GUTIERREZ, WINELL M.

5 NOVEMBER 2019
BSN II-3 RLE- CAMANTILES RHU

POLIOMYELITIS
Poliomyelitis, or polio, is a disease caused by poliovirus, a type of human Enterovirus. Poliovirus spreads
via fecal-oral transmission. Although the majority of poliovirus infections are asymptomatic, some may invade
the central nervous system, leading to motor neuron death and irreversible paralysis that can cause respiratory
insufficiency and death. The main clinical manifestations of poliomyelitis are weakness, decreased muscle tone,
and hyporeflexia.
3 CLASSIFICATIONS OF POLIOMYELITIS
1. Spinal Paralytic Polio

 Attacks motor neurons in the spinal cord and causes paralysis in arms and legs and breathing problems.
 Most common 70-80 % cases
 Results from lower motor neuron lesions of anterior horn cells of spinal cord
 Affects muscles and legs, arms and trunks
2. Bulbar Poliomyelitis

 Affects neurons responsible for sight, vision, taste, swallowing, and breathing
 Life threatening
 Virus attacks motor neurons in brainstem
 Affects cranial nerve functions
 Cranial nerve lesion- Vagus nerve
3. Bulbo-Spinal Poliomyelitis

 Accounts for 19% paralytic cases

 Affects extremities and cranial nerves
 Leads to severe respiratory involvement
 Combination of paralytic spinal polio and bulbar polio

DEFINITION OF TERMS:

 Oral Polio Vaccine (OPV) - is a live attenuated vaccine, is to be given by mouth. Less immunogenic and
therefore more doses are required (minimum 6).
 Inactivated Polio Vaccine (IPV) - Inactivated (killed) virus vaccine or you call it Injectable Polio Vaccine.
 Flaccid Paralysis-  is a neurological condition characterized by weakness or paralysis and reduced muscle tone
without other obvious cause
FACTS:

 Swedish physician Ivar Wickman suggests that polio is a contagious disease that can spread from person to
person, and also recognizes that polio could be present in people who show no symptoms. (1905)
 Philip Drinker and Harvard University’s Louis Agassiz Shaw Jr. invented an artificial respirator for patients
suffering from paralytic polio- the iron lung. (1929)
 The U.S. government licenses the oral polio vaccine developed by Dr. Albert Sabin (1960)
 A record 550 million children – almost 10% of the world’s population – received OPV (2000)
CHAIN OF INFECTION
 Infectious Agent
Virus
 Reservoir
Infected feces, contaminated water
 Portal of Entry
Mouth
 Portal Exit
Fecal route
 Mode of Transmission
Fecal-oral route: absorption of poliovirus in the intestinal tract 
Human to human
Rarely, droplet transmission may occur during epidemics.
 Susceptible Host
Humans are the only hosts
 Causative
Agent:
Polio Virus
Reservoir:
Susceptibl Infected
e Host: Feces.
Humans Contaminate
d Water

Poliomyelitis
Mode of
Transmission:
Fecal-Oral Route Portal of
Human to human Entry:
Rarely, droplet
transmission may Mouth
occur during
epidemics
Portal of
Exit:
Fecal
Route
INCUBATION PERIOD:

 Paralytic polio is 7-14 days with a range of between 3 and 35 days

PERIOD OF COMMUNICIBALITY:

 7-10 years and after the onset of symptoms

SEASONAL:

