478
ACUTE
POLIOMYELITIS
IN
INFANTS
UNDER
ONE
YEAR
OF
AGE:
EPIDEMIOLOGICAL
AND
CLINICAL
FEATURES
By Harold Abramson, M.D., and Morris Greenberg, M.D.*
ITrLE INFOSMATION is available on the
clinical and epidlellliobogical features
of polionlyelitis during tile first year of life.
\Veinsten, Shelokov, Seltser, audi \VincllebP collipaned the clinical features of tile dis-ease in adults and in children. Many case
reports are available on pobiomyelitis in
1levb0rfl infants and in the fetus,325 and
ill infants from 1 to 12 months.2 15. 2T3
Two slllall outbreaks of pohomyelitis ill
newborn infants are also recorded.3’ The
literature contams, however, few references to the general behavior and cilaracteniStics of tile disease during tile first year of
hf e.s 4
MATERIAL
Du-ing 1949 New York City experienced its third largest epidemic of poliomyebitis with
2,446 cases and 178 deaths.4’ In 1950, 1,064
cases and 64 deaths were reported. The total
number of cases in tile 2 years was 3,510, of
which 2,023 (57.7 per cent) were among males,
and 1,487 (42.3 per cent) among females. There
were 92 infants under 1 year of age in the
total nunlber of confirmed, reported cases (2.6
per cent) of which 52 were males (56.5 per
cent) and 40 were females (43.5 per cent).
These form the basis of this report.
The chagnosis of pobiomvelitis was made on
a clmical basis. Each reported case was visited
by a diagilostician of the Department of Health
to confirm the diagnosis. The criteria used
were, acute onset of illness with fever, nuchal
rigidity and/or spasm of the back muscles,
flaccid paralysis, cells above 10/mm.3 in the
spinal fluid, and elevation of spinal fluid protein above normal limits. At least 3 of the criteria had to be present for a patient to be considered
a case of poliomvelitis.42
About 90 per cent of reported cases were
From tile Bureau of Preventable Diseases, New
York City Department of health.
(Submitted December 1:3. 1954; accepted May 5,
1955.)
* ADDRESS: 1)epartnlent of Health, 125 \Vorth
Street, New York 1:3, New York.
hospitalized, 72 ier cent ill municipal
com-municabbe disease Ilospitais and 18 per cent in
voluntary ilOspitals.
EPIDEMIOLOGICAL CONSIDERATIONS
Age and Sex
ALL AGES. Table I shows the age specific
rates for all cases of poliomyelitis according
to sex. The disorder was illuch less frequent
ill infants undler 1 year of age (30.2 per 100,000 Pol)1lati0Il), tilan in children under 5 years (76.4 per 100,000). Still higher rates
were 1)resellt alllong children froni 5 to 9
‘ears (103.3 per 100,000). Thereafter the
rates declined with advance in age. Rates
were uniformly higher for Illales than for females, with tile exception of ages 25 to 29 years, when a reversal occurred.
UNDER 1 YEAR. Table II gives the
fre-quency of polionlyelitis according to sex
and illontils of age among infants under 1
year. The rates were lower than in older
children and adults. The attack rate in
in-fants from 6 to 11 months (24.3 per 100,000)
was much bligher than in those under 6
months (5.9 per 100,000). Males had a
higher rate than females (33.6 as against
26.6 per 100,000), as in older children and adults.
Bousfield4’ also, found that poliomyehitis
occurred less often in the first months of
life than in the next few years of childhood.
He thought that diagnosis might be more
difficult in tilat age group. Tile few cases reported in the first few months of life probably reflect inherited passive immunity
against poliomelitis.
