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Poliomyelitis and Injections - Literature Search

It is widely accepted that tonsillectomies and injections are related to getting paralytic or bulbar polio
Poliomyelitis and Injections - Literature Search
Natl Med J India 2001 May-Jun;14(3):143-4 Related Articles, Books

Erratum in:
  • Natl Med J India 2001 Jul-Aug;14(4):224

Injection use in a village in north India.

Anand K, Pandav CS, Kapoor SK; Undergraduate Study Team.

All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.

BACKGROUND: Injections can transmit infections such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV), and precipitate poliomyelitis. Complications such as injection abscesses and nerve damage may also occur. It is estimated that 50% of the injections given in developing countries are unsafe. However, limited information is available from India. We planned a pilot study to assess the prevalence of injection use and the knowledge of the community and private medical practitioners (PMPs) about injection use. METHODS: One in every four houses in the village under study was selected by systematic random sampling. One adult (> 18 years) respondent in the family was asked questions about family members receiving injections in the past 6 months. Nine PMPs were interviewed about their knowledge and practices regarding injection use. RESULTS: In the past six months, 1280 family members in 285 houses received 1575 injections (2.46 injections per person per year). About 35% had received at least one injection in the past 6 months. Children below 5 years received 3.1 injections/child/year of which about 60% were preventive. On their last visit to a health facility, 55% of the subjects were given injections using disposable syringes. About 45% of the 285 respondents knew that diseases could be spread by improper use of injections. While 18% of the respondents said they would prefer injections, 54% preferred oral medications if both were equally effective. After being told the average cost of disposable needles and syringes, 92% of the respondents were willing to buy them. None of the 9 PMPs practising in the village were formally trained in modern medicine. On the day of observation, 18 of 58 patients (30%) seen by PMPs were given injections. Three injections were observed and though they were all given with disposable syringes, the technique of administration did not follow standard guidelines in any. Two PMPs did not know of any disease transmitted by injections. The syringes were usually thrown in a nearby drain or outside the village. Four PMPs said that patients themselves did not ask for injections. CONCLUSION: The use of injections in the study area was high. The PMPs were not only giving a high number of injections but the technique of administration was also wrong. The community was less likely to ask for injections on their own but was willing to buy disposable syringes and needles. The awareness about the risk of injections was low.

PMID: 11467141 [PubMed - indexed for MEDLINE]
Bull Soc Pathol Exot 1999 Feb;92(1):33-7 Related Articles, Books

[Intramuscular injections in Sub-saharan African children, apropos of a frequently misunderstood pathology: the complications related to intramuscular quinine injections]

[Article in French]

Barennes H.

Unite de vaccinologie et de recherche operationnelle, Centre Muraz, Bobo-Dioulasso, Burkina-Faso.

In West Africa, the incidence of poliomyelitis has decreased in the past years thanks to intensive immunization campaigns. Nowadays intramuscular injection is the main reason for paralysis of the legs in African children as well as attendance at Rehabilitation Centres. Intramuscular injection of quinine is the most frequently reported. Faced with the lack of sterile material, health workers do not rationalize the use of intramuscular injections. Although the use of the same needle has decreased, using the same syringe for many patients, with only a rapid washing between, is still commonplace Poor septic conditions and abuse of prescriptions also contribute to the transmission of severe diseases (hepatitis, malaria, syphilis, filariasis, Ebola virus, tetanus and HIV). Paralysis due to injection is often confused with poliomyelitis and health workers are often not aware of the sequelae of injection. It seems important to prevent risk related to intramuscular injection in Africa through educating health workers and the local population. Rationalization of practises, promotion of oral therapy and alternatives to intramuscular administration should be carried out. In this respect, the intrarectal administration of an injectable solution of diluted quinine--its efficiency and pharmacokinetic having been studied over the last ten years--offers interesting opportunities.

Publication Types:
  • Review
  • Review, Tutorial

PMID: 10214519 [PubMed - indexed for MEDLINE]
Indian Pediatr 1998 Jan;35(1):73-5 Related Articles, Books, LinkOut

Did India have the world's largest outbreak of poliomyelitis associated with injections of adjuvanted DPT?

