The Superior College Nursing Campus

Topic
Poliomyelitis
Submit to
Mam Sayeda Sidra Tasneem Kauser
Submit by
Maria Tariq

Class
Post RN Green
 S/No Contents Page/No
1 HISTORY 3
2 DEFINITION 4
3 EPIDEMIOLOGICAL APPROACH 5
4 MODE OF TRANSMISSION 6
5 CLINICAL FEATURE 7
6 DIAGNOSTIC STUDY 8
7 MANAGEMENT 9
8 PREVENTION 10

9 ERADICATION 11

Objective
At the end of this you will be able to learn about Poliomyelitis
You will be able to understand this topic and also inform well to other people

Cognitive
History, Define, Epidemiological Aproach, Mode of transmission, Clinical
Feature, Diagnostic study

Psychomotor
To provide nursing management

Affective
It is just in process Government held Polio camp every 3 months

HISTORY OF POLIO
The disease of poliomyelitis has a long history. The first example may even
have been more than 3000 years ago. An Egyptian dynasty (1580-1350BCE)
shows a priest with a deformity of his leg characteristics of the flaccid paralysis
typical of poliomyelitis.
The words polio ( grey ) and myelon ( marrow, indicating the spinal cord ) are
derived from the Greek. It is the effects of poliomyelitis virus on the spinal cord
that leads to the classic manifestation of paralysis.

DEFINITION
Poliomyelitis is defined as an acute viral inflammation that damages or
destroys the nerves in the brain or spinal cord and can cause permanent
paralysis that sometimes leads to death.

( By Webster`s )

A serious disease that affects the nerves of the spine and often makes a person
permanently unable to move particular muscles.

( By Merriam-Webster`s )

EPIDEMIOLOGY
As a result of a massive, global vaccination campaign over the past 20 years,
polio exists only in a few countries in Africa and Asia.

In the Philippines, the last polio case was recorded in 1993, and in 2000 the
Philippines was certified polio free ( UNICEF, 2005 ).
EPIDEMIOLOGICAL APPROACH
AGENT
 STRUCTURE

The causative agent is the polio virus which has three serotypes, type1, type2,
type3.

Composed of an RNA genome and a protein capsid.

 RESISTANCE

In feces-for months 4C & years at -20C.

Inactivated by heat and chlorination.

 MODE OF TRANSMISSION

Feco-oral rout

In early stage of disease through inhalation or entry through conjunctiva of

droplets of respiratory secretion of patient.

 PERIOD OF COMMUNICABILITY

7 to 10 dayes before and after the onset of symptoms

HOST
AGE

 Most vulnerable 6 mounth to three years.

SEX

 Ratio = M:F 3:1

IMMUNITY

 First 6 months maternal antibody.

 Acquired through infection with the wild virus.
 Immunization.

RISK FACTORS

Certain provocative or risk factors have been found to precipitate an attack of

paralytic polio in individuals already infected with polio virus.

They are fatigue, trauma, intramuscular injections, operative procedures such

as tonsillectomy undertaken during polio epidemics, administering of
immunizing agents such as DPT,
ENVIRONMENT
 SEASONAL
 More during rainy season
 Environment al sources of infection
 Contaminated water and food
 Flies
 Overcrowding and poor sanitation
MODE OF TRANSMISSION
1. FAECAL-ORAL ROUTE
2. DROPLET INFECTION

1.FAECAL-ORAL ROUTE
This is the main route of transmission in developing countries

2.DROPLET INFECTION
This may occur in the acute during the acute phase of the disease when the
virus occurs in the throat.

INCUBATION PERIOD
Usually 7 to 14 days ( 3 to 35 days )
CLINICAL FEATURES
1.INAPPARENT ( 90 TO 95% )

2.APPARENT ( 5 TO 10% )

1. INAPPARENT ( SUBCLINICAL ) INFECTION

This occurs approximately in 90 to 95% of polio virus infection. There are no
presenting symptoms and recognition is done only by virus isolation or rising
antibody titres.

2.APPARENT ( CLINICAL ) INFECTION

 ABORTIVE POLIO
 NON PARALYTIC ASEPTIC MENINGITIS
 PARALYTIC POLIOMYELITIS
 POLIO ENCEPHALITIS

ABORTIVE POLIO
 4-8% of infections
 Minor illness
 Symptoms

Low grade fever

Sore throat

Vomiting

Abdominal pain

Loss of appetite

Malaise

NON PARALYTIC POLIO

Occurs in approximately 1% of all infection.

