Polio and tonsillectomies or injections

It is widely accepted that tonsillectomies and injections are related to getting paralytic or bulbar polio. What is not acknowledged is the relevance of these facts. Far more profitable to push a vaccine designed to clean up after the side effects of other interventions, than to avoid the intervention in the first place. - SM

Here are the results of a search I just did on this topic. Some of the articles have no abstract, so I cannot be sure what the conclusions were (for or against), but thought I'd pass them on, anyway.

TI: Injection use in a village in north India.
AU: Anand,-K; Pandav,-C-S; Kapoor,-S-K
SO: Natl-Med-J-India. 2001 May-Jun; 14(3): 143-4
JN: National-medical-journal-of-India,-The
IS: 0970-258X
LA: English
AB: 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.

TI: Les injections intramusculaires chez l'enfant en afrique subsaharienne,
a propos d'une pathologie souvent meconnue: les complications liees aux
injections intramusculaires de quinine.
[Intramuscular injections in Sub-saharan African children, apropos of a
frequently misunderstood pathology: the complications related to
intramuscular quinine injections]
AU: Barennes,-H
SO: Bull-Soc-Pathol-Exot. 1999 Feb; 92(1): 33-7
JN: Bulletin-de-la-Societe-de-pathologie-exotique
LA: French; Non-English
AB: 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.

TI: Did India have the world's largest outbreak of poliomyelitis associated
with injections of adjuvanted DPT?
AU: John,-T-J
SO: Indian-Pediatr. 1998 Jan; 35(1): 73-5
JN: Indian-pediatrics
IS: 0019-6061
LA: English

TI: Unnecessary injections and poliomyelitis in Pakistan.
AU: Wyatt,-H-V
SO: Trop-Doct. 1996 Oct; 26(4): 179-80
JN: Tropical-doctor
IS: 0049-4755
LA: English

TI: Intramuscular injections within 30 days of immunization with oral
poliovirus vaccine--a risk factor for vaccine-associated paralytic
poliomyelitis.
AU: Strebel,-P-M; Ion-Nedelcu,-N; Baughman,-A-L; Sutter,-R-W; Cochi,-S-L
SO: N-Engl-J-Med. 1995 Feb 23; 332(8): 500-6
JN: New-England-journal-of-medicine,-The
IS: 0028-4793
LA: English
AB: 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.

TI: Minimizing the risks associated with the prevention of poliomyelitis.
AU: Wright,-P-F; Karzon,-D-T
SO: N-Engl-J-Med. 1995 Feb 23; 332(8): 529-30
JN: New-England-journal-of-medicine,-The
IS: 0028-4793
LA: English

TI: Intramuscular injections and vaccine-associated poliomyelitis.
AU: Dalakas,-M-C; Illa,-I; Leon-Monzon,-M
SO: N-Engl-J-Med. 1995 Jul 6; 333(1): 62; discussion 64
JN: New-England-journal-of-medicine,-The
IS: 0028-4793
LA: English

TI: Intramuscular injections and vaccine-associated poliomyelitis.
AU: Weinberg,-R-J; Rustioni,-A
SO: N-Engl-J-Med. 1995 Jul 6; 333(1): 63; discussion 64
JN: New-England-journal-of-medicine,-The
IS: 0028-4793
LA: English

TI: Intramuscular injections and vaccine-associated poliomyelitis.
AU: Sepkowitz,-S
SO: N-Engl-J-Med. 1995 Jul 6; 333(1): 64
JN: New-England-journal-of-medicine,-The
IS: 0028-4793
LA: English

TI: Intramuscular injections and vaccine-associated poliomyelitis.
AU: Ross,-R-T
SO: N-Engl-J-Med. 1995 Jul 6; 333(1): 63; discussion 64
JN: New-England-journal-of-medicine,-The
IS: 0028-4793
LA: English

