TECHNOLOGIES IN HEALTHCARE

POLIOMYELITIS INFECTION

ASSIGNMENT 1

STUDENT NAME : ASHRITHA KOTTE

COURSE NAME : BIOLOGY

COURSE CODE : BL-101

ROLL NUMBER : 20165014

DEPARTMENT : PHARMACEUTICAL ENGINEERING

AND TECHNOLOGY

SUBMITTED TO : Dr. P. K. NAYAK SIR

DATE OF SUBMISSION: 10TH DECEMBER 2020

 TABLE OF CONTENTS

1. INTRODUCTION---------------------------------------------------> 3
1.1 Epidemiology ----------------------------------------------------------> 4

1.1.1 Polio incidence----------------------------------------------------> 4

1.1.2 Afghanistan and pakistan-----------------------------------------> 6

1.1.3 Nigeria--------------------------------------------------------------> 6
1.2 Causative Factors--------------------------------------------------------> 7
1.2.1 Symptoms of Poliomyelitis---------------------------------------->7
1.3 Pathophysiology---------------------------------------------------------->9
1.3.1 Infantile Paralysis------------------------------------------------->10
1.3.2 Other effects of Poliomyelitis on the human body----------->11

2. MANAGEMENT STRATEGIES----------------------------------------->12
2.1 Technological Innovations--------------------------------------------->12
2.1.1 Oral polio vaccine and its production-------------------------->13
2.1.2 Polio virus isolation---------------------------------------------->13
2.1.3 Specimen collection,storage and shipment-------------------->14
2.1.4 Polio vaccine composition.,dosage and administration------>15
2.1.5 vaccine effectiveness and duration of protection------------->16
2.1.6 Micro needle Patch----------------------------------------------->16
2.1.7 How do doctors treat polio?------------------------------------->17

3. CONCLUSION AND OVERVIEW--------------------------------->18

4. REFERENCE LIST---------------------------------------------------->19

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 LIST OF FIGURES

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fig10:----------------------------------------------------->14
fig11:----------------------------------------------------->16

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 1. INTRODUCTION

Polio or poliomyelitis, is a life threatening and a disabling disease caused by the polio
virus. It is a contagious viral disease that in its most serious cases causes nerve injury
leading to paralysis, difficulty in breathing and sometimes death.
It usually affects children under 5 years of age .

The polio viruses belong to the genus Enterovirus in the family Picornaviridae. All polio
particles are small and round 30 nm particles with icosahedral symmetry, and they have
no essential lipid envelope. Polio viruses share most of their biochemical and
biophysical characteristics with the other entero viruses and are different from some
of the other picorna viruses. The three types are different because your immune system
makes a different antibody for each.
The 3 wild types of polio virus namely:
• WPV Type1: It causes leg, arm and breathing muscle paralysis.
• WPV Type2: Causes non paralytic polio and damages the the bottom of the
brainstem
• WPV Type3:
The most rare, also caused leg and arm paralysis but was most likely to produced
so called “bulbar” polio, in which the bulb or stem of the brain was severely
damaged. This damage caused difficulties with swallowing, breathing and blood
pressure that were sometimes fatal.”

fig1:STRUCTURE OF THE VIRUS

fig2: POLIO VIRUS UNDER 3-D

MICROSCOPE

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1.1 EPIDEMIOLOGY

Poliomyelitis is present from a very long time. One of the earliest description is
evident in an Egyptian stele from around 1350 BC which tells about a young man with
typical atrophy of the leg and asymmetric flaccid paralysis .
From the late 1800s, outbreaks were common in several European countries and in the
United States, and they remained a major public health problem in the developed world
until the first half of the 20th century
The introduction and the widespread use of effective vaccines in the 1950 s and 1960 s led
to a massive reduction in polio-related numbers and new cases of poliomyelitis declined
dramatically in many industrialized countries. A global effort to eradicate polio began in
1988, and these efforts have reduced the number of cases diagnosed each year by 99.9
percent , from an estimated 350,000 cases in 1988 to 483 cases in 2001, after which the
count remained stable at a level of about 1,000–2000 cases per year for a few years.