Fatal Cases
ALL ACES. Deaths from poliomyebitis for
all age groups are considered in Table III. The case fatality rate increased generally
with age, being higher for males (7 per
‘FABLE I
A(-E I’E(IFI(’ ItATES OF CASES OF POLIOMYELITIS, A(C0UDING TO S:x
NEW \ORK CITY, 1949-195()
Age (years)
,
?s umber of
Cases
.4rerage Annual
Raies* per
100 ,()OO
Male
-
Female-
---Male
Number of (‘a.ies
-Attack Rate
-Number of
Cases
Attack Rate
F
10
Inderl 9’2 30.2 52 33.4 40 ‘26.8 1.3
1 164 59.0 95 66.9 69 50.7 1.3
‘2 ‘233 83.8 129 90.8 104 76.5 1.2
3 258 99.2 148 110.4 110 87.3 1.3
4 271 104.2 163 121.6 108 85.7 1.4
0- 4 1,018 76.4 587 86.4 431 66.0 1.3
5- 9 1,105 103.3 688 126.4 417 79.3 1.6
10-14 574 64.7 330 73.2 244 55.9 1.3
15-19 308 33.0 192 42.3 116 24.1 1.8
20-24 183 15.3 89 16.0 94 14.7 1.1
25-29 151 11.3 54 8.6 97 13.8 0.6
30-34 103 8.1 49 8.3 54 7.9 1.1
35-44 57 2.2 26 ‘2.1 31 ‘2.2 1.0
45-414 11 0.3 8 0.4 3 0.2 ‘2.0
‘lothhl 3,510 22.2 2,023 26.5 1,487 18.3 1.4
* Census data for 1950 were used for computing age specific rates. There were somewhat over 605,000 people 65 years of age and over, among whom there were no reported cases of poliomyelitis.
t Based on attack rates. To obtain annual rates the number of cases for the 2 years was divided by 2.
UNDER 1 YEAR. Among infants the case
fatality rate was higher than among
chil-dren. Table IV shows a considerable
dif-ference in rates between infants under 6
months of age (22 per cent), and those
from 6 to 11 months (5.0 per cent). The
rate was higher among male (11.5 per cent)
than among female infants (5.0 per cent).
TABLE II
CASES OF PoLIoMLITIs BY AGE AND SEX IN INFANTS UNDER ONE YEAR
NEw ORK CITY, 1949-1950
Age
(miinths)
Number of
Cases
Annual Rate*
per 100,000 Infants under
1 Year
fjj Female
Male
“7”
a
Number of
Cases
Attack Rate
Number of
Case8
Attack
Rate
0- 1 4 1.3 1 0.6 3 2.0 0.3
0- ‘2 5 J.6 2 1.3 3 2.0 0.6
3- 5 13 4.3 9 5.8 4 2.7 2.1
6-8 32 10.5 18 11.6 14 9.3 1.2
9-il 42 13.8 23 14.8 19 12.7 1.2
‘fotai 92 30.2 52 33.6 40 26.6 1.3
* These rates are based on the difference between the number of live births and the number of deaths under I year
in New York City 1949 and 1950.
Age Cases Deaths
(years)
Ijnder I
3 4
Case Fatality
Per Cent
0- 4
5- 9
10-14 15-19 20-24
25-29
30-34
35-44 45-64
Number Male Female Number Male Female Total Male Female
92 52 40 8 6 ‘2 8.7 9.6 7.5
164 95 69 4 1 3 2.4 1.1 4.3
233 129 104 9 6 3 3 .9 4.7 ‘2.9
‘258 148 110 4 1 3 it; 0.7 ‘2.7
271 163 107 7 5 ‘2 ‘2.6 3.1 1.9
1,018 587 431 32 19 13 3.1 3.2 3.0
1,105 688 417 61 41 20 5.5 6.0 4.8
574 330 244 30 19 11 5.2 5.8 4.5
308 192 116 46 ‘27 19 14.9 14.1 16.4
183 89 94 21 14 7 11.5 15.6 7.4
151 54 97 19 6 13 12.6 11.1 13.4
103 49 54 20 7 13 19.4 14.3 ‘24.1
57 26 31 9 6 3 15.8 23.1 9.7
11 8 3 4 3 1 36.4 37.5 33.3
Total 3,510 2,023 1,487 242* 142 lOt) 6.9 7.0 6.7
Does not include 17 additional deaths of non-residents who were hospitalized in New York City and died there.
