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[Flaccid paralysis following oral poliomyelitis vaccination]
Insights
A four-month-old boy developed polio-like symptoms after receiving the oral poliovirus vaccine. Investigations revealed a wild poliovirus type III infection, distinct from vaccine-related causes.
Area of Science:
- Pediatrics
- Virology
- Immunology
Background:
- Acute poliomyelitis can result from wild virus infection or, rarely, vaccine-associated disease.
- The possibility of vaccine virus remutation in patients with co-infections, such as cytomegalovirus, is also considered.
Observation:
- A four-month-old boy presented with serous meningitis and flaccid paralysis of the left extremities 17 days post-trivalent oral poliovirus vaccination.
- The patient exhibited normal humoral and cellular immunity.
- Virologic studies identified wild poliovirus type III in stool samples.
Findings:
- The patient recovered within two months, with residual mild functional disturbance and muscle wasting in the left leg.
- The isolated wild poliovirus type III raises questions about its origin: a newly acquired infection or remutation linked to a recent cytomegalovirus infection.
Implications:
- This case highlights the importance of considering wild poliovirus infections even in vaccinated individuals.
- Further investigation is needed to differentiate between newly acquired wild virus and potential vaccine virus remutation in specific clinical contexts.
- Understanding the precise etiology is crucial for public health strategies and vaccine policy.
Abstract:
This is the report of a four months old boy who developed a serous meningitis and flaccid paralysis of the left upper and lower extremity 17 days following the first immunisation with a trivalent life poliomyelitis vaccine. The patient recovered well within 2 months. Presently a mild functional disturbance and muscle wasting of the left leg can still be observed. An acute poliomyelitis can be due to a wild virus infection in an unimmunized child. Secondly an acute poliomyelitis can occur as vaccine associated poliomyelitis as it is reported in the immunocompromised host. As a third possibility the remutation of a poliomyelitis vaccine virus in a patient concomitantly infected with cytomegalovirus can be discussed. Our patient showed a normal humoral and cellular immunity. Virologic studies in our patient disclosed a wild poliomyelitis virus type III which was isolated from the stool. It cannot be clearly distinguished at the present time whether this wild virus is due to a remutation in the presence of a recent cytomegalovirus infection in our patient or due to a newly acquired wild virus infection.