1.1.1 POLIO INCIDENCE

Polio incidence maps tell us about the major reduction of the disease in geographic range.
• Four major region of the world have been declared has Polio free which are-
1. Americas
2. Europe
3. South East Asia
4. West pacific
• Only three polio-endemic countries remain-
1. Afghanistan
2. Nigeria
3. Pakistan
• Without any polio eradication efforts , more than 17 million people who are
currently healthy would have been paralyzed by the virus.

The below map also gives information about the substantial epidemiological
heterogeneity across countries. Despite the overall declining trend .

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fig 3: (a) Incidence per 100,000 for each country for the years 1990, 2000, 2010 and 2015. (b)
Percent changes in incidence of polio per country for the periods 1980–1990, 1990–2000,
2000–2010 and 2010–2015. Black color indicates zero incidence at the end of each period.

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 1.1.2 AFGHANISTAN AND PAKISTAN

• The number of cases in Pakistan has declined from 306 in 2014 to 54 in 2015 20 in
2016, 8 in 2017, and 12 in 2018. However, in 2019 a significant spread of the virus
occured and 144 polio cases were reported across all places.
in 2020, 80 cases have been reported from Punjab 13, Sindh 22, Khyber Pakhtunkhwa
22 and Baluchistan 23.
• There was a decline in case numbers during 2013–2016 but the number of cases in
Afghanistan has increased each year during 2017–2020. The number of WPV1 cases
reported in Afghanistan increased from 21 in 2018 to 29 in 2019. During January–July
2020, 41 WPV1 cases were reported as of August 29, 2020 (compared with 15 during
January–July 2019); in addition, 69 cases of circulating vaccine-derived polio virus
type 2 (cVDPV2), and one case of ambiguous vaccine-derived polio virus type 2
(aVDPV2) (isolates with no evidence of person-to-person transmission or from persons
with no known immunodeficiency) were detected

fig4:A child receiving 2 drops of polio vaccine

in Sindh, Pakistan. Photo: WHO Pakistan/A.
Zadi

1.1..3 NIGERIA

Nigeria was recently declared as polio free

by WHO. It was accounted for more than
half of all global cases less than a decade
ago.

fig5: A child receiving polio vaccine

in Nigeria
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1.2 CAUSATIVE FACTORS

The viral particles have a buoyant density of 1.34 g/ml in cesium chloride and a
sedimentation coefficient of approximately 156S. The particles are heat resistant (when
stabilized by magnesium cations), resistant to acid pH (pH 2.5 to 5.5 for one to three
hours), and also resistant to many detergents and disinfectants, including common soap,
non-ionic detergents, ether, chloroform, and other lipid solvents. The virus is sustainable
for weeks at 4°C and for days at room temperature. Drying, UV light, high
heat,formaldehyde, and free chlorine, readily inactivate the virus.

Polio virus can spread many ways. The most common way is the route is faecal-oral. The
virus replicates effectively in the intestinal tract and is shed in the stool for two to four
weeks, and
sometimes for several weeks longer.
Factors that affect transmission of the virus include extent of :
● crowding
● levels of hygiene
● water quality
● sewage handling facilities.
Since virus also replicates in the upper respiratory tract,polio viruses are spread through
upper respiratory tract secretions as well. Virus can be recovered from throat swabs and
washings during the early acute phases of infection.

1.2.1 SYMPTOMS OF POLIO

It was found that 95% to 99% of the people who contract the virus are asymptomatic.
Even without symptoms ,people infected with virus can spread the infection.

• non-paralytic polio:
The symptoms of this kind of polio can last from one to 10 days. The signs may
include:
1. fever
2. Sore throat
3. headache
4. vomiting
5. fatigue

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 • paralytic polio:

Paralytic polio leads to paralysis in the spinal cord (spinal polio), brainstem (bulbar

polio), or both (bulbospinal polio).