 Most common during rainy seasons, peak seosons July-September

SYMPTOMS
Polio, in its most severe forms, can cause paralysis and death. However, most people with polio do not display
any symptoms or become noticeably sick. When symptoms do appear, they differ depending on the type of polio.
Symptomatic polio can be broken down further into a mild form, called non-paralytic or abortive polio, and a
severe form called paralytic polio that occurs in around 1 percent of cases.
Many people with non-paralytic polio make a full recovery. Unfortunately, those with paralytic polio
generally develop permanent paralysis.
Non-paralytic polio symptoms
Non-paralytic polio, also called abortive poliomyelitis, leads to flu-like symptoms that last for a few days or weeks.
These include:

 fever
 sore throat
 headache
 vomiting
 fatigue
 back and neck pain
 arm and leg stiffness
 muscle tenderness and spasms
 meningitis, an infection of the membranes surrounding the brain
Paralytic polio symptoms
Paralytic polio affects only a small percentage of those invaded by the polio virus. In these cases, the virus
enters motor neurons where it replicates and destroys the cells. These cells are in the spinal cord, brain stem, or motor
cortex, which is an area of the brain important in controlling movements.
Symptoms of paralytic polio often start in a similar way to non-paralytic polio, but later progress to more
serious symptoms such as:

 a loss of muscle reflexes

 severe muscle pain and spasms
 loose or floppy limbs that are often worse on one side of the body
 Paralytic polio may also be classified as:
 Spinal polio: The virus attacks motor neurons in the spinal cord that causes paralysis in the arms and legs, and
breathing problems.
PATHOGNOMONIC SIGN
  Flaccid paralysis, weakness or paralysis, and reduced muscle tone
RISK FACTORS
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 immunized against polio is especially susceptible to contracting the infection.
Additional risk factors for polio include:

 traveling 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 a laboratory where live poliovirus is kept

VACCINE:
There are two types of vaccine that protect against polio:

 Inactivated poliovirus vaccine (IPV) - given at 2, 4, 6 months. Minimum age: 6 weeks

Dose: 0.5 ml SQ
95 % efficacy

 Oral poliovirus vaccine (OPV) - given at 2, 4, 6 months. Minimum age: 6 weeks

1st booster: 1 year after the primary dose
2nd booster: 4-6 years
Dose: 0.5 ml orally for single dose preparation or 2 drops for multiple dose
preparation. Lifelong immunity with 90% efficacy.
Possible Reaction: paralytic polio (extremely rare)
Adults in any of the four groups listed below should be assessed for immunity and offered any additional doses:

 Individuals traveling to countries where polio is endemic (Afghanistan, India, Pakistan and Nigeria) need to
be immunized, or if previously immunized will generally need a one-time booster immunization. 
 Health care personnel in close contact with patients shedding polio virus (unlikely in the United States).
 Groups that do not vaccinate, and have had an outbreak of even a single case of polio, especially after
traveling to endemic areas.
 Lab workers handling specimens that may contain polioviruses (unlikely in the United States).
The polio vaccine should be given to pregnant/breastfeeding women who are at risk; the attack rate of polio is
greater in pregnant versus non-pregnant women.
All current polio vaccines are trivalent, designed to protect against all three serotypes of poliovirus. IPV is
given to adults in three doses on the following schedule:

 Initial dose at anytime

 Second dose 1-2 months later
 Third dose 6-12 months following the second dose.
Some people should not get IPV or should wait.
These people should not get IPV:

 Anyone with a life-threatening allergy to any component of IPV, including the antibiotics neomycin,
streptomycin or polymyxin B, should not get polio vaccine. Tell your doctor if you have any severe allergies.
 Anyone who has a severe allergic reaction to a polio shot should not get another one.
These people should wait:

 Anyone who is moderately or severely ill at the time the shot is scheduled should usually wait until they
recover before getting polio vaccine. People with minor illnesses, such as a cold, may be vaccinated.

PREVENTION
Vaccines are the main way to prevent polio.
However, other methods of limiting the spread of this potentially fatal disease include:

 avoiding food or beverages that may have been contaminated by a person with poliovirus
 checking with a medical professional that your vaccinations are current
 being sure to receive any required booster doses of the vaccine
 washing your hands frequently
 using hand sanitizer when soap is not available
 making sure you only touch the eyes, nose, or mouth with clean hands
 covering the mouth while sneezing or coughing
 avoiding close contact with people who are sick, including kissing, hugging, and sharing utensils