The presenting features are stiffness and pain in the neck and back.

The disease lasts for 2 to 10 days.

Recovery is rapid. The disease is synonymous with septic meningitis.

PARALYTIC POLIO
Occurs in less than 1% of infection.

The virus invades CNS and causes varying degrees of paralysis.

The predominant sign is asymmetrical flaccid paralysis.

A history of fever at the time of onset of paralysis is suggestive of polio.

The other associated symptoms are malaise, nausea, vomiting, headache, sore
throat, constipation and abdominal pain.

Tripod sign may be present. The paralysis is characterized as descending. There

is no sensory loss. There might be facial asymmetry, difficulty in swallowing,
weakness or loss of voice.

POLIO ENCEPHALITIS
Polio encephalitis is a viral infection of the brain, causing inflammation within
the grey matter of the brain stem. The infection is caused by the poliomyelitis
virus which is a single stranded RNA virus surrounded by a non-enveloped
capsid.

DIAGNOSTIC STUDIES
o VIRUS CULTURE
The laboratory diagnosis of polio is confirmed by isolation of virus by cultures,
from the stool or throat swab or cerebrospinal fluid. In an infected person the
virus is most likely to be cultured in stool cultures.

o SEROLOGIC TEST

Acute and convalescent serum sample may be tested for rise in antibody titer,
but the report can be difficult to interpret as in many cases, the rise in titer
may occur prior to paralysis.

o SEREBROSPINAL FLUID TEST

Infection with polio virus may cause an increased number of white blood cells
and a mildly elevated protein level in cerebrospinal fluid
MANAGEMENT
 Treatment of pain with analgesics ( such as acetaminophen )
 Antibiotics for secondary infection
 Fluid therapy
 Bed rest ( if high grade fever )
 Adequate diet
 Minimal exertion and exercise
 Hot packs or heating pads ( for muscle pain )
 Prolong rehabilitation may be necessary including braces, splint or
surgery.
 Physiotherapy may be necessary
 Hospitalization if needed

PREVENTION
 PRIMARY PREVENTION
o Education- public, health care workers, & travelers
o Avoid travel to areas known to have polio outbreaks
o Vaccination
 SECONDARY PREVENTION
o Early detection diagnosis and prompt treatment
 TERTIARY PREVENTION
o Rehabilitation
 1. (IPV ) An inactivated (killed ) polio vaccine
2. (OPV) A live attenuated ( weakened ) oral polio vaccine

IPV
 Vaccine contains 40 units of type -1 antigen, 8 units of type- 2 and 32
units of type-3 D antigen.
 IM route
 1st 3 doses given at interval of 1-2 months and fourth dose 6-12 months
after the third dose.
 First dose: 6 weeks
 Drawback:
 No benefit to community
 Immunity not rapidly achieved
 Shouldn`t be administered during epidemic
 Advantages
 Safer vaccine

OPV
 Live attenuated vaccine, trivalent vaccine
 Contains 3,00,00 TCID 50 of type 1 poliovirus, 1,00,000 TCID 50 of type 2
virus and over 3,00,00 TCID 50 of type 3 virus.
 Dose : 2 drops
 National immunization programme: recommends primary course of 3
doses at 1 month intervals
 First dose at 6 weeks
POLIO ERADICATION
The World Health Organization (WHO) defines polio eradication essentially
as `zero incidence of wild poliovirus transmission anywhere in the world`

o Global Eradication of polio program was established in 1989.

o Today only 5 countries
1. Pakistan
2. Nigeria
3. India
4. Niger
5. afghanistan
REFERENCES

1. polio by Daniel J.Wilson, (2009), is part of the “ Biographies of Disease”

series which is edited by Julie K.Silver, M.D.history of disease and efforts to
find a way to prevent.USA.

2. www.medicalnewstoday.com > articles

3. https://en.m.wikipedia.org > wiki >polio

4. www.merriam-webster.com> dictionary

5.www.polioprevention.com
 DATA PACK
Monthly Review Meeting No. 13
Of District Coordinators, Field Program Officers
and Social Organizers
IRMNCH & Nutrition Program
2nd March, 2018

IRMNCH & Nutrition Program

Primary & Secondary Healthcare Department,
Govt. of the Punjab