This document provides information about poliomyelitis (polio). It begins by defining the objectives of the document, which are to define polio, explore its history and pathogenesis, describe the types and clinical manifestations, discuss management, and explain the nurse's role in prevention. It then provides key facts about polio, statistics on outcomes of paralysis, highlights from the history of polio research, global eradication efforts and statistics on cases in Pakistan. The document discusses the virus, pathogenesis, clinical manifestations including paralysis, management including rest and ventilation, and the nurse's role in vaccination and education.

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2. POLIOMYELITIS
Pervez Ali Mangne
(Generic BSN)
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3. By the end of this session the Participants will be able to:
 Define Poliomyelitis
 Explore the History of Poliomyelitis
 Define Pathogenesis of Polio Virus
 Describe the types of Poliomyelitis
 Discuss clinical Manifestation of Poliomyelitis
 Discuss Management of Poliomyelitis
 Explain the role of nurse in prevention
and control of poliomyelitis.
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4. Key Facts:
• Poliomyelitis is an acute infection.
• It is primarily an infection of the human alimentary tract.
• It invades the nervous system, and can cause total paralysis in matter of hours.
• Polio (Poliomyelitis) mainly affects children under 5 years of age.
• One is 200 infections leads to irreversible paralysis. Among those paralyzed, 5% to
10% die when their breathing muscles become immobilized.
• As long as a single child remains infected, children in all countries are at risk of
contracting polio.
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5. Among children who are paralyzed by polio:
• 30% make a full recovery
• 30% are left with mild paralysis
• 30% have medium to severe paralysis
• 10% die
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6. 1789 - British physician Michael Underwood provides the first clinical
description of polio, referring to it as "debility of the lower extremities.“
1840 - German physician Jacob von Heine publishes a 78-page monograph
in 1840 which not only describes the clinical features of the disease, but also
notes that its symptoms suggest the involvement of the spinal cord.
1908- Austrian physicians Karl Landsteiner and Erwin Popper make the first
hypothesis that polio may be caused by a virus.
By 1910, much of the world experienced a dramatic increase in polio cases.
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7.  The Americas were certified polio-free in 1994. (36 countries)
The western pacific was certified polio-free in 2000. (37 countries and areas
including china)
Europe, composed of 51 countries, was certified polio-free in June 2002. (51
countries)
2008 India certified as Polio free Country.
2014 only Three polio endemic countries left in the world,
 2014 Pakistanis are Banned on International Travelling due to Polio, by WHO.
Pakistanis can travel by submit POLIO FREE CERTIFICATE.
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8. Polio already eradicated in >100 countries
(& one type of poliovirus already eradicated)
19882009

10. Polio campaign
performance by
'finger marking'
2008
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<90 %
90-94 %
95 %
Prime Minster's Action Plan, Pakistan, 2009
Prime Minister Gilani announces PM's
Action Plan & National Polio Control Cell to
hold all districts accountable
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11. 0
10
20
30
40
50
60
70
80
90
100
2012 2013 2014
Polio Paralysis Cases Last Three Years In Pakistan
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12. HIGH RISK AREAS OF PAKISTAN
FATA
Khyber
Mohammad
Kurram
Orakzai
KHYBER PAKHTUNKHWA
Charsada
Mardan
Nowshera
Peshawer
Banu
Batagram
SINDH
Ghotki
Larkana
Kashmor
Shikarpur
Khairpur
Gaddap
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13. HIGH RISK AREAS OF PAKISTAN
PUNJAB
Multan
D.G khan
Rajanpur
Muzafargrah
R.Y Khan
Rawalpendi
Faislabad
Pak Pattan
BALOCHISTAN
Haffarabad
Nasirabad
K. Abdulla
Pishin
Quetta
Jhal Magsi
Musa Khail
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16. • polio= gray matter
• Myelitis= inflammation of the spinal cord
• This disease result in the destruction of motor neurons caused
by the poliovirus.
• Polio is causes by a virus that attacks the nerve cells of the
brain & spinal cord although not all infections result in sever
injuries and paralysis.
"Poliomyelitis" comes from the Greek word
Gray, polio, and myelo, meaning spinal cord.
The Latin suffix itis refers to inflammatory diseases.
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17. • AGENT: POLIOVIRUS
• TYPE : THREE SERO TYPES(TYPE-1,TYPE-2,TYPE-3)
• RESERVOIR: MAN
• INFECTIOUS MATERIAL: FAECES, ORO-PHARYNGEAL SECRETIONS
• INCUBATION PERIOD: 7 TO 14 DAYS( 3- 35 DAYS)
• PERIOD OF COMMUNICABILITY: 7 TO 10 DAYS
• HOST : AGE : 6 MONTHS TO 3 YEARS
• ENVIRONMENT : RAINY SEASON (JUNE TO SEPTEMBER)
• MODE OF TRANSMISSION: FAECO – ORAL ROUTE, DROPLET INFECTION
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18. PHASE 1 :
After ingestion, primary multiplication occurs in the epithelial cells of the
oropharynx, intestinal mucosa and also in subjacent lymphoid tissue (the
tonsils and paeyer’s patches).
