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1.
Andes Pediatr ; 93(1): 123-133, 2022 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-35506786

RESUMO

The birth of intensive care was a process that took place in Copenhagen, Denmark, during and after the polio epidemic of 1952-1953. The fact that marks its beginning was that anesthesiologist Björn Ibsen was asked to help and "came out of the operating room", not without some controversy. Ib sen proposed and advocated the use of tracheostomy, suctioning and ventilation. Given the lack of positive pressure ventilators, this task was carried out by students who contributed 165,000 hours of manual ventilation. Few years later, in Gothenburg, Sweden, the anesthesiologist Göran Haglund, motivated by the case of a four years old boy with complicated appendicitis, created the first multi disciplinary pediatric intensive care unit in the world (1955). In Chile, during the 1950s, the concept of pediatric intensive care began to develop under the direction of physicians with a solid vision of the future. Given that the planet is experiencing a pandemic, it seems an appropriate moment to review the role of the polio epidemic in the development of positive pressure ventilation, the birth of intensive care medicine and intensive care units, in order to assess the role of the various tasks and innovations carried out.


Assuntos
Cuidados Críticos , Poliomielite , Criança , Pré-Escolar , Humanos , Unidades de Terapia Intensiva Pediátrica , Respiração Artificial , Ventiladores Mecânicos
2.
Bull Math Biol ; 84(6): 62, 2022 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-35507206

RESUMO

Polio can circulate unobserved in regions that are challenging to monitor. To assess the probability of silent circulation, simulation models can be used to understand transmission dynamics when detection is unreliable. Model assumptions, however, impact the estimated probability of silent circulation. Here, we examine the impact of having distinct populations, rather than a single well-mixed population, with a discrete-individual model including environmental surveillance. We show that partitioning a well-mixed population into networks of distinct communities may result in a higher probability of silent circulation as a result of the time it takes for the detection of a circulation event. Population structure should be considered when assessing polio control in a region with many loosely interacting communities.


Assuntos
Poliomielite , Poliovirus , Humanos , Conceitos Matemáticos , Modelos Biológicos , Poliomielite/diagnóstico , Poliomielite/epidemiologia , Poliomielite/prevenção & controle , Probabilidade
3.
Eur J Med Res ; 27(1): 63, 2022 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-35505368

RESUMO

BACKGROUND: Immune thrombocytopenia (ITP) is a rare autoimmune disorder characterized by low platelet counts and increased bleeding risk. The disease may be induced by other disorders, including malignancies, autoimmune diseases, infectious agents or drugs. However, ITP has also been described following vaccinations, such as the measles-mumps-rubella vaccination. In rare cases, ITP may occur in children who received a DTaP-IP (diphtheria, tetanus, acellular pertussis vaccine and inactivated poliovirus) vaccine. Hereinafter, we report the first well-documented cases of ITP in an adult patient in the temporal context of a DTaP-IP vaccination. CASE PRESENTATION: This case report attempts to capture the life-threatening picture of a 36-year-old otherwise healthy Caucasian woman with newly diagnosed severe immune thrombocytopenia in the temporal context of a DTaP-IP vaccination. Four days after receiving the vaccine, the women presented to her primary care physician with malaise, fever and recurrent epistaxis. Clinical examination revealed oral petechiae, ecchymoses, and non-palpable petechiae on both legs. The patient was immediately referred to a local hematology unit where she developed hematuria and an intestinal bleeding (WHO Bleeding Grade III) requiring multiple transfusions. After receiving oral corticosteroids and intravenous immunoglobulins, her platelets gradually recovered. Common causes of secondary ITP were ruled out by laboratory investigations, bone marrow and peripheral blood examinations. This raises the possibility of a (secondary) vaccination-associated thrombocytopenia. To the best of our knowledge, this is the first well-documented case of a DTaP-IP vaccination-related ITP in an adult patient in the English literature. CONCLUSION: Although a causal connection between both entities may not be established, we would like to raise awareness in clinicians that ITP following DTaP-IP vaccinations is potentially not limited to children, but may also occur in adults. Users of DTaP-IP booster vaccines should be alert of the possibility of such adverse reactions.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular , Difteria , Poliomielite , Púrpura Trombocitopênica Idiopática , Tétano , Trombocitopenia , Coqueluche , Adulto , Anticorpos Antibacterianos , Criança , Difteria/etiologia , Difteria/prevenção & controle , Vacinas contra Difteria, Tétano e Coqueluche Acelular/efeitos adversos , Feminino , Humanos , Imunização Secundária/efeitos adversos , Poliomielite/induzido quimicamente , Poliomielite/prevenção & controle , Vacina Antipólio de Vírus Inativado/efeitos adversos , Púrpura Trombocitopênica Idiopática/induzido quimicamente , Tétano/etiologia , Tétano/prevenção & controle , Vacinação/efeitos adversos , Coqueluche/etiologia , Coqueluche/prevenção & controle
4.
MMWR Morb Mortal Wkly Rep ; 71(15): 538-544, 2022 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-35421079