Total 92 52 40 8 6 ‘2 8.7 11.5 5.0
TABLE III
I)EATHS AND FATALITY RATES BY AGE AND SEX IN CASES OF POLIOMYELITIS
NEW YORK CITY, 1949-1950
Type of Paralysis
ALL AGES. The relationship between age
and type of poliomyehitis is presented in
Table V. The lowest percentage of
para-lyzed cases was found in children between the ages of 5 and 15 years (55.3 per cent).
Thereafter, the rates rose with age.
Chil-dren under the age of 5 years had a higher
rate than older children. The percentage of
paralytic cases in this youngest age group
decreased with increasing age. This is
similar to the findings of Hill and
Know-eldent’ and Bradley and Gales15 in
Eng-land.
UNDER 1 YEAh. The infrequency of non-. paralytic forms of poliomyelitis during the
TABLE IV
DEATHS AND FATALITY RATES BY AGE AND SEX IN CASES OF POLIOMYELITIS UNI)ER ONE XEAR OF AGE
NEW YORK CITY, 1949-1950
Age
(months)
Cases Deaths
Case Fatality
Per CenI
Number Male Female
-Number Male
-Female
--Total Male Female
huller! 4 1 3 ‘2 1 1 50 100 33
0- ‘2 5 ‘2 3 2 1 1 40 50 33
3-5 13 9 4 2 2 0 15 22 0
6-8 32 18 14 ‘2 1 1 6 6 7
Total 92 9 9.8 74 80.4 9 9.8 90.2 TABLE V
C.&sES OF POLIOMYELITIS ACCORDING TO TYPE OF PARALYSIS, ALL AGES
NEW YOIIK CITY, 1949-1950
Age
(years)
Number of ( ases
Type of Case
Non-paralytic
-___________________
Paraljtic
----.
Spinal Ii ul bar
, Per (eat Paralyzed
Number Per (‘enI Number Per Cent Number Per Cent
Lnder I 92 9 9.8 74 80 .4 9 9.8 90 .‘2
I 164 16 9.7 132 80.5 16 9.8 90.3
2 ‘233 40 17.’2 156 67.0 37 15.8 82.8
3 ‘258 67 26.0 158 61.2 33 12.8 74.0
4 271 81 29.9 151 55.7 39 14.4 70.1
0- 4 1,018 213 20.9 671 65.9 134 13.2 79.1
5- 9 1,105 480 43.4 428 38.8 197 17.8 56.6
10-14 574 270 47.0 195 34.0 109 19.0 53.0
15-19 308 105 34.1 134 43.5 69 22.4 65.9
20-24 183 49 26.8 96 52.5 38 20.7 73.2
‘25-29 151 30 19.9 90 59.6 31 20.5 80.1
30-34 103 17 16.5 62 60.2 24 23.3 83.5
35-44 57 17 29.8 31 55.4 9 15.8 70.2
45-415 II I 9.1 6 54.6 4 36.3 90.9
Total 3,510 1,182 33.7 1,713 48.8 615 17.5 66.3
first year of life, is seen in Table VI. All cases in the first 3 months of life were para-lytic, all but 1 in the next 3 months, and 66
of the 74 cases in the batter half of the
first year.
Unpublished data46 for 1950 on cases
re-ported to the General Registrar’s Office of
London showed that the per cent of
para-lytic cases of poliomyelitis in infants under
1 year of age was higher than that for all
TABLE VI
CASES OF POLIOMYELITIS Ac-oItuING TO TYPE 01’ PARALYSIS IN INFANTS INDEH ONE YEAR OF AGE
NEW YORK CITY, 1949-1950
Age
(months)
Number of Cases
Type of Case
Non-paralytic
Number Per Cent
Paralytic
.
Spinal Bul bar
Number Per Cent Number Per Cent
Per Cent
Paralyzed
tinder 1 4 0 0 4 100 0 0 100
0-2
3-5 6- 8 9-11
5
13 32 42
0 0
1 8
5 16
3 7
5 100 0 0
6 62 4 30
24 75 3 9
37 88 2 5
100
92 84
Type of Cases ----______ Deaths - -Case
Fatality Type of
Cases --______ Deaths --Case Fatality
(‘ase .‘Viim- Per \‘um- Per Per Case .‘V sin- Per Nun- Per Per
ber Cent ber Cent Cent ber Cent ber Cent Cent
lOtill 3,510 100. 0 242 100 . (1 6.9
482 ABRAMSON ACUTE POLIOMYELITIS IN INFANTS
* The 3 non-paralytic cases not tapped had acute onsets with fever, nuchal rigidity and spasm of the muscles
of the back.
