massage, with prolonged kneading of damaged muscles and strong rubbing.

When performing a massage, it is important to remember that muscles constrained by paralysis should not be subjected to traumatic effects. The massage should be intense, but without excessive effort. Traumatic effects on the affected muscles can have the opposite effect.

To restore muscle activity, a long course of massage is indicated, up to six months. With regular procedures, the result will become noticeable after the first 5 sessions.

In addition to classic massage, good results are achieved by applying targeted pressure to painful nodes human body. In this case, you also cannot act directly on the stiff muscle. This technique improves metabolic processes in muscle fibers, stimulating the rapid restoration of mobility and sensitivity. The maximum effect is achieved by using two techniques simultaneously, alternating.

Folk remedies for a speedy recovery

Traditional methods can be supplemented with treatment, but only after consultation with your doctor. It is not possible to cure paralysis on your own using folk methods alone. Often, patients, preferring herbal treatment, ignore the doctor’s instructions, which leads to a worsening of the situation and the impossibility of further recovery with medications.

1. Make a decoction of a tablespoon of rose hip root with the addition of the same amount of berries and 500 ml of water. After cooling, the broth is diluted with 5 liters of water and used as a bath for paralyzed limbs.
2. Peony evasive is used to speed up recovery. To do this, you need to prepare a decoction from the rhizome of the plant, at the rate of 1 spoon of dry root per 600 ml of boiling water. After the decoction has infused and cooled, it should be taken three times a day before each meal, one small spoon.
3. Fresh leaves of dye sumac are poured with a glass of boiling water and left for 2 hours in a warm place. After cooling, take the decoction in a small spoon every 5 hours, regardless of meals.

Before starting such treatment, you should make sure that there is no allergic reaction to the ingredients in the recipes.

Prevention and prognosis

The prognosis largely depends on the degree of damage to spinal cord neurons. With moderate neuronal death, it is possible to achieve restoration of motor activity, but treatment will be long-term, up to several years. In the treatment of paralysis important role plays a timely visit to the clinic and correct diagnosis of the problem.

Preventive measures include timely treatment any infectious or viral disease. The presence of any source of infection in the body is dangerous due to its spread throughout the body through the bloodstream, which may result in the development of inflammatory damage to the peripheral nerves.

When the first symptoms of developing paralysis appear (muscle weakness, cramps, muscle and back pain), you should immediately consult a specialist.

The Russian national vaccination calendar includes vaccinations against more than ten infectious diseases. What is OPV vaccinated against and what drugs are used for this purpose? This means vaccination against a dangerous viral disease - polio, or spinal paralysis, which until recently was recorded throughout the globe.

So what is OPV vaccination? This acronym stands for “oral polio vaccine” or polio vaccine. The word "oral" means that the drug is administered through the mouth. Let's find out everything about this vaccine.

OPV vaccination - what is it?

Currently, only one drug for oral vaccination is approved in our country. This is “Oral polio vaccine types 1, 2, 3 (OPV).” She is being released Russian manufacturer FSUE Institute of Poliomyelitis and Viral Encephalitis named after. M.P. Chumakov RAMS".

The OPV vaccine contains live polio virus. It was obtained in the 1950s by American researcher Albert Sabin as a result of long-term cultivation of the wild strain in monkey cell culture. The peculiarity of this type of poliovirus is that it takes root well and multiplies in the intestines, but is not able to infect nervous tissue cells. Whereas field or wild poliovirus is dangerous precisely because it causes the death of neurons in the spinal cord - hence paralysis and disruption of nervous activity.

The vaccine virus includes three varieties - serotypes 1, 2, 3, which completely overlap wild strains of poliovirus. If necessary, monovalent drugs containing only one type of virus can be produced - they are used to combat the disease in foci of infection.

In addition to the virus, the vaccine contains antibiotics that do not allow bacteria to multiply in the nutrient medium - polymycin, neomycin, streptomycin. Those who have a history of allergies to these antibacterial agents should be aware of this.

The Sabin vaccine is widely used throughout the world and is the only live vaccine against poliovirus. Largely thanks to her, most developed countries are now declared polio-free zones by WHO. Since 2002, the European region, including the CIS countries, has been declared such a zone.

The vaccination schedule against polio includes two vaccines - OPV and IPV. What is the difference between them? IPV is an inactivated polio vaccine that contains killed (inactivated) virus. It is administered by injection. While the OPV vaccine contains live polio virus and is given orally.

Until 2010, vaccination against polio was carried out in Russia using exclusively inactivated vaccines - a favorable epidemiological situation allowed this. But in 2010, an outbreak of the disease occurred in neighboring Tajikistan, and one person died from polio in Russia. As a result, the decision was made to use mixed vaccination. In the first year of life, children are given an inactivated polio vaccine (Imovax polio, Poliorix), then three doses of a live vaccine. Revaccination at older ages is carried out only with live OPV vaccine.

Sometimes you can come across the abbreviation: r2 OPV vaccination - what is it? This refers to the second booster dose of oral polio vaccine, which is given at 20 months of age. What kind of vaccine is r3 OPV? Accordingly, this is revaccination No. 3, which is given to children at the age of 14.

