A brief discussion about POLIO... Though WHO declare Bangladesh as a polio free country it had a lot of hazardous effects in the past and we were the most sufferer country among all the countries... We thank our Govt. without their help we could not be able to call ourselves a polio free country... In this document I try my best to give you all a clear concept...... Hope it'll help everyone.....

1. Poliomyelitis
The history of poliomyelitis (polio) infections extends into prehistory. Although
major polio epidemics were unknown before the 20th century, the disease has
caused paralysis and death for much of human history. Over millennia, polio
survived quietly as an endemic pathogen until the 1900s when major epidemics
began to occur in Europe; soonafter, widespread epidemics appeared in the United
States. By 1910, frequent epidemics became regular events throughout the
developed world, primarily in cities during the summer months. At its peak in the
1940s and 1950s, polio would paralyze or kill over half a million people
worldwide every year.
Poliomyelitis
Poliomyelitis (polio) is a highly infectious viral disease, which mainly affects
young children. The virus is transmitted by person-to-personspread mainly
through the faecal-oral route or, less frequently, by a common vehicle (e.g.
contaminated water or food)and multiplies in the intestine, from where it can
invade the nervous system and can cause paralysis.
Initial symptoms of polio include fever, fatigue, headache, vomiting, stiffness in
the neck, and pain in the limbs. In a small proportion of cases, the disease causes
paralysis, which is often permanent. There is no cure for polio, it can only be
prevented by immunization.

2. Treatment history of Poliomyelitis – At first in 1789, British physician
Michael Underwood provides first clinical description of the disease. In 1921, Franklin
Delano Roosevelt (FDR) contracts polio at age 39. His example has a major impact
on public perceptions of individuals with disabilities. Although FDR is open about
having had polio, he conceals the extent of his disability, who dies in 1945 on
April 12. At the year between 1947-50, Dr. Jonas Salk is recruited by the
University of Pittsburgh to develop a virus research program and receives grant to
begin a polio typing project. He uses tissue culture method of growing the virus,
developed in 1949 by John Enders, Frederick Robbins, and Thomas Weller at
Harvard University.
1953, Salk and his associates develop a potentially safe, inactivated (killed),
injected polio vaccine.
1954, nearly two million children participate in the field trials.
1955, news of the success ofthe trials is announced by Dr. Thomas Francis in a
formal press conference at Ann Arbor, Michigan, on April 12, the tenth
anniversary of FDR's death. The news was broadcastbothon television and radio,
and church bells rang in cities around the United States.
1955 - 57, incidence of polio in the U.S. falls by 85 - 90%.
Key facts of poliomyelitis

3.  Polio (poliomyelitis) mainly affects children under 5 years of age.
 1 in 200 infections leads to irreversible paralysis. Among those paralysed,
5% to 10% die when their breathing muscles become immobilized.
 Polio cases have decreased by over 99% since 1988, from an estimated 350
000 cases then, to 74 reported cases in 2015. The reduction is the result of
the global effort to eradicate the disease.
 As long as a single child remains infected, children in all countries are at risk
of contracting polio. Failure to eradicate polio from these last remaining
strongholds could result in as many as 200 000 new cases every year, within
10 years, all over the world.
 In most countries, the global effort has expanded capacities to tackle other
infectious diseases by building effective surveillance and immunization
systems.
Symptoms of poliomyelitis
Although polio can cause paralysis and death, the vast majority of people who
are infected with the poliovirus don'tbecome sick and are never aware they've
been infected with polio.
Non-paralytic polio
Some people who develop symptoms from the poliovirus contractnonparalytic
polio — a type of polio that doesn'tlead to paralysis (abortive polio). This usually
causes the same mild, flu-like signs and symptoms typical of other viral illnesses.
Signs and symptoms, which generally last one to 10 days, include:
 Fever
 Sore throat
 Headache
 Vomiting
 Fatigue
 Back pain or stiffness
 Neck pain or stiffness
 Pain or stiffness in the arms or legs
 Muscle weakness or tenderness
 Meningitis
Paralytic polio

