Poliomyelitis

Poliomyelitis

Q. 1

False about Polio –

 A

Descending paralysis

 B

Bilateral symmetrical

 C

Non-progressive

 D

LMN type paralysis

Q. 1

False about Polio –

 A

Descending paralysis

 B

Bilateral symmetrical

 C

Non-progressive

 D

LMN type paralysis

Ans. A

Explanation:

Ans. is b  i.e., Bilateral symmetrical

  • Paralysis in polio is assymetric, descending, non-progressive and LMN type.

Q. 2

The most definitive method for laboratory diagnosis of poliomyelitis are A/E ‑

 A

Virus isolation from blood

 B

Virus isolation from CSF

 C

Virus isolation from faeces or throat

 D

Serological diagnosis

Q. 2

The most definitive method for laboratory diagnosis of poliomyelitis are A/E ‑

 A

Virus isolation from blood

 B

Virus isolation from CSF

 C

Virus isolation from faeces or throat

 D

Serological diagnosis

Ans. D

Explanation:

Ans. is di.e., Serological diagnosis

Lab diagnosis of polio

67rus isolation in tissue culture is the best method for specific diagnosis.

.  Specimens                    

Blood, CSF, Throat swab, Feces

.   Primary monkey kidney cultures are used.

  • Serodiagnosis is less often employed.

Q. 3

MgCl2 is added to polio vaccine because of the following –

 A

Potentiates the vaccine

 B

Vaccine can be kept at higher temperatures

 C

Preservative

 D

None of the above

Q. 3

MgCl2 is added to polio vaccine because of the following –

 A

Potentiates the vaccine

 B

Vaccine can be kept at higher temperatures

 C

Preservative

 D

None of the above

Ans. B

Explanation:

Ans. is ‘b’ i.e., Vaccines can be kept at higher temperature

.   Molar concentration of certain salts MgC12, Na2So4 protect polio virus from heat inactivation.

.   As it prevents heat inactivation mgCl2 can be added to polio vaccine so that it can be stored at a higher temperature.


Q. 4

All are features of non paralytic polio except ‑

 A

Absent deep tendon reflexes

 B

Head drop

 C

Nuchal rigidity

 D

Knee heel test negative

Q. 4

All are features of non paralytic polio except ‑

 A

Absent deep tendon reflexes

 B

Head drop

 C

Nuchal rigidity

 D

Knee heel test negative

Ans. A

Explanation:

Ans. is ‘a’ i.e., Absent Deep Tendon Reflexes 

Poliomyelitis

  • The usual age group affected by poliomyelitis is between 6 months to 3 years. o Incubation period —> 7-14 days.

Clinical manifestations

o Clinical course of Poliomyelitis has following stages.


Q. 5

Polio virus infection can result in all except ‑

 A

Anterior horn cell damage

 B

Autonomic involvement

 C

respiratory involvement

 D

Paralysis in > 70% of cases

Q. 5

Polio virus infection can result in all except ‑

 A

Anterior horn cell damage

 B

Autonomic involvement

 C

respiratory involvement

 D

Paralysis in > 70% of cases

Ans. D

Explanation:

Ans. is ‘d’ i.e., Paralysis in > 70 of cases 

o Poliovirus selectively damage motor and autonomic nervous system.

o Most commonly affected areas are the anterior horn of the spinal cord, vestibular and cranial nerve nuclei and vital centres in the medulla and vermis, and nuclei in the roof of cerebellum.

o When respiratory centers are involved the respiration becomes shallow and irregular.

o Areas which are usually not affected          

White matter of spinal cord, Cerebellar hemisphere, Nonmotor part of cerebral cortex.

o Paralytic polio is seen in less than 1% of polio infections.


Q. 6

Zero dose of Polio vaccine in which is give ‑

 A

Before giving DPT

 B

At birth

 C

When child is having diarrhoea

 D

When child is having Polio

Q. 6

Zero dose of Polio vaccine in which is give ‑

 A

Before giving DPT

 B

At birth

 C

When child is having diarrhoea

 D

When child is having Polio

Ans. B

Explanation:

Ans. is ‘b’ i.e., At birth 


Q. 7

Death in poliomyelitis is usually due to –

 A

Hypertension 

 B

Repiratory Paralysis

 C

Aspiration

 D

Arrythmias

Q. 7

Death in poliomyelitis is usually due to –

 A

Hypertension 

 B

Repiratory Paralysis

 C

Aspiration

 D

Arrythmias

Ans. B

Explanation:

Ans. is `b,’ i.e., Respiratory failure 

Clinical manifestations

o Incubation period —> 7-14 days

o After infection, one of the following responses may occur –

  • Inapparent (subclinical) infection

o Occurs in 95% of the infected individuals

o They play a dominant role in spread of infection.

