“I wanted to be a dancer, and dancing was my passion. But at the age of 13, I started feeling stiff, my joints

ached, and over a two week period, I lost my coordination and 20 pounds

& the saddest of all is I became paralyzed. My “Passion” thus

became my “Pain”……”????????..........

POLIOMYELITIS

SHEBA SUSAN BENNY

OBJECTIVES

Students will recall what they have already learned about Poliomyelitis and will update their knowledge regarding the topic and will demonstrate confidence in taking care of patients with polio and participate actively in awareness of polio eradication & vaccination

SPECIFIC OBJECTIVES

DEFINITION

“ Poliomyelitis is a highly infectious viral disease, which destructs the motor neurons and damages brain and spinal cord and is characterized by muscle weakness and paralysis”

1580–1350 BC

EPIDEMIOLOGYThis disease is seasonal, occurs

commonly in summerThe America in 1994, Eastern

Pacific in 2000 & Europe in 2002 are certified free from circulation of wild polio virus

Polio is currently reported wildly in mainly 4 countries- Nigeria, Pakistan, Afghanistan, Egypt

STATUS OF POLIO IN LAST 12 MONTHS

CLASSIFICATION

Non-paralytic

Paralytic

Asymptomatic Abortive

Asymptomatic Contribute more than 90% of the casesOccurs when the replication of virus is

restricted to gastro-intestinal tractThis is the case with attenuated vaccine

strain

Abortive

Also known as subclinicalAround 5% of cases are subclinicalAffected persons suffers from minor

symptoms starts with febrile disease & occurs in the first week of infection

Non-paralyticAbout 2% cases are experiencing this typeSevere form of polioStarts 3-4 days later to the onset of

infectionSymptoms last for 2 weeksSymptoms are associated with aseptic

meningitisVirus progress to brain and infects

meninges

Paralytic Less than 1% of cases are this

typeThis is the most severe form of

polioAbout 4 days after the end of

first minor symptoms, virus spread to the anterior horn cells of the spinal cord and to the motor cortex of brain

Degree of paralysis depends upon the neuron affected & amount of damage it sustain

Spinal

Bulbar

Bulbospinal

TYPES OF PARALYTIC POLIO

ETIOLOGYIt is caused by 3 poliomyelitis virus

types with different antigenic characteristics

Brunhilde Lansing Leon

MODE OF SPREADIn developing countries- ‘feco

oral’ transmission (poor sanitation)

Industrialized countries- ‘oral pharyngeal’ transmission

During outbreaks- ‘oral pharyngeal’ transmission

COMMUNICABILITY PERIODAs the virus is shed in feces,

transmission is via feco-oral route through ingestion of contaminated food or water

Virus is shed in stools for 6-8 weeksAverage incubation period is 7-10 daysVirus spreads rapidly to non-immune

personsHumans are the only reservoir of polio

virus and infection is spread from person to person

PATHOPHYSIOLOGY

Virus enters the body through feco-oral route

Reaches digestive tract and attaches to specific receptors

Replicates in the intestinal mucosa

Path physiology…..contd

Enters the blood stream

Virus enters the nervous system through blood

Spread along the axons of peripheral nerves to CNS

Path physiology…….contd

Progress along the fibers of motor neuron of brain and spinal cord

Destroys anterior horn cells of spinal cord or nerves within bulbar region

Nerve cell death results in failure of contraction of muscles

Path physiology…….contd

Muscle dysfunction results in respiratory failure and paralysis of legs

Virus is excreted through feces and contributes in further contamination & spread

CLINICAL MANIFESTATIONSSub-clinical

Headache Fever

Fatigue Sore throat

Vomiting

C/M….contd

C/M……contdParalytic

DIAGNOSISIt is based on symptomsAbsence of history of immunization or

presence of an epidemic in a particular region strengthens the diagnosis

Diagnosis……..contd Lab investigations & findings

Isolation of polio virus from the stool

WBC count will be normal or slightly elevated

Virus can be detected from onset to >_8weeks after paralysis

CSF findings:-Appearance-clearProtein-normal initially & rise up to

300mg% in 2-3 weeks after onset

DIFFERENTIAL DIAGNOSIS

Most common two are..Guillian Barre syndromeTransverse myelitisOther conditions are..Traumatic neuritisMeningitisencephalitis

TREATMENT OF POLIO IN EARLY YEARS

TREATMENT

“Treatment should be early and appropriate to the stage and degree of paralysis”

Acute stage (2-4 weeks)Strict bed rest to minimize extent of paralysisSymptomatic relief of muscle tightness & spasm, by administering analgesics, combined with application of hot packs for 15-30 mts to affected part, every 4 hours

Parasympathetic stimulant such as Urocholine can be given for urinary retention

Suitable body alignment in paralytic cases to avoid skeletal deformity

A firm bed prevents sagging of spine

Treatment Acute stage contd….

If muscles of foot are involved, feet should be kept at right angle to the legs

In bulbar poliomyelitis, with pooling of secretion main concern is airway maintenance & avoid risk of aspiration. Tracheostomy may be required.

Recovery or convalescent (3-6 mnths)

At this stage, emphasis is on physiotherapy

As soon as the pain subsides, passive movements can be started to prevent joint stiffness

Rehabilitation Certain patients remain permanently

paralyzed despite vigorous physiotherapy

Severe deformities & contractures require surgical corrections

Any idea who they are?...

VACCINESTwo types of vaccines are available

world wide◦The live attenuated oral polio vaccine(Salk)◦Inactivated or killed poliovirus

vaccine(Sabin)Both the vaccines are available as

trivalent preparations containing 3 types of polio virus and both when used as recommended, provide good protection from paralytic poliomyelitis as well as control of disease

PROGNOSIS

Decreased incidence of polio cases and improved medical care has resulted in a marked reduction in the Mortality rate

Bulbar polio is the most severe form with relatively poor prognosis

Estimation was that 10-15% of all cases of polio results in permanent paralysis

PREVENTION

Immunization with polio vaccine is the mainstay in the prevention of polio

Infant born to mothers with antibodies are protected naturally against paralytic disease for a few weeks

Immunity is acquired through infection with the wild virus through immunization

The Global Polio Eradication Initiative has significantly reduced the no.of cases reported

OUR ROLE

Strengthening of routine immunizationImprove environmental sanitation

LET US JOIN OUR

HANDS TOGETHER

TO ERADICATE

POLIO

THANK YOU