TABLE VIE
I):.tT1IS .(COLI1)ING TO TYPE OF I’ARALYSIS IN CASES
oF POLIOMYELITIS, ALL AGES
NEW loliK CITY, 1949-1950
Non-paralyt ic 1,182 33 .7 0 0.0 0.0
Paralytic ‘2,328 66.3 ‘241 100.0 10.3
Spinal 1,713 48.8 20 8.3 1.2
Bulbar 615 17.5 221 91.7 35.9
‘l’;BLE VIII
DEATHS ACCOHI)ING TO TYPE OF PARALYSIS IN CASES
OF P0LI0MYELITIs, UNDER ONE YEAR OF AGE
NEW ‘IOlIK CITY, 1949-1950
Non-paralytic 9 9.8 0 0.0 0.0 Paralytic 83 ‘ 90. ‘2 8 100 .0 9.6
Spinal 74 80.4 5 62.5 6.8
Bulbar 9 9.8 3 37.5 33.3
Total 92 100.0 8 100.0 8.7
ages, particularly so for the very young
infants in the first few months of life. Deaths According to Type of Paralysis
ALL AGES. All deaths occurred in paralytic
cases, 8.3 per cent in individuals with spinal
paralysis and 91.7 per cent in those with bulbar paralysis (Table VII). Case fatality
rates were considerably greater in cases
with bulbar paralysis (35.9 per cent), than in cases with spinal paralysis (1.2 per cent).
UNDER 1 YEAR. In infants, the case fatality
rate among the paralyzed was
approxi-mately the same as in the total of all age
groups (Table VIII). However, there were
fewer non-paralytic cases, so that the
fa-tabity rate was higher for infants than for older persons.
CLINICAL CONSIDERATIONS
M anifestations
The manifestations of pohiomyelitis in the 92 infants under 1 year of age are given in
Table IX. The onset was acute, and all but
2 had fever. Nuchab spasm was observed in
47 per cent of the patients and spasm of
the back muscles was shown by 15 per cent
of the patients. Only 1 infant had a
con-vulsion. All but 9 were paralyzed.
In the 9 non-paralytic infants the onset
of illness was acute with fever, nuchal
spasm, and spasm of the back muscles. In
addition, 6 had abnormal spinal fluid
find-ings. In the spinal paralytic group of 74
cases, 23 did not have spinal taps. These
latter cases were all seen and cared for at
TABLE IX
MANIFESTATIONS OF POLIOMYELITIS IN iNFANTS UNDER ONE YEAR OF AGE
NEW YORK CITY, 1949-1950
T,,pe. of Case
Number (if Infants Acute Onset Fever Nuchal . . . Rigidity Spasm of Back Muscles Con-. vulsion
Cerebrosp inal Fluid Findings
Abnormal Normal -______________ Not Tapped Non-Paralytic Spinal Paralytic Bulbar 9 74 9 9 74 9 8 74 8 7 31 5 1 11 2 . 1 0 0 6 41 7 0 10 0 3* 23 2
Total 92 92 90 43 14 1 54 10 28
Type of Paralysis
Infants Under
One Year
Number Per (‘cut
Arms, including shoulders, but excluding legs:
Single
Both
Legs, including hips, but excluding arms:
Single Both
198
153
45
.5.6 4.4
1.2
Trunk:
943 26.9
561 16.0
382 10.9
4 4.3 220 6.3
Trunk only 3 3.2 60 1.7
Trunk and extremities 1 1-1 160 4.6
Cranial nerves: 9 9.8 585 16.7
Cranial nerves only 3 3.3 373 10.6
Cranial nerves and extremities 6 6.5 ‘212 6. 1
9 9.8 1,182 33.7
No paralysis
Total 92 100.0 3,510 100.0
home by private physicians during the early stages of illness. They all had an acute on-set of illness with fever, nuchal rigidity and
spasm of the back muscles, in addition to
paralysis.
