Briefly description of poliomyelitis how it occur qnd its prevention

1. Tropical and Communicable Diseases
Poliomyelitis
15-04-2023

2. Objectives
By the end of session the students will be able to:
Define poliomyelitis
Describe the types of poliomyelitis
Discuss clinical manifestation.
Discuss management of poliomyelitis
Explain the role of nurse in prevention and control of Poliomyelitis.
Learning material (Video clips and articles).

3. Poliomyelitis
Poliomyelitis or Polio is a virus infection of cranial nerve
nuclei in the brain stem leading to temporary or permanent
paralysis of muscles that they activate.The virus affects
children under 5 years of age.
The word poliomyelitis originates from the Greek word
“polio” meaning “grey” and “myelon” meaning
“marrow.” The poliovirus, a member of the genus
Enterovirus, belonging to the Picornaviridae family.

4. Humans are the only known natural host; however, poliovirus can
replicate in other e.g monkeys.
Mode of transmission: The spread is mainly by fecal/food contamination
route and by droplet infection. Poliovirus is an Enterovirus that colonises the
GIT.
Polio (baby paralysis) is a communicable disease, polio spreads through
human-to-human contact, usually entering the body through the mouth due
to faecally contaminated water or food.
Sometimes poliovirus is spread through saliva from an infected person or
droplets expelled when an infected person sneezes or coughs. People become
infected when they inhale airborne droplets or touch something
contaminated with the infected saliva or droplets.
The infection usually begins in the intestine.

5. Types of poliomyelitis/Epidemology of poliovirus
• Type-1: Brunhilde, Type-2: Lanchi, Type-3: Leon.
People must protect themselves against all three types of the virus to prevent
polio disease. Polio vaccination is the best protection.
• Type 2 poliovirus was declared eradicated in September 2015.
The last detection was in India, 1999. Type 3 poliovirus was declared
eradicated in October 2019. It was last detected in November 2012. Only
type 1 poliovirus remains.

6. Poliovirus DNA or RNA virus?
• Poliovirus, the perfect picornavirus and causative agent of poliomyelitis,
is a non enveloped virus with a single-stranded RNA genome of
positive polarity.
• Anyone who is not fully vaccinated against polio is at risk for polio.
• However, there are some situations that put people at increased risk for
exposure to polio such as: Travelers who have recently visited polio
endemic countries (Afghanistan and Pakistan) or countries experiencing
polio outbreaks.

7. Stages
Alimentary Stage:
After gaining access to the body through the nasopharynx on the GIT,
the virus multiplies in the epithelial cells of the intestinal mucosa.
Viremic Stage:
The virus spreads through the blood stream and after a sort of conflict
between the virus and the antibodies, in case the virus turns victorious
then it leads to the third stage.
Neural Stage:
The virus finds its way to the anterior horn cells of the spinal cord and
nerve cells in the brain stem..

8. Clinical features
The course of the disease is divided into four stages
• Prodromal Stage or Pre-Paralytic Stage:
Few hours to a few days and 1 to 3 days is the usual duration.
Signs and Symptoms
• Headache, Sore throat, Malaise. Slight Cough.
• Diarrhea or constipation.
• Backache. Joint pains. Mild neck stiffness. Irritability.
• Pyrexia (raised body temperature) of variable duration and
severity.
Treatment
The only practical measures which can be taken is to stop the playing of
games and other such manual work if possible. An additional booster
dose may be given

9. • Acute Stage: 3 to 6 weeks from the onset of Poliomyelitis.
Signs and Symptoms
• Muscle tenderness is the most important sign seen in this
stage.
• To test this press the calf muscles when child is quiet. If he
cries, he has tenderness.
Treatment
• Rest, Isolation
• Booster dose
• Nutrition (diet rich in" Protein“).
• Massage should not be given as it may cause more damage
due to which the patient may not be able to walk later on.

