Polio

Overview

Polio (poliomyelitis) is an illness caused by the poliovirus, which primarily affects the nerves in the spinal cord or brain stem. In severe cases, it can result in paralysis, difficulty breathing, and, in rare instances, death. Polio was a major global health concern in the past, but thanks to extensive vaccination efforts, the number of cases has significantly decreased. However, the disease still spreads in areas with low vaccination rates. Vaccinated adults planning to travel to high-risk countries are advised to receive a booster dose of inactivated poliovirus vaccine (IPV) to maintain lifetime immunity. Most people with the poliovirus don't exhibit symptoms, but those who do may experience flu-like symptoms, including fever, headache, muscle aches, sore throat, stomachache, loss of appetite, nausea, and vomiting. Nonparalytic polio is a more severe form of the disease that causes flu-like symptoms and may include neck pain, aches or stiffness in the arms or legs, and severe headaches. Polio spreads through contact with feces or droplets from an infected person, and it can also contaminate water sources. The risk of contracting polio is higher for unvaccinated individuals, especially children.

Understanding the disease

Symptoms

Polio symptoms can be divided into two main categories: abortive poliomyelitis and nonparalytic polio. Abortive poliomyelitis: This milder version of the disease leads to flu-like symptoms that last 2 to 3 days. Symptoms include fever, headache, muscle aches, sore throat, stomachache, loss of appetite, nausea, and vomiting. Nonparalytic polio: This more severe form of the disease affects about 1% of those infected. Along with more severe flu-like symptoms, nonparalytic polio symptoms may include neck pain or stiffness, aches or stiffness in the arms or legs, and severe headache. It is important to note that polio symptoms can be similar to those of other viral diseases that affect the nervous system. If you experience any of these symptoms, it is crucial to seek a timely and accurate diagnosis from a healthcare provider.

Risk Factors

Risk factors for developing polio include the severity of the initial polio infection and the age at onset of the initial illness. Individuals who experienced a more severe polio infection, as well as those who developed polio as an adolescent or adult, have a higher chance of developing post-polio syndrome. Polio mainly affects children, but anyone who hasn't been vaccinated is at risk of getting the disease.

Development

Polio can develop in two main forms: abortive polio and nonparalytic polio.

1. Abortive polio: This form of the disease is the mildest, causing flu-like symptoms that last for 2 to 3 days. These symptoms include fever, headache, muscle aches, sore throat, stomachache, loss of appetite, nausea, and vomiting.
2. Nonparalytic polio: A more severe form of the disease, it affects about 1% of those infected. Nonparalytic polio causes more severe flu-like symptoms and can also include neck pain or stiffness, aches or stiffness in the arms or legs, and a severe headache. It is important to note that since 2000, the United States has used an injected vaccine with an inactivated poliovirus that does not create the risk for vaccine-derived poliovirus (VDPV). VDPV is a new version of the virus that develops within a community or region where not enough people are vaccinated.

Assessment and Diagnosis

Triage

You should see a doctor if polio is suspected based on the symptoms described. The most serious form of the disease, paralytic polio, can lead to muscle weakness, paralysis, and difficulty breathing or swallowing. If you or someone you know is experiencing these symptoms, it is important to seek medical attention immediately.

Diagnosis

To diagnose polio, health care providers often look for symptoms such as neck and back stiffness, abnormal reflexes, or muscle weakness. A lab test of a stool sample can detect the poliovirus, and a test of the cerebrospinal fluid can rule out other nervous system diseases. There is no specific test for post-polio syndrome, which is diagnosed based on medical history, physical exam, and the exclusion of other conditions causing the symptoms.

Management and Treatment

Complications

Polio, caused by the poliovirus, can lead to various complications, including:

1. Paralysis: In its most severe form, polio can result in paralysis, particularly in the limbs.
2. Respiratory muscle weakness: Paralysis of muscles involved in breathing can cause breathing difficulties and, in extreme cases, respiratory failure.
3. Difficulty swallowing: Polio can affect the muscles involved in swallowing, leading to dysphagia and an increased risk of aspiration pneumonia.
4. Post-polio syndrome: Decades after recovering from polio, individuals may experience new or worsening symptoms like muscle weakness, fatigue, pain, and breathing or swallowing problems.
5. Falls: Weak leg muscles due to polio can increase the risk of falling, leading to fractures and other complications.
6. Fatigue: Chronic fatigue is common in individuals with post-polio syndrome and can impact daily activities and overall quality of life.
7. Pain: Musculoskeletal abnormalities and muscle weakness caused by polio can result in chronic pain.
8. Malnutrition, dehydration, and pneumonia: Difficulty chewing and swallowing due to bulbar polio can lead to inadequate nutrition, dehydration, and an increased risk of aspiration pneumonia. It is essential to seek medical attention if you experience signs or symptoms of polio or post-polio syndrome. Timely diagnosis and treatment can help manage these complications and improve overall health outcomes.

Prevention

Polio can be prevented through vaccination. The Centers for Disease Control and Prevention (CDC) recommends four doses of inactivated poliovirus vaccine (IPV) for children at the following ages: 2 months, 4 months, between 6 and 18 months, and between ages 4 and 6 when children are just entering school. If a child is missing a dose, talk to a healthcare provider about a catch-up schedule for vaccination. In the U.S., most adults have immunity to the poliovirus due to childhood vaccination, but adults traveling to or living in regions with high rates of spreading poliovirus should receive additional vaccinations.

Treatment

There is no cure for polio, so treatment mainly focuses on relieving symptoms, promoting recovery, and preventing complications. Treatment options may include bed rest, pain relievers, hot moist packs to manage muscle pain and spasms, portable ventilators for breathing support, and physical therapy exercises to prevent bone deformity and muscle function loss. In addition, splints or devices may be used to maintain proper spinal and limb alignment. Self-care suggestions for individuals recovering from polio include limiting activities that cause pain or fatigue, pacing activities to avoid exhaustion, and seeking support from friends, family, or support groups.

Preparing for medical consultation

Preparing for an appointment for polio involves several steps to ensure you get the most out of your visit with your healthcare provider. Here's what you can do:

1. Research polio: Learn about the disease, its symptoms, diagnosis, and treatment options. This will help you better understand your condition and ask informed questions during your appointment.
2. Write down symptoms: Note down any symptoms you've been experiencing, including any that may seem unrelated to polio. This will help your doctor assess your condition more accurately.
3. Prepare your medical history: Create a list of your key medical information, including other conditions for which you're being treated and any medications, vitamins, or supplements you're currently taking.
4. Review your vaccination record: Find out if your vaccinations, including polio vaccines, are up to date. Bring a copy of your vaccination record, if possible.
5. Gather relevant records: Collect any previous test results, scans, X-rays, or other medical records that may be important for your appointment.
6. Prepare a list of questions: Compose a list of questions you want to ask your doctor during the appointment. Some questions to consider include the diagnosis process, treatment options, recovery time, and any potential complications.
7. Bring a support person: Consider bringing a family member or friend to the appointment for support and to help remember important details discussed during the appointment. By being well-prepared for your appointment, you can help ensure that you receive the most accurate diagnosis and appropriate treatment plan for polio.