Description of instructions for use of the OPV vaccine

According to the instructions, the OPV vaccine is intended for use in children aged from three months up to 14 years old. In areas of infection, the vaccine can be administered to newborns directly in maternity hospitals. Adults are vaccinated upon entering an affected area.

Where is OPV vaccination given? It is administered orally, that is, through the mouth.

The vaccine is a pink liquid, packaged in bottles of 25 doses (5 ml). Single dose equal to 4 drops, or 0.2 ml. It is taken using a special pipette or syringe and dripped onto the root of the tongue for infants or onto the tonsils of older children. The vaccine administration procedure must be carried out in such a way as not to provoke increased salivation, regurgitation and vomiting. If such a reaction does occur, the child is given another dose of the vaccine. The fact is that the virus must be “assimilated” by the mucous membrane of the oral cavity and enter the tonsils. From there it penetrates the intestines and multiplies, causing the development of immunity. If the virus comes out with vomiting or is washed away with saliva, then vaccination will be ineffective. When it enters the stomach, the virus is also neutralized gastric juice and does not achieve the desired goal. If the child burps after repeated application of the virus, then the vaccine is not repeated a third time.

OPV can be given at the same time as other vaccines. The exceptions are BCG and vaccine preparations administered orally - for example, Rotatek. OPV does not affect the development of immunity to other diseases and does not in any way affect the child’s tolerance to vaccines.

Contraindications and precautions

OPV vaccine should not be administered to following cases:

Respiratory infections elevated temperature, other minor weakening of the child’s immunity requires complete cure before OPV is administered.

Since OPV is a vaccine containing a live virus that actively multiplies in the body, a vaccinated child can infect non-immune people for some time. In this regard, OPV vaccination requires compliance with certain rules when using it; in other cases, it must be replaced with an inactivated vaccine.

1. If the family has children under the age of 1 year who are not vaccinated against polio (or children who have a medical exemption from the vaccine), it is better to vaccinate with IPV.
2. When carrying out mass vaccination with OPV, unvaccinated children are isolated from the group for a period of 14 to 30 days.

Also, OPV is sometimes replaced by IPV in closed preschool institutions (orphanages, specialized boarding schools for children, orphanages), anti-tuberculosis sanatoriums, and inpatient departments of hospitals.

Possible complications

In very rare cases - about one in 750,000 - the weakened virus in the OPV vaccine undergoes changes in the body and reverts to a type that can paralyze nerve cells. This side effect is called VAPP - vaccine-associated polio. VAPP is a serious complication of the OPV vaccine.

The risk of developing such a complication is highest after the first vaccination, less so after the second. That is why the first two vaccinations are given with inactivated vaccines - from them VAPP does not develop, but protection is produced. A child vaccinated twice with IPV has virtually no risk of developing a vaccine infection.

The first reaction in the event of the appearance of VAPP occurs from 5 to 14 days after administration of the drops. Complications from OPV vaccination may occur in people with immunodeficiency. Then the weakened immune system does not produce antibodies that protect against the virus, and it multiplies unhindered, causing serious illness. Therefore, vaccinations with live vaccines are contraindicated in this case.

Vaccination dates

According to the national vaccination calendar, vaccination against polio is carried out at the following times:

• at 3 and 4.5 months the child is given an IPV injection;
• at 6 months - live OPV;
• first revaccination with OPV at 18 months;
• second revaccination - at 20 months;
• third revaccination, the last one - OPV vaccination at 14 years of age.

Thus, revaccination with OPV is carried out three times.

If the child's parents wish, vaccinations against polio can be done using inactivated vaccines, at the patient's personal expense.

How to prepare for OPV vaccination

The OPV vaccine against polio requires preparation before vaccination. An examination by a pediatrician is required to assess the risk of infection of other family members (children, pregnant women) with the vaccine virus.

In order for the vaccine to be better absorbed, the child should not be fed or given water for one hour before and after vaccination.

Reaction to OPV vaccine

The reaction to OPV vaccination is usually not pronounced - children tolerate it easily. On the day of vaccination, you can walk with your child, bathe him and live as usual.

Side effects of the OPV vaccine may include mild stool upset (loose or frequent) for a few days after vaccination, which resolves without any intervention. It is also possible that a manifestation of weak allergic reactions- skin rashes. Sometimes nausea and single vomiting occur.

Fever after OPV vaccination is an uncharacteristic reaction. It is usually associated with other factors.

Let's summarize all of the above. OPV vaccination is defined as “oral polio vaccine.” This is a vaccine containing live polio virus and is administered as droplets into the mouth. Whether a polio vaccine is necessary is a decision for parents first and foremost. But it must be taken into account that doctors have no doubt about the benefits of mass vaccination, which has allowed relatively short time(from the 1960s to the 1990s) to minimize the manifestation of such a dangerous disease as polio. Even in countries that have been free of the disease for decades, polio vaccination continues. To eliminate VAPP and the circulation of the vaccine virus in the population, they switched to a full cycle of using inactivated vaccines. If the epidemiological situation in Russia stabilizes, it is planned to do the same.