Initially symptoms are similar to non -paralytic polio but after a week new
symptoms appear. Symptoms include:
1. Loss of reflexes
2. severe spasms and muscle pain
3. loose and floppy limbs
4. sudden paralysis(temporary or permanent)
5. deformed limbs(specially hips,ankles and feet)

• post polio syndrome:

At time polio returns even after recovery. This can occur after 15 to 40 years.
Common symptoms of post-polio syndrome (PPS) are:
1. continuing muscle and joint weakness
2. muscle pain that gets worse
3. becoming easily exhausted or fatigued
4. muscle wasting, also called muscle atrophy
5. trouble breathing and swallowing
6. sleep apnea, or sleep-related breathing problems
7. low tolerance of cold temperatures
8. new onset of weakness in previously uninvolved muscles
9. depression
10.trouble with concentration and memory

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1.3 PATHOPHYSIOLOGY

The virus enters the body through the mouth and gradually multiplies in the throat and
gastrointestinal tract, then moves into the bloodstream and is carried to the central nervous
system where it duplicates and destroys the motor neuron cells.
Motor neurons control the muscles for swallowing, circulation, respiration, and the trunk,
arms, and legs.
The main steps in the Life cycle of the Polio virus is :
• Entry in the host
• Attachment with host cell
• Release of the RNA
• production of new virions
• release of new virions
• attack on nerve cells

fig6: Attachment of the virus to nerve cell.

Human nerve cells have a protruding

protein structure on their surface whose
precise function is unknown. When polio
virus encounters the nerve cells, the
protruding receptors attach to the virus
particle, and infection begins. Once inside
the cell, the virus hijacks the cell’s
assembly process, and makes thousands of
copies of itself in hours.
fig7:life cycle of polio virus
The virus kills the cell and then spreads to
infect other cells.

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1.3.1 INFANTILE PARALYSIS

Polio virus usually infects children of 5 years and below and the cases of paralytic
polio are very less with just about 1% probability.
• Paralysis usually begins when the child is small, often with a bad cold with fever
and sometimes diarrhea.
• Paralysis may affect any muscles of the body, but is most common in the legs.
• Paralysis is of the 'floppy' type . Some muscles may be only partly weakened while
others limp or floppy.
• In time the affected limb may not be able to straighten all the way, due to
shortening( contractures) of certain muscles.
• The bones and muscles of the affected limb become thinner than the other limb.
The affected limb does not grow as fast, and so is shorter.
• Unaffected arms or legs often become extra strong to make up for parts that are
weak.
• Intelligence and the mind are not affected.
• Feeling is not affected.

fig 9:reduced tendon jerks

• 'Knee jerks' and other tendon

reflexes in the affected limb are
reduced or absent.
• The paralysis does not get
worse with time. However,
secondary problems like
contractures, curve of the
backbone and dislocations may
occur.
fig 8:muscles commonly weakened by polio

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 1.3.2 OTHER AFFECTS OF POLIO ON THE HUMAN BODY

• The disease most commonly affects the strength of muscles of the legs ,arms and
abdomen
• When polio sometimes affects the muscles of the neck and throat then it causes
difficulty speaking and swallowing.
• The most life-threatening form of polio weakens the muscles in the chest that are
needed for breathing.
• The virus also affects the parts of the brain that control breathing at times. When
a polio victim develops breathing trouble, they may need machines to help
breathe for them.

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 2. MANAGEMENT STRATEGIES

The paralytic polio is diagnosed based on a neurological exam . Polio could be suspected
if you have fever with limb weakness or paralysis that mainly affects one side of your
body. Your muscle reflexes would be tested and may be looked for muscle weakness,
abnormal muscle contractions, and decreased muscle tone. The polio virus can be found in
stool or throat samples . Antibodies produced to counter the virus can be detected in the
blood.
The recovery from minor polio occurs in about three to four days. The symptoms and
fever of paralytic polio can go away within a couple of days, but the paralysis could be
permanent. Some muscle function may return during the first six months after the illness,
and recovery can continue for two years.

2.1 TECHNOLOGICAL INNOVATIONS

The discovery of vaccines against polio in the 1950s was one of the most dramatic
achievements of preventive medicine.
There are two vaccines against polio:
• Inactivated polio virus (IPV)
• Oral polio vaccine (OPV)

The first objective in vaccine preparation was to find a vaccine of the type immunogenic,
inactivated vaccine, while the second objective to create attenuated strains and both
where successful.
• IPV vaccination a series of injections that starts 2 months after birth and is given
until the child is 4 to 6 years old. The vaccine is made from inactive polio virus(not
dead). It is safe and effective and does not cause polio

• OPV is made from a weakened form of polio virus. This method of vaccination is
choice in many countries because it is cheap, easy to administer, and gives an
excellent level of immunity. However, in very few cases, OPV has been found to
revert to a dangerous form of polio virus, which might cause paralysis.