10. • Convalescent ( recovering from an illness) Stage: Duration 3 months.
Signs and Symptoms
• Spinal Type: The" lower limb muscles are more often involved". Flexion
contractures of hip, knee and equinus (upward bending motion of the ankle
joint is limited) deformity of the ankle are common.
• Bulbar Type: The most important sign of Bulbar paralysis is the '' inability to
swallow" due o pharyngeal paralysis. The "early signs" of respiratory
involvement includes breathing, feeling of suffocation, slight cyanosis, use of
sternomastoids, and other accessory muscles of respiration.
• Spinobulbar: This type has a combination of both spinal and bulbar type.
• Postencephalic: Mental disturbance, coma, paralysis of facial muscles,
symptoms similar to meningitis like headache, vomiting, neck stiffness may
occur

11. Convalescent Stage:
Treatment
• Muscle Charting (assessment of muscle strength)
• Positioning.
• Changing the position, Turning the patient every 2 to 4 hours and
night prevents bed sores and keeps the skin dry.
Stage of Recovery: This stage extends for almost 2 years. Thus muscle
in the polio patient can be strengthened to their maximum capacity up to
2 years.

12. Stage of Residual Paralysis (Post-Polio Syndrome)
• Treatment
• Patient is given combination of stretching and strengthening.
• Tailor-made calipers can prevent the deformity from aggravating.
• Tendon transfers may be done for compromising balance on that
side.
• Arthrodesis (the uniting of two bones at a joint)
• Common Problems Encountered by Polio Patients
• Muscle weakness
• Bony Changes are common changes as Shortening,
Deformities.

13. What are the signs of polio in a child?
A mild and short course of the disease with one or more symptoms:
Fever (up to 103 degrees Fahrenheit or 39.4 degrees Celsius)
Decreased appetite, nausea and/or vomiting, sore throat, malaise (not
feeling well), constipation, or abdominal pain.
Non paralytic/paralytic poliomyelitis.

14. Complications of polio?
The most severe complication of polio is paralysis. This can lead to
problems with breathing, swallowing, and bowel and bladder function.
Post-polio syndrome can happen many years after the initial infection.
Blood tests
Blood is tested for antibodies for polio virus. Antibodies are
molecules that are produced by the body against an invading virus or
bacteria. When a person is infected with polio virus, tests can detect the
levels of polio virus specific antibodies and confirm the diagnosis.

15. Management of poliomyelitis
• The oral poliovirus vaccine (OPV) is used in many countries to protect
against polio disease. Oral poliovirus vaccine contains attenuated or
weakened version of either one (monovalent OPV; a vaccine with one
strain of a virus), two (bivalent OPV), or all three (trivalent OPV)
poliovirus types.
• Inactivated poliovirus vaccine (IPV) protects people against all three
types of poliovirus. IPV does not contain live virus and cannot cause
disease. It protects people from polio disease but does not stop
transmission of the virus.
• A ventilator (a device that helps you breathe)
• Physical therapy that can help keep your muscles working.
• Bed rest and rich diet.
• Antispasmodic medications to relax muscles.

16. Physiotherapy Management
Acute Stage
Correct handling technique: Child should not be lifted by one hand. While carrying the
child, they should be held in front and preferably with the Hip in extension without any
abduction.
Splinting and correct positioning: Splinting-Lower limb to be immobilized to prevent
further damage to the muscles. Gentle passive movement.
Convalescent Stage
• Continuous Splintage: Above knee splint or L splint, Below knee splint.
• Muscle Charting. Stretching, Stimulation and facilitation technique.
Stage of recovery
• Various strengthening techniques. Sensory integration, Resisted exercises with springs
and pulleys, Hydrotherapy and suspension, Play therapy.

17. Prevention and control of Poliomyelitis.
• Immunisation is the cornerstone of polio eradication. Two types of
vaccine are available:
• An inactivated poliovirus vaccine (IPV)
• A live attenuated OPV.
Oral polio vaccine has been the vaccine used largely in the past in
global campaigns and is still used in endemic areas.

18. References
Brown B, Oberste MS, Maher K, Pallansch MA. J Virol. 2003 Aug;77(16):8973-84.
Greene SA, Ahmed J, Datta SD, Burns CC, Quddus A, Vertefeuille JF, Wassilak SGF.
Progress Toward Polio Eradication - Worldwide, January 2017-March 2019.
Mehndiratta MM, Mehndiratta P, Pande R. Poliomyelitis: historical facts, epidemiology,
and current challenges in eradication. Neurohospitalist. 2014 Oct;4(4):223-9.
McBean AM, Thoms ML, Albrecht P, Cuthie JC, Bernier R. Serologic response to oral
polio vaccine and enhanced-potency inactivated polio vaccines. Am J Epidemiol. 1988
Sep;128(3):615-28.