4. In rare cases, poliovirus infection leads to paralytic polio, the most serious form of
the disease. Paralytic polio has several types, based on the part of your bodythat's
affected — spinal cord (spinal polio), brainstem (bulbar polio) or both (bulbospinal
polio).
Initial signs and symptoms of paralytic polio, such as fever and headache, often
mimic those of non-paralytic polio. Within a week, however, signs and symptoms
specific to paralytic polio appear, including:
 Loss of reflexes
 Severe muscle aches or weakness
 Looseand floppy limbs (flaccid paralysis), often worse on one side of the
body
Post-polio syndrome
Post-polio syndrome is a cluster of disabling signs and symptoms that affect some
people several years — an average of 35 years — after they had polio. Common
signs and symptoms include:
 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
Transmission of poliovirus
As a highly contagious virus, polio transmits through contact with infected feces.
Objects like toys that have come near infected feces can also transmit the virus.
Sometimes it can transmit through a sneeze or a cough, as the virus lives in the
throat and intestines. This is less common.
People living in areas with limited access to running water or flush toilets often
contract polio from drinking water contaminated by infected human waste.

5. According to the Mayo Clinic, the virus is so contagious that anyone living with
someone who has the virus can catch it too.
Pregnant women, people with weakened immune systems — such as those who are
HIV-positive — and young children are the most susceptible to the poliovirus.
If any personhas not been vaccinated, he can increase his risk of contracting polio
when he:
 travel to an area that has had a recent polio outbreak
 take care of or live with someone infected with polio
 handle a laboratory specimen of the virus
 have your tonsils removed
 have extreme stress or strenuous activity after exposure to the virus.
Life-cycle of Poliovirus

7. Diagnosis ofpoliovirus
Poliovirus can be detected in specimens from the throat, and feces (stool), and
occasionally cerebrospinal fluid (CSF), by isolating the virus in cell culture or by
detecting the virus by polymerase chain reaction (PCR).
CDC laboratories conducttesting for poliovirus including:
 Culture
 Intratypic differentiation
 Genome sequencing
 Serology
Virus Isolation
Virus isolation in culture is the most sensitive method to diagnose poliovirus
infection. Poliovirus is most likely to be isolated from stoolspecimens. It may also
be isolated from pharyngeal swabs. Isolation is less likely from blood or CSF.
To increase the probability of isolating poliovirus, collect at least two stool
specimens 24 hours apart from patients with suspected poliomyelitis. These
should be collected as early in the courseof disease as possible (ideally within 14
days after onset).
Real-time reverse transcription PCR is used to differentiate possible wild strains
from vaccine-like strains (“intratypic differentiation”), using virus isolated in
culture as the starting material.
Partial genome sequencing is used to confirm the poliovirus genotype and
determine its likely geographic origin.
Serologic testing
Serology may be helpful in supporting the diagnosis of paralytic poliomyelitis,
particularly if a patient is known or suspected to not be vaccinated. An acute serum
specimen should be obtained as early in the courseof disease as possible, and a
convalescent specimen should be obtained at least three weeks later.

8. CSF analysis
Detection of poliovirus in CSF is uncommon. CSF usually contains an increased
number of leukocytes [from 10 to 200 cells/mm3 (primarily lymphocytes)] and a
mildly elevated protein (from 40 to 50 mg/100 ml). These findings are nonspecific
and may result from a variety of infectious and noninfectious conditions.
Treatment including Polio
No antivirals are effective against polioviruses.T he treatment of poliomyelitis is mainly
supportive:
o Analgesia is indicated in cases of myalgias or headache.
o Mechanical ventilation is often needed in patients with bulbar paralysis.
o Tracheostomycare is often needed in patients who require long-term
ventilatory support.
o Physical therapy is indicated in cases of paralytic disease. In paralytic disease,
provide frequent mobilization to avoid development of chronic decubitus
ulcerations. Active and passive motion exercises are indicated during the
convalescent stage.
o Fecal impaction is frequent in cases of paralytic disease and can be treated with
laxatives as soonas it develops.
In advanced cases of leg weakness, you may need a wheelchair or other mobility
device.
Prevention of Polio
Although improved public sanitation and careful personal hygiene may help reduce
the spread of polio, the most effective way to prevent the disease is with polio
vaccine.
Polio vaccine
Currently, most children in the United States receive four doses ofinactivated
poliovirus vaccine (IPV) at the following ages:
 Two months
 Four months
 Between 6 and 18 months
 Between ages 4 and 6 when children are just entering school