acute flaccid paralysis - any case of acute flaccid paralysis in a child under 15 years of age (14 years 11 months 29 days), including Guillain-Barré syndrome, or any paralytic disease, regardless of age, with suspected polio;

acute paralytic poliomyelitis caused by wild polio virus - a case of acute flaccid spinal paralysis with residual effects on the 60th day after onset, in which the “wild” polio virus was isolated (according to ICD 10-A80.1.A80.2);

acute paralytic poliomyelitis associated with a vaccine in a recipient - a case of acute flaccid spinal paralysis with residual effects on the 60th day, which usually occurred no earlier than 4 and no later than 30 days after taking the OPV vaccine, in which the vaccine-derived poliovirus was isolated ( according to ICD 10 - A80.0.);

acute paralytic poliomyelitis associated with the vaccine in a contact - a case of acute flaccid spinal paralysis with residual effects on the 60th day, which usually occurred no later than 60 days after contact with a vaccinated person with OPV vaccine, in which the vaccine-derived poliovirus was isolated (according to the ICD 10 - A80.0.);

acute paralytic poliomyelitis of unspecified etiology - a case of acute flaccid spinal paralysis in which negative laboratory results were obtained (poliomyelitis virus was not isolated) due to inadequate collected material(late detection of the case, late selection, improper storage, insufficient volume of material for research) or laboratory research was not carried out, but residual flaccid paralysis is observed by the 60th day from the moment of its occurrence (according to ICD10 - A80.3.);

acute paralytic poliomyelitis of another, non-poliovirus etiology - a case of acute flaccid spinal paralysis with residual effects on day 60, in which a full adequate laboratory examination was carried out, but the polio virus was not isolated, and a diagnostic increase in antibody titer was not obtained or another neurotropic virus was isolated (according to ICD 10 - A80.3.).

III. Identification, registration, registration of patients with polio, acute flaccid paralysis, statistical observation

3.1. Identification of cases of POLI/AFP diseases is carried out by medical workers of organizations engaged in medical activities and other organizations (hereinafter referred to as medical workers of organizations), as well as by persons who have the right to engage in private medical practice and have received a license to carry out medical activities in the manner prescribed by law (hereinafter referred to as - privately practicing medical workers) when applying for and providing medical care, conducting examinations, examinations, and when carrying out active epidemiological surveillance.

When AFP is detected, priority (“hot”) cases of diseases are identified, which include:

Children with AFP who do not have information about preventive vaccinations against polio;

Children with AFP who do not have a full course of vaccination against polio (less than 3 doses of vaccine);

Children with AFP who arrived from polio-endemic countries (territories);

Children with AFP from migrant families, nomadic population groups;

Children with AFP who communicated with migrants, people from nomadic groups,

Children with AFP who had contact with those arriving from countries (territories) endemic (unaffected) with polio;

Persons suspected of having polio, regardless of age.

3.2. If a patient with PIO/AFP is identified, medical workers of organizations and private medical workers are obliged to report this by phone within 2 hours and within 12 hours to send an emergency notification of the established form (N 058/u) to the body exercising state sanitary and epidemiological supervision at the territory where a case of the disease was detected (hereinafter referred to as the territorial body exercising state sanitary and epidemiological supervision).

3.3. Upon receipt of an emergency notification of a case of Polio/AFP, within 24 hours, specialists from the territorial body exercising state sanitary and epidemiological supervision will organize an epidemiological investigation. Based on the results of the epidemiological investigation and examination of the patient by a neurologist (infectious disease specialist), part 1 of the epidemiological investigation card of POLI/AFP cases is filled out in accordance with the form given in Appendix 2

3.4. Copies of epidemiological investigation cards for polio/AFP cases as they are completed (and parts 2) on electronic and paper media are submitted in the prescribed manner to the Coordination Center for the Prevention of Poliomyelitis and Enterovirus (non-polio) Infection.

3.5. Patients with poliomyelitis or suspected of poliomyelitis (without age restrictions), as well as children under 15 years of age who have been diagnosed with AFP syndrome in any nosological form of the disease, are subject to registration and registration. Registration and accounting are carried out in the “Register of Infectious Diseases” (Form N 060/u) at the place of their detection in medical and other organizations (children’s, adolescents, health and other organizations), as well as by territorial bodies carrying out state sanitary and epidemiological supervision.

3.6. Territorial authorities carrying out state sanitary and epidemiological supervision submit a monthly report to the Coordination Center for the Prevention of Poliomyelitis and Enterovirus (Non-Polio) Infection (hereinafter referred to as the Coordination Center) on the registration of cases of POLIOT/AFP based on preliminary diagnoses and virological studies in accordance with the form presented in the Appendix 3 to these sanitary rules.

3.8. The list of confirmed cases of Polio/AFP is submitted by the body exercising state sanitary and epidemiological supervision in the constituent entity of the Russian Federation to the Coordination Center within the established time frame in accordance with the form presented in Appendix 4 to these sanitary rules.

IV. Measures for patients with polio, acute flaccid paralysis and carriers of the wild polio virus

4.1. A patient with suspected POLIIO/AFP disease must be hospitalized in an infectious disease hospital. The list of medical organizations to which patients with POLI/AFP are hospitalized is determined by the authorities exercising state sanitary and epidemiological supervision, together with the authorities executive power subjects of the Russian Federation in the field of protecting the health of citizens.

