Successfully managing risks to achieve wild polioviruses (WPVs) eradication and address the complexities of oral poliovirus vaccine (OPV) cessation to stop all cases of paralytic poliomyelitis depends strongly on our collective understanding of poliovirus immunity and transmission. With increased shifting from OPV to inactivated poliovirus vaccine (IPV), numerous risk management choices motivate the need to understand the tradeoffs and uncertainties and to develop models to help inform decisions. The U.S. Centers for Disease Control and Prevention hosted a meeting of international experts in April 2010 to review the available literature relevant to poliovirus immunity and transmission. This expert review evaluates 66 OPV challenge studies and other evidence to support the development of quantitative models of poliovirus transmission and potential outbreaks. This review focuses on characterization of immunity as a function of exposure history in terms of susceptibility to excretion, duration of excretion, and concentration of excreted virus. We also discuss the evidence of waning of host immunity to poliovirus transmission, the relationship between the concentration of poliovirus excreted and infectiousness, the importance of different transmission routes, and the differences in transmissibility between OPV and WPV. We discuss the limitations of the available evidence for use in polio risk models, and conclude that despite the relatively large number of studies on immunity, very limited data exist to directly support quantification of model inputs related to transmission. Given the limitations in the evidence, we identify the need for expert input to derive quantitative model inputs from the existing data.

Expert review on poliovirus immunity and transmission.

With the intensifying global efforts to eradicate wild polioviruses, policymakers face complex decisions related to achieving eradication and managing posteradication risks. These decisions and the expanding use of inactivated poliovirus vaccine (IPV) trigger renewed interest in poliovirus immunity, particularly the role of mucosal immunity in the transmission of polioviruses. Sustained high population immunity to poliovirus transmission represents a key prerequisite to eradication, but poliovirus immunity and transmission remain poorly understood despite decades of studies. In April 2010, the U.S. Centers for Disease Control and Prevention convened an international group of experts on poliovirus immunology and virology to review the literature relevant for modeling poliovirus transmission, develop a consensus about related uncertainties, and identify research needs. This article synthesizes the quantitative assessments and research needs identified during the process. Limitations in the evidence from oral poliovirus vaccine (OPV) challenge studies and other relevant data led to differences in expert assessments, indicating the need for additional data, particularly in several priority areas for research: (1) the ability of IPV-induced immunity to prevent or reduce excretion and affect transmission, (2) the impact of waning immunity on the probability and extent of poliovirus excretion, (3) the relationship between the concentration of poliovirus excreted and infectiousness to others in different settings, and (4) the relative role of fecal-oral versus oropharyngeal transmission. This assessment of current knowledge supports the immediate conduct of additional studies to address the gaps.

Review and Assessment of Poliovirus Immunity and Transmission: Synthesis of Knowledge Gaps and Identification of Research Needs

As the Global Polio Eradication Initiative progresses toward the eradication of wild polioviruses, national and global health leaders must still actively consider options for managing poliovirus risks, including risks associated with using oral poliovirus vaccine. Oral poliovirus vaccine continues to represent a highly effective tool, but its use causes noticeable, rare cases of vaccine-associated paralytic polio and with low coverage it can evolve to become circulating vaccine-derived polioviruse that causes outbreaks. National leaders face a wide range of options, but their choices depend in part on global policies. This article explores the current set of global options for poliovirus eradication or control, discusses constraints and prerequisites for their implementation and offers some insights based on dynamic modeling to inform discussions and frame future economic analyses.

https://www.tandfonline.com/doi/pdf/10.1586/erv.11.195

Current polio global eradication and control policy options: perspectives from modeling and prerequisites for oral poliovirus vaccine cessation.

With the circulation of wild poliovirus (WPV) types 1 and 3 continuing more than a decade after the original goal of eradicating all three types of WPVs by 2000, policymakers consider many immunization options as they strive to stop transmission in the remaining endemic and outbreak areas and prevent reintroductions of live polioviruses into nonendemic areas. While polio vaccination choices may appear simple, our analysis of current options shows remarkable complexity. We offer important context for current and future polio vaccine decisions and policy analyses by developing decision trees that clearly identify potential options currently used by countries as they evaluate national polio vaccine choices. Based on a comprehensive review of the literature we (1) identify the current vaccination options that national health leaders consider for polio vaccination, (2) characterize current practices and factors that appear to influence national and international choices, and (3) assess the evidence of vaccine effectiveness considering sources of variability between countries and uncertainties associated with limitations of the data. With low numbers of cases occurring globally, the management of polio risks might seem like a relatively low priority, but stopping live poliovirus circulation requires making proactive and intentional choices to manage population immunity in the remaining endemic areas and to prevent reestablishment in nonendemic areas. Our analysis shows remarkable variability in the current national polio vaccine product choices and schedules, with combination vaccine options containing inactivated poliovirus vaccine and different formulations of oral poliovirus vaccine making choices increasingly difficult for national health leaders.

Preeradication vaccine policy options for poliovirus infection and disease control.

Monovalent type 1 oral poliovirus vaccine among infants in India: report of two randomized double-blind controlled clinical trials.