           Minor (abortive) illness

o In 4-8% of infections

o Fever, sore throat, headach and malaise

           Aseptic meningitis (non-paralytic polio)

o In 1% of infections

o Signs & symptoms of meningitis

           Paralytic polio

o In less than 1% of cases

o Flaccid paralysis with absent tendon reflexes.

o Most common cause of death —) Respiratory paralysis.


Q. 8

All are true about polio, except –

 A

99% non paralytic

 B

Flaccid paralysis

 C

Exaggerated tendon reflexes

 D

Aseptic meningitis

Q. 8

All are true about polio, except –

 A

99% non paralytic

 B

Flaccid paralysis

 C

Exaggerated tendon reflexes

 D

Aseptic meningitis

Ans. C

Explanation:

Ans. is ‘c’ i.e., Exaggerated tendon reflexes

o There are absent tendon reflexes (not exaggerated).

o Paralytic polio occurs in only 1% cases (that means 99% is non-paralytic).

o There is flaccid paralysis.

o Aspetic meningitis occurs in 1% of cases.


Q. 9

True about polioviruses is –

 A

Most cases are symptomatic

 B

Spastic paralysis

 C

Injectables and severe exercise increases chance of paralysis

 D

Inactivated polio vaccine are given to child less than 3 years of age

Q. 9

True about polioviruses is –

 A

Most cases are symptomatic

 B

Spastic paralysis

 C

Injectables and severe exercise increases chance of paralysis

 D

Inactivated polio vaccine are given to child less than 3 years of age

Ans. C

Explanation:

Ans. is ‘c’ i.e., Injections and severe exercise increases the chance of paralysis


Q. 10

Trivalent oral polio vaccine contains, type 3 virus –

 A

100,000 TCID 50

 B

200,000 TCID 50

 C

300,000 TCID 50

 D

400,000 TCID 50

Q. 10

Trivalent oral polio vaccine contains, type 3 virus –

 A

100,000 TCID 50

 B

200,000 TCID 50

 C

300,000 TCID 50

 D

400,000 TCID 50

Ans. C

Explanation:

Ans. is ‘c’ i.e., 300,000 TCID 50 

Oral (sabin) polio vaccine

  • It contains live attenuated viruss (type 1, 2 and 3) grown in primary monkey kidney or human diploid cell culture.

o The vaccine contains :-

i)      Over 300,000 TCID 50 of type 1 poliovirus

ii)     Over 100,000 TCID 50 of type 2 poliovirus

iii)    Over 300,000 TCID 50 of type 3 poliovirus o Dose 2 drop (0.1 ml)

  • Schedule in National Immunization Programme of India.

Dose                                                         Age

OPV-0 (Zero dose)                       At birth

OPV-1                                        6 weeks

OPV-2                                        10 weeks

OPV-3                                        14 weeks

OPV-B (Booster dose)                 16-24 months

o Development of immunity –> OPV induces local intestinal immunity by production of secretory IgA as well as humoral immunity by inducing production of serum antibodies (IgG). So, it gives protection from paralysis and also prevents infection of the gut by wild viruses.


Q. 11

True about oral polio vaccine –

 A

Poliomyelitis in recipients

 B

Poliomyelitis in contact of recipient

 C

Guillein Bare syndrome

 D

a and b

Q. 11

True about oral polio vaccine –

 A

Poliomyelitis in recipients

 B

Poliomyelitis in contact of recipient

 C

Guillein Bare syndrome

 D

a and b

Ans. D

Explanation:

Ans. is ‘a’ i.e., Poliomyelitis in recipients & ‘b’ i.e., Poliomyelitis in contact of recipient 

Complications of OPV

o Being living viruses, the vaccine viruses, particularly type 3 do mutate in the course of their multiplication in vaccinated children, and rare cases of vaccine associated paralytic polio have occured in –

i)         Recipients of the vaccine

ii)       Thier contacts

Contraindiations of OPV

o Immunocompromized individuals

o Patients suffering from leukaemias & malignancy or AIDS.

o Persons recieving corticosteroids.

  • In pregnancy.

Vaccine derived poliovirus (VDPV)

  • Vaccine-associated paralytic poliomyelitis (VAPP) is the most important but a rare adverse effect of OPV. Cases of VAPP are clinically indistinguishable from poliomyelitis caused by wild polio virus (WPV), but can be distinguished by laboratory analysis.

o The incidence of VAPP has been estimated at 4 cases/I 000,000 birth cohort per year in countries using OPV.

o VAPP occurs in both OPV recipient and their unimmunized contacts; It is most frequently associated with type 3 virus (Sabin type 3), followed by Sabin 2 and Sabin 1.