4.2. In the referral for hospitalization of a patient with Polio/AFP, the following is indicated: personal data, date of illness, initial symptoms of the disease, date of onset of paralysis, treatment provided, information on preventive vaccinations against polio, contact with a patient with Polio/AFP, contact with an OPV vaccine within 60 days, about visiting polio-endemic countries (territories), as well as about communicating with persons arriving from such countries (territories).

4.3. When a patient with POLIIO/AFP is identified, two fecal samples are taken for laboratory virological testing with an interval of 24-48 hours. Samples should be taken as soon as possible, but no later than 14 days from the onset of paresis/paralysis.

If polio (including VAPP) is suspected, paired blood sera are collected. The first serum is taken upon admission of the patient to the hospital, the second - after 2-3 weeks.

When fatal outcome diseases in the first hours after death, sectional material is collected for laboratory research.

Collection and delivery of materials for laboratory research is carried out in accordance with established requirements.

4.4. If acute poliomyelitis is suspected, an immunological status study (immunogram) and electroneuromyography are performed.

4.5. A person who has recovered from polio caused by wild poliovirus can be discharged from the hospital after receiving a single negative result of a virological test.

4.6. In order to identify residual paralysis, a patient with POIO/AVP is examined 60 days from the onset of the disease (provided that the paralysis has not recovered earlier). The examination data is entered into the child’s medical documentation and into part 2 of the epidemiological investigation card of the PIO/AFP case in accordance with the form given in Appendix 2 to these sanitary rules.

4.7. Repeated examination and collection of fecal samples for laboratory testing from patients with poliomyelitis, including VAPP, is carried out on 60 and 90 days from the onset of paresis/paralysis. Examination data and laboratory results are included in the appropriate medical documentation.

4.8. The final diagnosis in each case is established by a commission based on the analysis and evaluation of medical documentation (history of the child’s development, medical history, epidemiological investigation card of a case of POLI/AFP, laboratory test results, etc.).

4.9. The medical organization that established the initial diagnosis is informed about confirmation of the diagnosis. The final diagnosis is entered into the relevant medical documentation of the patient and part 3 of the card in accordance with the form given in Appendix 2 to these sanitary rules

4.10. Persons who have had polio are subject to immunization against polio with an inactivated vaccine in accordance with their age.

4.11. A carrier of a wild strain of poliovirus (hereinafter referred to as a carrier of wild poliovirus) is isolated in an infectious diseases hospital for epidemic reasons - if there are children in the family who have not been vaccinated against polio, as well as persons belonging to decreed contingents (medical workers, trade workers, public catering workers, children's educational organizations).

When detected, a carrier of wild poliovirus must be immunized three times with the OPV vaccine with an interval between vaccinations of 1 month.

Carriers of wild poliovirus who visit organized groups of children or belong to a decreed contingent are not allowed into groups of children and to professional activity until a negative laboratory test result for wild poliovirus is obtained. Material for virological studies is collected from such individuals before the next dose of OPV vaccine is administered.

V. Sanitary and anti-epidemic (preventive) measures in the outbreak where a patient with POLI/AFP was identified

5.1. A specialist from the territorial body carrying out state sanitary and epidemiological supervision, when identifying a patient with POLIOT/AFP or a carrier of wild poliovirus, conducts an epidemiological investigation, determines the boundaries of the epidemic focus, the circle of people who communicated with the patient with POLIOT/AFP, a carrier of wild poliovirus, and organizes a set of sanitary and anti-epidemic measures ( preventive) measures.

5.2. Sanitary and anti-epidemic (preventive) measures in the outbreak of polio/AFP are carried out by medical and other organizations under the control of territorial bodies carrying out state sanitary and epidemiological supervision.

5.3. In the epidemic focus where a patient with POLI/AFP has been identified, measures are taken in relation to contact children under the age of 5 years:

Medical examination by doctors - pediatrician and neurologist (infectious disease specialist);

Taking one fecal sample for laboratory testing (in the cases provided for in paragraph 5.5);

Single immunization with OPV vaccine (or inactivated polio vaccine - IPV - in the cases provided for in paragraph 5.4.) regardless of previous preventive vaccinations against this infection, but not earlier than 1 month after the last immunization against polio.

5.4. Children who have not been vaccinated against polio, who have been vaccinated once with the IPV vaccine, or who have contraindications to the use of the OPV vaccine, are vaccinated with the IPV vaccine.

5.5. Taking one fecal sample from children under 5 years of age for laboratory testing in epidemic foci of Polio/AFP is carried out in the following cases:

Late detection and examination of patients with POLI/AFP (later than 14 days from the onset of paralysis);

Incomplete examination of patients with POLI/AFP (1 stool sample);

If you are surrounded by migrants, nomadic population groups, as well as those arriving from polio-endemic (polio-affected) countries (territories);

When identifying priority ("hot") cases of AFP.

5.6. Taking samples of feces from contact children under 5 years of age for laboratory testing is carried out before immunization, but not earlier than 1 month after the last vaccination against polio with the OPV vaccine.