RESUMO

Since the Global Polio Eradication Initiative (GPEI) was established in 1988, the number of reported poliomyelitis cases worldwide has declined by approximately 99.99%. By the end of 2021, wild poliovirus (WPV) remained endemic in only two countries (Pakistan and Afghanistan). However, a WPV type 1 (WPV1) case with paralysis onset in 2021, was reported by Malawi a year after the World Health Organization (WHO) African Region (AFR) was certified as WPV-free and circulating vaccine-derived poliovirus (cVDPV) cases were reported from 31 countries during 2020-2021 (1,2). cVDPVs are oral poliovirus vaccine-derived viruses that can emerge after prolonged circulation in populations with low immunity and cause paralysis. The primary means of detecting poliovirus transmission is through surveillance for acute flaccid paralysis (AFP) among persons aged <15 years, with confirmation through stool specimen testing by WHO-accredited laboratories, supplemented by systematic sampling of sewage and testing for the presence of poliovirus (environmental surveillance). The COVID-19 pandemic caused disruptions in polio vaccination and surveillance activities across WHO regions in 2020; during January-September 2020, the number of reported cases of AFP declined and the interval between stool collection and receipt by laboratories increased compared with the same period in 2019 (3). This report summarizes surveillance performance indicators for 2020 and 2021 in 43 priority countries* and updates previous reports (4). In 2021, a total of 32 (74%) priority countries† met two key surveillance performance indicator targets nationally, an improvement from 2020 when only 23 (53%) met both targets; however, substantial national and subnational gaps persist. High-performing poliovirus surveillance is critical to tracking poliovirus transmission. Frequent monitoring of surveillance indicators could help identify gaps, guide improvements, and enhance the overall sensitivity and timelines of poliovirus detection to successfully achieve polio eradication.


Assuntos
COVID-19 , Poliomielite , Poliovirus , Erradicação de Doenças , Saúde Global , Humanos , Programas de Imunização , Pandemias , Paralisia/epidemiologia , Poliomielite/diagnóstico , Poliomielite/epidemiologia , Poliomielite/prevenção & controle , Vacina Antipólio Oral , Vigilância da População , alfa-Fetoproteínas
5.
BMC Infect Dis ; 22(1): 414, 2022 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-35488227

RESUMO

BACKGROUND: Yemen has faced one of the worst humanitarian crises in the world since the start of the war in 2015. In 2020; 30 Vaccine Derived Polio Virus type 1 (VDPV1) isolates were detected in Saadah governorate. The aims are to characterize the outbreak and address the gaps predisposing the emergence and circulation of VDPV1 in Saadah governorate, Yemen. METHOD: A retrospective descriptive study of confirmed cases of VDPV1 between January and December 2020 was performed. Surveillance staff collected data from patient cases, contacts, as well as stool specimens that shipped to WHO accredited polio labs. Data of population immunity was also reviewed. The difference in days between the date of sample collection, shipment, and receiving lab result was used to calculate the average of delayed days for lab confirmation. RESULTS: From January to December 2020, a total of 114 cases of acute flaccid paralysis (AFP) were reported from 87% (13/15) districts, and cVDPV1 was confirmed among 26% (30) AFP cases. 75% (21) were < 5 years, 73% (20) had zero doses of Oral Polio Vaccine (OPV). The first confirmed case (3%) was from Saadah city, with paralysis onset at the end of January 2020 followed by 5 cases (17%) in March from another four districts, 8 cases (27%) in April, and 13 (43%) up to December 2020 were from the same five districts in addition to 3 (10%) form three new districts. The lab confirmation was received after an average of 126 days (71-196) from sample collection. The isolates differ from the Sabin 1 type by 17- 30 VP1 nucleotides (nt) and were linked to VDPV1 with 13 (nt) divergence that isolated in July 2020 from stool specimens collected before one year from contacts of an inadequate AFP case reported from Sahar district. CONCLUSION: The new emerging VDPV1 was retrospectively confirmed after one year of sample collection from Sahar district. Delayed lab confirmation, as well as the response and low immunization profile of children against polio, were the main predisposing factors for cVDPV1 outbreak. This outbreak highlights the need to maintain regular biweekly shipments to referral polio labs in the short-term, and the exploration of other options in the longer-term to enable the Yemen National Lab to fully process national samples itself.