FEVER AT ONSET OF ILLNESS.
Tempera-tures were lower in infants than in children
and adults. They ranged from 97.6#{176}F.
(36.3#{176}C.) to 102#{176}F.(38.8#{176}C.) with a mean of 98.3#{176}F. (36.8#{176}C.). Subsequent rises to
peak temperatures during the day of onset
were from 99.9#{176}F. (37.7#{176}C.) to 105#{176}F.
(40.5#{176}C.), the mean being 102.8#{176}F.
(39.3#{176}C.).
INTERVAL BETWEEN ONSET OF ILLNESS
AND PARALYSIS. The average interval
be-tween the date of onset of illness and the
first detection of paralysis was 5.5 days
among infants under 1 year of age as
con-trasted with 3.5 days among children and
adults. The spread was from the day of
onset to 25 days later in infants and to 20
days later in children and adults. The later
detection of paralysis in very young
in-fants further reflects difficulties inherent
in evaluating the manifestations of
polio-myelitis in this age grGup.
SEVERITY OF PAJ.iYsIs. As previously
in-dicated, 90 per cent of infants were
para-lyzed as compared with 66 per cent in
per-sons of all ages. Table X lists the types
of paralysis in the 2 groups. It will be noted that in all categories except the trunk mus-cles there was a higher rate of paralysis
among the infants. Bulbar cases occurred
more often in adults.
TABLE X
PARTS OF BODY PARALYZED AS A RESULT OF POLIOMYELITIS IN INFANTS AND IN ALL AGE GRouPs
Arms and legs including shoulders and hips, all combinations
NEW YORK CITY, 1949-1950
15 16.3
14 15.2
1 1.1
41 44.6
30 32.6
Il 12.0
14 15.2
All Ages
.\‘umber Per (cut
484 ABRAMSON ACUTE POLIOMYELITIS IN INFANTS
RATIO OF ARM TO LEG PARALYSIS. The
preponderance of leg over arm paralysis
has been noted by most observers. It holds for infants as well as for children and adults.
The ratio of leg to arm paralysis was 4.8
to 1 in persons of all ages and 2.7 to 1 in
infants under 1 year of age.
SPINAL PUNCFURE. Spinal punctures were
performed in 90 per cent of individuals of
all ages with poliomyelitis, and in 70 per
cent of infants under 1 year of age. The
fluids were generally clear, the cell counts
ranged from 14 to 500, with a mean of 125
celbs/mm., in all ages. In the infants the
range was from 9 to 275 cells, and the mean
number was 91/mm.3. Lymphocytes
pre-dominated. Sugar averaged 65 mg./100 ml.
of fluid ill all ages and 55 mg./100 ml. in
the infants. The average total protein was
56 mg./100 ml. in all ages and 72 mg./100 ml. in infants under 1 year of age.
Initial spinal taps were made in all ages
on an average of 5.1 days after onset for
non-paralytic cases and 4.3 days for
para-lytic cases, while in infants under 1 year
of age they were made on an average of
3.4 days after onset of illness in
non-para-lytic cases, and 5.7 days in paralytic cases.
The spinal fluid findings were positive in
54, or 84 per cent of the 64 infants on
whom taps were done, including 6 of the
9 non-paralytic cases (Table IX).
DISCUSSION
All statistics based on reported cases of
pobiomyelitis suffer from the fact that a
diagnosis cannot be made with certainty
without laboratory confirmation, particu-barly in the non-paralytic cases. However,
laboratory techniques are still too costly
and complicated to be used generally.
Fur-thermore, virus is not recovered from every case of poliomyelitis, even if paralytic, and
the complement-fixation reaction may be
equivocal. Properly selected statistics are,
however, necessary, because they help in
an understanding of the disease and in the
undertaking of proper control measures.
The most rapid confirmatory laboratory test
15 tile complement-fixation reaction, but
re-finements in technique are still needed
before it can be used generally. Under the
circumstances, care in diagnosis is
neces-sary.
