Vaccine related poliomyelitis in non-immunised relatives and household contacts.

The diagnosis of paralytic poliomyelitis is now rarely considered in cases ofacute lower motor neurone weakness in patients resident in Britain. Paralytic poliomyelitis still occurs,' however, and we report two cases, one of which would not have occurred had the present immunisation procedures been followed. The occurrence of the other case suggests that immunisation procedures should be modified. Case 1 A 16 year old boy developed a sore throat, nausea and anorexia, and general malaise two weeks after his niece, a household contact, had received oral poliomyelitis vaccine. Four days later he deteriorated with generalised headache and photophobia, and the next day he awoke with a completely paralysed left arm. He was said to have beenimmunized against poliomyelitis as a child but this could not be confirmed. On admission he had a fever of 380C, mild neck stiffness and photophobia, and flaccid paralysis of his left arm with absent reflexes in the arm and normal sensation. Results ofroutine blood tests were negative, as were viral antibody titres. Exmination of cerebrospinal fluid yielded 15 x 106 lymphocytes/I, a protein concentration of0-33 g/l, and a glucose concentration of3-6 mmol/l (65 mg/100 ml). Serum antibody titres to poliovirus on the day of admission and 14 days and six weeks later were less than 16 to PI and P3 but showed a fourfold or greater rise to P2 (1/64, 1/256, 1/1024). Stool culture grew a poliovirus type 2 of a vaccine related strain. The patient's systemic symptoms settled rapidly in two days, but over the next five years there was no appreciable return ofneurological function in the left arm. A 23 year old toolmaker developed a sore throat and mild frontal headache 47 days after his son had been immunised against poliomyelitis. Three days later his condition became worse with generalized headache and vomiting and general malaise. A week after his initial symptoms he noticed difficulty swallowing and weakness of his voice and was admitted to hospital. He had never been immunised against poliomyelitis and had had a tonsillectomy. On admission he was feverish (380C) with mild neck stiffness. Neurological examination showed nystagmus on lateral gaze, severe bilateral facial weakness, and weakness of jaw opening. Palatal movement was absent, though sensation was normal and there was no cough. There was severe weakness ofthe neck flexors and tongue protrusion. The limbs showed mild weakness of the right deltoid, biceps, and triceps with reduction in these …