Background: Perinatal asphyxia is an insult to fetus or newborn due to lack of oxygen /perfusion to various organs. Perinatal asphyxia occurs in 1 to 3 per 1000 live births and is related to gestational age and birth weight. Worldwide 4-9 million suffer from birth asphyxia. It occur in 9% of infants of 36 wks. Hypoxic ischemic brain injury is the most important consequence of perinatal asphyxia. Aim of study: To detect the measurement of cerebral blood flow in full term infants with birth asphyxia, by use of transcranial colour Doppler to measure RI (Resistive Index). Setting: Department of Paediatrics at MY hospital in collaboration with department of radiodiagnosis over a period of 1 yr from November 2013- October 14. Design: Observational study. Method: It included 40 consecutive cases of birth asphyxia who suffered from HIE. Measurement of cerebral blood flow velocity was done by the use of colour doppler ultrasound. Result: Resistive index values were lower in measured vessels in asphyxiated infant as compared by blood flow velocity, resistive index of ACA and MCA. It is observed in our study that maximum number of patients in asphyxiated group belongs to grade II HIE 87.5% (35), while in stage III there were 2.5% (1) and in stage I only 4 (10%) patients.  Conclusion: Colour Doppler USG would be of practical importance in evaluating the cerebral blood flow velocity in neonate with HIE. A skillful detection of decrease in cerebral blood flow of neonate in postnatal first 12 hrs & treatment being based on such detection would contribute to a good prognosis.

/pdf/study-of-transcranial-colour-doppler-in-the-measurement-of-3mzaalh2ig.pdf

Study of transcranial colour Doppler in the measurement of cerebral edema in birth asphyxia

Background: Stress hyperglycemia is mainly due to increased gluconeogenesis and glycogenolysis & insulin resistance. Longer duration of hyperglycemia during hospital stay is known to have adverse outcome. Aim of Study: To study the prevalence of hyperglycemia and its association with PICU mortality and morbidity in terms of duration of PICU stay. Design: Prospective Observational study. Method: All critically ill children belonging to age group of 1 month to 14 years, admitted in PICU from 1st May 2011 to 15th September 2011 over a period of four and a half months. Children were followed throughout their hospital stay and outcome in terms of mortality and duration of PICU stay were noted. Blood glucose levels weredone every 3 hourly during the first 48 hours of PICU admission. Highest blood glucose level in the first 48 hours was defined as the peak glucose level. The mean of glucose values of first 24 and first 48 hours were calculated. Result: Prevalence of hyperglycemia was 58%. Mortality rate was higher in the hyperglycemic patients (56%) as compared to normoglycemics (14%) and overall mortality (36%). The p value for difference in the mean of peak RBS and 24 hours mean RBS of the non-survivors and survivors was <0.005 and hence significant. Statistical Analysis: Independent student t test used for analysis. Conclusion: Hyperglycemia during first 24 hours of PICU admission was associated with higher mortality rate and longer duration of PICU stay.

/pdf/the-prevalence-of-hyperglycemia-in-critically-ill-children-3daer9la30.pdf

The prevalence of hyperglycemia in critically ill children admitted in PICU

Misleading report on clinical trials in India

Background: CPAP has become a useful in management of respiratory distress, especially in preterms. CPAP delivers a continuous distending pressure via the neonates pharynx to the upper and lower airways. The main indication for use of CPAP is RDS. Aim of study: To study the effectiveness of indigenous bubble CPAP in management of respiratory distress in newborn and to determine its outcome. Setting: Department of Pediatrics, MGM Medical College and MY Hospital, Indore during the period February-July 2005. Design: Prospective Observational Study. Method: This study was carried out on inborn neonates in the NICU of MY Hospital over a period of six months. Matched controls were taken from admissions during previous four months. It included the newborns developing respiratory distress with grunting and chest retractions within 6 hours of birth whose severity was measured by Silverman Anderson Score and oxygen saturation.Neonates with increasing Silverman Anderson Score or Oxygen saturation falling below 85%were taken on CPAP and their outcome studied. Result: There were 42 RDS cases in the study group of which 28 survived and 14 died. Indigenous BUBBLE CPAP was beneficial in managing babies with RDS. Conclusion: Indigenous BUBBLE CPAP is an effective and non-invasive way to provide ventilation in a setup with limited resources. It can be used to manage respiratory distress due to RDS, congenital pneumonia & MAS. It resulted in significant reduction in mortality but prognosis was bad in those who required CPAP >8 cm H2O.

/pdf/to-study-the-effectiveness-of-indigenous-bubble-cpap-in-41yww419vd.pdf

Hemant Jain

Papers

Monovalent type 1 oral poliovirus vaccine among infants in India: report of two randomized double-blind controlled clinical trials.

Study of transcranial colour Doppler in the measurement of cerebral edema in birth asphyxia

The prevalence of hyperglycemia in critically ill children admitted in PICU

Misleading report on clinical trials in India

To study the effectiveness of indigenous bubble CPAP in management of respiratory distress in newborns