Polio myelitis WITH MEDICAL AND NURSING MANAGEMENT (Pulse Polio Programme)

1. SUBMITTED TO: SUBMITTED BY:
MRS. VINAY KUMARI AMANDEEP KAUR
Associate professor(HOD) M.Sc. (N) 2nd Year
Medical-Sugical Nursing Deptt. Roll No. 11915703
SUBMITTED ON:- 17.04.2017

2. INTRODUCTION
 A viral disease which may affect the spinal cord causing
muscle weakness and paralysis.
 The words polio (grey) and myelin (marrow, indicating
the spinal cord) are derived from the Greek.
 Poliomyelitis is a disease of the anterior horn motor
neurons of the spinal cord and brain stem caused by
poliovirus.
 Poliomyelitis, literally meaning “grey spinal cord
inflammation
 It is a viral infection

3. INTRODUCTION
 Virus localized in the anterior horn cells of the spinal cord
and certain brain steam motor nuclei.
 It is contagious: usually spread from person to person.
 Only harmful to humans
 The virus enters the body through the mouth, usually from
hands contaminated of an infected person.
 3 types: Spinal, Bulbar and Bulbo-spinal
 Disease is more common in the summer/rainy season.
 It is primarily an intestinal infection that causes paralysis
in less than 1% of cases

4. Historical Background
 Sir Walter Scott(1771–1832) may have had the earliest
recorded case of polio.
 First described by Michael Underwood in 1789
 Initially thought to be due to trauma
 Became known as the Heine-Medin disease due to the
work of Dr. Jakob Heine and Dr. Karl Oskar Medin.
 Later called infantile paralysis, based on its propensity
to affect children.
 3rd human disease targeted for eradication.

5. Cont…
(Eradicated)
 Smallpox.
 Rinderpest.( also cattle plague or steppe murrain)
 Poliomyelitis (polio)
 Dracunculiasis.( Guinea worm disease)
 Yaws.
 Malaria.
 Hookworm.
 Lymphatic filariasis.

6. Cont…
 Americans believed that the Italians brought it over since
immigrants are “dirty” and live in the slums.
 25% of polio deaths came in the first 24 hours…85% of
deaths occurred during a victim’s first 20 days in the
hospital.
 Polio patients whose muscles were paralyzed faced
months, perhaps years, of burdensome physical therapy to
strengthen weakened muscles.
 Patients were often placed in iron lungs to help with
breathing regulation.

7. Immune system
 In immune individuals, IgA anti bodies against poliovirus are
present in the tonsils and gastrointestinal tract, and are able to
block virus replication; IgGand IgM antibodies against PV can
prevent the spread of the virus to motor neurons of the central
nervous system.
 Infection or vaccination with one serotype of poliovirus does
not provide immunity against the other serotypes, and full
immunity requires exposure to each serotype.
 A rare condition with a similar presentation, nonpoliovirus
poliomyelitis, may result from infections with nonpoliovirus
enteroviruses.

8. Census
 India was rated for 40,000 cases of polio in 1980s and
until 2002. The state of Uttar Pradesh alone was
accounted for 2/3rd of the world’s polio cases.
 No polio case reported since 2011.
9th Annual Plan By The Planning Commission Of India
a) Started the PPP: Dec 1995
b) Original Target of eradication: 2000
c) Revised Target of eradication: 2002
d) Further Revised Target of eradication: 2007

9. DEFINITION
 It is an acute viral infectious disease caused by
enterovirus.
 The word ‘myletis’ means an inflammation in the spinal
cord, which often targets insulating material covering
nerve cell fibers (myelin).
Greek word:-
 “polios”-grey
 “Myelos” –spinal cord
 Route:- feco-oral

10. Epidemiology
 Incidence
 (2011)India :- 5cases-
1wild polio, 4
VAPP(Vaccine-
Associated Paralytic
Poliomyelitis)
 (2010)42 confirmed
cases
 Last case detected in
Goa in 1997

11. Agent
 GENUS: Enterovirus
 SPECIES: poliovirus
 STRUCTURE: ssRNA enclosed in a protein capsid.
 TYPES: Three Types: - PV1, PV2, PV3. differentiated by
the type of capsid protein.
 SIZE: 30nm in diameter with icosahedral symmetry
 PV1 is most common encountered form & the one most
commonly associated with the paralysis.

