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Polio epidemic hits Uttar Pradesh

BMJ 2002; 325 doi: (Published 21 September 2002) Cite this as: BMJ 2002;325:617

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2002 rise in poliomyelitis episodes in India

2002 rise in poliomyelitis episodes in India
Editor_ Religious resentment against live poliovaccine (OPV) has been incriminated for the recent rise in poliomyelitis episodes in Muradabad and adjoining areas in India1. That is nothing unusual as, decades earlier, the Ordox Reformed Population, a religious group in the Netherlands had rejected all types of vaccinations2. Recently, resentment against OPV was recorded in northern Nigeria with pockets of resistance in Niger, Jigawa and Kano States3. Nevertheless, it would be better if all episodes of acute flaccid paralysis (AFP) attributable to poliovirus or non-poliovirus infection were diagnosed promptly by imaging techniques and offered antiviral therapy.
Magnetic resonance imaging of the cervical spine of a 27-year-old man who developed AFP three weeks after his 20 month-old infant was immunized with OPV revealed smooth hyperintense bands. Sagittal-spin proton-density T2-weoghted images revealed involvement of the regions corresponding to the anatomic location on the ventral horns4. Recently, therapeutic intervention with pleconaril in three patients with acute poliovirus infection, two vaccine-associated and wild type poliovirus, was associated with a definite clinical response. Neurological improvement was evident in two cases while in one case, there were better respiratory status and muscle strength. Furthermore, in one patient even the initial CSF positive viral culture and PCR were followed by negative results5.
Future episodes of poliomyelitis in India or elsewhere should be addressed by seeking a diagnostic indication of poliovirus replication in motor neurons by imaging technology. MRI based involovement of target neurons by poliovirus should be accompanied by a pleconaril recipe. Certainly, they should alter any poliovirus-induced morbidity during the 2002 spurt of polio cases in India1.

Subhash C Arya, MBBS, PhD
Research Physician
Centre for Logistical Research and Innovation
M-122 Greater Kailash-Part 2
New Delhi- 110048, India

1. Kumar S. Polio epidemic hits Uttar Pradesh. BMJ 2002; 325:617
2. Conyn-van Spaendonck MAE, de Melkar HE, Abbink F, et al. Immunity to poliomyelitis in the Netherlands. Am J Epidemiol 2001; 153:207-214
3. Mohammed I. Cases of polio in Nigeria are dropping. BMJ 2002; 325:493
4. Malzberg MS, Rogg JM, Tate CA, et al. Poliomyelitis: hyperintensity of the anterior horn cells on MRI images of the spinal cord. American Journal of Roentg 1993; 161:863-865
5. Robert HA, Webster AD. Treatment of potentially life-threatening enterovirus infection with pleconaril. Clin Inf Dis 2001; 32:228-235

Competing interests: No competing interests

29 September 2002
Subhash C Arya
Research Physician
New Delhi- 110048, India
Centre for Logistical Research and Innovation