VI. Sanitary and anti-epidemic (preventive) measures in the outbreak where a patient with poliomyelitis caused by a wild strain of poliovirus or a carrier of wild poliovirus has been identified

6.1. Activities in an outbreak where a patient with poliomyelitis caused by a wild strain of poliovirus or a carrier of wild poliovirus have been identified are carried out in relation to all persons, regardless of age, who have had contact with them, and include:

Primary medical examination of contact persons by a therapist (pediatrician) and a neurologist (infectious disease specialist);

Daily medical observation for 20 days with registration of observation results in the relevant medical documentation;

A one-time laboratory examination of all contact persons (before additional immunization);

Additional immunization of contact persons against polio as soon as possible, regardless of age and previous preventive vaccinations.

6.2. Additional immunization is organized:

Adults, including medical workers - once, OPV vaccine;

Children under 5 years of age - in accordance with clause 5.3. these sanitary rules;

Children under 15 years of age who arrived from countries (territories) endemic (problematic) for poliomyelitis, once (if there is information about vaccinations received in the Russian Federation) or three times (without information about vaccinations, if there are vaccinations carried out in another country ) - OPV vaccine;

Pregnant women who do not have information about preventive vaccinations against polio or have not been vaccinated against polio - a single dose of IPV vaccine.

6.3. In the population or in the territory where a patient with poliomyelitis caused by wild poliovirus (a carrier of wild poliovirus) has been identified, an analysis of the state of vaccination is carried out with the organization of the necessary additional anti-epidemic and preventive measures.

6.4. In the outbreak of polio after hospitalization of the patient, current and final disinfection is carried out using disinfectants approved for use in the prescribed manner and having virucidal properties, in accordance with the instructions/guidelines for their use. Organization and conduct of final disinfection are carried out in accordance with the established procedure.

VII. Organization of laboratory tests of biological material from patients with poliomyelitis, patients with suspected POLIOS/AFP

7.1. Two fecal samples are taken from a patient with polio, with suspicion of this disease and AFP, as soon as possible from the moment of onset of paresis/paralysis (but no later than 14 days). The material is collected by medical workers of the treatment and prevention organization where the patient is hospitalized. The first fecal sample is taken in the hospital on the day of clinical diagnosis, the second - 24-48 hours after taking the first sample. Optimal size fecal sample 8-10 g, which corresponds to the size of two nails thumb adult.

7.2. The collected samples are placed in special plastic containers with screw caps for collecting fecal samples and delivered to the Regional Center for Epidemiological Surveillance of Poliomyelitis and AFP (hereinafter referred to as the RC for POLIO/AFP) or to the National Laboratory for the Diagnostics of Poliomyelitis (hereinafter referred to as the NLDP), depending on the diagnosis and classification of AFP cases.

7.3. Delivery of the collected samples to the RC for Polio/ACP or to the NLDP must be carried out within 72 hours from the moment the second sample was taken. Samples are stored before shipment and during transportation at a temperature of 2 to 8 degrees C. In some cases, if delivery of samples to the virology laboratory of the Republican Center for Polio/AFP or to the NLDP will be carried out at a later date, then the samples are frozen at a temperature of minus 20 degrees C and delivered frozen.

7.4. Samples are delivered with a referral for laboratory testing, which is drawn up in 2 copies in accordance with the form presented in Appendix 5 to these sanitary rules.

7.5. The territorial body carrying out sanitary and epidemiological supervision, responsible for sending the material, informs the RC for Polio/OVP or the NLDP in advance about the route of its departure.

7.6. Sent to NLDP for research biological materials from all subjects of the Russian Federation in the cases specified in clauses 7.7.-7.9. of these rules.

7.7. For virological studies, fecal samples are sent to the NLDP from:

Patients with polio (including VAPP) with suspected these diseases;

Patients with priority (“hot”) cases of AFP;

Contacts in the epidemic focus with a patient with polio (including VAPP), with suspicion of these diseases, with a priority (“hot”) case of AFP.

Persons traveling to polio-endemic countries (territories) who are not vaccinated against this infection, who do not have information about vaccinations against polio, and also at the request of the receiving party; persons who have not been vaccinated against polio, regardless of age, are recommended to get vaccinated at least 10 days before departure;

For children under the age of 15 years who arrived from countries (territories) endemic (problematic) for polio, who are not vaccinated against this infection, and who do not have information about vaccinations against polio, immunization against polio is carried out once (upon arrival), subsequent vaccinations are carried out in in accordance with the national calendar of preventive vaccinations;

Children under 15 years of age from migrant families, nomadic groups, not vaccinated against this infection, who do not have information about vaccinations against polio - immunization against polio is carried out once (at the place of their detection), subsequent vaccinations are carried out at the place of their residence in accordance with national calendar of preventive vaccinations;

Persons with negative results of a serological study of the level of individual immunity to poliomyelitis to all three types of poliovirus or to one of the types of poliovirus - immunization is carried out twice with an interval of 1 month;

Persons working with material infected or potentially infected with a “wild” strain of poliovirus - once upon entry to work, then in accordance with the requirements of clause 8.7.

8.7. Persons working in the laboratory and having contact with material infected or potentially infected with the “wild” strain of poliovirus are examined every five years for the strength of immunity to polioviruses; based on the results of the examination, the issue of additional immunization is decided.

