Falls in Korean Polio Survivors: Incidence,Consequences, and Risk Factors

Falls and fall-related injuries are important issue among polio survivors. The purpose of this study was to determine the incidence of, and consequences and factors associated with falls among Korean polio survivors. A total of 317 polio survivors participated in this study. All participants completed a questionnaire including fall history, symptoms related to post-polio syndrome and other information through a telephone interview. Among them, 80 participants visited our clinic for additional physical measurements and tests. Of the 317 respondents, 68.5% reported at least one fall in the past year. Of the fallers, 42.5% experienced at least one fall during one month. Most falls occurred during ambulation (76.6%), outside (75.2%) and by slipping down (29.7%). Of fallers, 45% reported any injuries caused by falls, and 23.3% reported fractures specifically. Female sex, old age, low bone mineral density, the presence of symptoms related to post-polio syndrome (PPS), poor balance confidence, short physical performance battery and weak muscle strength of knee extensor were not significantly associated with falls. Only leg-length discrepancy using spine-malleolar distance (SMD) was a significant factor associated with falls among Korean polio survivors. Our findings suggest that malalignment between the paralytic and non-paralytic limb length should be addressed in polio survivors for preventing falls.     

Seronegativity to polio viruses among previously immunized adult candidates to solid organ transplantation

In the current effort to eliminate polio from the world, it is important to recognize and vaccinate susceptible groups, especially immunocompromised patients living in countries where attenuated polio vaccine is still used. In this report, we describe the frequency of protective antibodies in a small sample of adult SOT candidates in whom previous vaccination could be ascertained. Patients included in this report were selected among the participants of an ongoing prospective study carried out at the Reference Center for Special Immunobiologicals of the Evandro Chagas National Institute of Infectious Diseases in Rio de Janeiro, Brazil. Among the first 100 patients enrolled in this study, only seven adult SOT candidates had proven polio vaccination at childhood. Three of these seven patients (43%) had no protective antibody titers to one or more poliovirus subtype before solid organ transplant. Proven childhood vaccination against polio does not reliably provide lifelong protective antibody titers for adult SOT candidates and should not be used as a criterion to analyze the need for vaccination in this population.     

不同序贯程序的脊髓灰质炎灭活疫苗和减毒活疫苗的免疫效果研究

目的 评价脊髓灰质炎灭活疫苗（IPV）和减毒活疫苗（OPV）不同序贯免疫程序的免疫效果。方法 选取月龄≥2月的婴儿,分为1剂IPV和2剂OPV序贯组(I - O - O组)、2剂IPV和1剂OPV序贯组(I - I - O组)、IPV全程(I - I - I组)和OPV全程组(O - O - O),分别在2、3、4月龄时各接种1针,检测并比较各组人群血清中脊髓灰质炎中和抗体几何平均滴度（GMT）及抗体阳转率。结果 在完成基础免疫后,I - O - O 组Ⅰ、Ⅱ、Ⅲ型抗体GMT分别为948.78、930.91、955.08;I - I - O组抗体GMT分别为909.43、1 202.34、1 102.83;I - I - I 组GMT分别为333.02、298.56、411.98,O - O - O组抗体GMT分别为814.42、778.27、658.52;差异均有统计学意义;各组3个型别的抗体阳转率均为98％~100％,差异无统计学意义。接种1针IPV后脊髓灰质炎Ⅰ型、Ⅱ型、Ⅲ型中和抗体GMT分别为21.77、30.89、26.46,抗体阳转率分别为84.1％、91.5％、91.5％;接种第2剂IPV后,Ⅰ型、Ⅱ型、Ⅲ型中和抗体GMT分别69.42、133.89、212.58,抗体阳转率分别为100.0％、100.0％、99.9％。结论 IPV与OPV序贯接种后,对象产生的脊髓灰质炎中和抗体GMT比单独接种3剂IPV或3剂OPV高;不同序贯程序中,接种2剂IPV后抗体保护率较高。为了使机体产生更高的抗体水平并且避免疫苗相关麻痹病例发生,可采用IPV与OPV序贯程序,并以2剂IPV和1剂OPV的序贯程序为佳。     

南通市健康人群脊髓灰质炎抗体水平及免疫成功率监测

[目的]了解南通市健康人群脊髓灰质炎免疫现状及脊灰疫苗(OPV)免疫成功率.[方法]健康人群抗体水平监测按照5月龄～、1～2岁、3～4岁、5～6岁、7～14岁、15～19岁、20岁～7个年龄组,每个年龄组各随机抽取50名健康人群进行观察.免疫成功率监测选择2月龄未服过OPV的53名儿童作为观察对象,比较脊灰基础免疫前及...     

Body composition assessment in Taiwanese individuals with poliomyelitis

Chang K-H, Lai C-H, Chen S-C, Hsiao W-T, Liou T-H, Lee C-M. Body composition assessment in Taiwanese individuals with poliomyelitis.

