Traumatic neuritis and AFP surveillance
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《美国医学杂志》
Department of Pediatrics, JIPMER, Pondicherry-605006, India
National Polio Surveillance Project data is often a subject of continuing debate.[1] In India, surveillance of Acute Flaccid Paralysis (AFP) is conducted with the use of the Field Guide[2] in which the diagnosis of Traumatic Neuritis (TN) is ambiguous and imprecise.[3] The documents used for recording AFP omit details of site and date of injection, which muscles are paralyzed and when. 'Asymmetric' paralysis (is it asymmetric by muscle or limb) is not defined.
The diagnosis of TN is difficult.[4] It is significant that the diagnoses of TN appear to be made retrospectively and seem to occur in regions where cases of polio paralysis are frequent. It is common for 1, 2 or even 4 or more injections to be given to children with fever and, if that fever has been caused by poliovirus which has reached the spinal cord, aggravation paralysis may result.[5] About 75% of polio cases have received injections for fever with paralysis following from 24 to 48 hours later. A small number of cases of provocation polio follow from 6 to 14 days after injections of DPT.
Certainly injections should not be given in the gluteal region,[4] but far more important is the drastic reduction of any injections except immunizations. Injections for fever are unnecessary and many are unsterile. It is to be regretted that the program for the eradication of poliomyelitis did not include a parallel campaign to reduce the number of injections and, hence, the number of cases of aggravation paralysis.
It is essential that cases of polio are not misdiagnosed as TN.
References
1. Wenger J, Gupta D, Murthy P. Misinformation regarding national Polio Surveillance project data in Rajasthan. Indian J Pediatr 2003; 70 : 683-684.
2. Anonymous. Surveillance of acute flaccid paralysis. Field guide. MCH Division, Department of Family Welfare. Ministry of Health and Family Welfare, New Delhi, India. 2nd edn. 2000; 35 : 22-23.
3. Wyatt H V. Diagnosis of acute flaccid paralysis: injection injury or polio Natl Med J India 2003; 16 : 156-158.
4. Wyatt HV, Mahadevan S, Srinivasan S. Unnecessary Injections and Paralytic Poliomyelitis In India. Trans Roy Soc Trop Med & Hyg 1992; 86: 546-549.
5. Sharma S, Kale R. Post Injection Palsy in Chhatisgarh Region. Indian Pediatr 2003; 40 : 580-581.(Mahadevan S)
National Polio Surveillance Project data is often a subject of continuing debate.[1] In India, surveillance of Acute Flaccid Paralysis (AFP) is conducted with the use of the Field Guide[2] in which the diagnosis of Traumatic Neuritis (TN) is ambiguous and imprecise.[3] The documents used for recording AFP omit details of site and date of injection, which muscles are paralyzed and when. 'Asymmetric' paralysis (is it asymmetric by muscle or limb) is not defined.
The diagnosis of TN is difficult.[4] It is significant that the diagnoses of TN appear to be made retrospectively and seem to occur in regions where cases of polio paralysis are frequent. It is common for 1, 2 or even 4 or more injections to be given to children with fever and, if that fever has been caused by poliovirus which has reached the spinal cord, aggravation paralysis may result.[5] About 75% of polio cases have received injections for fever with paralysis following from 24 to 48 hours later. A small number of cases of provocation polio follow from 6 to 14 days after injections of DPT.
Certainly injections should not be given in the gluteal region,[4] but far more important is the drastic reduction of any injections except immunizations. Injections for fever are unnecessary and many are unsterile. It is to be regretted that the program for the eradication of poliomyelitis did not include a parallel campaign to reduce the number of injections and, hence, the number of cases of aggravation paralysis.
It is essential that cases of polio are not misdiagnosed as TN.
References
1. Wenger J, Gupta D, Murthy P. Misinformation regarding national Polio Surveillance project data in Rajasthan. Indian J Pediatr 2003; 70 : 683-684.
2. Anonymous. Surveillance of acute flaccid paralysis. Field guide. MCH Division, Department of Family Welfare. Ministry of Health and Family Welfare, New Delhi, India. 2nd edn. 2000; 35 : 22-23.
3. Wyatt H V. Diagnosis of acute flaccid paralysis: injection injury or polio Natl Med J India 2003; 16 : 156-158.
4. Wyatt HV, Mahadevan S, Srinivasan S. Unnecessary Injections and Paralytic Poliomyelitis In India. Trans Roy Soc Trop Med & Hyg 1992; 86: 546-549.
5. Sharma S, Kale R. Post Injection Palsy in Chhatisgarh Region. Indian Pediatr 2003; 40 : 580-581.(Mahadevan S)