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2.1.1 ORAL POLIO VACCINE AND ITS PRODUCTION

The steps involved in the production of vaccine are as follows→

1. The seed materials include cell lines and other biological reagents are used to make
the OPV.
2. A specific cell line is used to grow the virus for the final polio vaccine.
3. In the preparation of these cells , trysin a special product is needed to remove the
cells from their container.
4. Trysin is then completely washed off from cells when the cells are removed and
before the virus for vaccines is added.
5. The polio vaccine virus is added to the cells to grow the virus for vaccine . When
the virus is ready,it is extracted from the cells and further purified and put into the
vaccine vials
6. And in no time the final polio vaccine virus is ready for use.

2.1.2 POLIO VIRUS ISOLATION:

Polio virus can be detected by collecting and testing specimens from the throat, stool, and
sometimes cerebrospinal fluid (CSF) by isolating the virus in cell culture or by detecting
the virus by polymerase chain reaction (PCR).

The steps laboratories conduct testing for polio virus, include:

• Culture: Virus isolation culture is the most sensitive method to diagnose polio
virus infection. Polio virus is mostly isolated from stool specimens. Isolation of the
virus is less likely to happen from blood or cerebrospinal fluid.
• Intratypic differentiation.
• Genome sequencing:Partial genome sequencing is used to diagnose the polio
virus genotype and confirm its presence.
• Serology:Method in which the infection is diagnoised by collecting serum and
testing it.

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 fig 10:A public health scientist in 1961 explaining the laboratory techniques
involved in the isolation of the poliovirus. | CDC/ Wallace Richter

2.1.3 SPECIMEN COLLECTION, STORAGE, AND SHIPMENT

SPECIMEN TYPES:
1. Stool:

• collection→ Collected in a sterile container with no transport medium is added

• amount→ greater than or equal to 1 gram
• storage→ to be frozen at -20 C
• shipping→ shipped in dry ice
• highest likelihood of virus isolation from the stool

2. Serum:
• collection→ collected in sterile container
• amount→ 0.2ml

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 • storage→ to be frozen at -20 C
• shipping→ ship on dry ice
• not a primary specimen , but helpful in diagnosis.

3. Respiratory – Nasopharyngeal/Oropharyngeal Swab

• collection→ stored in viral transport medium
• amount→ 1ml
• storage→ to be frozen at -20
• shipping→ shipped on dry ice

4. Cerebrospinal fluid
• collection→ collected in a sterile container with no medium and no dilution
• amount→ 0.2ml
• storage→ to be frozen at -20 C

2.1.4 POLIO VACCINE COMPOSITION, DOSAGE, AND ADMINISTRATION

IPV(Inactivated polio vaccine) is given in single dose syringes or in 10-dose vials. The
highly recommended dose for children and adults is 0.5mL. It is usually administered by
the intramuscular route, using a needle length approximate for the age and the size of the
person receiving the vaccine.
Most preferred injection sites:
• for infants and little children: anterolateral aspect of the thigh
• older children and adults: posterior aspect of the upper arm for subcutaneous
injection and deltoid muscle for intramuscular injection

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2.1.5 VACCINE EFFECTIVENESS AND DURATION OF PROTECTION:

A person who is considered to be vaccinated if she or he has received

• 4 doses of any combination of IPV or tOPV(trivalent oral polio virus
vaccine(tOPV)
• atleast 3 doses of primary series of IPV or tOPV(trivalent oral polio virus
vaccine).
The last dose in any of the two series should be given after 4 years of age and after 6
months of the previous dose.
2 doses of IPV( inactivated polio vaccine) are 90% effective or more against poilio;
3 doses are 99%-100% effective.
It is unknown how long people who received Inactive polio virus vaccine (IPV) will be
immune to polio virus, but they are most likely to be protected for many years after a
completing the series of IPV.

