Poliomyelitis

What is Poliomyelitis?
• Polio = gray matter
• Myelitis = inflammation of the spinal
cord
• This disease result in the destruction of
motor neurons caused by the poliovirus.
• Polio is a highly infectious disease
• The virus invades the nervous system,
and can cause total paralysis in a matter
of hours
 When was it reported?
• Poliomyelitis was recorded in the late
1700’s with the first epidemic in the
late 1800’s.
• The cases that were reported in 1979
where mild and self-limited and do
not result in paralysis.
 How is polio transmitted?
• Poliovirus is transmitted by person to
person spread mainly through fecal-
oral route or less frequently by a
common vehicle (contaminated food
and water) and multiplies in the
intestine.
• The incubation period is usually 7 -
14 days.
• Poliovirus - first identified in
1909 by inoculation of specimens
into monkeys. The virus was
first grown in cell culture in
1949 which became the basis for
vaccines.
 What are the symptoms?
• Initial symptoms include fever, fatigue,
headache, vomiting, stiffness in the neck
and pain in the limbs.
• One in 200 infections leads to irreversible
paralysis ( usually in the legs)
• Among those paralyzed, 5-10% die when
their breathing muscles become
immobilized
 Clinical Manifestations
There are 3 possible outcomes of infection:

1. Abortive Poliomyelitis (Mild illness)

- most common form
• fever, malaise, drowsiness, headache, nausea,
vomiting, constipation, and sore throat in
various combinations.
• recovery occurs in a few days
 Clinical Manifestations
2. Non-paralytic poliomyelitis (Aseptic
meningitis) - fever and stiff neck and
meningismus can develop as the
poliovirus infects the meninges.
Recovery is complete in 1 week
3. Paralytic poliomyelitis – flaccid paralysis
due to necrosis of large motor neurons
in the anterior horn of the spinal cord
Polio in children
 Prevention
• There is no cure for polio, it can only be
prevented
• Bed rest with close monitoring of
respiratory and cardiovascular functioning
is essential during the acute stage of
poliomyelitis along with fever control and
pain relievers for muscle spasms.
• Mechanical ventilation, respiratory therapy
may be needed depending of the severity
of patients.
 Vaccine
• Polio vaccine first appeared to be licensed in
the United States in 1955.
Advantages:
• Easy to administer
• Good local mucosal immunity
Disadvantages:
• Strict cold shipping & storage requirements
• Multiple doses are required to become
effective
• (4 doses in babies through out their infancy)
There are two vaccines available.
1. Intramuscular Poliovirus Vaccine (IPV)
- developed by Jonas Salk
- Salk Vaccine
- consists of formalin-killed polio virus that
is injected subcutaneously
2. Oral Polio Vaccine (OPV)
- developed by Albert Sabin
- attenuated polio virus is ingested
 Statistics
• Polio was one of the most dreaded child
disease in the 20th century in the U.S.
• An epidemic in 1916 killed 6,000 people
and left 27,000 more paralyzed.
• In 1950 parents would not let their
children go to local swimming pools or
movies because of the polio virus.
 Polio fact
The “march of dimes” began in 1938, a
fund-raising campaign for polio. People
were asked to send one dime directly to
the White House to help fight the
disease. In the first 3 days the White
House received 230,000 dimes. President
Franklin D. Roosevelt, whose profile is
now on the dimes was himself paralyzed
by polio.
• Polio mainly affects children under 5 yrs
of age
• Polio cases have decreased by over 99%
since 1988 from an estimated 350,000
cases then, to 416 reported cases in 2013
• In 2014, only 3 countries ( Afghanistan,
Nigeria and Pakistan) remain polio-
endemic down from more than 125 in
1988
• As long as a single child remains
infected, children in all countries are
at risk of contracting polio. Failure to
eradicate polio from these last
remaining strongholds could result in
as many as 200,000 new cases every
year, within 10 years, all over the
world.