12. Resistance
 In feces :- for months at 4oC & years at 20oC
 Inactivated by heat and chlorination.
Host range :- natural infection occurs only in humans.
Mode of transmission
 Feco-oral route
 In early stage of disease, through inhalation or entry
through conjunctiva of droplets of respiratory secretions
of patient.

13. Period of communicability
 7-10 years before & after the onset of symptoms.
Age :- most vulnerable from 6months to 3 years.
Seasonal :- most common
during rainy season, peak season
from July to September.
Environmental source
of infection:-
 Contaminated water and food
 Flies
 Overcrowding and poor sanitation.

14. Risk Factors
Age: Infants and elderly

15. Cont…
 Living with an infected person

16. Cont…
 Compromised immmune
system
 Lack of immunization
against polio
 Extreme stress or
strenous activity

17. Cont…
 Travel to an area that has experienced a polio outbreak.

18. Entero viruses
The Nomenclature has given Numbers
1. Polio virus types 1 to 3.
2. Coxsasackie virus Group A. 1- 24.
3. Coxsasackie virus Group B. 1-6.
4. Echo virus type 1-33.
5. Entero virus type 68-71.

19. Life cycle of polio virus
 Poliovirus, the causative agent of
poliomyelitis, is a human
enterovirus and member of the
family of Picornaviridae.
 Poliovirus is composed of a RNA
genome and a protein capsid.
 The genome is single-stranded
positive-sense RNA

20. Life cycle of polio virus
Enters through mouth
Intestine if the virus finds a cell with the correct receptor in
the intestine
Infection begins
The polio virus genoma (RNA) enters the intestinal cell

21. The viral RNA takes over the cell
Replicates (RNA) in intestinal cell
New RNA+ new capsids (shells) = new polio virus
Thousands of polio virus burst out of cell and enters the
blood stream

22. Life cycle of polio virus

23. PATHOPHYSIOLOGY

32. Pathophysiology

33. CLINICAL FEATURES/ TYPES

34. CLINICAL FEATURES/ TYPES
Infection may occur in two forms:-
1. Inapparent/ asymptomatic(90-95%)
 Accounts for approximately 95% of cases
 Virus stays in intestinal tract and does not attack the nerves
 Virus is shed in the stool so infected individual is still able to
infect others
2. Apparent/ symptomatic (5-10%)
 Abortive polio
 Non-paralytic aseptic meningitis
 Paralytic poliomyelitis
 Polio encephalitis

35. Abortive polio
 4-8% infections
 Does not lead to paralysis
 Minor illness
Symptoms :-
 Low grade fever
 Sore throat
 Vomiting
 Abdominal pain
 Loss of appetite
 Malaise
 Recovery:- complete, most recover in <1 week , no paralysis.

36. Non-paralytic aseptic meningitis
 Occurs in 1-2% of polio infections
Symptoms :-
 Headache
 Nausea
 Vomiting
 Pain and stiffness of neck, back and legs.
 Complete recovery after 2-10 days of symptoms.

37. Signs
 Tripod sign

38. Signs
Kiss the knee test
 Method:- knees kept
down, child ask to kiss his
knees.
 Observation:- cannot do
the maneuver due to
stiffness spine may draw
up the knees sharply.

39. Head drop sign
 Method:- hand placed
under patient’s shoulder
and trunk is raised.
 Observation:- head lags
behind limply.

40. Neck rigidity
 Method:- in
uncooperative
child- place child’s
head beyond the
edges of table.
Observation:- true
involuntary neck
rigidity persists,
voluntary stiffening
of muscles
disappears.