2.1.6 MICRO NEEDLE PATCH

The micro needle patch, which is a small, round adhesive bandage, brings polio vaccines
to the doorsteps of the people that need it. By applying on to the skin and pushing it down,
the vaccine is delivered in a matter of time may be few minutes . Rather than requiring
highly trained medics, minimally trained personnel could go from door to door, quickly
administering the vaccine.
With the rapid development of
nanotechnology, micro needle patches
have been improved by switching from
undissolving to dissolving micro needles,
and their safety has also improved
dramatically. As a drug delivery tool,
microneedle patches can deliver bioactive
molecular of different physical size.
Additionally, microneedle patches can be
fig11:Micro needle patch coated or encapsulate with DNA vaccine,
subunit antigen, inactivated or live virus vaccine. Combining clinical results with the

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results of patient interview, micro needle patches are found to be feasible and are
predicated to soon be acceptable for the medical service.

2.1.7 HOW DO DOCTORS TREAT POLIO ?

Doctors only treat the symptoms of polio while the infection runs its course. There is no
cure for polio infection therefore the best way to treat polio is to prevent it with
vaccinations.
The most common treatments include:
• pain killers
• bed rest
• antispasmodic drugs to relax muscles
• physical therapy for treatment of pain in affected muscles
• warm towels and heating pads to relax muscles aches and spasms
• antibiotics for urinary tract infections
• corrective braces for help with walking
• portable ventilators to help with breathing.

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 3. CONCLUSION AND OVERVIEW

However the affects the polio infection causes on the body cannot be treated and the body
remains deformed .Only the symptoms of the polio infection can be controlled and
stopped and the virus can be prevented from causing infection. More than 2.5 billion
children have been vaccinated with a corresponding decline of over 99% in the annual
wild polio virus (WPV) incidence .Polio remains endemic in two
countries .i.e.Afghanistan and Pakistan. Until polio virus transmission is stopped in these
countries, all the other countries remain at risk of importation of polio, especially those
countries with have weak public health and immunization services and travel or trade
links to endemic countries.

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 4. REFERENCE LIST

1. Centers for Disease Control and Prevention. (2019). What is Polio? [online]
Available at: https://www.cdc.gov/polio/what-is-polio/index.htm [Accessed 30
Nov. 2020].
2. Healthline. (n.d.). Polio: Types, Causes, & Symptoms. [online] Available at: https://
www.healthline.com/health/poliomyelitis#prevention [Accessed 2 Dec. 2020].
3. Landau, A.S., CNN and Liz (n.d.). 60 years after a vaccine, new technology may
finally eradicate polio. [online] CNN. Available at:
https://edition.cnn.com/2015/04/10/health/polio-vaccine-anniversary/index.html
[Accessed 9 Dec. 2020].
4. Si.edu. (2005). NMAH | Polio: How the Poliovirus Works. [online] Available at:
https://amhistory.si.edu/polio/virusvaccine/how.htm [Accessed 4 Dec. 2020].
5. World Health Organization. Department Of Immunization, Vaccines And
Biologicals (2004). Polio laboratory manual. Fourth edition ed. Geneva:
Immunization, Vaccines And Biologicals, World Health Organization, pp.46–54.
6. www.emro.who.int. (2020). WHO EMRO | Polio Eradication Initiative |
Programmes | Pakistan. [online] Available at:
http://www.emro.who.int/pak/programmes/polio-eradication-initiative.html
[Accessed 1 Dec. 2020].
7. www.mayoclinic.org. (2018). Polio - Diagnosis and treatment - Mayo Clinic.
[online] Available at:
https://www.mayoclinic.org/diseases-conditions/polio/diagnosis-treatment/drc-
20376517#:~:text=Doctors%20often%20recognize%20polio%20by [Accessed 6
Dec. 2020].
8. www.unicef.org. (n.d.). Polio eradication. [online] Available at:
https://www.unicef.org/afghanistan/polio-eradication#:~:text=Afghanistan%20is
%20one%20of%20only [Accessed 6 Dec. 2020].
9. www.who.int. (n.d.). Poliomyelitis (polio). [online] Available at:
https://www.who.int/health-topics/poliomyelitis#tab=tab_1 [Accessed 30 Nov.
2020].

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