John TJ.

Publication Types:
  • Letter

PMID: 9707912 [PubMed - indexed for MEDLINE]
Trop Doct 1996 Oct;26(4):179-80 Related Articles, Books, LinkOut

Unnecessary injections and poliomyelitis in Pakistan.

Wyatt HV.

University of Leeds, UK.

PMID: 8937237 [PubMed - indexed for MEDLINE]
: N Engl J Med 1995 Feb 23;332(8):500-6 Related Articles, Books, LinkOut

Comment in: Click here to read
Intramuscular injections within 30 days of immunization with oral poliovirus vaccine--a risk factor for vaccine-associated paralytic poliomyelitis.

Strebel PM, Ion-Nedelcu N, Baughman AL, Sutter RW, Cochi SL.

Epidemiology and Surveillance Division, Centers for Disease Control and Prevention, Atlanta, GA 30333.

BACKGROUND. In Romania the rate of vaccine-associated paralytic poliomyelitis is for unexplained reasons 5 to 17 times higher than in other countries. Long ago it was noted that intramuscular injections administered during the incubation period of wild-type poliovirus infection increased the risk of paralytic disease (a phenomenon known as "provocation" poliomyelitis). We conducted a case-control study to explore the association between intramuscular injections and vaccine-associated poliomyelitis in Romania. METHODS. The patients were 31 young children in whom vaccine-associated paralytic poliomyelitis developed from 1988 through 1992. Eighteen were vaccine recipients, and 13 had acquired the disease by contact with vaccine recipients. Each of these children was matched with up to five controls according to health center, age, and in the case of vaccine recipients, history of receipt of the live attenuated oral poliovirus vaccine. Data were abstracted from medical records that documented the injections administered in the 30 days before the onset of paralysis. RESULTS. Of the 31 children with vaccine-associated disease, 27 (87 percent) had received one or more intramuscular injections within 30 days before the onset of paralysis, as compared with 77 of the 151 controls (51 percent) (matched odds ratio, 31.2; 95 percent confidence interval, 4.0 to 244.2). Nearly all the intramuscular injections were of antibiotics, and the association was strongest for the patients who received 10 or more injections (matched odds ratio for > or = 10 injections as compared with no injections, 182.1; 95 percent confidence interval, 15.2 to 2186.4). The risk of paralytic disease was strongly associated with injections given after the oral polio virus vaccine, but not with injections given before or at the same time as the vaccine (matched odds ratio, 56.7; 95 percent confidence interval, 8.9 to infinity). The attributable risk in the population for intramuscular injections given in the 30 days before the onset of paralysis was 86 percent (95 percent confidence interval, 66 to 95 percent); that is, we estimate that 86 percent of the cases of vaccine-associated paralytic poliomyelitis in this population might have been prevented by the elimination of intramuscular injections within 30 days after exposure to oral poliovirus vaccine. CONCLUSIONS. Provocation paralysis, previously described only for wild-type poliovirus infection, may rarely occur in a child who receives multiple intramuscular injections shortly after exposure to oral poliovirus vaccine, either as a vaccine recipient or through contact with a recent recipient. This phenomenon may explain the high rate of vaccine-associated paralytic poliomyelitis in Romania, where the use of intramuscular injections of antibiotics in infants with febrile illness is common.

PMID: 7830731 [PubMed - indexed for MEDLINE]
N Engl J Med 1995 Jul 6;333(1):62; discussion 64 Related Articles, Books, LinkOut

Comment on:
Intramuscular injections and vaccine-associated poliomyelitis.

Dalakas MC, Illa I, Leon-Monzon M.

Publication Types:
  • Comment
  • Letter

PMID: 7777001 [PubMed - indexed for MEDLINE]
N Engl J Med 1995 Jul 6;333(1):63; discussion 64 Related Articles, Books, LinkOut

Intramuscular injections and vaccine-associated poliomyelitis.

