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Polio
There was this disease
Out gobbling up the children
It grabbed us
Around the chest
Beat at our limbs
With mangling wing
So bad
Our parents
Tried to snatch us back
As if we were in the path of buses
Which meant
No swimming pools
No merry – go round in Hunting Park
Or play with other children
Who might be carriers
Poem by Elaine Terranova
On polio – 1928
Evidence of poliomyelitis can be traced back to ancient Egypt.
1789 – British physician Michael Underwood records the first clinical description.
1894 – In Vermont the first outbreak of polio epidemic in the US occurs, with 132 cases
1908 – Scientists Karl Landsteiner and Erwin Popper are the first to identify a virus of the causative agent of polio through experiments of transmission to a monkey.
1916 – Another polio epidemic occurs in the US.
1921 – Franklin D Roosevelt, The Former President of America is diagnosed with polio at the age of 39. He inadvertently becomes the face of polio and helped change public perception on the disease.
1930 – Three strains of poliovirus are discovered.
1953 – Dr Jonas Salk and his associates develop an inactivated polio vaccine.
1955 – 1957 – US polio incidence declines by 84 to 90 percent
1979 – Post polio syndrome identified by physicians.
1981 – Publication of poliovirus genome sequence.
1999 – Inactivated polio vaccine as the recommended form of polio immunisation in the US.
In August 2020, after a long period of battling the polio virus, Africa was declared free of the wild poliovirus by the Independent Africa Regional Certification Commission.
Nigeria was declared free of wild poliovirus in August 2020, a major milestone.
Poliomyelitis commonly known as polio is an infectious viral disease caused by the genus Enterovirus from the Picornaviridae family.
Poliomyelitis is a paralytic disease resulting from the destruction of motor nervous in the central nervous system and can lead to partial or full paralysis
There are usually three forms of polio infections, sub-clinical, non-paralytic and paralytic.
The virus enters through the mouth, and primary multiplication of the virus occurs at the site of implantation in the pharynx and gastro – intestinal tract. The virus is usually present in the throat and in the stool before the onset of illness, as I stated ad nauseam in my earlier write ups.
One week after onset there is less virus in the throat, but virus continues to be excreted in the stool for several weeks.
Poliomyelitis occurred worldwide but is not limited to Asia and African continents. During 2003 the disease was endemic in 6 countries, Indian, Niger, Pakistan, Afghanistan and Egypt.
However, importations from these endemic countries have been reported recently in other polio free countries and states.
The disease is seasonal, with cases starting to increase sharply in June with peaks during July through September. Cases – continue to be high in areas with low immunisation coverage and poor sanitation.
Poliomyelitis is a disease caused by infection with the polio – virus. The virus spreads by – direct person to person contact, contact with infected mucus or phlegm from the nose or mouth and contact with infected feces.
As is the case with many other infectious diseases, people who get polio tend to be some of the most vulnerable members of the population. This includes the very young, pregnant women, and those with immune systems that are substantially weakened by other medical conditions.
Anyone who has not been immunised against polio is especially susceptible to contracting the infection.
Additional risk factors include, travelling to places where polio is endemic or widespread, especially Pakistan and Afghanistan, living with someone infected with polio. Having a weak immune system.
Pregnant women are more susceptible to polio, but it does not appear to affect the unborn child. Working in laboratory where live poliovirus is kept.
Symptoms of non-paralytic polio include, fever, sore throat, headache, vomiting, fatigue, back and neck pain, arm and leg stiffness, muscle tenderness and spasms, and meningitis.
For paralytic polio the symptoms start as those of non- paralytic, and then progress to more serious symptoms such as, loss of muscle reflexes, severe muscle pain and spasms, loose or floppy limbs that are often more on one side of the body.
For diagnosis of polio, cerebrospinal fluid examination, throat wasting and blood test help in identifying the incriminating organism.
Once the polio virus is isolated it is tested by a special method called “oligonucleotide mapping” (finger printing) or genomic sequencing.
This is essentially looking at the genetic sequence of the virus to detect if the origin of the virus is “wild type” or ‘vaccine like’.
Wild type virus naturally occurs in the environment and may occur as 3 subtypes – P1, P2 and P3.
Vaccine like virus is derived after a spontaneous, mutation of the genes of the virus in the polio vaccine.
No cure for polio exists; the focus on treatment is increasing comfort, speeding recovery and preventing complications.
Supportive treatments include bed rest, pain relievers, and portable ventilators to assist breathing, moderate exercise (physical therapy) to prevent deformity and loss of muscle function plus a nutritious diet.
People with major poliomyelitis may require additional treatments including, physical therapy, measures to prevent urinary tract infections, mechanical breathing support, splint, orthosis, crutches, walkers, wheelchairs.
Symptoms of fever, headache, back, neck pain and muscle pain are relieved by using pain relievers and muscle relaxant medications. Usually NSAIDS like Ibuprofen, Diclofenac and Acetaminophen are preferred.
Aspirin is not used in children with viral infection for fear of Reyes Syndrome that causes severe irreversible liver damage.
For pain, spasm and stiffness in the muscles, moist heat, using warm towels and healing pads, may be used.
Patients who have difficulty breathing or have paralysis of respiratory muscles may need breathing support, using artificial support like ventilators.
Those with urinary tract infections need antibiotics. There may be problems in urinating due to difficulty in the beginning of urination. This may lead to retention of urine.
Opioids like morphine etc are not prescribed as they may suppress breathing further leading to respiratory failure.
Prevention of polio is one of the best approaches towards the disease. Paralytic polio has no cure and may lead to death and disability.
Prevention of polio involves, maintenance of good hygiene to prevent transmission of the virus.
This involves drinking clean water, regular hand washing and appropriate disposal of nasal and muscles secretions.
Vaccines are two types. One is the inactivated polio vaccine (IPV) and the other oral polio vaccine (OPV).
•Always be medically guided
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