May 22, 2012

Poliomyelitis



Filed under: Infectious Diseases
 Polio is a contagious viral illness that in its most severe form causes paralysis, difficulty breathing and sometimes death.
In the U.S., the last case of wild polio — polio caused naturally, not by a vaccine containing live virus — occurred in 1979. Today, despite a concerted global eradication campaign, wild poliovirus continues to affect children and adults in Afghanistan, India, Nigeria and Pakistan.
The Centers for Disease Control and Prevention (CDC) advises taking precautions to protect against polio if you're traveling anywhere there's a risk of polio. If you're a previously vaccinated adult who plans to travel to an area where polio is occurring, you should receive a booster dose of inactivated poliovirus. Immunity following a booster dose lasts a lifetime.
Although polio can cause paralysis and death, the vast majority of people who are infected with the poliovirus don't become sick and are never aware they've been infected with polio.

Nonparalytic polio
. Some people who develop symptoms from the poliovirus contract nonparalytic polio — a type of polio that doesn't lead to paralysis (abortive poliomyelitis). This usually causes the same mild, flu-like signs and symptoms typical of other viral illnesses.
Signs and symptoms, which generally last two 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 spasms or tenderness
                Meningitis
Paralytic polio
. Fewer than 1 percent of people infected with poliovirus develop paralytic polio, the most serious form of the disease. Initial signs and symptoms of paralytic polio, such as fever and headache, often mimic those of nonparalytic polio. Between one and 10 days later however, signs and symptoms specific to paralytic polio appear, including:
                Loss of reflexes
                Severe muscle aches or spasms
                Loose and floppy limbs (acute flaccid paralysis), often worse on one side of the body
The onset of paralysis may be sudden.
Classifications of paralytic polio
Paralytic polio has historically been divided into several types, depending primarily on which part of the body is affected. These classifications aren't rigid, and overlap may occur among the different forms.
                Spinal polio. This most common form of paralytic polio attacks certain nerve cells (motor neurons) in your spinal cord and may cause paralysis of the muscles that control breathing and those in your arms and legs. Sometimes the neurons are only damaged, in which case you may recover some degree of muscle function. But if the neurons are completely destroyed, the paralysis is irreversible, although you still retain your sense of feeling, unlike after many spinal cord injuries.
                Bulbar polio. In this severe type of polio, the virus affects the motor neurons in your brainstem, where the centers of the cranial nerves are located. These nerves are involved in your ability to see, hear, smell, taste and swallow. They also affect the movement of muscles in your face and send signals to your heart, intestines and lungs. Bulbar polio can interfere with any of these functions but is especially likely to affect your ability to breathe, speak and swallow and can be fatal without respiratory support.
                Bulbospinal polio. A combination of both bulbar and spinal paralytic polio, this form can lead to paralysis of your arms and legs and may also affect breathing, swallowing and heart function.
Post-polio syndrome. 

