Provocation poliomyelitis: vaccine associated paralytic poliomyelitis related to a rectal abscess in an infant

A. R. J. Bosley^, ^,^a, Gail Speirs^b and N. I. Markham^c

^a Department of Paediatrics, North Devon District Hospital, Raleigh Park, Barnstaple, North Devon, UK
^b Department of Microbiology, North Devon District Hospital, Raleigh Park, Barnstaple, North Devon, UK
^c Department of Surgery, North Devon District Hospital, Raleigh Park, Barnstaple, North Devon, UK

Accepted 12 January 2003. ; Available online 29 March 2003.

Abstract

Objective. To describe a case of vaccine associated paralytic poliomyelitis (VAPP) and relate this to current UK immunization policy.

Method. A case report in which the clinical course and factors leading to the diagnosis are described and then related to reports of paralytic poliomyelitis in the literature.

Results. The child in this case was left severely disabled by paralytic poliomyelitis. The pathological process was related to a pararectal abscess needing urgent drainage shortly after immunisation.

Conclusion. The skeletal muscle damage due to the presence of the pararectal abscess may have acted as the `provocation' in the development of poliomyelitis. Adoption of a policy of initial vaccination by the parenteral route as in the USA and European countries has been shown to greatly reduce this risk. The UK could adopt this policy which would minimise the risk of VAPP, as all recorded paralytic poliomyelitis in the UK in the last decade has been vaccine related.

Author Keywords: Poliomyelitis; Vaccine associated; Paralytic; Provocation; Immunisation policy

References

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