Weinberg RJ, Rustioni A.

Publication Types:
  • Letter

PMID: 7777002 [PubMed - indexed for MEDLINE]


: N Engl J Med 1995 Jul 6;333(1):64 Related Articles, Books, LinkOut

Intramuscular injections and vaccine-associated poliomyelitis.

Sepkowitz S.

Publication Types:
  • Letter

PMID: 7777003 [PubMed - indexed for MEDLINE]
: N Engl J Med 1995 Jul 6;333(1):63; discussion 64 Related Articles, Books, LinkOut

Comment on:
Intramuscular injections and vaccine-associated poliomyelitis.

Ross RT.

Publication Types:
  • Comment
  • Letter

PMID: 7632271 [PubMed - indexed for MEDLINE]
Indian Pediatr 1994 May;31(5):529-31 Related Articles, Books, LinkOut

Intramuscular injection as a provocative factor in paralytic poliomyelitis.

Mathur GP, Gahlaut IV, Mathur S, Upadhyay GC, Gupta VK.

Department of Pediatrics, G.S.V.M. Medical College, Kanpur.

PMID: 7875883 [PubMed - indexed for MEDLINE]
J Epidemiol Community Health 1993 Jun;47(3):210-4 Related Articles, Books, LinkOut

Paralytic poliomyelitis in children under 6 years in Pondicherry: a community survey.

Soudarssanane MB, Rotti SB, Srinivasa DK, Ramalingam G.

Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.

STUDY OBJECTIVES--To assess the amount of poliomyelitis and its epidemiological features including risk factors. DESIGN--This was a retrospective study of cases of paralytic poliomyelitis among children 0-6 years of age. SETTING--Pondicherry, India, 1983-89. SUBJECTS--A total of 47,960 children aged less than 6 years. MEASUREMENTS AND MAIN RESULTS--In 1989, 469 field workers undertook a door to door survey of children 0-6 years old to identify those with limb paralysis. This was followed by clinical examination to establish the cause, supplemented by case notes held by the Child Development Services. Altogether 203 cases of limb paralysis were identified, 188 of which were judged a result of paralytic poliomyelitis. The prevalence of poliomyelitis in 1989 was 3.9/1000 among children below 6 years of age. There was a male preponderance with a male:female ratio of 1.4:1. The prevalence was least in infants (1/1000) and highest in children aged 2 to 3 years (6.4/1000). The age at onset was less than 12 months in 42% of cases and less than 3 years in 98%. The median age at onset was 13.4 months. Time series analysis showed a high occurrence of cases from May to September between 1983 and 1989. The legs were affected in 97%. About 41% of children had received three doses of oral polio vaccine. There was a history of intramuscular injection, possibly provoking a paralytic attack, in 54% of cases. CONCLUSION--This retrospective community study involving the staff of the Integrated Child Development Services provided valid data about poliomyelitis with little additional cost and minimum training. Because the study covered a whole population of children under 6 years, rather than a sample, the data will help in monitoring and surveillance of poliomyelitis and also in planning strategies for effective control.

PMID: 8350034 [PubMed - indexed for MEDLINE]
Indian J Pediatr 1993 May-Jun;60(3):451-4 Related Articles, Books, LinkOut

Comment in:
  • Indian J Pediatr. 1993 May-Jun;60(3):327-9

Unnecessary injections given to children under five years.

Ashwath D, Latha C, Soudarssanane MB, Wyatt HV.

Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, U.K.

Adults accompanying 64 children attending a hospital out-patient clinic were questioned about treatment and injections given for illnesses in the previous month. Half the children had received injections, almost all given by private doctors: we consider most of these injections to have been unnecessary. Three girls were paralysed by aggravation poliomyelitis after unnecessary injections. Adults approved of injections although they did not know what was injected.

PMID: 8253497 [PubMed - indexed for MEDLINE]


Indian J Pediatr 1993 May-Jun;60(3):327-9 Related Articles, Books, LinkOut

Comment on:
  • Indian J Pediatr. 1993 May-Jun;60-3:451-4

Unnecessary injections and poliomyelitis.

