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Unnecessary injections and paralytic poliomyelitis in India
H V Wyatt1, S Mahadevan, S Srinivasan
1Department of Public Health Medicine, University of Leeds, UK.
Insights
Unnecessary injections significantly worsen paralytic poliomyelitis (polio) in children. Reducing these injections could decrease polio prevalence and severity.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Prior injections have been anecdotally linked to the severity of paralytic poliomyelitis.
- The specific impact of injection timing and location on polio paralysis patterns requires further investigation.
Purpose of the Study:
- To retrospectively analyze the effect of prior injections on the pattern and severity of paralytic poliomyelitis in children.
- To determine if unnecessary injections influence polio paralysis distribution and outcomes.
Main Methods:
- Retrospective analysis of case notes from a pediatric outpatient clinic in South India.
- Examined 262 children diagnosed with acute polio.
- Compared paralysis patterns and severity in children with and without prior injections.
Main Results:
- 176 out of 262 children received unnecessary injections within 48 hours of paralysis onset.
- Injections in the gluteal region increased paralysis risk in injected legs by 19% and decreased it in uninjected legs by 31%.
- Injected leg muscles showed reduced strength compared to controls, with outcomes worsening with bilateral injections. Over 96% of children had leg paralysis, and 40% of non-paralytic cases became paralytic after injections.
Conclusions:
- Unnecessary injections significantly increase the severity and likelihood of paralysis in poliomyelitis.
- Reducing unnecessary injections, particularly in favor of oral medications, could substantially decrease polio prevalence and severity.
- The findings highlight the critical need to re-evaluate injection practices in pediatric care to prevent iatrogenic complications of polio.
Abstract:
The effect of prior injections on the pattern and severity of paralytic poliomyelitis has been examined by a retrospective analysis of case notes from an outpatient pediatric clinic in South India. Of 262 children with acute polio, 176 had received unnecessary injections < 48 h before paralysis and 12 had received diphtheria-pertussis-tetanus or provocative injections. Two children injected in the right arm had paralysis in that limb only. Children with no injections (controls) had an equal chance of paralysis (0.73) in each left and right leg. Children with injections in the right or left gluteus or in both had a 19% greater chance of paralysis in the injected leg(s), whereas uninjected legs had a 31% lower chance of paralysis. Injected leg muscles were weaker than those of control children. Legs of control children were stronger than those with one leg injected and much stronger than those with both injected. More than 96% of the children had at least one leg paralysed. Age and vaccine status did not affect the results of injections. After injections there was greater likelihood of death or lack of recovery of muscle strength. About three-quarters of the children had received unnecessary injections; of these 60% had more severe paralysis and a non-paralytic attack became paralytic in 40%. If oral medicines for fevers and diarrhoea replaced unnecessary injections, the prevalence and severity of paralytic polio would be reduced.