Fortunately, in New York City about 90
per cent of cases are hospitalized.
Further-more, all but a small fraction are cared for in 5 hospitals, all with medical school af-fihiations and all attended by prominent
and experienced pediatricians. In addition,
the cases are visited by experienced
diag-nosticians of the Department of Health
about 1 week after onset of illness. Almost
every case admitted for poliomyelitis has a spinal tap performed. The level of
diag-nosis is fairly high. It is perhaps attested to
by the fact that approximately 20 per cent
of cases originally reported as poliomyehts
are later dropped as “no cases.” In 2
sepa-rate studies, done by others, virus recovery was attempted in children in whom a
defi-nite diagnosis of poliomyelitis was made in 1 of these hospitals, and was not much
lower in the non-paralytics than in the
paralytics.
It is fair to assume that the diagnoses are reasonably accurate. When laboratory tests
for general use become available confirma-tory studies will undoubtedly be made. In
the meantime we must work with the tools
available and must make an effort to keep
them as sharp as possible.
The high rate of paralysis in infants
under 1 year of age, 90 per cent, raises
some questions. Is this a true rate or is it factitious, due to greater difficulty in
diag-nosis at this age, so that the non-paralytic
cases are missed. Some cases of
non-para-lytic disease are probably missed at all ages, but there is little reason to believe that the number is much higher in infants. Diagno-sis of non-paralytic disease should not offer
many difficulties in children between 2 and 3 years of age or in adults 25 to 35 years of
age. Yet the paralytic rate in infants was
only 7 per cent higher than in the former
and 8 per cent higher than in the latter.
That susceptible infants are more severely
affected than older children is
dis-ORIGINAL ARTICLES
eases. It is certainly true in whooping
cough and measles. Fortunately, most
in-fants are protected by maternal antibodies
and become infected under cover of passive
immunity. The manifestations may be so
mild as to escape detection or may even be
SuI)clinical. However, the infants whose
mothers are not immune and who do not
receive passive antibody develop the fully
manifest disease with severer symptoms
and higher mortality, as in other infectious
diseases.
The age specific rate was higher in
fe-males than in males in only 1 age group,
25 to 29 years. The reason for this is not clear. A similar reversal was found in calcu-lating the rates for the years 1951-1953. The increased incidence of poiiomyelitis in preg-nancy does not account for it. There were
11 more cases observed among the
preg-nant in this age group than were expected on the basis of incidence in the non-preg-nant. If these are deducted there still
re-main 86 cases among the females, giving a
rate of 12.2 per 100,000 and an M:F ratio
of 0.7. No adequate explanation is available
for the higher rate in females than in males
ill this age group.
SUMMARY
In order to compare the epidemiobogical and clinical features of poliomyelitis in in-fants under 1 year with those in children
and adults, a study was made of all cases of poliomyeiitis that occurred in New York
City in 1949 and 1950. This revealed the
following characteristics of the disease
among infants in the first year of life: Clinically recognizable poliomyelitis was
of infrequent occurrence among infants
under 1 year of age. It was even more infre-quent among infants in the first 6 months
of life. This is in marked contrast to the
findings in the 1950 epidemic in Israel,
where one-third of all cases occurred in the first year of life, and one-tenth in infants in the first half year of life.38 Male infants
exhibited a greater susceptibility to the
disease than females. Fatalities in this age
group were high, particularly among
in-fants under 3 months, with some
predomi-nance of deaths in males.
Under 1 year of age, non-paralytic polio-myelitis was unusual, especially in the first
6 months of life. Paralytic forms of the
disorder were dominant, spinal involvement
being more common than bulbar. Case
fatality occurred chiefly in bulbar forms of the disease, as in older children and adults.
The fatality rate was higher than in older
children and higher than in all ages
coin-bined.