Affecting some people who have recovered from polio, post-polio syndrome is a cluster of disabling signs and symptoms that appears decades — an average of 30 to 40 years — after the initial illness. Common signs and symptoms include:
                Progressive muscle or joint weakness and pain
                General fatigue and exhaustion after minimal activity
                Muscle atrophy
                Breathing or swallowing problems
                Sleep-related breathing disorders, such as sleep apnea
                Decreased tolerance of cold temperatures
When to see a doctor
. Be sure to check with your doctor for polio vaccination recommendations before traveling to a part of the world where polio may still occur naturally or where oral polio vaccine (OPV) is still used, such as Central and South America, Africa and Asia. In countries that use the OPV — vaccine made with live, but weakened (attenuated) polio virus — the risk of paralytic polio to travelers is extremely low, but not zero.
Additionally, call your doctor if:
                Your child hasn't completed the series of polio vaccinations
                Your child experiences an allergic reaction after receiving polio vaccine
                Your child has problems other than a mild redness or soreness at the vaccine injection site
                You have questions about adult vaccination or other concerns about polio immunization
                You had polio years ago and are now experiencing unexplained weakness and fatigue
The poliovirus resides only in humans and enters the environment in the feces of someone who's infected. Poliovirus spreads primarily through the fecal-oral route, especially in areas where sanitation is inadequate.
Poliovirus can be transmitted through contaminated water and food or through direct contact with someone infected with the virus. Polio is so contagious that anyone living with a recently infected person is likely to become infected too. Although people carrying the poliovirus are most contagious seven to 10 days before and after signs and symptoms appear, they can spread the virus for weeks in their feces.
You're at greatest risk of polio if you haven't been immunized against the disease. In areas with poor sanitation and sporadic or nonexistent immunization programs, the most vulnerable members of the population — pregnant women, the very young and those with weakened immune systems — are especially susceptible to poliovirus.
These factors also increase your risk if you haven't been vaccinated:
                Travel to an area where polio is common or that has recently experienced an outbreak
                Living with or caring for someone who may be shedding poliovirus
                Handling laboratory specimens that contain live poliovirus
                A compromised immune system, such as occurs with HIV infection
                Having had your tonsils removed (tonsillectomy)
                Extreme stress or strenuous physical activity after being exposed to poliovirus, both of which can depress your immune system
Paralytic polio can lead to temporary or permanent muscle paralysis, disability, and deformities of the hips, ankles and feet. Although many deformities can be corrected with surgery and physical therapy, these treatments may not be options in developing nations where polio is still endemic. As a result, children who survive polio may spend their lives with severe disabilities.
Doctors often recognize polio by symptoms such as neck and back stiffness, abnormal reflexes, and difficulty swallowing and breathing. To confirm the diagnosis, a sample of throat secretions, stool or cerebrospinal fluid — a colorless fluid that surrounds your brain and spinal cord — is checked for the presence of poliovirus.
Because no cure for polio exists, the focus is on increasing comfort, speeding recovery and preventing complications. Supportive treatments include:
                Bed rest
                Antibiotics for secondary infections (none for poliovirus)
                Analgesics for pain
                Portable ventilators to assist breathing
                Moderate exercise (physiotherapy) to prevent deformity and loss of muscle function
                A nutritious diet 


Poliomyelitis

Epidemiology and Prevention of Vaccine-Preventable Diseases

The Pink Book: Course Textbook - 12th Edition Second Printing (May 2012)

Poliomyelitis 

  • First described by Michael Underwood in 1789
  • First outbreak described in U.S. in 1843
  • More than 21,000 paralytic cases reported in the U.S. in 1952
  • Global eradication within next decade
The words polio (grey) and myelon (marrow, indicating the spinal cord) are derived from the Greek. It is the effect of poliomyelitis virus on the spinal cord that leads to the classic manifestation of paralysis.
Records from antiquity mention crippling diseases compatible with poliomyelitis. Michael Underwood first described a debility of the lower extremities in children that was recognizable as poliomyelitis in England in 1789. The first outbreaks in Europe were reported in the early 19th century, and outbreaks were first reported in the United States in 1843. For the next hundred years, epidemics of polio were reported from developed countries in the Northern Hemisphere each summer and fall. These epidemics became increasingly severe, and the average age of persons affected rose. The increasingly older age of persons with primary infection increased both the disease severity and number of deaths from polio. Polio reached a peak in the United States in 1952, with more than 21,000 paralytic cases. However, following introduction of effective vaccines, polio incidence declined rapidly. The last case of wild-virus polio acquired in the United States was in 1979, and global polio eradication may be achieved within the next decade.

Poliovirus

Poliovirus is a member of the enterovirus subgroup, family Picornaviridae. Enteroviruses are transient inhabitants of the gastrointestinal tract, and are stable at acid pH. Picornaviruses are small, ether-insensitive viruses with an RNA genome.
There are three poliovirus serotypes (P1, P2, and P3). There is minimal heterotypic immunity between the three serotypes. That is, immunity to one serotype does not produce significant immunity to the other serotypes.
The poliovirus is rapidly inactivated by heat, formaldehyde, chlorine, and ultraviolet light.

Pathogenesis

The virus enters through the mouth, and primary multiplication of the virus occurs at the site of implantation in the pharynx and gastrointestinal tract. The virus is usually present in the throat and in the stool before the onset of illness. One week after onset there is less virus in the throat, but virus continues to be excreted in the stool for several weeks. The virus invades local lymphoid tissue, enters the bloodstream, and then may infect cells of the central nervous system. Replication of poliovirus in motor neurons of the anterior horn and brain stem results in cell destruction and causes the typical manifestations of poliomyelitis.http://www.cdc.gov/vaccines/pubs/pinkbook/polio.html#schedule
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