Poliomyelitis – What is important to know?

Poliomyelitis is commonly known as polio. It was once incredibly widespread , which lead to people using the shortened name. It is a highly-contagious disease transmitted by viruses, often first seen in childhood (under the age of five). Infections with the polio virus can lead to permanent paralysis , and can also infect adults who are not sufficiently immunized. Before polio vaccines were introduced, wild polioviruses were found worldwide. Still, no treatment exists.

Where does the pathogen come from? In 1988, the WHO (World Health Organization) introduced a Global Poliomyelitis Eradication Initiative using the new live-polio vaccine. Its aim was to eliminate poliomyelitis by the year 2000. Although this goal was delayed, a great deal was nevertheless achieved: more than 19 million people were saved from paralysis and 1.5 million people from death.

Five out of six WHO regions are now certified polio-free: America 1994, Western Pacific 2000, Europe 2002, South-East Asia 2014, Africa 2020. The Eastern Mediterranean region is not yet considered polio-free.

What causes polio? Polioviruses are small, spherical , non-enveloped, single-stranded RNA viruses. They belong to the genus Enterovirus, and the family of Picornaviridae. Serologically, three types of wild polioviruses are distinguished (types 1, 2 and 3). WPV type 2 was declared eradicated in the year 2015, as was WPV type 3 in 2019. Only WPV type 1 is still circulating e. g., in Afghanistan and Pakistan. In 2022, an outbreak of WPV 1 was reported in Malawi. The virus was genetically related to a Pakistan strain.

Like all enteroviruses, polioviruses are stable for gastrointestinal passage and resistant to many enzymes. Furthermore, it lacks a lipid envelope , and is therefore resistant to lipid-soluble agents.

How is polio transmitted? Transmission is mainly fecal-oral, from person to person. Shortly after the start of infection, there is massive virus reproduction in the intestinal epithelia. The pathogens are passed in the stool and spread through contact infection. Infection through coughing and sneezing is also possible for a short time after the start of the infection because the primary virus replication occurs in the pharyngeal epithelia.

Drinking or bathing water contaminated with feces can also cause infection. Wastewater is generally not a source of infection for the general population in Germany.

How long does the incubation period last? Non-paralytic form: 3–6 days

Paralytic form: 3–35 days.

Infectiousness exists as long as the virus is being excrete d.

What are the symptoms? The majority of infections (> 95 %) are asymptomatic ( silent infection ). In around 4 to 8 % of infected people, fever, nausea , sore throat, abdominal pain, muscle aches or headaches occur briefly for 6 to 9 days after infection. In rare cases, the central nervous system is also affected.

In around 2 to 4 % of those infected, meningitis occurs without signs of paralysis. Typical symptoms comprise fever, neck stiffness, back pain and muscle cramps. Very rarely (in 0.1 to 1 % of those infected), in addition to severe back, neck and muscle pain, the patient experiences paralysis or weakness in the arms, legs or other muscles (often on one side). Some paralysis can last permanently.

Late effects (post-polio syndrome): Years after a polio infection, muscle weakness and muscle wasting can increase or occur again.

What differential diagnostic diseases are there? Paralytic forms of the disease: Guillain-Barré syndrome (GBS)

Non-paralytic forms: Meningitis, encephalitis

What laboratory diagnostic tests are available? If polio is clinically suspected, a diagnostic test must always be carried out by the National Reference Center for Poliomyelitis and Enteroviruses.

Stool samples are best suited for virological and molecular detection of polioviruses: within the first 14 days approx. 80 % of infestations can be detected. If necessary, throat swabs and cerebrospinal fluid can also be used.

The diagnostic sensitivity can be increased by culturing the virus. Typing between wild-types and vaccine strains is carried out using molecular methods such as PCR, and sequencing.

How can I protect myself? The German Standing Committee on Vaccination (STIKO) recommends complete protection against polio through vaccination with an inactivated polio vaccine (IPV). Adults can get boosters after ten years, or before travel to risk regions/high-risk employment.

As polioviruses are excreted in the stool and are mainly transmitted by contact infection, careful hand hygiene is of central importance. Thorough hand washing after using the toilet, before preparing food, and before eating significantly reduces the risk of infection.

What therapeutic measures are available? At present, there is no specific therapy (antiviral substances), so treatment is symptomatic. Subsequently, longer physiotherapeutic and orthopaedic follow-up treatments are usually required (on a case-to-case basis).

EXERCISE:

1. Transmission is mainly fecal-oral, from person to person. A) True B) False

2. At present, there are specific therapies (antiviral substances) for polio. A) True B) False

3. There are no differential diagnostic diseases to polio. A) True B) False

You’ll find the answer below.

BIBLIOGRAPHY 1. https://pmc.ncbi.nlm.nih.gov 2. www.cdc.gov 3. www.dict.cc 4. www.nhs.uk 5. www.pei.de 6. www.rki.de 7. www.webster-dictionary.org

CARMEN LOBITZ Carmen Lobitz ist freie Trainerin, Lehrerin und MTL. Sie gründete 1998 in Berlin lobitz seminare, die unter anderem Englischseminare für Health Professionals anbieten.

Kontakt: mail@lobitz-seminare.de

www.lobitz-seminare.de

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Lösung für Exercise:

1. A

2. B

3. B

Poliomyelitis – What is important to know?

Where does the pathogen come from?

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Poliomyelitis – What is important to know?

Where does the pathogen come from?

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