Acute Transverse Myelitis in a Child Following Oral Live Polio Vaccine Administration

Transverse myelitis is an urgent medical problem all over the world. Acute transverse myelitis is more common in children than in adults. Postvaccinal transverse myelitis is a rare complication of vaccination. In vaccine-associated paralytic poliomyelitis, the virus mosaically infects the motor neurons of the anterior horns of the spinal cord, resulting in asymmetric paralysis of predominantly proximal muscles.

The case of acute transverse myelitis in a 12-year-old child corresponds to the existing definition of a vaccine-associated paralytic poliomyelitis case: a temporal relationship between the onset of flaccid paralysis and the administration of oral polio vaccine and the duration of paralysis. The child developed flaccid paralysis 18 days after (August, 2024) the administration of oral polio vaccine and persisted for more than 60 days from the onset of the disease. Vaccine virus type 3 was isolated from the feces. However, the child received 2 doses of inactivated oral polio vaccine and 1 dose of bivalent (types 1 and 3) oral polio vaccine before the disease. The child did not have an increase in the titer of antibodies in paired sera to polioviruses types 1 and 3. Spinal cord magnetic resonance imaging revealed an intramedullary focus with hyperintense MR signal on 2WI, 2FS at the level of the spinal cord cone (Th₁₁-L₂), which spread across the entire diameter and unevenly accumulated paramagnetic. These changes were characteristic of acute transverse myelitis.

This article presents a clinical case of Acute transverse myelitis in a child after administration of live oral polio vaccine. We aimed to emphasize the importance of differential diagnosis of myelitis in a child who received OPV. This is important from the point of view of epidemiological surveillance of poliomyelitis and possible adverse reactions after vaccination.