Wyatt HV, Mahadevan S.

Department of Clinical Medicine, University of Leeds, U.K.

Publication Types:
  • Comment

PMID: 8253483 [PubMed - indexed for MEDLINE]
: Lancet 1992 Oct 24;340(8826):1005-6 Related Articles, Books, LinkOut

Comment in:
Provocation paralysis.

Publication Types:
  • Editorial

PMID: 1357404 [PubMed - indexed for MEDLINE]
: Lancet 1993 Jan 2;341(8836):62 Related Articles, Books, LinkOut

Comment on:
Provocation paralysis.

Eggers HJ, Weyer J.

Publication Types:
  • Comment
  • Letter

PMID: 8093318 [PubMed - indexed for MEDLINE]
Medicine (Baltimore) 1992 Sep;71(5):311-5; discussion 324-5 Related Articles, Books, LinkOut

J Infect Dis 1992 Mar;165(3):444-9 Related Articles, Books, LinkOut

Attributable risk of DTP (diphtheria and tetanus toxoids and pertussis vaccine) injection in provoking paralytic poliomyelitis during a large outbreak in Oman.

Sutter RW, Patriarca PA, Suleiman AJ, Brogan S, Malankar PG, Cochi SL, Al-Ghassani AA, el-Bualy MS.

Division of Immunization, Centers for Disease Control, Atlanta, Georgia 30333.

Although injections administered during the incubation period of wild poliovirus infection have been associated with an increased risk of paralytic poliomyelitis, quantitative estimates of the risk have not been established. During a poliomyelitis outbreak investigation in Oman, vaccination records were reviewed for 70 children aged 5-24 months with poliomyelitis and from 692 matched control children. A significantly higher proportion of cases received a DTP (diphtheria and tetanus toxoids and pertussis vaccine) injection within 30 days before paralysis onset than did controls (42.9% vs. 28.3%; odds ratio, 2.4; 95% confidence interval, 1.3-4.2). The proportion of poliomyelitis cases that may have been provoked by DTP injections was 35% for children 5-11 months old. This study confirms that injections are an important cause of provocative poliomyelitis. Although the benefits of DTP vaccination should outweigh the risk of subsequent paralysis, these data stress the importance of avoiding unnecessary injections during outbreaks of wild poliovirus infection.

PMID: 1538150 [PubMed - indexed for MEDLINE]
Trans R Soc Trop Med Hyg 1992 Sep-Oct;86(5):546-9 Related Articles, Books, LinkOut

Unnecessary injections and paralytic poliomyelitis in India.

Wyatt HV, Mahadevan S, Srinivasan S.

Department of Public Health Medicine, University of Leeds, UK.

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.

PMID: 1475830 [PubMed - indexed for MEDLINE]
Indian Pediatr 1992 Jan;29(1):25-8 Related Articles, Books, LinkOut

Epidemiological and clinical features of acute poliomyelitis children admitted in an urban hospital.

Deivanayagam N, Nedunchelian K.

ACCERT/CEU, Institute of Child Health, Egmore, Madras.

Six hundred and fourteen acute poliomyelitis children (57% boys) admitted to the Institute of Child Health, Madras, during January 1988 to September 1989 were studied. Diagnosis was based on clinical grounds. The age ranged from 2 months to 75 months. Residents of Madras city area were 31%, the rest being from neighbouring district (55%) and states (14%). Only 24% got protected water supply and 26% had access to safe disposal of excreta. Only a quarter (26.4%) had been immunized with 3 or more doses of oral polio vaccine. Intramuscular injection was given in 70% within one month of onset of paralysis. The commonest presentation was spinal form (80%) followed by spinobulbar (18%) and bulbar form (2%). Paralysis was severe in 72%, moderate in 6% and mild in 22%. Case fatality was 3.3%. The age at paralysis and clinical features in India have not changed over years. We conclude that the immunization programme should be effectively implemented to the maximum efficiency especially for the poor/illiterate community. Clinicians must be educated to avoid unwarranted intramuscular injections for any febrile illness.

