Poliomyelitis

Often called polio or infantile paralysis, is an

infectious disease caused by a virus.
This virus is a member of the enterovirus
subgroup of the Picornaviridae family
and has three serotypes: PV1, PV2 and PV3.
The tissue most
commonly
affected is the
spinal cord which
leads to the
classic
manifestations of
paralysis.
 Epidemiology
As a result of a massive, global vaccination
campaign over the past 20 years, polio exists only
in a few countries in Africa and Asia.
In the Philippines, the last polio case was
recorded in 1993, and in 2000 the Philippines was
certified polio-free (UNICEF, 2005).
Transmission

Person-to-person spread of poliovirus via the

fecal-oral route is the most important route of
transmission, although the oral-oral route may
account for some cases.
Risk Factors
Age: Infants and elderly
Living with an infected person
Compromised
immmune system

Lack of
immunization
against polio

Extreme stress or
strenous activity
Travel to an area that has
experienced a polio outbreak
 Pathogenesis
The mouth is the portal of entry of the virus 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
stools before the onset of illness. One week after onset
there is little virus in the throat, but virus continues to
be excreted in the stools for several weeks. The virus
invades local lymphoid tissue, enters the blood stream,
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.
 Paralytic polio is classified into three types...

 Spinal polio - the most common, and accounted

for 79% of paralytic cases from 1969-1979. It is
characterized by asymmetric paralysis that most
often involves the legs.
 Bulbar polio - accounts for 2% of cases and leads
to weakness of muscles innervated by cranial
nerves.
 Bulbospinal polio - it accounts for 19% of cases
and is a combination of bulbar and spinal
paralysis.
Clinical Features
The incubation period for poliomyelitis is
commonly 6 to 20 days with a range from 3 to
35 days. The response to poliovirus infection is
highly variable and has been categorized based
on the severity of clinical presentation.
PATHOGNOMONIC SIGN

flaccid paralysis, weakness or paralysis and

reduced muscle tone.
• PATHOGNOMONIC SIGN
• flaccid paralysis, weakness or paralysis and
reduced muscle tone.
ASSESSMENT
INAPPARENT INFECTION no manifestation no manifestation

ABORTIVE • sore throat • upper respiratory • Pain

POLIOMYELITIS • abdominal pain tract infection • Fluid Volume
• constipation or • fever Deficit
diarrhea • Imbalanced
• nausea Nutrition: less than
body requirement
• decreased
appetite • Fatigue
• Hyperthermia
NONPARALYTIC • stiffness of the • Pain
POLIOMYELITIS neck, back, and/or • Hyperthermia
legs
PARALYTIC • severe muscle • loss of superficial • Disturbed body
POLIOMYELITIS aches and spasms reflexes image
in the limbs or • diminished deep • Risk for Injury
back tendon reflexes • Self-Care Deficit
• flaccid paralysis • weakened • Impaired breathing
breathing pattern
• flushed or blotchy
skin
 DIAGNOSTIC STUDIES

 Virus Culture
The laboratory diagnosis of polio is confirmed by isolation of virus by
cultures, from the stool or throat swab or cerebrospinal fluid (rare). In an
infected person, the virus is most likely to be cultured in stool cultures.

 Serologic test
Acute and convalescent serum sample may be tested for rise in antibody
titer (antibodies to the poliovirus), but the report can be difficult to
interpret as in many cases, the rise in titer may occur prior to paralysis.

 Cerebrospinal fluid test

Infection with polio virus may cause an increased number of white blood
cells and a mildly elevated protein level in cerebrospinal fluid
 MANAGEMENT
 Treatment of pain with analgesics (such as acetaminophen).
 Antibiotics for secondary infections (none for poliovirus).
 Fluid Therapy
 Bed rest (until fever is reduced)
 Adequate diet
 Minimal exertion and exercise
 Hot packs or heating pads (for muscle pain).
 Prolong rehabilitation may be necessary including braces,
splint or surgery.
 MANAGEMENT
Hospitalization (may be required for those
individuals who develop paralytic poliomyelitis).
If the respiratory is involved, LONG-TERM
VENTILATION is necessary.
Physiotherapy may be necessary.
Place the child on firm mattress with support for
feet, change position frequently.
Encourage oral intake of food and fluid.
Catheterization of distended bladder may be
necessary.
 PREVENTION
• The best preventive measure for poliomyelitis
is ensuring hygiene and encouraging good
sanitation practices. But, polio prevention
begins with polio vaccination. Polio vaccine
has been developed against all 3 subtypes of
the poliovirus and is very effective in
producing protective antibodies that induces
immunity against the poliovirus and provides
protection from paralytic polio.
Two types of vaccine are available:
 an inactivated (killed) polio vaccine (IPV) and
 a live attenuated (weakened) oral polio
vaccine (OPV).
 ADVANTAGES
Inactivated Polio Vaccine It is inactivated, so it cannot
replicate, and cannot be
shed in the stool of a
vaccinated person.
It cannot cause vaccine
associated paralysis, and is
safe to use in
immunodeficient persons
or in household contacts of
immunodeficient persons.
DISADVANTAGES
Requires injection
More expensive
Produces less local
gastrointestinal immunity
Recipients could become
infected with wild polio
virus

Oral Polio Vaccine It is very easy to administer May cause vaccine-

Less expensive associated paralytic polio
Produces excellent
intestinal immunity which
helps
Prevent infection with wild
virus
 GUIDE ON POLIOMYELITIS
IMMUNIZATION (OPV)
Route Oral
Site Mouth
Number of Dose 3 doses
Age at First Dose 6 weeks after birth
Minimum Intervals 4 weeks
between Doses
Dosage 2 drops
Storage Temperature -15 to -25 °C
 EVALUATION

PROGNOSIS

• The outlook depends on the form of the disease (subclinical, or

paralytic) and the body area affected. Most of the time, complete
recovery is likely if the spinal cord and brain are not involved.

• Brain or spinal cord involvement is a medical emergency that may

result in paralysis or death (usually from respiratory problems).

• Disability is more common than death. Infection that is located high

in the spinal cord or in the brain increases the risk of breathing
problems