TI: Vaccine-associated paralytic poliomyelitis in the United States: no
evidence of elevated risk after simultaneous intramuscular injections of
vaccine.
AU: Izurieta,-H-S; Sutter,-R-W; Baughman,-A-L; Strebel,-P-M;
Stevenson,-J-M; Wharton,-M
SO: Pediatr-Infect-Dis-J. 1995 Oct; 14(10): 840-6
JN: Pediatric-infectious-disease-journal,-The
IS: 0891-3668
LA: English
AB: During the past 30 years, Romania reported rates of vaccine-associated
paralytic poliomyelitis (VAPP) approximately 10-fold higher than in the
United States. The elevated VAPP risk was largely caused by multiple
intramuscular (im) injections with antibiotics given within 30 days of onset
of paralysis. Because it is not known whether im injections contribute to
the VAPP risk in the United States, we examined VAPP cases reported since
1980. We reviewed injection histories of VAPP cases reported to the Centers
for Disease Control and Prevention from 1980 to 1993: with vaccines for 1980
to 1987; and for all substances for 1988 to 1993. Rates of VAPP by number of
im injections with vaccines were calculated from 1988 to 1993 with estimated
vaccine coverage data from the National Health Interview Survey. From 1980
to 1993 a total of 119 cases of poliomyelitis were reported to the Centers
for Disease Control and Prevention. Of these, 87 (73%) were
vaccine-associated and immunologically normal: 41 were oral polio vaccine
(OPV) recipient cases; 40 were OPV contact cases; and 6 were
community-acquired cases. A history of im injections in the 45 days before
onset of paralysis was obtained from 28 (72%) of 39 recipient cases reported
from 1980 to 1993 for which dates of paralysis onset could be determined and
from 1 (8%) of 13 contact cases reported from 1988 to 1993. With one
exception all substances administered intramuscularly were routine childhood
vaccines. No clustering of im injections in the "high risk" windows, 0 to 3
and 8 to 21 days before onset of paralysis, was observed.(ABSTRACT TRUNCATED
AT 250 WORDS)

TI: Intramuscular injection as a provocative factor in paralytic
poliomyelitis.
AU: Mathur,-G-P; Gahlaut,-I-V; Mathur,-S; Upadhyay,-G-C; Gupta,-V-K
SO: Indian-Pediatr. 1994 May; 31(5): 529-31
JN: Indian-pediatrics
IS: 0019-6061
LA: English

TI: Intramuscular injection as a provoking factor for paralysis in acute
poliomyelitis. A case control study.
AU: Deivanayagam,-N; Nedunchelian,-K; Ahamed,-S-S; Ashok,-T-P; Mala,-N;
Ratnam,-S-R
SO: Indian-Pediatr. 1993 Mar; 30(3): 335-40
JN: Indian-pediatrics
IS: 0019-6061
LA: English
AB: In order to identify the role of intramuscular injection (IM) as a
provoking factor for poliomyelitis, a case control study as done at the
Institute of Child Health, Madras from May 1988 to May 1989. The case was
defined as acute poliomyelitis if he had acute asymmetric flaccid paralysis
of lower motor neurone type without objective sensory disturbance following
a short episode of fever. Controls were taken from children attending
outpatient department for fever. Two controls matched for aged and sex were
recruited for each case. Recruitment, data collection and clinical
examination were done by a single pediatrician. IM injection received within
30 days prior to onset of paralysis or illness was considered to be the risk
factor. The total number of cases and controls recruited were 257 and 515,
respectively. Among cases, 172 (66.9%) out of 257 and among controls 252
(48.9%) out of 515, received IM injection within one month earlier to onset
of paralysis or illness. The overall risk of paralysis, estimated for IM
injection, was increased [odds ratio (OR) 2.1 (95% CI, 1.5-3.0)]. The
maximum risk for paralysis was observed to be 2 weeks preceding the illness;
the ORs for < 7 days was 2.2 (95% CI, 1.6-3.2) and for 7-13 days 3.2 (95%
CI, 1.8 to 5.8). The risk of paralysis associated with IM injection was
similar for unimmunized and immunized cases (OR 2.4 and 2.2). Multiple
injections were not associated with a higher risk of developing
paralysis.(ABSTRACT TRUNCATED AT 250 WORDS)

TI: Unnecessary injections and poliomyelitis.
AU: Wyatt,-H-V; Mahadevan,-S
SO: Indian-J-Pediatr. 1993 May-Jun; 60(3): 327-9
JN: Indian-journal-of-pediatrics
IS: 0019-5456
LA: English

TI: Unnecessary injections given to children under five years.
AU: Ashwath,-D; Latha,-C; Soudarssanane,-M-B; Wyatt,-H-V
SO: Indian-J-Pediatr. 1993 May-Jun; 60(3): 451-4
JN: Indian-journal-of-pediatrics
IS: 0019-5456
LA: English
AB: 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.