8.8. Immunization against polio according to epidemic indications in the territory (in the population) in the form of additional immunization campaigns is carried out:

In the territory (in the population) where the importation of wild poliovirus or the circulation of vaccine-related polioviruses has been detected;

In the territory (in the population) where a case of polio caused by wild poliovirus has been registered;

In the territory (in the population) where wild poliovirus has been isolated in materials from people or from environmental objects;

On the territory of a constituent entity of the Russian Federation (in cities, districts, settlements, medical organizations, at medical and paramedic stations, in preschool organizations and educational institutions) with a low (less than 95%) level of vaccination coverage against polio in children at the prescribed time: vaccination at the age of 12 months and a second revaccination against polio at the age of 24 months;

On the territory of a constituent entity of the Russian Federation (in cities, districts, settlements, at medical and paramedic stations, in preschool organizations and educational institutions) with a low (less than 80%) level of seropositive results serological monitoring individual age groups of children when conducting representative studies;

On the territory of a constituent entity of the Russian Federation (in cities, districts, settlements, at medical clinics, paramedic stations, in preschool organizations and educational institutions) with unsatisfactory quality indicators of epidemiological surveillance of polio and acute flaccid paralysis (no detection of AFP in the subject for 2 years) .

8.9. Supplementary immunization against polio is provided through organized countrywide immunization campaigns ( National days immunization), in certain constituent entities of the Russian Federation (Subnational immunization days), in certain territories (districts, cities, towns, pediatric areas and others) in addition to routine immunization of the population against polio and is aimed at a specific age group, regardless of vaccination status. Additional immunization against polio is carried out in accordance with the resolution of the Chief State Sanitary Doctor of the Russian Federation, which determines the age of those subject to additional immunization against polio, the timing, procedure and frequency of its implementation.

8.10. Additional immunization on the territory of a constituent entity of the Russian Federation, in certain territories (districts, cities, towns, medical organizations, pediatric areas, paramedic stations, children's educational organizations) is carried out in the form of additional immunization campaigns in accordance with the resolution of the Chief State Sanitary Doctor of the constituent entity of the Russian Federation, which determines the age of those subject to immunization against polio, the timing, location (district, city, town, etc.), the procedure and frequency of its implementation.

8.11. Immunization against polio according to epidemic indications (additional immunization) is carried out regardless of previously administered preventive vaccinations against this infection, but not earlier than 1 month after the last immunization against polio.

If the timing of immunization against polio of children for epidemic reasons coincides with the age regulated by the National Calendar of Preventive Vaccinations, immunization is counted as planned.

8.12. Information on immunization against polio according to epidemic indications is entered into the appropriate medical records.

8.13. Subsequent preventive vaccinations against polio for children are carried out in accordance with age within the framework of the national calendar of preventive vaccinations.

8.14. Additional immunization against polio with OPV for children at risk is carried out regardless of the date of arrival, if detected, without preliminary or additional serological testing.

8.15. A report on additional immunization against polio in children for epidemic indications is submitted in the prescribed form and within the established time frame.

8.16. The main criteria for assessing the quality and effectiveness of additional immunization against polio for children with OPV is the timeliness and completeness of vaccination coverage of at least 95% of total number children subject to additional immunization.

IX. Measures to prevent vaccine-associated polio (VAPP) cases

9.1. To prevent VAPP in a vaccine recipient:

The first 2 vaccinations against polio are carried out with the IPV vaccine within the time limits established by the national calendar of preventive vaccinations - for children under one year old, as well as for older children who have not received vaccination against polio previously;

Children who have contraindications to the use of the OPV vaccine are immunized against polio only with the IPV vaccine within the time limits established by the national schedule of preventive vaccinations.

9.2. To prevent VAPP in contacts of children who have received OPV vaccinations, measures are taken in accordance with paragraphs 9.3-9.7 of these sanitary rules.

9.3. When children are hospitalized in a hospital, the referral for hospitalization indicates the child’s vaccination status (number of vaccinations given, date of the last vaccination against polio and the name of the vaccine).

9.4. When the wards in medical organizations are full, it is not allowed to hospitalize children who have not been vaccinated against polio in the same ward with children who have received the OPV vaccine within the last 60 days.

9.5. In medical organizations, preschool organizations and general educational institutions, summer health organizations, children who do not have information about immunization against polio, who have not been vaccinated against polio, or who have received less than 3 doses of polio vaccine, are separated from children vaccinated with OPV vaccine within the last 60 days for a period 60 days from the date the children received their last OPV vaccine.

9.6. In closed children's groups (orphanages and others), in order to prevent the occurrence of contact cases of VAPP caused by the circulation of vaccine strains of polioviruses, only the IPV vaccine is used for vaccination and revaccination of children.

9.7. When immunizing one of the children in the family with the OPV vaccine, the medical worker must check with the parents (guardians) whether there are children in the family who have not been vaccinated against polio, and if there are any, recommend vaccinating the unvaccinated child (in the absence of contraindications) or separating the children for a period of 60 days .

X. Serological monitoring of population immunity to polio

10.1. Serological monitoring of population immunity to polio is organized by territorial bodies exercising state sanitary and epidemiological control, together with health authorities of the constituent entity of the Russian Federation in the field of public health in order to obtain objective data on the state of population immunity to polio in accordance with current regulatory and methodological documents .