Assuntos
Poliomielite , Poliovirus , Criança , Surtos de Doenças/prevenção & controle , Humanos , Poliomielite/epidemiologia , Poliomielite/prevenção & controle , Poliovirus/genética , Vacina Antipólio Oral , Estudos Retrospectivos , Iêmen/epidemiologia
6.
Vaccine ; 40(19): 2705-2713, 2022 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-35367069

RESUMO

Eradication of poliomyelitis globally is constrained by fecal shedding of live polioviruses, both wild-type and vaccine-derived strains, into the environment. Although inactivated polio vaccines (IPV) effectively protect the recipient from clinical poliomyelitis, fecal shedding of live virus still occurs following infection with either wildtype or vaccine-derived strains of poliovirus. In the drive to eliminate the last cases of polio globally, improvements in both oral polio vaccines (OPV) (to prevent reversion to virulence) and injectable polio vaccines (to improve mucosal immunity and prevent viral shedding) are underway. The E. coli labile toxin with two or "double" attenuating mutations (dmLT) may boost immunologic responses to IPV, including at mucosal sites. We performed a double-blinded phase I controlled clinical trial to evaluate safety, tolerability, as well as systemic and mucosal immunogenicity of IPV adjuvanted with dmLT, given as a fractional (1/5th) dose intradermally (fIPV-dmLT). Twenty-nine volunteers with no past exposure to OPV were randomized to a single dose of fIPV-dmLT or fIPV alone. fIPV-dmLT was well tolerated, although three subjects had mild but persistent induration and hyperpigmentation at the injection site. A ≥ 4-fold rise in serotype-specific neutralizing antibody (SNA) titers to all three serotypes was seen in 84% of subjects receiving fIPV-dmLT vs. 50% of volunteers receiving IPV alone. SNA titers were higher in the dmLT-adjuvanted group, but only differences in serotype 1 were significant. Mucosal immune responses, as measured by polio serotype specific fecal IgA were minimal in both groups and differences were not seen. fIPV-dmLT may offer a benefit over IPV alone. Beyond NAB responses protecting the individual, studies demonstrating the ability of fIPV-dmLT to prevent viral shedding are necessary. Studies employing controlled human infection models, using monovalent OPV post-vaccine are ongoing. Studies specifically in children may also be necessary and additional biomarkers of mucosal immune responses in this population are needed. Clinicaltrials.gov Identifer: NCT03922061.


Assuntos
Escherichia coli Enterotoxigênica , Poliomielite , Poliovirus , Adjuvantes Imunológicos , Anticorpos Neutralizantes , Anticorpos Antivirais , Criança , Temperatura Alta , Humanos , Imunidade nas Mucosas , Lactente , Poliomielite/prevenção & controle , Poliovirus/genética , Vacina Antipólio de Vírus Inativado , Vacina Antipólio Oral , Sorogrupo
7.
Sante Publique ; Vol. 33(5): 741-751, 2022 Mar 11.
Artigo em Francês | MEDLINE | ID: mdl-35485131

RESUMO

INTRODUCTION: Co-administration of the bilié de Calmette et Guérin (BCG) and birth doses of oral polio (OPV zero) and hepatitis B (HepB BD) vaccines is strongly recommended. The objective was to determine the factors associated with this co-administration in the health district of Podor (Senegal). METHODS: This cross-sectional study was conducted among 726 children aged 12 to 23 months. This was a two-stage cluster sampling. The data was collected in June 2020. An electronic questionnaire was developed using the Open Data Kit Collect application. Co-administration was modeled as one dose, two doses and three doses. Ordinal logistic regression was used to search for factors likely to influence co-administration. RESULTS: Of the 726 children, 115 (16%), 234 (32%) and 377 (52%) received a single dose, two and three doses, respectively. Factors associated with co-administration were recognition by mothers or caregivers that several vaccines can be administered simultaneously (adjusted OR = 1.46, p-value = 0.017), availability of a health record kept at home (adjusted OR = 6.88, p-value = 0.006), hospitalization of the newborn after birth (adjusted OR = 1.74, p-value = 0.002) and receipt of advice during postnatal care (adjusted OR = 1.72, p-value = 0.01). CONCLUSION: Co-administration of birth doses is an infrequent practice in Podor. Awareness and availability and proper maintenance of health information management tools would be necessary.