Objectives

To measure the changes in the total and regional body fat mass, and assess the clinical usefulness of the body mass index (BMI) in detecting overweight subjects with sequelae of poliomyelitis.

Design

Prospective, cross-sectional study.

Setting

General community.

Participants

Subjects with poliomyelitis (n=17; age range, 42–57y; mean, 47y; 12 men, 5 women) and able-bodied people (n=17) matched by sex, age, body weight, and body height participated in the study.

Interventions

Not applicable.

Main Outcome Measures

Total and regional body composition was measured with dual-energy x-ray absorptiometry. Clinical characteristics such as blood pressure, serum biochemical studies, and habitual behaviors (daily cigarette smoking, alcohol consumption, and exercise regimen) of all participants were evaluated.

Results

Compared with able-bodied controls, subjects with poliomyelitis had a 50% greater total body fat mass, significant increases in the regional fat mass in every part of the body, and had the greatest increase of fat mass in the thorax. Nearly all the subjects (94%) with poliomyelitis were obese according to standards of body composition. However, one third of them had a BMI value of less than 25.0kg/m².

Conclusions

People with poliomyelitis have a higher prevalence of obesity and a significant increase in total and regional fat mass. Current BMI underestimates the total body fat mass percentage compared with the control; therefore, a population-specific BMI should be used to address the prevalence of obesity in postpolio survivors.     

2004～2008年保山市流动儿童脊髓灰质炎疫苗强化免疫接种资料分析

[目的]了解保山市流动儿童脊髓灰质炎疫苗(OPV)强化免疫活动中的免疫状况及其影响因素,以便为进一步加强流动儿童管理,调整相应的免疫策略提供依据。[方法]对保山市所辖5个县区2004～2008年OPV强化免疫活动中流动儿童的监护人进行调查,在保山市隆阳区和腾冲县于规定服苗时间结束后1周内,在流动人口较多的车站、农贸市场、街道和集镇进行接种率快速评估。[结果]2004～2008年的7轮OPV强化免疫活动中,合计调查0～4岁流动儿童22111人次,其中,持有儿童免疫接种证的占41.04%,OPV"零"剂次的占7.48%,由家长主动携带到固定接种点服苗的占4.14%;在调查地居住不足90d的占16.89%,居住时间≥90d的占83.11%,38.47%的人已在调查地公安机关登记。强化免疫快速评估合计抽查0～4岁儿童630人次,平均服苗率为91.75%,其中,流动儿童为68.97%,常住儿童为94.06%(P0.01)。[结论]保山市流动儿童OPV强化免疫接种率不高,儿童到公安机关登记者所占比例偏低是其主要原因。     

脊髓灰质炎灭活疫苗和减毒活疫苗不同序贯免疫程序基础免疫安全性观察

目的 评价脊髓灰质炎灭活疫苗(inactivated polio vaccine,IPV)和减毒活疫苗(oralpolio vaccine,OPV)不同序贯免疫程序基础免疫的安全性.方法 2009至2011年在北京市选择2月龄(60～89 d)婴儿,分为1剂IPV和2剂OPV序贯(I-O-O)、2剂IPV和1剂OPV序贯(I-I-O)、IPV全程(I-I-I)、OPV全程(O-O-O)4个观察组,分别在2、3、4月龄时接种疫苗,收集每次接种后全身和局部不良反应发生情况,计算不良反应发生率.最终入组553名婴儿,中途退出89名,观察1492人次.结果 I-O-O组、I-I-O组、I-I-I组和O-O-O组总不良反应发生率分别为22.9％ (94/410)、18.4％(60/327)、22.0％(78/354)和17.7％(71/401),差异无统计学意义(x2=4.84,P=0.184).第1剂不良反应发生率最高[22.7％(32/141) ～35.3％(54/153)],第2、3剂依次降低.没有与接种疫苗有关的严重不良事件报告.I-O-O组、I-I-O组、I-I-I组和O-O-O组全身不良反应发生率分别为21.5％(88/410)、17.7％(58/327)、20.1％ (71/354)和17.7％(71/401),差异无统计学意义(x2 =2.53,P=0.472).异常哭闹在各组中发生率最高[7.2％(29/401) ～11.3％(37/327)],异常哭闹、嗜睡和易激惹观察到极少数重度不良反应,其他不良反应均为轻、中度反应.I-O-O组、I-I-O组和I-I-I组局部压痛、硬结和红肿发生率分别为2.2％(5/229) ～5.6％(22/393)、0～0.9％(2/229)、0～ 1.0％(4/393),均以轻度为主[0 ～4.1％(5/12t)].结论 IPV全程及IPV/OPV序贯免疫程序与口服三剂OPV-样具有较好的安全性.     