The onset of pobiomyeiitis among infants
under 1 year of age was variable. It was
acute, with fever, or fever with nuchal
spasm, or the triad of fever, nuchal spasm
and spasm of back muscles. Temperature at
onset of illness averaged 98.3#{176}F.(36.8#{176}C.), with a low of 97.6#{176}F.(36.3#{176}C.), and a high of 102#{176}F.(38.8#{176}C.). Temperatures recorded
subsequently during the day of onset of
illness were from 99.9#{176}F. (37.7#{176}C.) to 105#{176}F.(40.5#{176}C.), the mean being 102.8#{176}F. (39.3#{176}C.). The interval between onset of ill-ness and first detection of paralysis
aver-aged 5.5 days, with a spread from the day
of onset to 25 days later. Paralysis of a
single limb occurred more frequently than
of 2 or more limbs, and the ratio of arm to
leg paralysis was about 1 to 3.
Initial spinal punctures in infants under
1 year were made on an average of 3.4 days
after onset of illness in non-paralytic cases, and 5.7 days in paralytic cases. The spinal fluid was usually clear, with a mean count
of 91 lymphocytes/mm.3. The average
sugar content was 55 mg./and protein 72
mg./100 ml. of fluid.
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SPANISH ABSTRACT
Poliomielitis aguda en Lactantes
Menores de un A#{241}ode Edad:
Aspectos Epidemiol#{243}gicos y Cimnicos
Los autores presentan aigunas observaciones
en niflos menores de un aflo de edad
prac-ticadas en la epidemia de Ia ciudad de Nueva York, 1949 a 1950; en un total de 3510
pa-cientes 92 fueron lactantes de Ia edad seflalada,
52 del sexo masculino (56.5%) y 40 del femenino (43.5%). El diagn#{243}stico se bas#{243}en por bo menos
tres de los siguientes datos cbInicos: principio
agudo y febril del padecimiento, rigidez del
cuello y/ o de Ia espalda, par#{225}lisis fl#{225}ccida, m#{225}sde 10 c#{233}lulaspor mm.3 y protelnas sobre Ilmites normales, en el lIquido c#{233}falo-raquIdeo.
La enfermedad se observ#{243}
m#{225}sfrecuente-mente en bactantes de 6 a 11 meses que en m#{225}s pequenos; Ia mortalidad fu#{233}mayor en ebbs que
en ni#{241}osmayorcitos, siendo de 5% y 22% re-spectivamente para los lactantes mayores y
menores de 6 meses de edad y superior en los ni#{241}osque en las niflas. Todos los casos en bos
primeros 3 meses de la vida, todos menos uno
de los siguientes tres meses y 66 de los 74 en
eb segundo semestre (be Ia ‘ida fueron
paralIti-cos. Seg#{233}nlas formas clInicas iaraiIticas,
pre-(bominaron las espinales pero en cambio ba
mortalidad fue superior en Ia bulbares
(approxi-madamente 8.3% para Ia forma espinal y 91.7%
para Ia bulbar); ba mortalidad de los lactantes fue mayor que ll los ni#{241}osmayorcitos y que en todas las edades combinadas.
El principio del padecimiento Il los niflos menores de un a#{241}ode edad fue variable; aguda
con manifestaciones febribes, febril con rigidez de nuca, 0 bien con la triada de fiebre, rigidez
de nuca y rigidez de espalda. La fiebre vari#{243}
al principio de Ia enfermedad de 36.8#{176}(a veces
tan baja como 36.3#{176}) hasta 40.5#{176}C.; en los dIas subsecuentes vari#{243}de 37.7#{176}a 40.5#{176}con un promedio de 39.3#{176}C. El intervalo entre el principio de ba enfermedad y la primera mani-festaci#{243}n de par#{225}lisis promedi#{243} 5.5 dIas, en
contraste con 3.5 dIas para los niflos mayores
y adultos, siendo a veces hasta de 25 dIas,
perlodo de tan barga duraci#{243}n que seflala Ia
dificultad para valorar en los lactantes pequeflos los smntomas y signos fIsicos de la pobiomiebitis en esta edad. El 90% de los niflos presentaron
par#{225}lisis, contra el 66% de las personas de todas
las edades; los casos bulbares feuron m#{225}s frecuentes en los adultos. La relaci#{243}n de
par#{225}-lisis en miembros inferiores y superiores fue de
4.8 a 1 para todas las personas y de 2.7 a 1
en los menores de un aflo de edad; Ia par#{225}lisis de un solo miembro fu#{233}m#{225}sfrecuente que de dos o m#{225}s.