Assuntos
Poliomielite , Vacinas , Criança , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Mães , Vacinação
8.
J Integr Neurosci ; 21(2): 65, 2022 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-35364653

RESUMO

BACKGROUND: The cerebellum integrates a multitude of motor and cognitive processes through ample spinal and supratentorial projections. Despite emerging evidence of adaptive neuroplasticity, cerebellar reorganisation in response to severe spinal insult early in life is poorly characterised. The objective of this study is the systematic characterisation of cerebellar integrity metrics in a cohort of adult poliomyelitis survivors as a template condition for longstanding lower motor neuron injury. METHODS: A total of 143 participants, comprising 43 adult poliomyelitis survivors and 100 age- and sex-matched healthy controls were recruited in a prospective, single-centre neuroimaging study with a uniform structural and diffusion imaging protocol. First, standard voxelwise grey and white matter analyses were performed. Then, the cerebellum was anatomically segmented into lobules, and cortical thickness and grey matter volumes were evaluated in each lobule. The integrity of cerebellar peduncles was also assessed based on their diffusivity profiles. RESULTS: Compared to healthy controls, poliomyelitis survivors exhibited greater cortical thickness in lobules I, II, and III in the right hemisphere and in lobules VIIIA and VIIIB bilaterally. A trend of higher cortical thickness was also detected lobules I, II and III in the left hemisphere. Enhanced cerebellar peduncle organisation was detected, particularly within the middle cerebellar peduncles. CONCLUSIONS: Increased cerebellar integrity measures in poliomyelitis survivors are primarily identified in lobules associated with sensorimotor functions. The identified pattern of cerebellar reorganisation may represent compensatory changes in response to severe lower motor neuron injury in childhood and ensuing motor disability.


Assuntos
Pessoas com Deficiência , Transtornos Motores , Poliomielite , Adulto , Cerebelo/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética/métodos , Plasticidade Neuronal , Estudos Prospectivos , Sobreviventes
11.
J Hist Biol ; 55(1): 115-146, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35233686

RESUMO

This essay argues that the racialized geopolitics of the rhesus monkey trade conditioned the trajectory of tissue culture in polio research. Rhesus monkeys from north India were important experimental organisms in the American "war against polio" between the 1930s and 1950s. During this period, the National Foundation for Infantile Paralysis (NFIP) expended considerable effort to secure the nonhuman primate for researchers' changing experimental agendas. The NFIP drew on transnational networks to export hundreds of thousands of rhesus monkeys from colonial and later postcolonial India amid the geopolitical upheavals of World War II, the 1947 Partition, and the Cold War. In this essay, I trace how NFIP officials' anxieties about the geopolitics of the monkey trade configured research imperatives in the war against polio. I show how their anxieties more specifically shaped investment in tissue culture techniques as a possible means of obviating dependence on the market in monkeys. I do so by offering a genealogy of the contingent convergence between the use of rhesus monkeys and HeLa cell cultures in the 1954 Salk vaccine trial evaluation. Through this genealogy, I emphasize the geopolitical dimensions of the search for the "right" experimental organisms, tissues, and cells for the "job" of scientific research. The technical transformation of polio research, I argue, relied on the convergence of disparate, racialized biomedical economies.


Assuntos
Poliomielite , Animais , Células HeLa , Humanos , Testes Imunológicos , Macaca mulatta , Poliomielite/história , Poliomielite/prevenção & controle , Vacina Antipólio de Vírus Inativado , Estados Unidos
13.
Hum Vaccin Immunother ; 18(1): 2041944, 2022 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-35258415

