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Making Sense of ... Poliomyelitis

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Polio

What is poliomyelitis?

Poliomyelitis, or polio ("infantile paralysis"), is an acute, contagious, viral disease, usually spread via the fecal-oral route.

Where is poliomyelitis usually found?

Until the 1950s, polio existed all over the world, with periodic epidemics that left many thousands of people with varying degrees of paralysis.

How common is poliomyelitis?

Polio has been eradicated from most countries in the world, following a World Health Organization plan for complete eradication by 2000 - that didn't happen, and there are currently (May 2008) four countries where eradication is considered to be incomplete: Afghanistan, Nigeria, India and Pakistan

However, there have been cases confirmed in eight countries so far this year (including cross-border contagion and cases resulting from live vaccine.

The WHO is still confident, but with security issues making it tough on the ground - and the ever-present risk of the disease escaping to a previously eradicated country, it wuld be unwise to set specific target dates at this time.

None the less, a 99% reduction in incidence, and a drop from 125 to four nations where incidence has been uninterrupted, is a great achievement.

Is there a genetic / familial / hereditary factor?

The onset of illnesses among family members usually occurs at the same time, suggesting a common exposure. Research shows that the virus may persist for several weeks in cases of familial outbreak, prhaps suggesting reinfection - and prolonging the carrier state. There is no evedince that the events depend on the familial link, rather than simply the close proximity of members within the home.

Can poliomyelitis be spread from person-to-person?

Polio is a highly contagious disease. Transmission of the virus occurs easily from person to person, with all close contacts of an infected person being at very high risk.

Polio transmission usually occurs through contact with faecal matter from an infected person, but may occur through contact with respiratory droplets or saliva.

Who is most at risk from poliomyelitis?

Anyone living with or near to an infected person, especially in high density accomodation - and with poor hygiene facilities or practice.

As the disease nears eradication, the risk is of overconfidence by governments, premature discontinuation of vaccination programs, failure to stockpile emergency vaccine supplies, and poor quality surveillance.

What are the symptoms of poliomyelitis?

Subclinical InfectionNonparalytic PoliomyelitisParalytic Poliomyelitis
  • No symptoms, or max 72 hr.
  • Slight fever
  • Headache
  • General malaise
  • Sore throat
  • Red throat
  • Vomiting

 

 

 

 

 

source: UMMC

  • Symptoms last 1 to 2 weeks
  • Moderate fever
  • Headache
  • Vomiting
  • Diarrhea
  • Tiredness, fatigue, irritability
  • Pain or stiffness of the back, arms, legs, abdomen
  • Muscle tenderness or spasm - any area of the body
  • Neck pain and stiffness
  • Pain front part of neck
  • Back pain or backache
  • Leg pain (calf muscles)
  • Skin rash or lesion with pain
  • Muscle stiffness
  • Fever, occurring 5 to 7 days before other symptoms
  • Headache
  • Stiff neck and back
  • Muscle weakness, asymmetrical (one side or worse on one side)
    -Rapid onset
    -Progresses to paralysis
    -Location varies
  • Abnormal sensations
  • Sensitivity to touch; may be painful
  • Difficulty beginning to urinate
  • Constipation
  • Bloated feeling of abdomen
  • Swallowing difficulty
  • Muscle pain
  • Muscle contractions or spasms, - often calf, neck, or back
  • Drooling
  • Breathing difficulty
  • Irritability or poor temper control
  • Positive Babinski's reflex

What are the long term effects of poliomyelitis?

Only about one percent of people infected with the polio virus develop paralytic polio.

Spinal polio refers to the form of paralytic polio in which attacks motor neurons in the spinal cord are affected; this may cause paralysis of the muscles that control breathing, and those in the arms and legs. The extent of the paralysis will depend on which part of the spinal cord is affected, and how seriously. In adults, paralysis of both arms and both legs is common, while in children under five, paralysis of a single extremity is more likely. Unlike many other formsof paralysis, there is no loss of sensation, as the sensory nerves an are not affected.

Bulbar polio is the form in which the virus affects the motor neurons in the brain stem. These nerves are involved in the senses, and the control of facial muscles. Cranial nerves also transmit to the heart, lungs, and intestines. While any of these functions can be damaged, likely areas are the ability to breathe, speak and swallow. People living with bulbar polio may require permanent respiratory support.