En los lactantes de Ia edad comentada Ia
punci#{243}n lumbar se hizo en un promedio de 3.4 dIa para los csos no parailticos y de 5.7 dIas para los paraiIticos; los hallazgos en el lIquido c#{233}fabo-raquIdeo fueron positivos en 54 (84%) de los 64 lactantes puncionados, inclu-yendo 6 de 9 no parabIticos. El lIquido fue generalmente claro, con 90 linfocitos por mm.3
y 55 mgr. de glucosa y 56 mgrs. de protemnas por 100 ml., como cifras promedio.
INTERLINGUA ABSTRACT
Acute Poliomyelitis in Infantes de
Etates de Infra 1 Anno: Characteristicas
Epidemiologic e Clinic
Con be objectivo de comparar be character-istics epidemiologic e clinic de poliomyebitis in infantes de etates de infra 1 anno con le
cor-respondente characteristicas in be caso de
488 ABRAMSON ACUTE POLIOMYELITIS IN INFANTS
onme casos de poliomyelitis occurrente in be
Citate de New York in 1949 e 1950. Iste studio revebava be sequente characteristicas del morbo in infantes durante be prime anno de br vita:
Poliomyelitis in forma cbinicamente
recog-noscibile esseva infrequente in infantes de
etates de infra 1 anno. Le morbo esseva mesmo plus illfrequente inter infantes durante be prime 6 menses del vita. Iste constatation contrasta
marcatemente con be observationes facite
durante be epidemia de 1950 in Israel ubi un tertio del casos occurreva durante be prime anno del vita e un decimo durante be prime medic anno del vita. Infantes mascule exhibiva un plus aite susceptibibitate al morbo que infantes feminin. Le mortabitate in iste gruppo de etate esseva abte, specialmente inter infantes de etates de infra 3 menses. Le mortes inter mascubos
esseva alique dominate.
Infra 1 anno de etate, pobiomyelitis non-paralytic esseva inusual, specialmente durante be prime 6 menses del vita. Formas paralytic del disordine esseva dominante. Involvimento spinal esseva plus commun que involvimento bulbar. Le forma bubbar del morbo se charac-terisava per be plus alte mortalitate. Isto esseva de accordo con statisticas pro infantes e juv-eniles de etates plus avantiate e pro adultos. Le
mortabitate inter le infantes de etates de infra
1 anno esseva plus alte que Ic mortabitate pro infantes e juveniles de etates plus avantiate.
Ilbo esseva plus abte que le inortabitate com-binate pro omne gruppos de etate.
Le declaration de poiiomyebitis in infantes de etates de infra 1 anno esseva variabibe. Ibbo es-seva acute, con febre, o febre con spasmo
nuchal, o exhibiva be triade de febre, spasmo nuchab, e spasmo del musculos dorsal. Le
tem-peratura median al tempore del declaration del
morbo esseva 36,8 C, COIl un minomo de 36,3 C e un maximo de 38,8 C. Le culmines del tem-peratura registrate subsequentemente durante be die del declaration del morbo esseva inter
37,7 C e 40,5 C, con un valor median de 39,3 C. Le intervablo median inter Ic declaration del morbo e be prime detection del paralsye esseva 5,5 dies, con Ull dispersion intre Ic extremos de detection al die del declaration del morbo e
25 dies plus tarde. Paralyse de ui sob extremi-tate esseva plus frequente que parabyse e 2 o plus extremitates. Le proportion de paralyses brachial a paralyses del gambas esseva circa 1 a 3.
Le prime puncturas spinal in infantes de
etates de infra 1 anno esseva facite a un periodo
median de 3,4 dies post be declaration del
morbo in casos non-paralytic e de 5,7 dies in casos paralytic. Le fluido spinal esseva usual-mente clar. Le conto median de bymphocytos
esseva 91 per mm.3 Le contento median de