RESUMO

OBJECTIVE: To evaluate the safety of concomitantly administering inactivated poliomyelitis vaccine produced from Sabin strains (sIPVs) with other vaccines. METHODS: A descriptive analysis was carried out on adverse events following immunization (AEFI) based on the administration of sIPV alone or concomitant with other vaccines (from 2015 to 2020) using data from the national AEFI surveillance system of China (CNAEFIS). All adverse reactions (ADRs) of the concomitant immunization were coded using a medical dictionary for regulatory activities (MedDRA) before comparison. RESULTS: The CNAEFIS reported a total of 9130 sIPV-related AEFI cases, including 6842 AEFI cases collected after immunization with sIPV alone and 2288 AEFI cases collected after immunization of sIPV concomitant with other vaccines. The combination of sIPV with diphtheria, tetanus and pertussis vaccine (DTaP) was correlated with the highest frequency of AEFI, which accounted for 53.50% of all 2288 AEFI cases. After MedDRA-based coding, the most frequent ADR was fever (70.18%), followed by erythema and swelling at the injection site (6.95%), induration at the injection site (3.85%), dermatitis allergy (3.56%) and urticaria (1.55%). A statistically significant difference (P < .001) was found between sIPV immunization and sIPV immunization concomitant with other vaccines for general reactions (95.36% and 93.22%, respectively) and abnormal reactions (4.64% and 6.78%, respectively). CONCLUSION: No new safety signal is found for sIPV administered concomitantly, although its administration with other vaccines may increase the occurrence of abnormal reactions. Vaccine manufacturers should focus on the safety of administering sIPV with DTaP and carry out relevant clinical studies when necessary.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular , Difteria , Poliomielite , Tétano , Humanos , Imunização , Lactente , Poliomielite/prevenção & controle , Vacina Antipólio de Vírus Inativado , Tétano/prevenção & controle , Vacinação
17.
Comput Methods Programs Biomed ; 218: 106709, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35235894

RESUMO

BACKGROUND AND OBJECTIVE: In this work, a mathematical model based on differential equations is proposed to describe the propagation of polio in a human population. The motivating system is a compartmental nonlinear model which is based on the use of ordinary differential equations and four compartments, namely, susceptible, exposed, infected and vaccinated individuals. METHODS: In this manuscript, the mathematical model is extended in order to account for spatial diffusion in one dimension. Nonnegative initial conditions are used, and we impose homogeneous Neumann conditions at the boundary. We determine analytically the disease-free and the endemic equilibria of the system along with the basic reproductive number. RESULTS: We establish thoroughly the nonnegativity and the boundedness of the solutions of this problem, and the stability analysis of the equilibrium solutions is carried out rigorously. In order to confirm the validity of these results, we propose an implicit and linear finite-difference method to approximate the solutions of the continuous model. CONCLUSIONS: The numerical model is stable in the sense of von Neumann, it yields consistent approximations to the exact solutions of the differential problem, and that it is capable of preserving unconditionally the positivity of the approximations. For illustration purposes, we provide some computer simulations that confirm some theoretical results derived in the present manuscript.


Assuntos
Modelos Teóricos , Poliomielite , Número Básico de Reprodução , Simulação por Computador , Difusão , Humanos
19.
J Immunol Methods ; 504: 113259, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35314144

RESUMO

Next generation poliovirus vaccines are critical to reaching global poliovirus eradication goals. Recent efforts have focused on creating inactivated vaccines using attenuated Sabin strains that maintain patient safety benefits and immunogenicity of conventional inactivated vaccines while increasing manufacturing safety and lowering production costs, and on developing novel oral vaccines using modified Sabin strains that provide critical mucosal immunity but are further attenuated to minimize risk of reversion to neurovirulence. In addition, there is a push to improve the analytical tools for poliovirus vaccine characterization. Conventional and Sabin inactivated poliovirus vaccines typically rely on standard plate-based ELISA as in vitro D-antigen potency assays in combination with WHO international standards as calibrants. While widely utilized, the current D-antigen ELISA assays have a long time to result (up to 72 h), can suffer from lab-to-lab inconsistency due to non-standardized protocols and reagents, and are inherently singleplex. For D-antigen quantitation, we have developed the VaxArray Polio Assay Kit, a multiplexed, microarray-based immunoassay that uses poliovirus-specific human monoclonal antibodies currently under consideration as standardized reagents for characterizing inactivated Sabin and Salk vaccines. The VaxArray assay can simultaneously quantify all 3 poliovirus serotypes with a time to result of less than 3 h. Here we demonstrate that the assay has limits of quantification suitable for both bioprocess samples and final vaccines, excellent reproducibility and precision, and improved accuracy over an analogous plate-based ELISA. The assay is suitable for adjuvanted combination vaccines, as common vaccine additives and crude matrices do not interfere with quantification, and is intended as a high throughput, standardized quantitation tool to aid inactivated poliovirus vaccine manufacturers in streamlining vaccine development and manufacturing, aiding the global polio eradication effort.


Assuntos
Poliomielite , Poliovirus , Anticorpos Antivirais , Antígenos Virais , Ensaio de Imunoadsorção Enzimática , Humanos , Poliomielite/diagnóstico , Poliomielite/prevenção & controle , Vacina Antipólio de Vírus Inativado , Vacina Antipólio Oral , Reprodutibilidade dos Testes , Vacinas de Produtos Inativados
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