PHASE 2 :
After primary multiplication, virus spreads via the draining lymphatics into
the regional lymph nodes and undergoes further replication and
amplification  it then enters the blood stream and results in transient
viremia, which clinically manifests as mild febrile illness.
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19. PHASE 3 :
Virus is disseminated into various extra neural tissue e.g. reticuloendothelial
cells of a number of viscera  here replication of virus occurs  this
continuously supplies the blood stream and produces a persistent
viremia.
The virus reaches CNS via two routes:
1. Hematogenous route: Transmission directly through the cappillary wall
of the CNS.
2. Neurological route: Transmission to CNS by travelling up the
autonomic nervous system of the intestine.
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20. Many include fever, pharyngitis, headache, anorexia,
nausea, and vomiting. Illness may progress to aseptic
meningitis and menigoencephalitis in 1% to 4% of
patients. These patients develop a higher fever,
myalia and sever headache with stiffness of the neck
and back.
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21. • Paralytic disease occurs 0.1% to 1% of those who
become infected with the polio virus.
• Paralysis of the respiratory muscles or from cardiac
arrest if the neurons in the medulla oblongata are
destroyed.
• Patients have some or full recovery from paralysis
usually apparent with proximally 6 months
• Physical therapy is recommended for full recovery.
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22. • The virion consists of a single strand of RNA containing genetic
information and a protein coat. Humans are its only natural host.
• The poliovirus is a member of a larger family known as
Picornaviruses, which also includes rhinoviruses (such as influenza) and
the hepatitis A virus.
• Polio belongs to the enterovirus subgroup, made up of over 70
viruses that infect the intestines.
• It is one of the smallest RNA viruses, measuring around 25 nm in
diameter.
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24. Left: Picture of poliovirus.
The poliovirus is extremely
small, about 50 nm
(nanometer = one-billionth
of a meter) Courtesy of
David Belnap and James
Hogle
Right: Cross-section of the poliovirus
showing the RNA, capsid, and nerve cell
receptors Illustration courtesy of Link Studio
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25. •Inapperent(sub-clinical) Infection: this occurs approximately in 95
per cent of poliovirus infection. There are no presenting
symptoms. Recognition only by isolation.
•Abortive Polio Or Minor Illness: occurs approximately in 4-8 per
cent of the infection. It causes only a mild or self limiting
illness due to viraemia. The patient recovers quickly.
•Non paralytic polio: occurs approximately in one per cent of all
infections. The presenting features are stiffness and pain in
neck and back. The disease lasts for two to ten days.
Recovery is rapid.
•Paralytic polio: occurs in less then one per cent of infections.
The virus enters the brain and causes varying degree of
disability.
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26. • Bed rest with close monitoring of respiratory and
cardiovascular functioning is essential during the
acute stage of poliomyelitis along with fever
control and pain relievers for muscle spasms.
• Mechanical ventilation, respiratory therapy may
be needed depending of the severity of patients.
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27. • Polio vaccine first appeared to be licensed in the United States
in 1955.
• Advantages:
• Ease to administration
• Good local mucosal immunity
• Disadvantage:
• Strict cold shipping & storage requirements
• Multiple doses required to achieve high humeral conservation
rates against all virus types
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28. •Babies are given 4 doses through out their infancy.
•Adolescents and adults should get vaccinated as well.
Adolescents younger than 18 should receive the routine four
doses.
•You should get it if you travel outside places where polio id still
an epidemic
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29. •This can affect between 25 to 50 serious of polio. they show symptoms of muscle and
joint pain general fatigue and weakness.
•Three indications of PPS
•Previous diagnoses of polio ( late affect of polio to people that got it like when they
where 10 years old)
•Long interval following recovery( people usually live long but effect can occur during 30
to 35 years after the diagnoses)
•Gradual onset (weakness that tends to be perceptible until it interferes with daily
activities)
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30. There is no cure for polio, it can only be prevented.
Polio Vaccine, given multiple times, can protect a child for life.
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31. 1. Complete bed rest is essential in early course of disease, exercise
at this stage predispose to paralysis.
2. If respiratory difficulty, gave comfortable position, and
intermittent positive pressure ventilation.
3. Once the acute phase has subsided, subsequent treatment is by
physiotherapy and orthopedic measures.
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32. Book Sources
1. Short Text Book Of Medical Diagnosis and Management By Mohammad Inaam Danish
2. EXCEL Book Of Community Medicine By Dr. M. Naveed Alam
3. Basis Of Paediatrics (6th Edt:) By Pervez Akber Khan
Article Sources:
Polio. (2011, March 5). Mayo Clinic. Retrieved June 8, 2012, from
http://www.mayoclinic.com/health/polio/DS00572
Polio Disease In-Short. (n.d.). Centers for Disease Control and Prevention. Retrieved
June 8, 2012, from http://www.cdc.gov/vaccines/vpd-vac/polio/in-short-both.htm
Poliomyelitis. (2011, August 24). PubMed Health.Retrieved June 18, 2012, from
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002375/
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