9. IPV is 90 percent effective after two shots and 99 percent effective after three. It
can't cause polio and is safe for people with weakened immune systems, although
it's not certain just how protective the vaccine may be in cases of severe immune
deficiency. Common side effects are pain and redness at the injection site.
Allergic reaction to the vaccine
Signs and symptoms of an allergic reaction usually occurwithin minutes to a few
hours after the shotand may include:
 Difficulty breathing
 Weakness
 Hoarseness or wheezing
 Rapid heart rate
 Hives
 Dizziness
 Unusual paleness
 Swelling of the throat
Recovery after poliomyelitis
Acute phase: (i.e. the first half-year) is a time when there can be alot of pain,
so children are often left to lie quietly. This frequently results in contractures.
The incidence of contractures can be markedly reduced with gentle exercises
and proper positioning.
Convalescent phase: (i.e. the next 2−3 years) is a time when there may be
some gradual recovery of muscle strength. Exercises to prevent contractures
are continued, and an effort is made to gradually get the child active.
Chronic phase: After 2−3 years, recovery of muscle strength stops. At this
point, plans need to be made to get the child up and walking if possible, using
crutches and/or orthoses. During this phase, surgery is often needed to allow
the child to fit comfortably into the orthosis, or to move muscles into a
different position to reduce deformity due to uneven muscle pull. In
Tajikistan, by 2015, all children who contracted poliomyelitis during the
2010 epidemic will now be in the chronic phase of rehabilitation, which lasts
for the rest of the child’s life.
CHILDREN WITH CHRONIC POLIOMYELITIS PARALYSIS

10. Rehabilitation plan : Doctors and therapists need to decide what each
child will be capable of doing within the limits of his/her muscle
weakness. This is recorded in a rehabilitation plan. Part of the planning is
to decide what sort of assistive devices the child needs.
Exercises to reduce contractures :
 Range -of -motion exercises - Each joint in the bodycan move a specific
amount. We call this the “range of motion” of the joint. Through passive and
active range -of-motion exercises, we try to maintain the normal amount of
movement in all joints in order to prevent contractures.
 Positioning - Ensuring that the child sits with his/her feet flat on the
floor in a child - sized chair (proper positioning) can help to prevent the
development of foot contractures. Making certain that the person does not
always lie or sit in one position can help to prevent tightness and contractures.
 Assistive devices
1) A splint is a device designed to keep a part of the body in a normal position of
asymmetrical posture. A splint may be used to facilitate and assist movement,
support weak muscles and avoid contractures and deformities. A splint may
be used during therapy (for standing and walking) or for a short period of
time after surgery or trauma to support a body part during healing. Sometimes,
a splint is used at night when the child sleeps. The use of a night splint is
suggested when a major goal is to avoid deformities and contractures.
2) An orthosis provides support for a weak body part and thus allow s a
person to function better, e.g. to walk. If poliomyelitis has left a child with
permanent muscle weakness (paralysis), an orthosis will be needed for life.
For example, if the thigh muscles (quadriceps) are too weak to straighten the
child’s knee, using an orthosis may allow the child to walk.
Survey on Bangladesh about Poliomyelitis

11. Bangladesh along with 10 other countries of WHO South-EastAsia Region was
certified polio-freein 2014 by an independent commission under the WHO
certification process. South-EastAsia Region is home to a quarter of the world’s
population.
This is the fourth of six WHO Regions to be certified, marking an important step
towards globalpolio eradication.
With this step, 80% of the world’s population now lives in certified polio-free
regions according to a WHO press release.
According to WHO, only 2% of Bangladeshi children under 5 years old were
immunized before1985, butthis number jumped to 60% within 10 years
following the introduction of routine immunizations in 1985. This was the time
when more and more people became confident of the positive impact of vaccines
on their children’s welfare. The motivation of parents and caregivers for child
vaccination made polio immunization events morepopular and successful. The
country has to date observed 21 National Immunization Days for polio; the one in
January 2014 reached confirmed coverageof 100%.
Reference
1. euro.who.int
2. Wikipedia,
3. who.int/en/
4. cdc.gov
5. myoclinic.com
6. National museum of American history
7. medscape.com
8. theindependentbd.com