PMID: 1601491 [PubMed - indexed for MEDLINE]
Rev Infect Dis 1990 May-Jun;12(3):547-56 Related Articles, Books, LinkOut

Incubation of poliomyelitis as calculated from the time of entry into the central nervous system via the peripheral nerve pathways.

Wyatt HV.

University of Leeds, United Kingdom.

A new theory of how poliovirus reaches the central nervous system (CNS)--that it enters at many peripheral nerve endings with passage along nerve pathways to the CNS, with limited dispersal in the CNS--is used in making predictions of incubation periods, and these are compared with data from the literature and with predictions from other theories. The virus transit speed along the nerve of 2.4 mm/h has been used in calculating the incubation time. The calculated incubation time for Cutter vaccinees is similar to the actual times reported, and the calculated minimal and maximal incubation times in humans are similar to the published ranges. Incubation times in different animals and for different paralyses are explained. The pathology of lesions in humans and the consequent paralyses are compatible with the model. Tonsillectomy-associated poliomyelitis is reviewed and discussed in relation to possible entry of virus from peripheral nerve endings in muscle. Increased lymphocyte concentrations in the muscle may account for continuing susceptibility after tonsillectomy. Severe paralysis following exercise is explained as an effect of increased blood supply to nerves in the CNS that has already been invaded by virus. In developing countries, the phenomenon of paralysis in the injected muscle a few hours after injection in febrile children may occur in a similar fashion. The entry of poliovirus from many sites at nerve endings in muscles is consistent with clinical, experimental, and pathologic data and provides an explanation of the incubation times and related phenomena of poliomyelitis.

Publication Types:
  • Review
  • Review, Tutorial

PMID: 2163095 [PubMed - indexed for MEDLINE]
Trans R Soc Trop Med Hyg 1989 Jul-Aug;83(4):545-9 Related Articles, Books, LinkOut

Poliomyelitis in developing countries: lower limb paralysis and injections.

Wyatt HV.

Department of Community Medicine, University of Leeds, UK.

The distribution of muscle paralysis due to poliomyelitis is different in temperate and tropical countries. In temperate countries, 49% of children with paralysis were affected only in the legs compared with 85% in developing countries, 79% and 89% respectively had affected legs with other paralysis. This suggests that correction for lameness surveys is unnecessary. Muscles frequently injected and those with adjacent motor neurone tracts in the central nervous system were much more frequently affected in Nigerian than in UK children, whereas paralysis in other muscles was less frequent than in the UK children. This and other evidence points to a major causal role for injections in the high prevalence of polio in developing countries. Proof may however be impossible to obtain because less than 0.5% of all injections are followed by paralysis. There may also be damage to motor neurones, without paralysis, which may lead to later disabilities. Injections should be given to young children only when absolutely necessary.

PMID: 2617611 [PubMed - indexed for MEDLINE]
N C Med J 1988 Feb;49(2):85-6 Related Articles, Books, LinkOut

Isolated superior gluteal neuropathy due to intramuscular injection.

Kaufman MD.

PMID: 3422711 [PubMed - indexed for MEDLINE]


Dev Biol Stand 1986;65:123-6 Related Articles, Books, LinkOut

Injections and poliomyelitis: what are the risks of vaccine associated paralysis?

Wyatt HV.

Provocation by injections can increase the risk of paralytic poliomyelitis by up to 25 fold. In England and Wales the risk of provocation paralysis from DPT given with oral poliovirus is 1 to 2 cases per million children immunized. Cases in India following immunization with oral poliovaccine and DPT are likely to be caused by wild rather than vaccine virus. Most cases of poliomyelitis in the Third World probably follow provocation by unsterile and unnecessary injections. There should normally be very few cases due to immunization. Injections should be sterile and only given when necessary.

Publication Types:
  • Review

PMID: 3549394 [PubMed - indexed for MEDLINE]
: Public Health 1986 Sep;100(5):297-301 Related Articles, Books, LinkOut

Paralytic poliomyelitis in Benin City in Nigeria.

