poliomyelitis

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Poliomyelitis (polio) is a highly infectious viral disease that largely affects children under 5 years of age. The virus is transmitted by person-to-person spread mainly through the faecal-oral route or, less frequently, by a common vehicle (e.g. contaminated water or food) and multiplies in the intestine, from where it can invade the nervous system and cause paralysis.

In 1988, the World Health Assembly adopted a resolution for the worldwide eradication of polio, marking the launch of the Global Polio Eradication Initiative, spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF, and later joined by the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.  Wild poliovirus cases have decreased by over 99% since 1988, from an estimated 350 000 cases in more than 125 endemic countries then to 175reported cases in 2019. 

Of the 3 strains of wild poliovirus (type 1, type 2 and type 3), wild poliovirus type 2 was eradicated in 1999 and no case of wild poliovirus type 3 has been found since the last reported case in Nigeria in November 2012.  Both strains have officially been certified as globally eradicated.  As at 2020, wild poliovirus type 1 affects two countries:  Pakistan and Afghanistan.

The strategies for polio eradication work when they are fully implemented. This is clearly demonstrated by India’s success in stopping polio in January 2011, in arguably the most technically challenging place, and polio-free certification of the entire WHO Southeast Asia Region in March 2014.

Symptoms

Although polio can cause paralysis and death, the majority of people who are infected with the virus don’t get sick and aren’t aware they’ve been infected.

Nonparalytic polio

Some people who develop symptoms from the poliovirus contract a type of polio that doesn’t lead to paralysis (abortive polio). This usually causes the same mild, flu-like signs and symptoms typical of other viral illnesses.

Signs and symptoms, which can last up to 10 days, include:

• Fever
• Sore throat
• Headache
• Vomiting
• Fatigue
• Back pain or stiffness
• Neck pain or stiffness
• Pain or stiffness in the arms or legs
• Muscle weakness or tenderness

Paralytic polio

This most serious form of the disease is rare. Initial signs and symptoms of paralytic polio, such as fever and headache, often mimic those of nonparalytic polio. Within a week, however, other signs and symptoms appear, including:

• Loss of reflexes
• Severe muscle aches or weakness
• Loose and floppy limbs (flaccid paralysis)

Post-polio syndrome

Post-polio syndrome is a cluster of disabling signs and symptoms that affect some people years after having polio. Common signs and symptoms include:

• Progressive muscle or joint weakness and pain
• Fatigue
• Muscle wasting (atrophy)
• Breathing or swallowing problems
• Sleep-related breathing disorders, such as sleep apnea
• Decreased tolerance of cold temperatures

Signs and symptoms, which can last up to 10 days, include:

• Fever
• Sore throat
• Headache
• Vomiting
• Fatigue
• Back pain or stiffness
• Neck pain or stiffness
• Pain or stiffness in the arms or legs
• Muscle weakness or tenderness

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Paralytic polio

This most serious form of the disease is rare. Initial signs and symptoms of paralytic polio, such as fever and headache, often mimic those of nonparalytic polio. Within a week, however, other signs and symptoms appear, including:

• Loss of reflexes
• Severe muscle aches or weakness
• Loose and floppy limbs (flaccid paralysis)

Causes

Polio virus can be transmitted through direct contact with someone infected with the virus or, less commonly, through contaminated food and water. People carrying the poliovirus can spread the virus for weeks in their feces. People who have the virus but don’t have symptoms can pass the virus to others.

Risk factors

Polio mainly affects children younger than 5. However, anyone who hasn’t been vaccinated is at risk of developing the disease.

Complications

Paralytic polio can lead to temporary or permanent muscle paralysis, disability, bone deformities and death.

Prevention

The most effective way to prevent polio is vaccination.

Polio vaccine

Most children in the United States receive four doses of inactivated poliovirus vaccine (IPV) at the following ages:

• Two months
• Four months
• Between 6 and 18 months
• Between ages 4 and 6 when children are just entering school

IPV is safe for people with weakened immune systems, although it’s not certain just how protective the vaccine is in cases of severe immune deficiency. Common side effects are pain and redness at the injection site.

Allergic reaction to the vaccine

IPV can cause an allergic reaction in some people. Because the vaccine contains trace amounts of the antibiotics streptomycin, polymyxin B and neomycin, it shouldn’t be given to anyone who’s reacted to these medications.

Signs and symptoms of an allergic reaction usually occur within minutes to a few hours after the shot. Watch for:

• Difficulty breathing
• Weakness
• Hoarseness or wheezing
• Rapid heart rate
• Hives
• Dizziness

If you or your child has an allergic reaction after any shot, get medical help immediately.

Adult vaccination

In the U.S., adults aren’t routinely vaccinated against polio because most are already immune, and the chances of contracting polio are minimal. However, certain adults at high risk of polio who have had a primary vaccination series with either IPV or the oral polio vaccine (OPV) should receive a single booster shot of IPV.

A single booster dose of IPV lasts a lifetime. Adults at risk include those who are traveling to parts of the world where polio still occurs or those who care for people who have polio.

If you’re unvaccinated or your vaccination status is undocumented, get a series of primary polio vaccination shots — two doses of IPV at four- to eight-week intervals and a third dose six to 12 months after the second dose.

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Physical Therapy Management

There is no cure for PPS and to date there are no pharmaceutical treatments that have been identified at being effective in stopping or reversing the deterioration or symptoms. Emphasis is currently on managing symptoms and the role of the physiotherapist is important to help people with PPS find suitable aids and interventions to lead independent lives.

Physiotherapy is safe and effective when carefully prescribed and monitored by experienced health professionals.Cardiopulmonary endurance training is usually more effective than strengthening exercises. An intense strengthening programme using resistance or weights may be counterproductive as they can fatigue and already weaken compromised muscles. All exercise should be carefully monitored and any signs of further weakness,increased fatigue or long periods of recovery time should be an indicator to either revise the programme or stop exercise completely until recovery is evident.

Plan for Rehabilitation

Strengthening programs performed as described show a 60% increase on isokinetic strength, improved cardiorespiratory status, no decline in strength in 6-12 months, and 5% increase in isometric strength.

In one randomized controlled study, progressive resistance training program consisted of 3 sets of 8 isometric contractions, 3 times weekly for 12 weeks. Postpolio patients showed a significant improvement in their strength. The training did not adversely affect motor unit survival, and the improvement was largely attributable to an increase in voluntary motor drive.

Use of Modalities

Electrical stimulation has been used to strengthen weakened muscles or to reeducate muscles weakened through disuse, as well as to decrease pain

For myofascial pain, consider heat, electrical stimulation, trigger point injections, stretching exercises, biofeedback, muscle relaxation exercises, or static magnetic fields for trigger points. Exercise therapy and training programs in PPS patients should be carefully customized and planned by physiotherapists to avoid both overuse and disuse, and the level of physical activity should be modified to decrease pain.

Prevention

Polio survivors often ask if there is a way to prevent post-polio syndrome. Presently, no intervention has been found to stop the deterioration of surviving neurons. But physicians recommend that polio survivors get the proper amount of sleep, maintain a well-balanced diet, avoid unhealthy habits such as smoking and overeating, and follow an exercise program as discussed above. Proper lifestyle changes, the use of assistive devices, and taking certain anti-inflammatory medications may help some of the symptoms of post-polio syndrome.

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