Following information has been added in 22nd/e of Park

o VDPVs resemble WPVs biologically and differ from the majority of vaccine – related poliovirus (VRPV) isolates in that they have genetic properties consistent with prolonged replication or transmission, which is substantially longer than the normal period of vaccine virus replication of 4-6 weeks in OPV recipients.

o All poliovirus isolates are characterized by Global Polio Laboratory Network. The diagnosis is made by real-time reverse transcription PCR (rRT-PCR) nucleic acid amplification.

o VPDVs are divided into three categories : (1) Circulating VPDV (cVDPV), which is transmitted from person to person; (2) immunodeficiency-associated VPDV (iVDPV), which is isolated from patients with primary immunodeficiency; and (3)Ambiguous VDPV (aVDPO, which are either clinical isolates from person with no immunodeficiency or sewage isolates whose source is unknown.

o Because of emergence of VDPV, OPV use will be discontinued worldwide once all WPV transmission has been interrupted, i.e., IPV will replace OPV.


Q. 12

The characteristics of polio vaccine are all except‑

 A

Maintenance of cold chain

 B

100 % immunisation

 C

Killed vaccine is effective in India

 D

5 doses of OPV given

Q. 12

The characteristics of polio vaccine are all except‑

 A

Maintenance of cold chain

 B

100 % immunisation

 C

Killed vaccine is effective in India

 D

5 doses of OPV given

Ans. B

Explanation:

Ans. is ‘b’ i.e., 100% immunization 

  • In OPV, the viruses multiply in the gut and the vaccine progency is excreted in the feces and secondary spread occurs to house hold contacts and susceptible contacts in the community.
  • Non-immunized person may therefore, be immunized.
  • Thus widespread herd immunity results, even if only approximately 66% of the community is immunized (100% coverage is not required).

Advantages of OPV

o Easy to administer

o Induces both humoral and intestinal immunity.

o Antibody is quickly produced in a large proportion of vacciness, even a single dose elicits substantial immunity. o The vaccine excretes the virus and so infects others who are also immunized thereby.

o Useful in controlling epidemics.

o Relatively inexpensive.

Disadvantages

o OPV is a thermolabile vaccine –p maintenance of cold chian is required and vaccine is stored at -20°C in deep freez.

Also know

o Stabilized vaccine Recent oral polio vaccines are heat stabilised. They can be kept without losing potency for a year at 4°C and for a month at room temprature.


Q. 13

Oral polio vaccine was developed by – 

 A

Louis Pasteur 

 B

Albert Sabin

 C

Jonas Salk

 D

None

Q. 13

Oral polio vaccine was developed by – 

 A

Louis Pasteur 

 B

Albert Sabin

 C

Jonas Salk

 D

None

Ans. B

Explanation:

Ans. is ‘b’ i.e., Albert Sabin

o OPV was discovered by —> Albert Sabin (Sabin vaccin).

o I PV was discovered by —> Jonas Salk (Salk vaccine).


Q. 14

In a epidemic of poliomyelitis, the best way to stop spread is by –

 A

Injection of killed vaccine

 B

OPV drops to all children

 C

Isolation of cases

 D

Chlorination of all wells

Q. 14

In a epidemic of poliomyelitis, the best way to stop spread is by –

 A

Injection of killed vaccine

 B

OPV drops to all children

 C

Isolation of cases

 D

Chlorination of all wells

Ans. B

Explanation:

Ans. is ‘b’ i.e., OPV drops to all children 

  • ‘Immunization is the sole effective way of preventing poliomyelitis’    -Park
  • OPV is best suited for control of epidemics. IPV is not recommended     -Park
  • Within an epidemic area, OPV should be provided to all persons over 6 weeks age who have not been completely immunized or whose immune status is unknown -Park

Q. 15

Ideally immunization against poliomyelitis should be started at:

September 2004

 A

Birth

 B

6 weeks

 C

12 weeks

 D

9 months

Q. 15

Ideally immunization against poliomyelitis should be started at:

September 2004

 A

Birth

 B

6 weeks

 C

12 weeks

 D

9 months

Ans. A

Explanation:

Ans. A i.e. Birth


Q. 16

All are true regarding killed polio vaccine EXCEPT:

