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Infection caused by human poliovirus — Clinical Guidelines

Overview

Human poliovirus infection can manifest as acute flaccid paralysis, primarily affecting children under five years old. Circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreaks highlight the ongoing risk despite vaccination efforts 1 2.

Diagnosis

Clinical Presentation: Acute flaccid paralysis, often asymmetric, with muscle weakness or paralysis 1.

Laboratory Tests: Stool samples for poliovirus isolation and RT-PCR 1 2.

Surveillance: Enhanced acute flaccid paralysis (AFP) surveillance to detect cases 1 2.

Management

Supportive Care: Physical therapy, respiratory support if needed 1.

No Specific Antiviral Therapy: No antiviral treatment is currently recommended for poliovirus infection 1 3.

Vaccination: Intensified vaccination campaigns with novel oral polio vaccine type 2 (nOPV2) for outbreak control 1 2.

Special Populations

Pediatrics: Primary target group for both infection and vaccination efforts 1 2.

Comorbidities: Immunodeficient individuals may be at higher risk for severe outcomes, including vaccine-associated paralytic poliomyelitis (VAPP) 3.

Key Recommendations

Implement supplementary immunization activities using nOPV2 during cVDPV2 outbreaks to enhance population immunity (Evidence: Strong 1).

Strengthen surveillance systems for AFP to rapidly detect and respond to poliovirus outbreaks (Evidence: Strong 1 2).

Monitor vaccine safety closely during emergency use of nOPV2 through integrated surveillance systems (Evidence: Moderate 1).

Prioritize vaccination campaigns in regions with multiple emergencies to maintain herd immunity (Evidence: Moderate 2).

Provide supportive care focusing on physical rehabilitation for patients with paralysis (Evidence: Expert opinion).

References

1 Longley AT, Nsubuga F, Gilani Z, Tobolowsky FA, Kisakye A, Greene SA et al.. Safety of nOPV2 administered during a supplementary immunisation activity in Uganda, 2022: data triangulation from a prospective cohort event monitoring programme and vaccine safety surveillance reports. The Lancet. Global health 2025. link00110-X) 2 Mashal MT, Eltayeb D, Higgins-Steele A, El Sheikh IS, Abid NS, Shukla H et al.. Effective partnership and in-country resource mobilization in Sudan for cVDPV2 outbreak response amid multiple emergencies in 2020-2021. BMC public health 2024. link 3 Suares JE, Khan S, Aadrika A, Poojari PG, Rashid M, Thunga G. Vaccine-associated paralytic poliomyelitis in oral polio vaccine recipients: disproportionality analysis using VAERS and systematic review. Expert opinion on drug safety 2024. link 4 Iqbal S, Shi J, Seib K, Lewis P, Moro PL, Woo EJ et al.. Preparation for global introduction of inactivated poliovirus vaccine: safety evidence from the US Vaccine Adverse Event Reporting System, 2000-12. The Lancet. Infectious diseases 2015. link00059-6) 5 Nzolo D, Ntetani Aloni M, Mpiempie Ngamasata T, Mvete Luemba B, Bazundama Marfeza S, Bothale Ekila M et al.. Adverse events following immunization with oral poliovirus in Kinshasa, Democratic Republic of Congo: preliminary results. Pathogens and global health 2013. link 6 Sugawara T, Ohsuka Y, Taya K, Yasui Y, Wada N, Sakano M et al.. Diarrhea as a minor adverse effect due to oral polio vaccine. Japanese journal of infectious diseases 2009. link 7 Szeri I, Anderlik P, Bános Z. Outlines of the immunological research in the Institute of Microbiology; Semmelweis Medical University. Acta microbiologica et immunologica Hungarica 1998. link 8 Dal Canto MC, Barbano RL, Jubelt B. Ultrastructural immunohistochemical localization of poliovirus during virulent infection of mice. Journal of neuropathology and experimental neurology 1986. link 9 Ferguson M, Minor PD, Magrath DI, Schild GC. Antigenic analysis of poliovirus type 3 using monoclonal antibodies. Developments in biological standardization 1984. link 10 Payment P, Larose Y, Trudel M. Polioviruses as indicator of virological quality of water. Canadian journal of microbiology 1979. link 11 Miller JR, Calliguiri LA, Tamm J. Reaction of poliovirus RNAs with antibodies to double-stranded RNA demonstrated by an immunochemical binding assay. Journal of virology 1975. link

Infection caused by human poliovirus