POLIO

By- Yewande Ayodele, 6th year, group 2

INTRODUCTION

What is Poliomyelitis? This is an acute, viral disease caused by small RNA viruses of the enterovirus group of Picornavirus family. The disease can be caused any of the three serotypes of Polio Virus PV-1, PV-2,PV-3. Mode of transmission is through the oral-oral route or Fecal-oral route which is most common, by ingestion of contaminated food or water

CLINICAL FINDINGS
The incubation period is between 6-12 days from exposure And at least 95% of infections are asymptomatic, but in those who become ill, manifestations include: abortive poliomyelitis, nonparalytic poliomyelitis, and paralytic poliomyelitis.

Abortive poliomyelitis (minor illness) Minor illness occurs in 48% of infections and the symptoms are fever, headache, vomiting, diarrhea, constipation, and sore throat lasting 23 days. This entity is suspected clinically only during an epidemic. Nonparalytic poliomyelitis In addition to the above symptoms, signs of meningeal irritation and muscle spasm occur in the absence of frank paralysis. This disease is indistinguishable from aseptic meningitis caused by other viruses.

Paralytic poliomyelitis this represents 0.1% of all poliomyelitis cases (the incidence is higher when infections are acquired later in life). Paralysis may occur at any time during the febrile period. Tremors, muscle weakness, constipation, and ileus may appear. Paralytic poliomyelitis is divided into two forms, which may coexist: (1) spinal poliomyelitis, with involvement of the muscles innervated by the spinal nerves, and (2) bulbar poliomyelitis, with weakness of the muscles supplied by the cranial nerves (especially nerves IX and X) and of the respiratory and vasomotor centers.

In spinal poliomyelitis, paralysis of the shoulder girdle often precedes intercostal and diaphragmatic paralysis, which leads to diminished chest expansion and decreased vital capacity. The paralysis occurs over 23 days, is flaccid, has an asymmetric distribution, and affects the proximal muscles of the lower extremities more frequently.

In bulbar poliomyelitis, symptoms include diplopia (uncommonly), facial weakness, dysphagia, dysphonia, nasal voice, weakness of the SCM and trapezius muscles, difficulty in chewing, inability to swallow or expel saliva, and regurgitation of fluids through the nose. The most life-threatening aspect of bulbar poliomyelitis is respiratory paralysis which can lead to eventual death. Bulbar poliomyelitis is more common in adults

Other types include - Vaccine associated poliomyelitis (which has a high incidence in immunodeficient patients. - Postpolio syndrome.
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Laboratory findings: The peripheral WBC count may be normal or slightly raised. Cerebrospinal fluid pressure and protein are normal or slightly increased. Glucose is not decreased. White blood cells usually number < 500/mcL and are principally lymphocytes after the first 24 hours. Cerebrospinal fluid is normal in 5% of patients. Neutralizing and complement-fixing antibodies appear during the first or second week of illness. Serologic testing cannot distinguish between wild-type and vaccine-related virus infections.

MANAGEMENT
Prevention : Currently in the United States, the inactive (Salk) parenteral vaccination is used for all four doses (at ages 2 months, 4 months, and 618 months and at 46 years). Inactivated vaccine is also routinely used elsewhere in the developed world. Oral vaccines are limited to usage for outbreak control, travel to endemic areas within the ensuing month, and protection of children whose parents do not comply with the recommended number of immunizations

Treatment : In the acute phase of paralytic poliomyelitis patients should be hospitalized. Strict bed rest in the first few days of illness reduces the rate of paralysis. Cranial nerve involvement must be vigilantly sought. Comfortable but rotating positions should be maintained in a "polio bed": firm mattress, footboard, sponge rubber pads or rolls, sandbags, and light splints. Intensive physiotherapy may help recover some motor function with paralysis. Fecal impaction and urinary retention (especially with paraplegia) are managed appropriately. In cases of respiratory weakness or paralysis, intensive care is needed.

Medications (such as acetaminophen or ibuprofen) to control fever or pain -Fluids -Rest until the fever improves. In these cases, after 2-10 days, polio symptoms will usually have faded completely. If paralytic paralysis occurs, treatment may be more extensive and long-term. Depending on the severity of symptoms, treatment for polio can include: Medications to reduce pain and improve strength Antibiotic medications for bacterial infections Breathing assistance with a mechanical ventilator.

ERADICATION OF POLIO
The Global Polio Eradication Initiative (GPEI), the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF, are responsible for the eradication of polio in most countries today . Since 1988, some two billion children around the world have been immunized against polio thanks to the unprecedented cooperation of more than 200 countries and 20 million volunteers, backed by an international investment of US$ 3 billion.

POLIO WORLDWIDE IN 2005

POLIO IN NIGERIA

Although polio has been eradicated across much of the world, the disease remains endemic in Nigeria , Pakistan , Chad and Afghanistan Status: endemic Nigeria is one of the most entrenched reservoirs of wild poliovirus in the world. It is the only country with ongoing transmission of all three serotypes: wild poliovirus type 1, wild poliovirus type 3, and circulating vaccine-derived poliovirus type 2. States in the north of the country are the main source of polio infections elsewhere in Nigeria and in neighboring countries. In 2009, operational improvements in these northern states led to a 90% decline in cases of wild poliovirus type 1 and a 50% decline in overall cases compared with 2008.

STATISTICS
2005 there were 1,979 cases of wild poliovirus worlwide. Most remaining polio infections were located in two areas: the Indian subcontinent and Nigeria. 2006-2009 - A total of 1,997 cases worldwide were reported in 2006, Nigeria accounted for the majority of cases (1,122 cases).In Nigeria, there were- 798 in 2008, 388 in 2009. 2010- there were 1,352 cases of wild polio in 20 countries in 2010. Reported cases of polio are down 95% in Nigeria (to a historic low of 21 cases) 2011- the WHO recorded a total of 650 cases worldwide in 16 countries, 80 of the cases from Nigeria

2012- Nigeria remains the only polio-endemic country in Africa. The first case of wild poliovirus (WPV3) in 2012 in the country was reported on 14th January, 2012 from Sokoto State. Up to the 3rd of April four countries have reported cases: Pakistan 15, Nigeria 17, Afghanistan 5 and Chad 3 (total 40). As of the 23rd of May, the total number of reported cases worldwide stands at 60, compared to 165 at this point in 2011. Major uncertainties loom for Nigeria against polio eradication in 2012 , after the setback in 2011 but we hope to see major improvements soon.

Thanks for your attention.