新疆石河子市幼儿园保育员脊髓灰质炎知识知晓状况及其影响因素研究

目的了解新疆石河子市幼儿园保育员对脊髓灰质炎相关知识知晓情况,为政府相关部门开展脊髓灰质炎健康教育工作提供依据。方法采用分层整群抽样方法,分别抽取石河子市公立和私立幼儿园保育员42人和78人,对其采用问卷调查方式进行调查。结果保育员问卷平均得分（80．16±5．79）分,平均及格率（≥70分）为65％;保育员脊髓灰质炎首要知识来源中政府宣传占33．3％,互联网占21．7％,知识培训占18．3％;幼儿园保育员在脊髓灰质炎基础知识、流行环节方面问题正确率较低,最低达6．41％。公立幼儿园保育员及格率（80．95％）高于私立幼儿园（56．41％）（X^2=9．645,P=0．002）;有孩子的保育员及格率（84．44％）高于无孩子的保育员（53．33％）（X^2=11．966,P〈0．001）。Logistic回归模型分析可见,有孩子（OR=10．522）和公立幼儿园（OR=11．914）的保育员对脊髓灰质炎知识掌握程度高,更易于及格。结论石河子市幼儿园保育员脊髓灰质炎知识知晓率低,知识培训少,相关部门应重点对私立幼儿园和无小孩的保育员开展多种形式的培训,提高培训质量。     

Effect of substituting IPV for tOPV on immunity to poliovirus in Bangladeshi infants: An open-label randomized controlled trial

BackgroundThe Polio Endgame strategy includes phased withdrawal of oral poliovirus vaccines (OPV) coordinated with introduction of inactivated poliovirus vaccine (IPV) to ensure population immunity. The impact of IPV introduction into a primary OPV series of immunizations in a developing country is uncertain.MethodsBetween May 2011 and November 2012, we enrolled 700 Bangladeshi infant-mother dyads from Dhaka slums into an open-label randomized controlled trial to test whether substituting an injected IPV dose for the standard Expanded Program on Immunization (EPI) fourth tOPV dose at infant age 39 weeks would reduce fecal shedding and enhance systemic immunity. The primary endpoint was mucosal immunity to poliovirus at age one year, measured by fecal excretion of any Sabin virus at five time points up to 25 days post-52 week tOPV challenge, analyzed by the intention to treat principle.FindingsWe randomized 350 families to the tOPV and IPV vaccination arms. Neither study arm resulted in superior intestinal protection at 52 weeks measured by the prevalence of infants shedding any of three poliovirus serotypes, but the IPV dose induced significantly higher seroprevalence and seroconversion rates. This result was identical for poliovirus detection by cell culture or RT-qPCR. The non-significant estimated culture-based shedding risk difference was −3% favoring IPV, and the two vaccination schedules were inferred to be equivalent within a 95% confidence margin of −10% to +4%. Results for shedding analyses stratified by poliovirus type were similar.ConclusionsNeither of the vaccination regimens is superior to the other in enhancing intestinal immunity as measured by poliovirus shedding at 52 weeks of age and the IPV regimen provides similar intestinal immunity to the four tOPV series, although the IPV regimen strongly enhances humoral immunity. The IPV-modified regimen may be considered for vaccination programs without loss of intestinal protection.     

The effect of diarrheal disease on bivalent oral polio vaccine (bOPV) immune response in infants in Nepal

BackgroundA globally-coordinated phase out of all type 2 containing oral polio vaccine (OPV) is planned for April 2016 during which bivalent 1 + 3 OPV (bOPV) will replace trivalent OPV (tOPV) in routine immunization schedules and campaigns. Diarrhea impairs the immune response to tOPV, but the effect of diarrhea on bOPV is unknown.MethodsInfants aged 6 weeks to 11 months, who had received <3 doses of OPV and had mild-moderate diarrhea or no diarrhea, were recruited at five health facilities in Nepal. Neutralizing antibody titers to poliovirus types 1 and 3 were measured before and 28 days after bOPV administration. The effect of diarrhea and other factors on seroconversion or boosting in antibody titers to poliovirus was assessed by multivariable analysis.ResultsInfants with diarrhea, versus those without diarrhea, had reduced response for poliovirus types 1 (56% [87/156] vs 66% [109/164]) and 3 (34% [70/209] vs 52% [122/236]). After adjusting for other factors, infants with diarrhea had significantly reduced response for type 3 (odds ratio [OR] = 0.44, 95% CI 0.29–0.68), as did infants with >5 loose stools per day (OR = 0.36, 95% CI 0.21–0.62).ConclusionsDiarrhea reduced the immune response to bOPV. Provision of additional doses of polio vaccine is necessary to maintain high population immunity in areas with high prevalence of diarrheal disease.Clinical trial registryThis study is registered at clinicaltrials.gov as NCT01559636.