POLIOMYELITIS

Sep 7, 2016,

                                              POLIOMYELITIS

 

DEFINITION

Poliomyelitis (polio) is a highly infectious viral disease, which mainly affects young children. It mostly affects children between the ages of 6months and 5yrs. It is most common in developing tropical countries. It occurs more during the rainy season.

 

MODE OF TRANSMISSION

The virus is transmitted by person-to-person spread 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.

Other environmental sources of infections could be:

  1. Overcrowding
  2. Poor sanitation
  3. flies

 

 

SIGNS AND SYMPTOMS

Incubation period ranges from 6-20days. The cases are most infectious 7-10days before and after onset of symptoms.

Two phases of acute polio can be distinguished

  1. A non-specific febrile illness (minor illness)
  • Moderate fever
  • Upper respiratory tract illness e.g. sore throat
  • Gastrointestinal manifestations e.g. vomiting, abdominal pain and diarrhoea

 

  1. Followed by(in a small proportion of people) aseptic meningitis/or paralytic disease (major illness)
  • Paralysis usually appears within 4 days after the minor illness (7-10days after the onset of disease)
  • The lower limbs are mostly affected

 

Indication for admission:

  • Paralysis of upper limbs >3days duration
  • Progression of paralysis
  • Respiratory distress
  • Marked drowsiness

TREATMENT

The acute phase can be managed with:

  1. Bed rest
  2. Analgesics
  3. Anatomical positioning of the limbs and gentle passive exercises of all joints
  4. Close monitoring of respiratory and cardiovascular functions

 

 

COMPLICATIONS ASSOCIATED WITH POLIO

  • Respiratory: pneumonia, pulmonary oedema
  • Cardiovascular: myocarditis, cor pulmonale, hypertension
  • Urinary tract infections
  • Late complications: soft tissue and bone deformities, osteoporosis and chronic distension of the colon

 

 

PROGNOSIS

  • Non paralytic case: complete recovery. Most clinical recovery occurs during the 1st month and almost complete within 6 month.
  • Paralytic polio: permanent weakness in 2/3rd of cases

 

Physical, emotional, psychological and social rehabilitation will also go a long way in helping the patients attain full recovery.

 

 

PREVENTION

The polio Vaccine is the most effective way to prevent the disease. There are 2 types;

  1. Inactive
  • Highly effective
  • >90% immune after 2 doses
  • >99% immune after 3 doses
  • Duration of immunity not known g=for certain
  1. Oral polio:
  • Highly effective
  • 50% immune after 1 dose
  • >95% immune after 3 doses
  • Immunity is lifelong
  • Sheds in the stool for up to 6wks after vaccination

 

 

 

VACCINATION SCHEDULE IN NIGERIA

 

AGE

VACCINE

MINIMAL INTERVAL

At birth

OPV-0

 

6 WKS

OPV 1 + IPV

4WKS

10 WKS

OPV-2 + IPV

4WKS

14WKS

OPV-3 + IPV

4WKS

16-24 MONTHS

OPV + IPV

 

5 YRS

OPV

 

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