TI: Provocation paralysis.
AU: Anonymous
SO: Lancet. 1992 Oct 24; 340(8826): 1005-6
JN: Lancet-
IS: 0140-6736
LA: English

TI: Tonsillectomy and poliomyelitis. I. Epidemiologic considerations. 1942.
AU: Aycock,-W-L
SO: Medicine-(Baltimore). 1992 Sep; 71(5): 311-5; discussion 324-5
JN:
Medicine-analytical-reviews-of-general-medicine,-neurology,-psychiatry,-derm
atology,-and-pediatries
IS: 0025-7974
LA: English

TI: Attributable risk of DTP (diphtheria and tetanus toxoids and pertussis
vaccine) injection in provoking paralytic poliomyelitis during a large
outbreak in Oman.
AU: Sutter,-R-W; Patriarca,-P-A; Suleiman,-A-J; Brogan,-S; Malankar,-P-G;
Cochi,-S-L; Al-Ghassani,-A-A; el-Bualy,-M-S
SO: J-Infect-Dis. 1992 Mar; 165(3): 444-9
JN: Journal-of-infectious-diseases,-The
IS: 0022-1899
LA: English
AB: 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.

TI: Unnecessary injections and paralytic poliomyelitis in India.
AU: Wyatt,-H-V; Mahadevan,-S; Srinivasan,-S
SO: Trans-R-Soc-Trop-Med-Hyg. 1992 Sep-Oct; 86(5): 546-9
JN: Transactions-of-the-Royal-Society-of-Tropical-Medicine-and-Hygiene
IS: 0035-9203
LA: English
AB: 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.

TI: Incubation of poliomyelitis as calculated from the time of entry into
the central nervous system via the peripheral nerve pathways.
AU: Wyatt,-H-V
SO: Rev-Infect-Dis. 1990 May-Jun; 12(3): 547-56
JN: Reviews-of-infectious-diseases
IS: 0162-0886
LA: English
AB: 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 simi
lar 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.

TI: Immunizations to the deltoid region.
AU: Bergeson,-P-S
SO: Pediatrics. 1990 Jan; 85(1): 134-5
JN: Pediatrics-
IS: 0031-4005
LA: English

TI: Poliomyelitis in developing countries: lower limb paralysis and
injections.
AU: Wyatt,-H-V
SO: Trans-R-Soc-Trop-Med-Hyg. 1989 Jul-Aug; 83(4): 545-9
JN: Transactions-of-the-Royal-Society-of-Tropical-Medicine-and-Hygiene
IS: 0035-9203
LA: English
AB: 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.

TI: Isolated superior gluteal neuropathy due to intramuscular injection.
AU: Kaufman,-M-D
SO: N-C-Med-J. 1988 Feb; 49(2): 85-6
JN: North-Carolina-medical-journal
IS: 0029-2559
LA: English

TI: Injections and poliomyelitis: what are the risks of vaccine associated
paralysis?
AU: Wyatt,-H-V
SO: Dev-Biol-Stand. 1986; 65123-6
JN: Developments-in-biological-standardization
IS: 0301-5149
LA: English
AB: 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.

TI: Paralytic poliomyelitis in Benin City in Nigeria.
AU: Offor,-E; Obi,-J-O
SO: Public-Health. 1986 Sep; 100(5): 297-301
JN: Public-health
IS: 0033-3506
LA: English

TI: Injections cripple, injections kill.
AU: Wyatt,-H-V
SO: J-Indian-Med-Assoc. 1986 Jun; 84(6): 193-4
JN: Journal-of-the-Indian-Medical-Association
IS: 0019-5847
LA: English

TI: Provocation of poliomyelitis by multiple injections.
AU: Wyatt,-H-V
SO: Trans-R-Soc-Trop-Med-Hyg. 1985; 79(3): 355-8
JN: Transactions-of-the-Royal-Society-of-Tropical-Medicine-and-Hygiene
IS: 0035-9203
LA: English
AB: 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.