September 2012

 A

Produces circulatory antibody

 B

Does NOT require stringent refrigeration

 C

Immunity against paralytic and wild strains

 D

NOT effective in an epidemic

Q. 16

All are true regarding killed polio vaccine EXCEPT:

September 2012

 A

Produces circulatory antibody

 B

Does NOT require stringent refrigeration

 C

Immunity against paralytic and wild strains

 D

NOT effective in an epidemic

Ans. C

Explanation:

Ans: C i.e. Immunity against paralytic and wild strains

Polio vaccine

  • OPV produces excellent immunity in the intestine, the primary site of wild poliovirus entry, which helps prevent infection with wild virus in areas where the virus is endemic.
  • The live virus used in the vaccine is shed in the stool and can be spread to others within a community.
  • IPV produces less gastrointestinal immunity than does OPV, and primarily acts by preventing the virus from entering the nervous system.
  • In regions without wild poliovirus, inactivated polio vaccine is the vaccine of choice.
  • In regions with higher incidence of polio, and thus a different relative risk between efficacy and reversion of the vaccine to a virulent form, live vaccine is still used.

Q. 17

Poliomyelitis is diagnosed by:   

September 2010 March 2013 (a, h)

 A

Clinical presentation

 B

Antibody titer measurement in blood

 C

Isolation of virus from blood

 D

Isolation of virus from stool

Q. 17

Poliomyelitis is diagnosed by:   

September 2010 March 2013 (a, h)

 A

Clinical presentation

 B

Antibody titer measurement in blood

 C

Isolation of virus from blood

 D

Isolation of virus from stool

Ans. D

Explanation:

Ans. D: Isolation of virus from stool

Poliomyelitis diagnosis may be confirmed with a laboratory diagnosis.

Viral isolation

Poliovirus may be recovered from the stool or pharynx of a person with presumed poliomyelitis. Isolation of virus from the cerebrospinal fluid (CSF) is diagnostic, but is rarely accomplished. If poliovirus is isolated from a person with acute flaccid paralysis, it must be tested further, using oligonucleotide mapping (fingerprinting) or genomic sequencing, to determine if the virus is “wild-like” or “vaccine-like.”

Serology

Neutralizing antibodies appear early and may be at high levels by the time the patient is hospitalized and, therefore, a 4-fold rise may not be demonstrated.

Cerebrospinal fluid (CSF)

The CSF in poliovirus infection usually contains an increased number of white blood cells (10 to 200 cells/mm 3, primarily lymphocytes) and a mildly elevated protein from 40 to 50 mg/100 ml.


Q. 18

Which of the following is affected in spinal paralytic polio:     

September 2011

 A

Anterior horn cells

 B

Spinothalamic tract

 C

Cerebral cortex

 D

Cranial nerve lesion

Q. 18

Which of the following is affected in spinal paralytic polio:     

September 2011

 A

Anterior horn cells

 B

Spinothalamic tract

 C

Cerebral cortex

 D

Cranial nerve lesion

Ans. A

Explanation:

Ans. A: Anterior horn cells

Spinal paralytic poliomyelitis, most common form of paralytic poliomyelitis, results from a lower motor neuron lesion of the anterior horn cells of the spinal cord and affects the muscles of the legs, arms and/ or trunk

Polio:

  • Tonsillectomy and intramuscular injections should be avoided in polio epidemic because of risk of paralytic polio increases then
  • Cause of death in polio: Respiratory paralysis
  • Pulse polio was introduced in 1995
  • Pulse polio is give below 5 years of age
  • A country is said to be polio free if no polio case has been confirmed for last 5 years
  • In acute flaccid paralysis, examination for residual paralysis should be done after 60 days

Q. 19

Paralysis in polio is characterized by ‑

 A

Spasticity

 B

Symmetrical

 C

LMN type

 D

Progressive

Q. 19

Paralysis in polio is characterized by ‑

 A

Spasticity

 B

Symmetrical

 C

LMN type

 D

Progressive

Ans. C

Explanation:

Ans. is ‘c’ i.e., LMN type

Clinical manifestations of polio

  • Incubation period ranges from 3-35 days (usually 7-14 days). The clinical spectrum includes :-
  1. Subclinical (inapparent) infections (95%) : Most common and play predominant role in spread of infection.
  2. Minor (abortive) illness (4.8%) : Present with fever, sore throat, headache and malaise.
  3. Aseptic meningitis/ non paralytic polio (1%) : There are signs and symptoms of meningitis.
  4. Paralytic polio (<1%) : There is flaccid paralysis with absent reflexes. Respiratory paralysis is the most common cause of death.