41. Paralytic poliomyelitis
0.5-1% of of those infected develop this type.
2 phases-
 Minor- same as abortive polio
 Major- muscle pain, spasm and return of fever
 Followed by rapid onset flaccid paralysis, complete within
72hrs.
It is of three types:-
1. Spinal paralytic poliomyelitis
2. Bulbar poliomyelitis
3. Bulbo-spinal poliomyelitis

42. 1. Spinal paralytic poliomyelitis
 Attacks motor neurons in the spinal cord and
causes paralysis in arms and legs and breathing
problems.
 Most common 79-80% of cases
 Results from lower motor neuron lesion of
anterior horn cells of spinal cord
 Affects muscles of legs, arms and trunk.
 Severe cases- quadriplegia, paralysis of trunk,
abdominal and thoracic muscles.

43. Cont…
 Paralysis- asymmetrical (legs> arms) , descending paralysis,
Children <5 years most likely to become paralyzed in
one leg
Adults are most commonly paralyzed in both arms and
legs
 Muscles- floppy
 Reflexes- diminished, Deep tendon reflex lost before onset of
paralysis
 Sensation- normal
 Residual paralysis- after 60 days.

44. 2. Bulbar poliomyelitis
 Affects neurons responsible for sight, vision, taste,
swallowing, and breathing
 Accounts for 2% of paralytic polio
 Life threatening
 Virus attacks motor neurons in brainstem
 Affects cranial nerve function
 Cranial nerve lesion- vagus
 Primarily inhibits ability to breathe, speak, and swallow
effectively
 Facial asymmetry present

45. Symptoms
 Nasal twang and hoarseness of voice
 Nasal regurgitation
 Dyspnea(difficult or laboured breathing.)
 Dysphagia (difficulty or discomfort in swallowing)
 Child refuses to feed
 Secretions accumulate in pharynx- aspiration
 Involvement of
 Respiratory centre- shallow, irregular respiration
 Vasomotor centre- BP rises then fall
 Pulse- rapid, weak thread
 Skin- dusky and mottoled
 Restless, confused and comatose

46. 3. Bulbo-spinal poliomyelitis
 Accounts for 19% of paralytic cases.
 Affects extremities and cranial nerves.
 Leads to severe respiratory involvement.
 Combination of spinal paralytic and bulbar polio.

47. Polio encephalitis
 Occurs in rare cases
 Causes inflammation of gray matter of brain
 Autonomic dysfunction is common and it has a high
mortality
Signs & Symptoms:-
 Agitation,
 Confusion,
 Stupor
 coma
 Irritability
 Delirium

48.  Disorientation
 Tremors
 Convulsions
 Paralysis of upper motor neuron type
Residual paralysis
 Acute phase of illness lasts for 0-4 weeks
 Recovery- variable
 At 60 days mild to severe residual paresis
 Maximum recovery up to first 6 months
 Slow recovery up to 2 years.
 After 2 years post polio residual paralysis persists

49. DIAGNOSIS
1. History,
2. Clinical examination,
3. Stool examination,
4. CSF examination,
5. Serological tests

50. Stool examination
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.
Collection of sample:-
 2 samples 24hr apart
 Within 14 days of onset of paralysis
 8-10 grams or thumb size
 Collection in a clean wide mouth bottle- plastic or glass
with screw cap

51. Cont…
 Sample stored below 8oC
 No dessication or leakage till received at WHO accredited
lab
 If paralysis detected after 2 weeks sample taken up to
60days after onset.
Contact sampling:-
 Done when child has died without adequate stool
sampling,
 5 children in close contact with the child are taken
 Single stool sample collected

52. CSF examination
 Infection with polio virus may cause an increased number
of white blood cells and a mildly elevated protein level in
cerebrospinal fluid
Sr. no. Characteristics Observation
1. Appearance Clear/slightly turbid
2.
Cells 0-5 cells/µL (< 2
polymorphonucleocytes)
Leukocytosis (mainly
lymphocytes)
3. Proteins < 45 of serum protein
Normal/slightly raised
100-300 mg/dL
4. Glucose >60% of serum glucose Normal

53. Serological tests
 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.
Three types of antibodies
 Neutralizing antibodies (IgG)
 Antibodies to C antigen (IgM)
 Anti –D antibodies

54. Complement fixation test:-
 Detects IgM and anti D antibodies
 Identifies exposure to poliovirus not for type- specific
diagnosis
 Less often employed

55. Differential diagnosis
 GB syndrome
 Transverse myelitis
Others
 Traumatic neuritis
 Meningitis
 Encephalitis
 Toxin- diphtheria and botulism

56. TREATMENT
Symptomatic and supportive
The goal of the treatment is to control symptoms while
the infection runs its course as there is no specific
treatment for the viral infection.
Treatment may includes :
 Hospitalization (may be required for those individuals who
develop paralytic poliomyelitis).
 If the respiratory is involved, LONG-TERM VENTILATION
is necessary.