Offor E, Obi JO.
From the article:  "In view of the observations that a majority of the paralytic children had injections of various drugs for fever, it would appear there is a need to make physicians and even the public more aware of the hazards of injections during any febrile conditions in children 0-5 years of age, particularly in developing countries."

PMID: 3786652 [PubMed - indexed for MEDLINE]

J Indian Med Assoc 1986 Jun;84(6):193-4 Related Articles, Books, LinkOut

Injections cripple, injections kill.

Wyatt HV.

Publication Types:
  • Letter

From the letter:  "In the Third World there has been a large increase in the number of children who are paralysed each year by poliomyelitis........In 1950, when triple antigen or DPT vaccine was given in mass campaigns in the UK and Australia, 3 observant doctors noticed that children were presenting unusually, with first paralysis of poliomyelitis in the left arm, which had been injected about 10 days previously.  Within a short time it was confirmed by a large epidemiological study and by animal experiments that intramuscular injections provoked paralytic poliomyelitis which was more sever than usual and increased the number of children paralysed.......Any substance which causes an inflammatory response will provoke paralysis, if injected intramuscularly viz, quinine, chloroquine, penicillin, DPT, any unsterile liquid or emulsion, many herbs, any substance contaminated with blood from a previous injection.  Multiple injections will also provoke because of recurrent trauma.  "

PMID: 3559225 [PubMed - indexed for MEDLINE]
Trans R Soc Trop Med Hyg 1985;79(3):355-8 Related Articles, Books, LinkOut

Provocation of poliomyelitis by multiple injections.

Wyatt HV.

Injections of vaccines provoked paralytic poliomyelitis in children in the UK and elsewhere. The effect of multiple injections has not been recognized previously but could be important in the tropics where children receive many injections. A number of epidemics of poliomyelitis between 1914 and 1962 are related to children with congenital syphilis or yaws under treatment with arsenicals or penicillin. Rates of 25% of children with paralysis occurred in epidemics while in non-epidemic periods the increase in susceptibility was about 25 fold. Other possible cases of provocation are discussed. Although in the tropics injections before paralysis may be causal, it will be difficult to prove that they are not coincident. The very high rate of paralysis following multiple injections is powerful evidence that injections in the tropics are often causal.

PMID: 4035736 [PubMed - indexed for MEDLINE]


: Soc Sci Med 1984;19(9):911-5 Related Articles, Books, LinkOut

The popularity of injections in the Third World: origins and consequences for poliomyelitis.

Wyatt HV.

Paralysis from poliomyelitis may follow injections yet injections are extremely popular in the Third World. Some injections are given by hospital doctors and nurses but the majority are given by traditional healers, pharmacists and paramedical workers who have acquired syringes. Many injections may be given to a sick child. I suggest that the early use of vaccines did not persuade people of the mystic of injections and that the mystic predated the use of penicillin. The earliest mystical result would have been the injection of quinine for malaria and antrypal for sleeping sickness. The words brilliant, spectacular and dramatic were first used to describe the mass campaigns against yaws and kala-azar in the 1920s and 1930s. A single injection healed the ugly lesions in a week: cause and effect were visible. In the 1950s penicillin was used in mass eradication campaigns. The countries where injections are so popular correspond roughly with the areas of mass eradication programmes. Many or perhaps most of the injections are not sterile and present a great risk of attendant paralysis. Proof that injections are causal may be impossible. Meanwhile we need to know why injections are so popular and how they can be less so.

PMID: 6515426 [PubMed - indexed for MEDLINE]
: Lancet 1982 Sep 4;2(8297):550 Related Articles, Books, LinkOut

Poliomyelitis, paralysis, and provocative injections.

Morley D.

Publication Types:
  • Letter

PMID: 6125696 [PubMed - indexed for MEDLINE]
Trop Geogr Med 1982 Jun;34(2):163-8 Related Articles, Books, LinkOut

A prevalence survey of lower limb motor disorders in school-age children in Niger and an estimation of poliomyelitis incidence.

