| Poliomyelitis (polio) is a highly contagious infectious disease caused by three types of polio virus. The virus attacks the entire body, causing severe damage to the nervous system that can result in paralysis. A communicable disease, polio is transmitted by direct person-to-person contact, contact with infected nose or mouth secretions, or contact with infected feces. It enters through the mouth and nose and replicates in the intestinal tract; it is then absorbed by and spread via the blood and lymph system. The average incubation time is 7 to 14 days.
There are two basic patterns of polio infection: minor (subclinical) and major (nonparalytic or paralytic). An estimated 95% of cases are the minor forms of the disease, and individuals may be asymptomatic (Wener).
The more serious forms (nonparalytic and paralytic) primarily affect the central nervous system; symptoms are most often seen in the legs but can extend to involve any muscle in the body and can cause paralysis or death. Although paralysis occurs in 2% or less of infections, the involvement of respiratory muscles can lead to life-threatening respiratory failure ("Poliomyelitis"). The risk for paralysis from the disease increases with age.
Although there is no treatment for polio, there is an effective vaccine.
The Americas have been certified polio-free since 1994, and polio has been virtually eliminated from the World Health Organization (WHO) European and Western Pacific regions (including China). There are, however, unexpected breakouts from time to time, even in areas of the world considered free of the disease. Most recently (2000), an area of France identified the virus in its sewer system; it was eventually traced to viral escape from a biomedical laboratory. Today, polio is mostly confined to parts of sub-Saharan Africa and the Indian subcontinent. WHO plans to eliminate the vaccine once it declares polio eradicated, which it hopes to do by 2005.Risk: Polio is largely a disease of young children; infection in adulthood is very rare. Children 5 years and younger (particularly those under 3) are at the highest risk for infection. The very old are also susceptible.
Risk factors for the polio virus include lack of immunization, poor hygiene, poverty, unsanitary living conditions, or travel to a high-risk area or area experiencing a recent outbreak. Trauma to the mouth, nose, or throat, such as a recent tonsillectomy or dental surgery, increases the risk of the disease. In those exposed to the virus, unusual stress or exertion can heighten the chances of infection.
The infection is most common during the summer and fall months. Incidence and Prevalence: Poliovirus infections are extremely rare in the US, due to the widespread use of the polio vaccine. There have been no known infectious cases of polio since 1979 in the US, and an estimated 8 cases of the disease are reported each year ("Poliomyelitis"). Almost all these cases were traced to the oral poliovirus vaccine. The number of countries in which poliomyelitis is endemic dropped from 20 in 2001 to 10 at the beginning of 2002. The World Health Organization estimates there are 20 million individuals worldwide with some degree of disability caused by poliomyelitis ("Late Effects of Polio"). |
Source: Medical Disability Advisor
| History: Symptoms depend on the severity of disease. Symptoms of a mild case of polio may include fever, headache, sore throat, constipation, malaise, abdominal pain, vomiting, or loss of appetite.
In a more severe form of the illness, symptoms may include moderate fever; headache; vomiting or diarrhea; excessive fatigue; irritability; pain or stiffness of the neck, back, arms, legs, and abdomen; muscle tenderness; spasm or stiffness; and leg muscle pain. In the most severe form of the virus, symptoms may include fever (occurring 5 to 7 days before other symptoms), headache, stiff neck and back, and asymmetrical muscle weakness that may come on suddenly and progress to paralysis. Other symptoms may include abnormal sensations in a particular area; sensitivity to touch; difficulty beginning to urinate; constipation; a bloated feeling in the abdomen; difficulty swallowing; muscle contractions or spasms in the neck, calf, or back; drooling; breathing difficulty; and irritability. Physical exam: Meningeal irritation may be apparent, such as stiffness of the neck or back. The individual may have difficulty lifting the head or the legs when lying flat on the back. Cranial nerves may affect reflexes and cause the individual to have difficulty with facial expressions, swallowing, chewing, or breathing. An acute feverish illness combined with muscle paralysis is so characteristic of polio that it usually enables an immediate diagnosis. Tests: The polio virus can be isolated from a throat culture, stool culture, or cerebrospinal fluid (CSF) taken by a puncture of the spinal canal with a needle (lumbar puncture). |
Source: Medical Disability Advisor
| There is no effective medical cure for polio, so treatment is supportive. Bed rest, heating pads, and analgesics may be recommended for muscle pain and stiffness. Paralysis of the respiratory muscles may require making an opening in the windpipe in order to insert a breathing tube (tracheostomy), and breathing may need to be maintained by ventilation. Paralysis of the lower body interferes with normal bladder function, requiring catheterization. Physical therapy is essential to prevent muscle damage and to help retain muscle function. |
Source: Medical Disability Advisor
| Individuals whose spinal cord and brain are not affected, which occurs in 90% of cases, usually recover completely (Wener). A small percentage of individuals are left with minor muscle weakness or severe disability. Brain or spinal cord involvement may result in paralysis or death, usually from respiratory involvement. A small number of individuals who experienced extensive polio paralysis as children may have a recurrence of muscle pain and weakness years later (postpoliomyelitis syndrome). |
Source: Medical Disability Advisor
| Complications include permanent muscle paralysis, disability, deformity, respiratory failure, pneumonia, pulmonary edema, blood clot to the lungs (pulmonary embolism), inflammation of the heart muscle (myocarditis), hemorrhage, cor pulmonale (right-sided heart failure), shock, high blood pressure (hypertension), kidney stones, paralysis of the intestines (paralytic ileus), and urinary tract infections. |
Source: Medical Disability Advisor
| Individuals whose job responsibilities require heavy lifting or physical activity may need to be transferred to sedentary duties. A leave of absence may be required. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has diagnosis of polio been confirmed?
-
Is this an episode of postpoliomyelitis syndrome rather than an initial occurrence?
-
Has individual experienced any complications that may affect recovery?
Regarding treatment:
- How extensive is the paralysis?
-
What body systems are affected?
-
Has individual received physical therapy as part of the rehabilitative process? Is function returning?
Regarding prognosis:
- Is paralysis still resolving? How much more function is individual expected to regain?
-
To what extent does residual impairment affect function?
-
What accommodations would need to be made for individual to return to occupational duties?
|
Source: Medical Disability Advisor
| "Poliomyelitis (Polio)." University of Utah Health Sciences Center. 1 Nov. 2004 <http://www.med.utah.edu>. "The Late Effects of Polio: An Overview." Post-Polio Health International. 1 Nov. 2004 <http://www.post-polio.org/ipn/lep.html>. Wener, Kenneth. "Poliomyelitis." MedlinePlus. National Library of Medicine. 1 Nov. 2004 <http://www.nlm.nih.gov/medlineplus/ency/article/001402.htm>. |
Source: Medical Disability Advisor
| Feedback |
| Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must
include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment.
If you are seeking medical advice, please contact your physician. Thank you! |
Send this comment to:
Sales
Customer Support
Content Development
|
|
| |
|
|
|
|
|
This publication is designed to provide accurate and authoritative information in
regard to the subject matter covered. It is published with the understanding that
the author, editors, and publisher are not engaged in rendering medical, legal,
accounting or other professional service. If medical, legal, or other expert assistance
is required, the service of a competent professional should be sought. We are unable to respond to requests for advice.
Any Sales inquiries should include an email address or other means of
communication.
|