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ACUTE POLIOMYELITIS IN INFANTS UNDER ONE YEAR OF AGE: EPIDEMIOLOGICAL AND CLINICAL FEATURES

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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

(2)

‘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.

(3)

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

(4)

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

(5)

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

(6)

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

(7)

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

(8)

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.

REFERENCES

1. Weinstein, L., Shebokov, A., Seltser, H., and Winchell, C. D.: A comparison of the clinical features of poiiomyelitis in adults and in children. New England

J.

Med., 246:296, 1952.

2. McConnell, A. A.: Poliomyelitis in infants under the age of 6 months. Arch. Dis. Childhood, 27:121, 1952.

3. Falk, 0.: Ueber einen Fall von spinaber Kinderlahmung bei einem 15 Tage alten

Kinde mit Ausgang in Cenesung.

(9)

486 ABRAMSON ACUTE POLIOMYELITIS IN INFANTS 4. Batten, F. S. : Does poliomyebitis occur

dur-ing intrauterine life? Brain, 33: 149, 1910.

5. Cunewardene, T. H. : Acute pobiomyelitis

ill an infant 12 days old, with extensive paralysis and recovery. Lancet, 2:847, 1918.

6. Lance, NI. : Paralysie infantile (poliomy#{233}-bite) constat#{233}e des Ia naissance. Bull. Soc. pediat. Paris, 31:229, 1933.

7. Cislaghi, F. : Sopra un caso di malattia di Heine-Medin in un neonato di 15 giorni. Pediatria, 42:1456, 1934.

8. de Lange, C. : Erworbene Lahmungen bei

jungell siluglingen. Acta paediat., 18: 142, 1935.

9. Severin, C. : Case of poliomyebitis in new-born. Nord. med., 1 :55, 1939.

10. Als#{233}n,P. : Fall au poliomyebitis acuta i forsta levnadsmhnaden. Nord. med., 1:

871, 1939.

11. Gracoski, S., and Hurmazache, E.: Polio-myelitis in infant twenty days old. Noun-ison, 28:33, 1940.

12. Biermann, A. H., and Piszczek, E. A. : Case of poliomveiitis in a newborn infant.

J.A.M.A., 124:296, 1944.

13. Buccellato, C. : Su Ull caso di malattia di

Heine-Medin in un battante di 20 giorni

. di uita. Gior. med., 4:142, 1947. 14. Palmstierna, K. : Poliomyelit hos modrar

och nvfoddo barn. Nord. med., 27:1178, 1945.

15. Frvig, A. C. : Poliomvelitt hos mor og

nyfdt barn i en familie med multiple tilfelie. Nord. med., 34:1115, 1947. 16. Horn, H. A., and Weidenthal, C. M. :

Polio-myelitis in 3-week-old infant.

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33:484, 1948.

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18. Mouton, C. M., Smilbie,

J.

C., and Bower,

A. C. : Report on ten cases of

polio-myelitis iii infants under six months of

age. j. Pediat., 36:482, 1950.

19. Baskin,

J.

L., Souie, E. H., and Mills, S. D.: Poliomyelitis of the newborn : patho-logical changes in two cases. Am.

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20. Kreibich, H., and Wolf, H.: Ueber einen Fall von diapiazentar erfolgter Poliomyelitis-Infektion des Feten im 9 Schwanger-schaftsmonat. Zentralbi Cynak, 72:694, 1950.

21. Sheiokov, A., and Weinstein, L.: Polio-mvelitis in early neonatal period: report of a case of possible intrauterine infec-tion. j. Pediat., 38:80, 1951.

22. Johnson,

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F., and Stimson, P. M.: Clinical poliomyelitis in the early neonatal period.

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NI. C.: Pobiomyelitis in the newborn in-fant.

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and Li, C. P.:

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1: 1307, 1954.

26. Krumbhaar, C. D. : A case of poliomyelitis

complicating pregnancy, with death of

mother and baby. Am.

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27. Cuyot, L., and Rocher, C. : Infantile paraby-sis of the left upper extremity, with re-action of regeneration in an infant age two months. Bull. Soc. anat. et physiol. norm. et pathol. Bordeaux, 23:213, 1902. 28. Carpenter, C. : Infantile paralysis of

ab-dominal muscles, both legs and one arm in an infant 2 months old. Proc. Soc. Dis. Child., 6:53, 1905-1906.

29. Ravenna, A. : Un caso di pobiomiebite

sub-acuta ill una bambina di 10 mesi;

os-servazione clinica et anatomo-patobogica. Riv. cliii. pediat., 10:840, 1912. 30. Peabody, F. W., Draper, C., and Dochez,

A. R.: A clinical study of acute polio-myebitis. Monograph of the Rockefeller

Illst. for Med. Res., No. 4, 1912.

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and Moren,

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: Anterior

polio-myelitis in a child aged six months. Am.

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heredo-luetico. Arch. am. med., 9:55,

1933.

33. Hess,

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H., Levinson, S. 0., and Hess, E. R. : Poiiomyelitis in infant four months of

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41:549, 1944. 35. Lopez Clares, F., and Vallin Ochoa, S. : Un

caso de poliomielitis en un lactante de dos meses v meclio de edad. Bob. med. Hosp. inf. Mexico, 4:754, 1947.

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T. C., and Thomson, D.: Poliomyelitis in infancy, especially in the neonatal period : Report of an outbreak. Month. Bull. Mm. Health & Pub. Lab.

Serv., pp. 152-163 ,1953.

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(10)

89. Ceffen, D. H., and Tracy, S. : Polioniycbitis

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40. Horstmann, D. : Poliomyeiitis: Severity and type of disease in different age groups. In preparati.on.

41. Greenberg, M., Siegel, M., and Magee, M. Catherine: Poliomyelitis in New York

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43. Bousfield, C. : Paralyses following immuniz-ing injections : measures calculated to diminish the risk. Lancet, 1 : 1028, 1951. 44. Hill, A. B., and Knowelden,

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: Inoculation

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General Register Office, England and

Wales.

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

(11)

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

(12)

1955;16;478

Pediatrics

Harold Abramson and Morris Greenberg

EPIDEMIOLOGICAL AND CLINICAL FEATURES

ACUTE POLIOMYELITIS IN INFANTS UNDER ONE YEAR OF AGE:

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1955;16;478

Pediatrics

Harold Abramson and Morris Greenberg

EPIDEMIOLOGICAL AND CLINICAL FEATURES

ACUTE POLIOMYELITIS IN INFANTS UNDER ONE YEAR OF AGE:

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