Poliomyelitis, or polio ("infantile paralysis"),
is an acute, contagious, viral disease, usually spread via the fecal-oral route.
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?
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
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.
most at risk from poliomyelitis?
Anyone living with or near to an infected
person, especially in high density accomodation - and with poor hygiene facilities
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.
are the symptoms of poliomyelitis?
Infection||Nonparalytic Poliomyelitis||Paralytic Poliomyelitis|
No symptoms, or max 72 hr.
- Slight fever
- Sore throat
- Red throat
Symptoms last 1 to 2 weeks
- Moderate fever
- Pain or stiffness of the back, arms, legs, abdomen
tenderness or spasm - any area of the body
- Neck pain and stiffness
front part of neck
- Back pain or backache
- Leg pain (calf muscles)
rash or lesion with pain
- Muscle stiffness
Fever, occurring 5 to 7 days before other symptoms
neck and back
- Muscle weakness, asymmetrical (one side or worse on one
-Progresses to paralysis
- Sensitivity to touch; may be painful
- Difficulty beginning
- Bloated feeling of abdomen
- Muscle pain
- Muscle contractions or spasms, - often
calf, neck, or back
- Breathing difficulty
or poor temper control
- Positive Babinski's reflex
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.
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.
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.
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.
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 25% in children and up 30% in
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.
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.
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
There is no specific treatment for poliomyelitis.
the early stages, the priority is support, including analgesics, exercise, dietary
support if required, and managing specific problems (eg antibiotics for secondary
Is there a way to prevent infection?
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
The protocol varies between countries and with time; fa,mily
doctor services for yuor country will have details.
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
Are there adverse reactions to the
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.
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.
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'
What can be learned from history?
- 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
2001 - WHO EURO region (51 countries) was certified on 21
2006 - Fewer than 2000 cases were reported.
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Article written by Andrew Heenan BA (Hons), RGN, RMN