57. Cont…
 Catheterization of distended bladder may be
necessary.
 Antibiotic for urinary tract infection.
 Moist heat to reduce pain and muscle spasm
 Pain killer to reduce muscle pain, headache (such
as acetaminophen).
 Physical therapy, braces or corrective shoes, or
orthopedic surgery to help recover muscle strength &
function

58. Bed rest
 Essential during acute phase:- physical activity and trauma
increases risk of paralytic polio
 Posture to be changed every 2-3hrs.
 Child to be placed on stomach for short period each day,
to prevent pneumonia
Optimum position for limbs
 Hip- slight flexion
 Knee- 5o flexion
 Foot- 90o support against the sole

59. Pain relief
 Sister Kenny’s treatment:- hot moist packs applied to the
muscles to relieve pain and spasm.
 Analgesics
 Physiotherapy
 Method
 Joints and paralysed muscles- moved passively through full
range for 10min., 2-3times/day
 Benefits
 Prevents deformities and contracture
 Promote development of muscle power in paralysed muscles.

60. Physiotherapy
Method
 Joints and paralysed
muscles- moved passively
through full range for
10min., 2-3times/day.
Benefits
 Prevents deformities and
contracture
 Promote development of
muscle power in paralysed
muscles.

61. Good nursing
 Team approach is
essential
 Nursing staff is an
important part in patient
care.

62. Diet
 Nutritious, balanced and wholesome
 In non-paralytic polio- normal diet
 In paralytic polio- fed by naso-gastric tube, calories/kg
body weight.
 In dysphasia patients nursed in prone position with foot
end raised- gravity drainage of
pooled secretions in pharynx.
 Or intermittent suction
 Tracheostomy
 Respiratory failure- assisted respiration
with mechanical ventilator.

63. Indications for hospitalization
 Paralysis of upper limbs <3 days duration
 Progression of paralysis
 Bulbar involvement
 Respiratory distress
 Marked drowsiness
 Complications

64. Rehabilitation
Physical
 Physical therapy is recommended for full recovery.
 Passive stretching exercises and wedging casts can be used for
mild to moderate contractures.
 Surgical release of tight fascia and muscle aponeuroses and
lengthening of tendons may be necessary for contractures
persisting longer than 6 months.
Orthoses should be used until no further recovery is anticipated.
 Static joint instability can be controlled by Orthoses.
 Dynamic joint instability result in a fixed deformity that
cannot be controlled by Orthoses.

66. Emotional and
psychological: It is
mainly emotional
support to the child
helps prepare himself
for better adjustment
in life despite the
handicap.

67. Occupational Therapy
 Occupational therapy (OT) provides purposeful activities
or interventions in order to promote function, health, and
wellness and to prevent further injury or disability.
 The goal is to assist survivors in achieving
their maximum level of independence.
 To be seen by an occupational therapist, a referral by a
physician is usually required.

68. Recreational Therapy
 Patients may attend leisure activities to reduce stress and
learn how to get involved in group activities

69. Speech Therapy
 Patients with cranial nerve involvement may develop
swallowing dysfunction. To protect the airway and prevent
aspiration pneumonia, a speech therapist needs to be
involved early to perform an evaluation of the safety of
swallowing.
 Decisions on the appropriate consistency of oral foods and
use of various strategies/techniques greatly reduce the risk
of aspiration.
 Periodic follow up of patient status can be performed with
serial video swallow testing.