Thuriaux MC.

An investigation of lower limb motor disorders among school-age children in Niger has shown a prevalence rate of seven per thousand in this age group. Sequelae of poliomyelitis, the major group among these disorders, show no significant difference according to sex or to school attendance status. Eight per cent of children suffering from poliomyelitis sequelae are unable to work and a further eight per cent need crutches or other aids. Patient histories indicate that over 90% of cases occurred before the child's fourth birthday. Extrapolation from the observed data indicate a tentative annual incidence rate for paralytic poliomyelitis in the order of 45 per 100,000, a figure seven to ten times higher than the figures gathered from routine notifications of poliomyelitis in Niger. The total number of those unable to walk unaided among children under 15 can be estimated in 1981 at 1600, half of whom are unable to walk at all. Trauma to peripheral nerves after intramuscular injections, usually of quinine salts, is second only to poliomyelitis as a cause of lower limb motor disorders.

PMID: 6981872 [PubMed - indexed for MEDLINE]
East Afr Med J 1981 Jun;58(6):405-11 Related Articles, Books, LinkOut

Acute paralytic poliomyelitis among Nigerian children in Enugu.

Izuora GI.

PMID: 7308096 [PubMed - indexed for MEDLINE]
Afr J Med Med Sci 1980 Mar-Jun;9(1-2):73-80 Related Articles, Books, LinkOut

Is poliomyelitis in the tropics provoked by injections?

Wyatt HV.

In the tropics and sub-tropics, poliomyelitis is characterized by a high non-seasonal case-rate, very young victims and a predominance of leg paralysis following injections. It is proposes that this could be caused by infection of immunosuppressed infants with poliovirus of low virulence following mal-nutrition, infections with malaria and measles and treatment by injections. Vaccination policies are briefly reviewed and the complete safety of inactivated and oral poliovaccines in the tropics is queried on theoretical grounds. Even if injections are coincident with and not causal of paralysis, it may be difficult to persuade parents of this .

PMID: 6282092 [PubMed - indexed for MEDLINE]
Bull World Health Organ 1980;58(2):285-91 Related Articles, Books, LinkOut

Injections and paralytic poliomyelitis in tropical Africa.

Guyer B, Bisong AA, Gould J, Brigaud M, Aymard M.

PMID: 6249510 [PubMed - indexed for MEDLINE]
: J Bone Joint Surg Am 1979 Jan;61(1):52-5 Related Articles, Books, LinkOut

Contracture of the hip secondary to fibrosis of the gluteus maximus muscle.

Hang YS.

Twenty-eight children were treated who had limited flexion of the hips and various degrees of contracture of the abductor and external rotator muscles because of fibrosis of the gluteus maximus muscle. Although the lesions could be classified as those associated with poliomyelitis, infection of the gluteus maximus muscle, and fibrosis of unknown etiology, all forty-five hips had a typical restriction of motion such that an affected hip could not be flexed in the usual sagittal plane, but had to be flexed in abduction. Poliomyelitis may have been adjunctive to the causative factor of the lesion in some cases but the probable primary etiology was multiple intramuscular injections. Excellent correction of the hip contracture was achieved in all patients by division of the fibrotic bands.

PMID: 759436 [PubMed - indexed for MEDLINE]
Clin Pediatr (Phila) 1972 Dec;11(12):698-700 Related Articles, Books, LinkOut

Paralytic poliomyelitis before and after mass vaccination. A record of clinical and emographic experiences in southern Iran.

Kazemi B, Nourmand A, Ziai M.

From the article:  "Of the 200 patients, 98 or 49 percent, had been given an injection of some sort by their local physician two to 12 hours prior to the onset of paralysis.  Of these 98 patients, 84 were given penicillin; 6, vitamins; and 8, injections of unknown nature.  Interestingly, the extremity which had been injected was always involved in the paralysis." 

PMID: 4639316 [PubMed - indexed for MEDLINE]



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