Diseases and what they mean

Poliomyelitis (polio)
What is poliomyelitis?

Poliomyelitis, or polio, is a crippling disease caused by anyone of three related viruses, poliovirus types 1, 2 or 3. All member states of WHO agreed in 1988 to eradicate polio, and WHO aims to certify the world as free of the disease by 2005. Since the global initiative to eradicate polio was launched, the number of reported cases of polio has been reduced from an estimated 350 000 in 1988 to 483 cases associated with wild poliovirus in 2001.

How is polio spread? The only way to spread poliovirus is through the faecal/oral route. The virus enters the body through the mouth when people eat food or drink water that is contaminated with faeces. The virus then multiplies in the intestine, enters the bloodstream, and may invade certain types of nerve cells, which it can damage or destroy. Polioviruses spread very easily in areas with poor hygiene.

Nearly all children living in households where someone is infected become infected themselves. Children are most likely to spread the virus between 10 days before and 10 days after they experience the first symptoms of the disease. It is important to know that the great majority of people who are infected do not have symptoms, but they can still spread the disease. The incubation period is six to 20 days.

What are the signs and symptoms of polio?
Most children infected by poliovirus never feel ill. Less than 5% of those infected may have general flu-like symptoms such as fever, loose stools, sore throat, upset stomach, headache, or stomach ache.

Most children who have a poliovirus infection without symptoms develop immunity and have lifelong protection against paralytic polio. Paralytic polio begins with mild symptoms and fever. These symptoms are followed by severe muscle pain and paralysis, which usually develop during the first week of illness. Patients may lose the use of one or both arms or legs. Some patients may not be able to breathe because respiratory muscles are paralysed. Some patients who develop paralysis from polio do recover to some degree over time. But the degree of recovery varies greatly from person to person.
A diagnosis of polio is confirmed by laboratory testing of stool specimens.

What are the complications of paralytic polio?
Death may occur if the respiratory muscles of the chest are affected and no respirator is available to support breathing. Without adequate physiotherapy paralysed limbs will not regain full function, often leaving a child seriously crippled.

What is the treatment for polio?
While the initial symptoms - muscle pain and fever - can be relieved, no treatment exists to cure paralysis from polio. A respirator can help patients who have difficulty in breathing. Regular physical therapy, as well as orthopaedic treatment and operations and the use of braces, can help reduce the long-term crippling effects of polio.

How is polio prevented?
Polio can be prevented through immunization with oral polio vaccine (OPV) or inactivated polio vaccine (IPV).
OPV is recommended for both routine immunization and supplementary campaigns for polio eradication. IPV is also an effective vaccine. But OPV is less expensive, safe, and easy for health workers and volunteers to administer.

What are the eradication goals and strategies for polio?
In 1988, the Forty-first World Health Assembly launched a global initiative to eradicate polio.

    There are four core strategies to stop transmission of the wild poliovirus and certify all WHO regions polio-free by the end of 2005:
  • high infant immunization coverage with four doses of oral polio vaccine in the first year of life;

  • supplementary doses of oral polio vaccine to all children under five years of age during national immunization days (NIDs);

  • surveillance for wild poliovirus through reporting and laboratory testing of all cases of acute flaccid paralysis (AFP) among children under fifteen years of age;

  • targeted "mop-up" campaigns once wild poliovirus transmission is limited to a specific focal area.
    In the 15 years since the Global Polio Eradication Initiative was launched, the number of cases has fallen by over 99%, from an estimated 350 000 cases in 1988, to 1919 reported cases in 2002. The number of polio-infected countries has been reduced from more than 125 in 1988 to just seven in 2002.
    Key points
  • Polio is caused by any of three related polioviruses and can easily spread by the faecal/oral route.

  • Many people/children who are infected with poliovirus do not become paralysed but may still spread the disease to others.

  • Less than one in 100 non-immunized children infected by poliovirus develop paralysis.

  • The recommended method of prevention in children is immunization with oral polio vaccine (OPV).

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