Q. 20

Salk polio vaccine is ‑

 A

Killed

 B

Live attenuated

 C

Subunit

 D

Recombinant

Q. 20

Salk polio vaccine is ‑

 A

Killed

 B

Live attenuated

 C

Subunit

 D

Recombinant

Ans. A

Explanation:

Ans. is ‘a’ i.e., Killed

Inactivated polio (Salk) vaccine

  • IPV is usually made from selected wild polio virus (WPV) strains-namely, Mahoney (Salk type 1), MEF-1 (Salk type 2) and Saukett (Salk types) – that are grown in vero cell culture or in human diploid cells.
  • Vaccine contains all the three types of poliovirus, inactivated by formalin, i.e. killed vaccine.
  • It contains 40, 8 and 32 D antigen units of type 1, 2 and 3 virus respectively (Previous vaccine had 20, 2 and 4 D antigens, according to 20th/e of Park).
  • The primary or initial course of immunization consists of 4 inoculation (4 doses).
  • The first 3 doses are given at intervals of 1-2 months and 4′ dose 6-12 months after the third dose.
  • First dose usually given when the infant is 6 weeks old.
  • Additional doses are recommended prior to school entry and then every 5 years until the age of 18.
  • Being an inactivated vaccine, it can be given to immunosuppressed individuals, e.g. AIDS patients.
  • IPV is administered by IM injection (preferred) or subcutaneous injection.
  • It can be combined with DPT, Hepatitis, and/or H. influenzae type B vaccine. In the combination vaccines, the alum or the pertussis vaccine, or both have an adjuvant effect.

Q. 21

Most common type of polio is ‑

 A

Non-paralytic polio

 B

Paralytic polio

 C

Abortive illness

 D

Inapparent infection

Q. 21

Most common type of polio is ‑

 A

Non-paralytic polio

 B

Paralytic polio

 C

Abortive illness

 D

Inapparent infection

Ans. D

Explanation:

Ans. is `d’ i.e., Inapparent infection


Q. 22

Which of the following is not a type of vaccine derived polio virus?

 A

iVDPV

 B

cVDPV

 C

aVDPVd

 D

mVDPV

Q. 22

Which of the following is not a type of vaccine derived polio virus?

 A

iVDPV

 B

cVDPV

 C

aVDPVd

 D

mVDPV

Ans. D

Explanation:

Ans. d. mVDPV

75.  m-VDPV is not a type of vaccine-derived polio virus.

Vaccine derived polio virus (VDPV)

Types of VDPV:

  • c-VDPV: Person-to-person transmission in community
  • i-VDPV: Isolates from immunodeficient persons
  • a-VDPV: Ambiguous from health person or sewage isolates

Diagnosis:

  • VDPV is diagnosed by Real time Reverse transcription-PCR nucleic acid amplification

Key risk factors for cVDPV emergence

Development of immunity gaps (due to low OPV coverage)

Low routine immunization coverage with trivalent OPV

Prior elimination of WPV types  Insensitive AFP surveillance

Q. 23

Which of the following regarding oral polio vaccine (OPV) is not true?

 A

Useful in epidemics

 B

Excretion of virus in stools may cause disease to the unimmunized

 C

Rapid antibody response

 D

Protective even in the presence of maternal antibodies

Q. 23

Which of the following regarding oral polio vaccine (OPV) is not true?

 A

Useful in epidemics

 B

Excretion of virus in stools may cause disease to the unimmunized

 C

Rapid antibody response

 D

Protective even in the presence of maternal antibodies

Ans. B

Explanation:

Ans. b. Excretion of virus in stools may cause disease to the unimmunized

Oral Polio Vaccine (OPV):

  • The OPV progeny excreted in the feces and secondary spread occurs to household contacts and susceptible contacts in the community.
  • This property of OPV has been exploited in controlling epidemics of polio by administering the vaccine simultaneously in a short period to all susceptibles in a community.
  • Nevertheless, several studies show that among breastfed infants, who are fed OPV in the first three days of life, 20-40 percent develop serum antibodies and 30-60 percent excrete vaccine virus.
  • Colostrum produced in the first three days after child-birth contains secretory IgA antibody which might interfere with the production of immune response to OPV
  • “The OPV progeny excreted in the feces and secondary spread occurs to household contacts and susceptible contacts in the community. Non-immunized persons may therefore be immunized Thus, widespread ‘herd immunity’ results, even if only approximately 66 percent of the community is immunized. This property of OPV has been exploited in controlling epidemics of polio by administering the vaccine simultaneously in a short period to all susceptibles in a community. This procedure virtually eliminates the wild polio strains in the community and replaces them with attenuated strains.


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