Bulbospinal polio is a combination of the other two forms, and can involve paralysis of the limbs as well as breathing, swallowing and heart function.

In all forms of polio, the damage is usually permanent; in most cases, the level of support needed is clear from a few days after diagnsois, and in most cases, absolutely fixed by six weeks. Specialist rehabilitation cab have some benefit prvided it is started earl, and consistently applied.

What are the late effects of poliomyelitis?

Some studies have identified late effects, such as further weakening and muscle degeneration in some people (sometimes referred to as post-polio syndrome), while other research suggests this may be normal effects of aging, or a result of lifestyle changes forced by the disease's original damage. If these effects do occur, it is in a small minorty of polio survivors.

What is the mortality rate for poliomyelitis?

Poliomyelitis with respiratory involvement can lead to a 5-10% mortality, including death from suffocation or aspiration pneumonia. The rate varies from 2–5% in children and up 30% in adults.

Without respiratory support, bulbar polio leads to death in up to 75% of cases; varying with the age of the patient. Positive pressure ventilation reduces the mortality rate to 15%.

Spinal polio is rarely fatal.

How is poliomyelitis diagnosed?

Poliomyelitis may be suspected in acute onset of flaccid paralysis in one or more limbs, with decreased or absent tendon reflexes, with no other apparent cause, and without sensory deficit.

A laboratory diagnosis from a stool sample or pharyngeal swab. Poliovirus antibodies in the blood are also diagnostic. Poliovirus in the cerebrospinal fluid is rare, but diagnostic of paralytic polio.

Is there a treatment for poliomyelitis?

There is no specific treatment for poliomyelitis.

In the early stages, the priority is support, including analgesics, exercise, dietary support if required, and managing specific problems (eg antibiotics for secondary infection)

Is there a way to prevent infection?

Polio vaccines have been available for over 60 years, and have contributed to near-eradication of the disease from the world. They are often given to young children as part of a combined vaccine, which may include defence against (for example) whooping cough and diphtheria.

What is the protocol for poliomyelitis vaccination?

The protocol varies between countries and with time; fa,mily doctor services for yuor country will have details.

Who should get vaccinated against poliomyelitis?

Until the disease is eradicated, everyone needs protection form this terrible disease.Vaccination is normally offered to children, but may be available to unprotected travelers going to endemic or epidemic areas.

Are there adverse reactions to the poliomyelitis vaccine?

The principle contraindications to the polio vaccine are a history of hypersensitivity to the vaccine (or components of the vaccine), and the presence of acute febrile illness or intercurrent infection.

 

Can poliomyelitis be controlled environmentally?

The WHO is attempting to eradicate the disease totally, and is making good progress, thought the end date has had to be postponed on several occasions; only Afghanistan, Nigeria, India and Pakistan have endemic disease, though isolated cases have been identified in other countries - and will continue to do so until eradication is complete. Travel is cheap and easy, and no border is virus-proof.

In indidiual cases, isolation and quarantine and rapid medical assistance are the best controls.

Any country that failed to fully co-operate with eradication would deservedly acquire pariah status.

Is there legal protection for workers and others?

The usual matter of preparaion, information and vaccination for anyone in - or traveling to - endemic or 'at risk' areas.

What can be learned from history?

1988 - The World Health Assembly passes a resolution to eradicate polio by the year 2000. At this time, wild poliovirus was endemic in more than 125 countries on five continents, paralyzing more than 1000 children every day.

1994 - The Americas are certified polio-free by the International Commission for the Certification of Polio Eradication.

2000 - The 37 countries and territories of the WHO Western Pacific Region (WPR) are certified polio-free, the second WHO Region to be certified.

2001 - WHO EURO region (51 countries) was certified on 21 June, 2002.

2006 - Fewer than 2000 cases were reported.

Bibliography and Further Information Sources

If your question has not been answered, email me at the address below, and I'll try to get the information you seek.

If this article hasn't answered your question, email me at the address below, and I'll try to get the information you seek. I regret I cannot assist with individual cases or essays and school projects, but if it's something I've missed, I'll be happy to try and help.

Article written by Andrew Heenan BA (Hons), RGN, RMN

First Published: 06 May 2008
Last updated: 11 March 2012
© Andrew Heenan 2008-2012
 

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