70. COMPLICATIONS
1. Myocarditis
2. Hypertension
3. Pulmonary edema
4. Pneumonia
5. Urinary tract infections
6. Compression neuropathy
7. Scoliosis
8. Osteoporosis
9. Bone fractures
10. Skeletal deformities-
Equinus foot

71. NURSING MANAGEMENT
Nursing Diagnosis
 Imbalanced Nutrition: Less Than Body Requirements
related to anorexia, nausea and vomiting
 Ineffective Thermoregulation related to the infection
process
 Ineffective Airway Clearance related to muscle paralysis
 Ineffective Breathing Pattern related to muscle paralysis
 Acute pain related to the infection that attacks the nerve
 Impaired physical mobility related to paralysis
 Anxiety: in children and families related to disease
conditions.

72. 1. Imbalanced Nutrition: Less Than Body Requirements
related to anorexia, nausea and vomiting
 Nursing intervention
 Encourage frequent small meals to promote nutritional and
fluid intake.
 Maintain naso-gastric tube feeding, if ordered.
 Hyper alimentation may be necessary to ensure adequate
nutrition.
 Eliminate unpleasant stimuli and odors from the environment
during meals.
 Monitor skin turgor every shift.
 Involve a nutritionist in planning a diet for the child that
includes favorite foods.

73. 2. Ineffective Thermoregulation related to the infection
process
Nursing Intervention
 Reduce or eliminate the sources of heat loss in infants:
 When a shower, prepare a warm environment.
 Avoid the flow of air (air conditioning, ceiling fan,
open vent)
 Warm all the goods for care (stethoscope, scales,
hand care givers, clothes, bed linen)
 Place the baby swing bed away from the wall
(outside) or window if possible.

74.  Monitor the baby's body temperature
 If the temperature is below normal
 Use with two blankets
 Wear headgear
 Assess the environmental sources for heat loss
 If hypothermia settled more than 1 hour, refer to the more
expert.
 Review of the complications of cold stress, hypoxia,
respiratory acidosis, hypoglycemia, fluid and electrolyte
imbalance, weight loss.

75.  If the temperature is above normal
 Remove the blanket
 Remove the headgear, when worn
 Assess the environmental temperature again
 If the temperature hyperthermia settled more than 1
hour, report the physician.
 Teach caregivers why babies are vulnerable to temperature
(hot and cold)
 Demonstrate how to save heat during the bath.

76. 3.Ineffective Airway Clearance related to muscle paralysis.
Nursing Interventions
 Assess respiratory rate, depth, rythm, effort, and breath
sounds.
 Position: HOB elevated.
 Promote o ptimum level of activity for best possible lung
expansion, Ambulate.
 Suction per: Nasal, Oral, Tracheal

77. 4. Acute pain related to the infection that attacks the nerve
Nursing Interventions
 Analgesic Administration
 Pain Management
 Patient-Controlled Analgesia Assistance

78. 5. Impaired physical mobility related to paralysis
Nursing Interventions
 Exercise Therapy: Ambulation
 Joint Mobility
 Fall Precautions
 Positioning
 Bed Rest Care

79. PROGNOSIS
 Non paralytic cases- complete recovery
 Paralytic polio- permanent weakness in 2/3rd cases
 Worse- older children , sudden onset of illness with high
fever.

80. POST POLIO SYNDROME
 Observed in people who had polio during their childhood,
having complete recovery but may develop signs of polio
in later stage.
 Affects about 25-50% of the polio survivors.
 More common in females.

81. Common signs and symptoms:
 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
 Cognitive problems, such as concentration and memory
difficulties
 Depression or mood swings

82. 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.

83. Cont…
 Global Polio Eradication Initiative launched in 1988.
 Polio cases have decreased by over 99% since 1988, from
an estimated 3,50,000 cases then, to 1,604 reported cases
in 2009.
 In 2010, only four countries in the world remain polio-
endemic, down from more than 125 in 1988. The
remaining countries are Afghanistan, India, Nigeria and
Pakistan.

