Question

Primary secondary tertiary prevention of poliomyelitis

Answer 1

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Primary Prevention - trying to prevent yourself from getting a disease. Secondary Prevention - trying to detect a disease early and prevent it from getting worse. Tertiary Prevention - trying to improve your quality of life and reduce the symptoms of a disease you already have.

Prevention and control for Poliomyelitis

• Provision of clean water, improved hygienic practices and sanitation are important for reducing the risk of transmission in endemic countries.
• Immunisation is the cornerstone of polio eradication. Two types of vaccine are available: an inactivated poliovirus vaccine (IPV) and a live attenuated OPV.

1.Oral polio vaccine has been the vaccine used predominantly in the past in global campaigns and is still used in endemic areas. It has the advantages of inducing both humoral and intestinal immunity and of being cheap and easy to administer. The disadvantage is the small risk of vaccine associated paralytic poliomyelitis (VAPP), which occurs in about 4 out of every 1 000 000 vaccinated children and unvaccinated contacts.

2.Inactivated poliovirus vaccine is injected intramuscularly and does not carry any risk of VAPP. The disadvantage is that it does not confer intestinal immunity and is not effective for outbreak control. It is more expensive and requires better trained staff for deliverance.

• European countries have gradually shifted from OPV to IPV over the last decades and today all EU Member States use IPV in their childhood immunisation programmes. National immunisation schedules and policies are available here . (For more recent updates, please refer to national vaccination websites.)
• Sensitive surveillance for acute flaccid paralysis (AFP) cases or, alternatively, testing for virus in sewage water (which is routinely done in several EU countries) along with rapid case investigations and containment of outbreaks are essential for maintaining polio-free status in Europe.
• For surveillance purposes, the WHO and the European Centre for Disease Prevention and Control (ECDC) have approved clinical, laboratory and epidemiological criteria for defining poliomyelitis.
• Mandatory surveillance of all cases of AFP (even non-polio) is a part of the WHO strategy to monitor the effectiveness of the reporting system. In Europe, 43 of the 53 WHO member countries are involved in active AFP surveillance and reporting.
• Testing for WPV and VDPV in sewage water is a sensitive surveillance method for poliomyelitis risk.

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