10.2. The results of serological tests must be included in the appropriate medical records.

10.3. A report on serological monitoring of population immunity to polio is submitted in the prescribed manner.

XI. Activities aimed at detecting the importation of wild poliovirus, the circulation of wild or vaccine-related polioviruses

In order to timely detect the importation of wild poliovirus and the circulation of vaccine-related polioviruses:

11.1. Territorial bodies carrying out state sanitary and epidemiological supervision organize:

Periodically informing medical and other organizations about the global epidemiological situation regarding polio;

Active epidemiological surveillance of Polio/AFP in medical organizations;

Door-to-door (door-to-door) inspections for epidemic indications;

Additional laboratory testing of fecal samples for polioviruses in specific population groups;

Laboratory research of environmental objects;

Identification of all strains of polioviruses, other (non-polio) enteroviruses isolated in fecal samples from environmental objects;

Monitoring compliance with sanitary legislation requirements to ensure biological safety of work in virology laboratories.

11.2. Additional laboratory tests are carried out on fecal samples for polioviruses in children under 5 years of age:

From migrant families, nomadic population groups;

From families arriving from polio-endemic countries (territories);

Healthy children - selectively (according to epidemiological indications in accordance with paragraph 11.3 of these sanitary rules and as part of surveillance to monitor the circulation of enteroplioviruses).

11.3. Epidemiological indications for laboratory testing of fecal samples from healthy children for polioviruses are:

Lack of registration of AFP cases in a constituent entity of the Russian Federation during the reporting year;

Low indicators of quality, efficiency and sensitivity of epidemiological surveillance of Polio/AFP (detection of less than 1 case of AFP per 100 thousand children under 15 years of age, late detection and examination of AFP cases);

Low (less than 95%) rates of immunization against polio among children in decreed groups;

Unsatisfactory results of serological monitoring of population immunity to poliovirus (seropositivity rate less than 80%).

11.4. Laboratory tests are carried out when those specified in paragraph 11.2 are identified. contingents of children, regardless of the date of their arrival, but not earlier than 1 month. after the last immunization against polio with OPV.

Organization and conduct of laboratory tests of samples of feces, material from environmental objects and their delivery to the laboratory are carried out in accordance with Chapter VII of these sanitary rules.

XII. Measures in case of importation of wild poliovirus, detection of circulation of vaccine-related polioviruses

12.1. In the event of the importation of wild poliovirus or the detection of the circulation of vaccine-related polioviruses, territorial bodies carrying out state epidemiological surveillance, together with executive authorities of the constituent entities of the Russian Federation in the field of protecting the health of citizens, carry out a set of organizational and sanitary-anti-epidemic (preventive) measures aimed at preventing the spread of infection.

12.2. Organize an epidemiological investigation of cases of diseases suspected of poliomyelitis, cases of isolation of wild poliovirus, vaccine-related polioviruses in fecal samples, material from environmental objects in order to identify the possible source of infection, routes and factors of transmission.

12.3. They are working to identify children who have not been vaccinated against polio and who do not have medical contraindications to vaccination, and immunize them in accordance with the national calendar of preventive vaccinations.

12.4. Organize supplementary immunization campaigns as quickly as possible. It is recommended that the first round of immunization be carried out within four weeks from the moment of detection of the first confirmed case (carrier) of polio caused by wild or vaccine-related poliovirus, and detection of circulation of wild poliovirus in environmental objects. The procedure for additional immunization is set out in paragraphs. 8.8.-8.16.

12.5. Take measures to strengthen active epidemiological surveillance of Polio/AFP, including:

Expanding the list of objects of active epidemiological surveillance;

Conducting a retrospective analysis of medical records to actively identify unregistered patients with suspected POLIIO/AFP;

Organizing door-to-door (door-to-door) visits to identify missed cases of AFP.

12.6. An assessment is made of the degree of risk of the spread of infection, taking into account the number of detected cases, the intensity of migration flows of the population, the number of children who have not been vaccinated against polio, and the quality indicators of epidemiological surveillance of Polio/AFP.

12.7. They are expanding the population for laboratory testing of fecal samples and increasing the volume of research.

12.8. They are expanding the list of environmental objects for laboratory research and increasing the volume of research.

12.9. Strengthen control over compliance with biological safety requirements in virology laboratories.

12.10. Organize informing medical workers and the population about the epidemiological situation and measures to prevent polio.

XIII. Safe handling of materials contaminated or potentially contaminated with wild poliovirus

In order to prevent intra-laboratory contamination with wild poliovirus, the release of the pathogen into the human population from virology laboratories, work with materials infected or potentially infected with wild poliovirus, or storing such materials, must be carried out in strict accordance with biological safety requirements.

XIV. Monitoring the circulation of polioviruses in environmental objects

14.1. In order to monitor the circulation of polioviruses in environmental objects (EPS), a virological method is used to study materials from the EPA (wastewater).

Research is carried out by virological laboratories of the Federal Budgetary Institution of Health "Center for Hygiene and Epidemiology" in the constituent entities of the Russian Federation, RCs for Polio/AFP, NLDP on a planned basis and according to epidemic indications.

14.2. When conducting planned research, the objects of research are wastewater generated in the territory where surveillance is carried out in relation to certain groups of the population. Sampling locations are determined jointly with representatives of the engineering service. In accordance with the set goals, untreated wastewater is examined. Wastewater that may be contaminated with industrial waste is not selected for research.