84. Core strategies of GPEI (Global Polio
Eradication Initiative)
1. High infant immunization coverage with four doses of oral
poliovirus vaccine (OPV) in the first year of life
2. Supplementary doses of OPV to all children under five
years of age during PPI.
3. AFP (acute flaccid paralysis) surveillance among children
under fifteen years of age.
4. Targeted “mop-up” campaigns once wild poliovirus
transmission is limited to a specific focal area.

85. 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).

86. Type of vaccine ADVANTAGES DISADVANTAGES
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
immune-deficient persons or in
household contacts of immune-
deficient persons.
• 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
• Less expensive
• Produces excellent intestinal
immunity which helps.
• Prevent infection with wild virus
• May cause vaccine-
associated paralytic
polio

87.  GUIDE ON POLIOMYELITIS IMMUNIZATION
Rationale for IPV
use
- Lowers the risk of reemergence of type 2 wild and vaccine-derived poliovirus and
facilitates control and interruption of reintroduced type 2 polioviruses in
conjunction with targeted use of monovalent OPV.
Type of vaccine - Inactivated (killed) vaccine with types 1,2,&3 antigens
- Antigen dose 40-8-32 for each vaccine type
Route of adm. - Intramuscular or subcutaneous injection
Immunization
Schedule
-WHO recommends 1 dose of IPV with DTP3 and OPV3 which is typically
recommended at 14 weeks or at 4 months, based on country EPI schedules and
SAGE recommendations.
Volume per dose - Each dose is 0.5 ml
Storage conditions:
heat & freeze
sensitivity
- Store at 2°C to 8°C. DO NOT FREEZE
- DISCARD opened vial at the end of the vaccination session or after 6 hours
whichever comes first—do not return open vial to refrigerator.
Presentation & vial
size
- WHO prequalified in stand-alone 1 and 10 dose vials (5-dose vials anticipated in
the second half of 2014)
Package volume per
dose
- 1-dose presentation: 1, 10, & 50 vial cartons with volume per dose (cm3) of 101.4,
26.8, and 12.9 respectively
- 5-dose presentations (volume information pending)
- 10-dose presentation: 10 vials cartons with volume per dose (cm3) of 2.46
Co-administration
with other vaccines
-Can be co-administered with other injectable vaccines but with separate syringe in
a separate injection site (at least 2.5 cm apart)
- IPV can be co-administered with OPV in the same session.

88.  (OPV)
Route Oral
Site Mouth
Number of Dose 3 doses
Age at First Dose 6 weeks after birth
Minimum Intervals between Doses 4 weeks
Dosage 2 drops
Storage Temperature -15 to -25 °C

89. Polio Vaccine Adverse Reactions
 Rare local reactions (IPV)
 No serious reactions to IPV have been documented
 Paralytic poliomyelitis (OPV)
Polio Vaccine Contraindications and Precautions
 Severe allergic reaction to a vaccine component or
following a prior dose of vaccine
 Moderate or severe acute illness

90. Vaccine-Associated Paralytic Polio
 Mutation of the vaccine inside the body may cause lose of attenuation
(itself brought on by reversion) leads to paralytic polio
 Increased risk in persons >18 years & those with immunodeficiency
(B cell)
 No procedure available for identifying persons at risk of paralytic disease
 5-10 cases per year with exclusive use of OPV
 2005 in India: Wild case: 66; VAPP 180,
 Many countries switched to sequential IPV-OPV and then only IPV
schedules once the number of VAPP cases exceeded wild polio cases.

91. POLIO & ITS PREVENTION IN INDIA
 India was one of the four countries with wild polio virus in
2010.
 Most cases were reported from Bihar & UP
 Cases seen in various states of north India were due to
import from their 2 states
 2010 – 42 cases
 Last case of type 2 in 1999
 Last WPV3 Oct 2010
 Last WPV1 Jan 2011
 Polio free country – Jan 2014

92. Celebrity Engagement For a Public Cause
 Celebrity endorsement is a technique of brand / advertising
campaign that involves a famous person using their fame to
help them in promoting a product /service .
 Attracting users
 Put life into the cause
 Build awareness
 Influence behavior
 Positioning

93. The Major Campaign
“Do Boond Zindagi Ki”
 Translated meaning : “Two drops of Life”.
 Meaning: This meant two drops that had the power to
decide whether a child will walk , limp or die .