TI: The popularity of injections in the Third World: origins and
consequences for poliomyelitis.
AU: Wyatt,-H-V
SO: Soc-Sci-Med. 1984; 19(9): 911-5
JN: Social-science-and-medicine
IS: 0277-9536
LA: English
AB: 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.

TI: Poliomyelitis, paralysis, and provocative injections.
AU: Morley,-D
SO: Lancet. 1982 Sep 4; 2(8297): 550
JN: Lancet-
IS: 0140-6736
LA: English

TI: A prevalence survey of lower limb motor disorders in school-age
children in Niger and an estimation of poliomyelitis incidence.
AU: Thuriaux,-M-C
SO: Trop-Geogr-Med. 1982 Jun; 34(2): 163-8
JN: Tropical-and-geographical-medicine
IS: 0041-3232
LA: English
AB: 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.

TI: Acute paralytic poliomyelitis among Nigerian children in Enugu.
AU: Izuora,-G-I
SO: East-Afr-Med-J. 1981 Jun; 58(6): 405-11
JN: East-African-medical-journal
IS: 0012-835X
LA: English

TI: Is poliomyelitis in the tropics provoked by injections?
AU: Wyatt,-H-V
SO: Afr-J-Med-Med-Sci. 1980 Mar-Jun; 9(1-2): 73-80
JN: African-journal-of-medicine-and-medical-sciences
IS: 0309-3913
LA: English
AB: 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 .

TI: Injections and paralytic poliomyelitis in tropical Africa.
AU: Guyer,-B; Bisong,-A-A; Gould,-J; Brigaud,-M; Aymard,-M
SO: Bull-World-Health-Organ. 1980; 58(2): 285-91
JN: Bulletin-of-the-World-Health-Organization
IS: 0042-9686
LA: English

TI: Contracture of the hip secondary to fibrosis of the gluteus maximus
muscle.
AU: Hang,-Y-S
SO: J-Bone-Joint-Surg-Am. 1979 Jan; 61(1): 52-5
JN: Journal-of-bone-and-joint-surgery,-The
IS: 0021-9355
LA: English
AB: 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.

TI: Tonsillectomy and adenoidectomy: are too many being done?
AU: Karelitz,-S
SO: N-Y-State-J-Med. 1975 Nov; 75(13): 2428-30
JN: New-York-state-journal-of-medicine
IS: 0028-7628
LA: English

TI: Die Tonsillektomie im Kindesalter. Gefahren und Komplikationen
[Tonsillectomy in childhood. Dangers and complications]
AU: Munzel,-M
SO: Fortschr-Med. 1974 Sep 12; 92(25): 971-3
JN: Fortschritte-der-Medizin
IS: 0015-8178
LA: German; Non-English

TI: Mycobacterium chelonei in abscesses after injection of
diphtheria-pertussis-tetanus-polio vaccine.
AU: Borghans,-J-G; Stanford,-J-L
SO: Am-Rev-Respir-Dis. 1973 Jan; 107(1): 1-8
JN: American-review-of-respiratory-disease,-The
IS: 0003-0805
LA: English

TI: Paralytic poliomyelitis.
AU: Anonymous
SO: J-Indian-Med-Assoc. 1973 Apr 16; 60(8): 309-10
JN: Journal-of-the-Indian-Medical-Association
IS: 0019-5847
LA: English

TI: Paralytic poliomyelitis before and after mass vaccination. A record of
clinical and emographic experiences in southern Iran.
AU: Kazemi,-B; Nourmand,-A; Ziai,-M
SO: Clin-Pediatr-(Phila). 1972 Dec; 11(12): 698-700
JN: Clinical-pediatrics
IS: 0009-9228
LA: English

TI: Effect of tonsillectomy and adenoidectomy on nasopharyngeal antibody
response to poliovirus.
AU: Ogra,-P-L
SO: N-Engl-J-Med. 1971 Jan 14; 284(2): 59-64
JN: New-England-journal-of-medicine,-The
IS: 0028-4793
LA: English

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