Poliomyelitis

Causative organism:
Poliovirus, belonging to picorna viruses (small RNA-containing viruses). It has
three antigenically distinct types, giving no cross immunity : type I, the
commonest in epidemics, type II, the prevailing type in endemic areas, and type
III. Polioviruses can survive for long time under suitable conditions but are readily
destroyed by heat and disinfectants as chlorine. Poliovirus is a neurotropic virus.

Reservoir of infection:
Cases: All clinical forms of the disease.
Carriers: All types of carriers (healthy carriers are the most frequent due to
polluted environment). There is no chronic carriers
Pattern of spread:
It was endemic in Egypt, but now, it is about to be eradicated (due to effective
eradication strategies) . Cases may occur sporadic or in epidemics. Age of
incidence (< 5 years).
Period of Infectivity:
6 – 8 weeks, through the incubation period to convalescence. The
organism appear in the throat 1 ½ day after exposure and in the stool 3 days
after exposure.

Modes of transmission:
1- Oral-Oral infection: Direct droplet infection.
2- Faecal-oral infection :
­ Food-borne infection (ingestion of contaminated food, water or milk)

­ Hand-to-mouth infection.
Incubation period: 7 – 14 days.

Clinical picture and sequelae of polio infection:

 1- Inapparent infection: It is associated with acquired immunity and or carrier
state.
2- Clinical poliomyelitis : Either
a. Abortive poliomyelitis with moderate fever and either upper respiratory or
gastrointestinal manifestations, then clears up and gives immunity.
b. Major illness with involvement of the CNS :
c. Few days after subsidence of abortive disease, a small percent of cases
shows :
­ Nonparalytic cases: With meningeal irritation (fever, headache,
vomiting, neck rigidity, stiffness in the back and pleocytosis.
­ Paralytic poliomyelitis : Affects the anterior horn cells of motor
nerves in about 1% of cases causing flaccid paralysis. Appears 7-
10 days from onset of disease. Paralytic poliomyelitis may be spinal
(e.g. lower limbs), bulbar (cranial nerves e.g, dysphagia,
dysphonia, diplopia diplopia) or bulbo-spinal.

Complications:
Respiratory, myocarditis, urinary infection, soft tissue and bone deformities, and
others.
Fatality: (2-10%) due to respiratory muscles paralysis.
Predisposing factors: (for invasion of the CNS)
­ Mouth and throat surgery.

­ Giving inoculations (SC or IM),

­ Excessive muscular activity & fatigue.

­ Pregnancy (especially in non endemic areas).

Diagnosis:
Poliomyelitis is suspected only when CNS involvement occur.
 Laboratory Diagnosis : Suspected cases can be confirmed by isolation of the
virus from throat washing or stools, or serologic testing for neutralizing
antibodies (rising titer is diagnostic).

Prevention:
1. General preventive measures.
2. Specific prevention :
a- Active immunization: (see practical book)
i- Sabin poliovaccine .
ii- Salk poliovaccine :
Application of Salk vaccination : In some countries
­ Mass immunization of infants and children.

­ During pregnancy, to provide the newborn with maternally acquired

immunity.
­ At-risk groups, during polio outbreaks.

­ Susceptible travelers going to visit endemic areas.

Control:
1. Case-finding: Cases are suspected in the non paralytic or paralytic
stage.
2. Control of Cases: Notification, isolation at home (of little value) or
hospital (with enteric precautions). Concurrent disinfection and terminal
cleaning. Medical care and rehabilitation of paralytic cases.
3. Control of Contacts: Examined for case-finding, seroprophylaxis and
immunization, if necessary.
4. Epidemic Measures: When poliomyelitis outbreak threatens a
community.

Eradication of poliomyelitis in Egypt:

The World Health Organization declared Egypt; a polio free country in a
celebration held on Wednesday 8 March 2006.
More than one year has lapsed since the isolation of the last wild poliovirus
from the environment, and more than one and a half years have passed
since the last confirmed poliomyelitis case, which occurred in Assiut in May
2004.
In addition to routine immunization, many activities have been conducted
before achieving this goal. These activities include:
­ Implementation of annual national immunization days targeting all
children under 5 years.
­ Improvement in immunization campaign being implemented from house
to house all over the country.
­ Improvement and strengthening of the surveillance system to detect and
investigate all cases with acute flaccid paralysis..
­ The environmental sampling was expanded in order to detect the chain
of virus transmission.
­ In 2005 a monovalent vaccine specific against the type of virus
circulating in Egypt was used for the first time on a national scale.