94. Polio Vaccination under UIP (universal immunization
programme)
Age Vaccine
Birth OPV0
6 wks OPV1
10 wks OPV2
14 wks OPV3
16-24 Months OPV4
 Two drops of OPV is used
 Nose should not be pinched
 Instead apply pressure to both side of mouth
 Breast feeding is not contraindicated
 Hot liquids to be avoided for ½ hr after OPV

95. Pulse Polio Immunization (PPI)
 The supplementary immunization activities (SIAs) in India
launched in 1995
 Irrespective of the immunisation status
 Usually Dec & Jan – Peak transmission
 Providing additional OPV doses to every child aged <5 years at
intervals of 4-6 weeks during National Immunization Days
(NIDs) & sub-National Immunization Days (SNID's)
 It “Flood” the community with OPV within a very short period
of time, thereby interrupting transmission of virus throughout
the community.
 Intensification - house-to-house “search and vaccinate”
component.
 The number of PPI rounds is determined by the extent of
poliovirus transmission in the country.

96. Vaccine Vial Monitoring
 The vaccine vial monitor is a
small thermo chromic sticker on
the vaccine vial and changes
colour as the vaccine is exposed
to heat.
 The colour of the sticker tells
whether the vaccine must be
discarded due to excessive heat
exposure.
 It reduces uncertainty and waste.

97. Feelings of a child with polio-Addie Flowers Vance,
Charlotte, Mecklenburg County, 1996
"I won’t ever forget the feeling in my legs when I lost the
use of them. It was just such a weird feeling. It was just
like it went through me, just a surge went through my
body. I can feel it right now just thinking about it. It
was very frightening for a little 14-year-old girl to
think, gosh, my life’s gone, you know?”

98. 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 .

99. Case Study: Polio
 Polio has been around for thousands of years, but it had
generally been a mild disease. When sanitation techniques
improved at the end of the 19th century, people stopped getting
the mild form of polio when they were babies. Instead, older
children and adults got a more serious illness that was
extremely contagious, and yet no one knew how it was
transmitted.
 Animal research was crucial to identifying what caused polio
and finding a vaccine. In 1908 Drs. Karl Landsteiner and Erwin
Popper proved that polio was an infectious disease by showing
that monkeys injected with tissue from a person who died of
polio would become ill with the disease. We now know that
polio is transmitted when bodily wastes from a person who has
the disease contaminate food or water, which then is ingested
by another person.

100.  Polio was difficult to stop because it is caused by a virus.
Antibiotics such as penicillin were considered "wonder drugs" in
the 1940s because they could cure bacterial infections, but they
were useless against polio. Viruses are also harder to isolate than
bacteria. In 1949 Drs. John Enders, Frederick Robbins, and
Thomas Weller made a breakthrough when they figured out how
to grow the polio virus in cell cultures. This achievement earned
them a Nobel Prize.
 During the 1950s, Drs. Jonas Salk and Albert Sabin developed
two different polio vaccines. These vaccines "teach" the immune
system how to defend itself against polio by exposure to the virus
in a killed or weakened form. The vaccines were tested in
animals to make sure that they were safe and effective before
they were used in people.
 Today polio has been virtually eradicated in the industrialized
world, but it remains a problem in some developing countries.

101. BIBLIOGRAPHY
 O.P. Ghai et al. Essential Pediatric. CBS Publishers & distributors; 2009.
 Park JE Textbook of preventive and social medicine ; a treatise on
community health. Banarsidas Bhanot; 1972.
 Fauci AS, Eugene B, M.D SLH, M.D DLL, JJ, Joseph L. Harrison’s
principles of internal medicine. McGraw- Hill; 2008.
 Bradford, Mak, Carrie Palmer, and Fiona Kouyoumdjian. "Vaccine
Strategies." N.p. Brown.edu. N.d. Web. 27 Apr. 2011.
 Wilson, Daniel J. Living with Polio: The Epidemic and Its Survivors.
Chicago: University of Chicago, 2005. Print.
 www.nursing-help.com › Nursing Care Plans