14.3. The duration of planned studies should be at least one year (the optimal period is 3 years), the collection frequency should be at least 2 samples per month.

XV. Organization of state sanitary and epidemiological surveillance of polio and acute flaccid paralysis

15.1. Epidemiological surveillance of POLI/AFP is carried out by bodies carrying out state sanitary and epidemiological surveillance in accordance with the legislation of the Russian Federation.

15.2. The effectiveness and sensitivity of epidemiological surveillance of Polio/AFP is determined by the following indicators recommended by the World Health Organization:

Identification and registration of cases of POLIOS/AFP - at least 1.0 per 100 thousand children under 15 years of age;

The timeliness of identifying patients with POLI/AFP (no later than 7 days from the onset of paralysis) is at least 80%;

The adequacy of fecal sampling from patients with POLI/AFP for virological research (taking 2 samples no later than 14 days from the onset of the disease) is at least 80%;

The completeness of laboratory tests of fecal samples from patients with POLI/AFP (2 samples from one patient) in the RC for POLI/AFP and NCLPDP is at least 100%;

Timeliness (no later than 72 hours from the moment of taking the second fecal sample) of delivery of samples from patients with Polio/AFP to the RC for Polio/AFP, NCLPDP - at least 80%;

The proportion of fecal samples received by the laboratory for research that meet the established requirements (satisfactory samples) is at least 90%;

Timely submission of results by the laboratory (no later than 15 days from the date of receipt of the sample if the test result is negative and no later than 21 days if the test result is positive) to the institution that sent the samples - at least 90%;

Epidemiological investigation of POLIOS/AFP cases within 24 hours after registration - at least 90%;

Repeated examination of patients with POLI/AFP 60 days from the onset of paralysis - at least 90%;

The proportion of polio patients examined virologically on days 60 and 90 from the onset of paralysis is at least 90%;

The final classification of POLI/AFP cases 120 days from the onset of paralysis is at least 100%;

Timely submission of monthly information on the incidence of Polio/AFP (including zero) in a timely manner and in accordance with the established procedure - at least 100%;

Timeliness of submission of copies of epidemiological investigation cards of cases of Polio/AFP diseases in a timely manner and in the prescribed manner - at least 100%;

The completeness of presentation in a timely manner and in the prescribed manner of isolates of polioviruses and other (non-polio) enteroviruses isolated in fecal samples from people and from environmental objects is at least 100%.

15.3. Activities to prevent polio are carried out within the framework of the implementation of the National Action Plan to maintain the polio-free status of the Russian Federation, the corresponding action plans to maintain the polio-free status of the constituent entities of the Russian Federation and the established requirements of federal legislation in the field of diagnosis, epidemiology and prevention of polio.

15.4. An action plan to maintain the polio-free status of a constituent entity of the Russian Federation is developed by the executive authorities of the constituent entities of the Russian Federation in the field of protecting the health of citizens together with the bodies exercising state sanitary and epidemiological supervision, and is approved in the prescribed manner, taking into account specific local conditions and the epidemiological situation.

In the constituent entities of the Russian Federation, a plan for conducting active epidemiological surveillance of Polio/AFP is annually developed and approved.

15.5. Documentation confirming the polio-free status of a subject of the Russian Federation is prepared and submitted by the subject of the Russian Federation in the prescribed manner.

15.6. The executive authorities of the constituent entities of the Russian Federation in the field of protecting the health of citizens, together with the bodies exercising state sanitary and epidemiological supervision in the constituent entities of the Russian Federation, are creating Commissions for the diagnosis of polio and acute flaccid paralysis (hereinafter referred to as the Diagnostics Commission).

15.7. If there are laboratories in a subject of the Russian Federation that store a wild strain of poliovirus or work with material potentially infected with a wild strain of poliovirus, the body exercising sanitary and epidemiological supervision in the subject of the Russian Federation shall create a Commission for the safe laboratory storage of wild polioviruses.

The activities of the commissions are carried out in accordance with the established procedure.

15.8. National commissions provide organizational and methodological assistance to the constituent entities of the Russian Federation: Commission for the Diagnosis of Poliomyelitis and Acute Flaccid Paralysis, Commission for Safe Laboratory Storage of Wild Polioviruses, Commission for Certification of Poliomyelitis Eradication.

The organizational structure of the bodies and organizations implementing the National Action Plan to maintain the polio-free status of the Russian Federation is presented in Appendix 6 to these sanitary rules.

XVI. Hygienic education of the population on the prevention of polio

16.1. In order to improve health literacy, hygiene education population, which includes informing about the main clinical forms, symptoms of polio, prevention measures, the global situation on the incidence of polio, with the attraction of funds mass media and the release of visual propaganda tools: leaflets, posters, bulletins, as well as conducting individual interviews.

16.2. Work on organizing and conducting information and explanatory work among the population is carried out by bodies exercising state sanitary and epidemiological supervision, executive authorities of the constituent entities of the Russian Federation in the field of protecting the health of citizens and organizing healthcare, and medical prevention centers.

Appendix 1. Codes for the final classification of cases of diseases with acute flaccid paralysis syndrome (in accordance with the International Classification of Diseases, 10th revision)