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Vaccine-associated paralytic poliomyelitis in an infant with perianal abscesses


We describe a case of vaccine-associated paralytic poliomyelitis (VAPP) in a 7-month-old infant with perianal abscesses. The infant had suffered from perianal abscesses from 3 weeks after birth. The abscesses repeatedly developed and spontaneously drained through the orifice. Twenty-seven days before admission, a live attenuated oral poliovirus vaccine (OPV) was given to the infant for the first time for routine immunization. His body temperature rose to 38°C 19 days after receiving the OPV and fell 4 days later. Flaccid paralysis of the right leg appeared 26 days after receipt of the OPV. A Sabin type 3 poliovirus was isolated from a stool obtained at admission. The DNA sequences of the VP1 region of the isolated virus were more than 99% identical with those of the vaccine strain. Mild muscle atrophy with moderate motor impairment in the right leg persisted at 18 months of age. One VAPP case provoked by a perianal abscess has been reported from the United Kingdom. Database search revealed that one of nine VAPP cases reported during 2003–2008 in Japan had a perianal abscess. Taken together, these reports and our case imply that we should give OPV with caution to infants with a perianal abscess.

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  1. Robart H. Enteroviruses. In: Katz SL, Gershon AA, Hotez PJ, editors. Krugman’s infectious diseases of children. 10th ed. St. Louis: Mosby; 1998. p. 81–97.

    Google Scholar 

  2. Centers for Disease Control and Prevention. Wild poliovirus type 1 and type 3 importation countries, Africa, 2008–2009. MMWR. 2009;58:357–62.

    Google Scholar 

  3. Centers for Disease Control and Prevention. Poliomyelitis prevention in the United States. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2000;49:1–22.

    Google Scholar 

  4. Hao L, Toyokawa S, Kobayashi Y. Poisson-model analysis of the risk of vaccine-associated paralytic poliomyelitis in Japan between 1971–2000. Jpn J Infect Dis. 2008;61:100–3.

    PubMed  Google Scholar 

  5. Strebel PM, Ion-Nedelcu N, Baughman AL, Sutter RW, Cochi SL. Intramuscular injections within 30 days of immunization with oral poliovirus vaccine—a risk factor for vaccine-associated paralytic poliomyelitis. N Engl J Med. 1995;332:500–6.

    CAS  Article  PubMed  Google Scholar 

  6. World Health Organization. The Department of Immunization, Vaccines and Biologicals. Polio laboratory manual. 4th ed. Geneva: WHO Production Serves; 2004.

    Google Scholar 

  7. Klein MD, Thomas RP. Surgical conditions of the anus, rectum and colon. Perianal abscess and fistula. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, editors. Nelson textbook of pediatrics. 18th ed. Philadelphia: Saunders; 2007. p. 1639–40.

    Google Scholar 

  8. Bosley ARJ, Speirs G, Markham NI. Provocation poliomyelitis: vaccine associated paralytic poliomyelitis related to a rectal abscess in an infant. J Infect. 2003;47:82–4.

    CAS  Article  PubMed  Google Scholar 

  9. Ishii K, Matsuo M, Ichimaru T, Sakai R, Hamasaki Y. A case of flaccid monoplegia after oral polio vaccination seeding. Nippon Shonika Gakkai Zasshi. 2003;107:1631–4 (in Japanese).

    Google Scholar 

  10. Matsufuji H, Nakayama H, Kajimoto M, Izumi H, Ichiyama T, Furukawa S. A case of poliomyelitis-like paralysis after receiving a live oral poliovirus vaccine. Nippon Shonika Gakkai Zasshi. 2004;108:437 (abstract, in Japanese).

    Google Scholar 

  11. Nagasawa T, Abe Y, Oka A. A case of vaccine-associated paralytic poliomyelitis. Neuroinfection. 2006;11:73 (abstract, in Japanese).

    Google Scholar 

  12. Asahina N, Matunami Y, Sueda K, Nawate M, Shiraishi H, Kousaka S, et al. A suspicious infant case of vaccine-associated paralytic poliomyelitis. No To Hattatsu. 2007;39:S343 (abstract, in Japanese).

    Google Scholar 

  13. Kiyomasu T, Hamamoto N, Uenisi T, Sunagawa M. A case of acute paralysis after receiving oral poliovirus vaccine. Shonika. 2008;49:1271–5 (in Japanese).

    Google Scholar 

  14. Kajimoto M, Matushige T, Suenaga N, Matsufuji H, Ichiyama H, Matsubara T, et al. Two suspicious cases of vaccine-associated paralytic poliomyelitis. No To Hattatsu. 2008;40:343 (abstract, in Japanese).

    Google Scholar 

  15. Sakuma H, Sumikoshi M, Ono A, Imaizumi T, Suzuki K, Morita H, et al. A case of vaccine-associated paralytic poliomyelitis. J Pediatr Infect Dis Immunol. 2009;21:213–7 (in Japanese).

    Google Scholar 

  16. Ishiwazawa H, Nohara F, Kajino M, Sakata H. A case of vaccine-associated paralytic poliomyelitis. J Pediatr Infect Dis Immunol. 2008;20:S135 (abstract, in Japanese).

  17. Bun K, Yamada K, Mogami Y, Toribe Y, Yanagihara K, Mano T, et al. An infant case of monoplegia of the right lower leg after receiving oral poliovirus vaccine. Osaka Shonika Gakkai Zasshi. 2008;25:5 (abstract, in Japanese).

    Google Scholar 

  18. Gromeier M, Wimmer E. Mechanism of injury-provoked poliomyelitis. J Virol. 1998;72:5056–60.

    CAS  PubMed  Google Scholar 

  19. Infectious Disease Surveillance Center. Infectious Agent Surveillance Report.

  20. Finn A, Bell F. Polio vaccine: is it time for a change? Arch Dis Child. 1998;78:571–4.

    CAS  Article  PubMed  Google Scholar 

  21. Alexander LN, Seward JF, Santibanez TA, Pallansch MA, Kew OM, Prevots DR, Strebel PM, Cono J, Wharton M, Orenstein WA, Sutter RW. Vaccine policy changes and epidemiology of poliomyelitis in the United States. JAMA. 2004;31:390–2.

    Google Scholar 

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We thank Dr. Shigehiro Akachi, Mie prefecture Health and Environment Research Institute, for isolation and identification of the poliovirus.

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Correspondence to Masamune Higashigawa.

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Higashigawa, M., Maegawa, K., Honma, H. et al. Vaccine-associated paralytic poliomyelitis in an infant with perianal abscesses. J Infect Chemother 16, 356–359 (2010).

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  • Oral poliovirus vaccine (OPV)
  • Vaccine-associated paralytic poliomyelitis (VAPP)
  • Perianal abscess
  • Infant