All You Need to Know About Polio

Polio (poliomyelitis) is a highly contagious infectious disease. If left untreated, it can lead to death due to severe paralysis that can attack the lungs and respiratory organs and render them inoperable. However, there is a vaccination against polio, so that this disease has only rarely occurred in Germany since the 1960s.

What is polio?

Even if poliomyelitis is largely under control in this country thanks to oral vaccination, many people still suffer from the long-term effects of early childhood polio. The early symptoms of polio can be non-specific and undramatic. Poliomyelitis only takes a severe course in a few infected people.

Polio (poliomyelitis), or simply polio, is a highly contagious infectious disease transmitted by poliovirus types I, II, and III. After an illness, paralysis can remain or even lead to death. See AbbreviationFinder for abbreviations related to Polio.

Usually the viral disease is always febrile. The paralysis is caused by the polio virus infested spinal cord, which controls movement. In principle, poliomyelitis has become rare in industrialized countries since around 1960 and the introduction of preventive oral vaccination. The last disease in Germany caused by a wild virus was reported in 1990. However, vaccination coverage in society is declining more and more.

In more than 95 percent of the cases, poliomyelitis goes unnoticed and without symptoms. In about one percent of cases, the described paralysis or meningitis occurs, which can leave permanent damage.

Causes

With polio (poliomyelitis) you get infected by RNA viruses from the group of polioviruses. These are highly contagious and are transmitted fecal-orally. The infection is comparable to the transmission of hepatitis A, which means that you become infected by consuming contaminated food or drink. In contrast, infection through coughing, sneezing or kissing is rare.

The incubation period for polio is quite long, ranging from three to 35 days before it breaks out. The disease proceeds in two phases. After infection, the viruses multiply in the body and unspecific symptoms such as headaches and body aches, loss of appetite, diarrhea, fever and difficulty swallowing occur.

After this first phase of the disease there is a symptom-free interval and the viruses penetrate the central nervous system and thus trigger the second phase of the disease. Symptoms of this phase are muscle pain in general, especially back pain, paralysis, increased sensitivity to stimuli and meningitis.

Symptoms, Ailments & Signs

Symptoms of polio infection may be absent or lead to mild abortive poliomyelitis. There are usually unspecific symptoms such as high temperature, headache and body aches, loss of appetite, sore throat or diarrhea. About five out of a hundred infected people show such symptoms at all. Two forms of polio can occur in severely affected individuals: non-paralytic polio and classic paralytic polio.

The former leads to meningitis with fever, stiff neck, muscle and back pain and increased sensitivity to external stimuli. Classic polio leads to permanent signs of paralysis on the extremities. In addition, severe back pain and complaints of varying severity in the breathing, swallowing, speech and eye muscles can occur. Fatal respiratory paralysis can occur.

course of the disease

Child paralysis (poliomyelitis) can occur in three different courses of the disease. They differ in the type and intensity of the symptoms and, above all, whether the central nervous system is affected or not.

In the low, the so-called subclinical course, the signs of the disease are rather minor. After six to nine days, the disease breaks out in the form of fever, nausea, headache and sore throat. Overall, it is milder and the central nervous system is not infected.

In the non-paralytic course (which occurs in about one percent of all people infected with polio), the person affected has fever, back and muscle pain and neck stiffness. In this course of the disease, the central nervous system is affected, but the course of the disease is milder than in the paralytic course.

In this case, the person concerned suffers from paralysis, especially of the legs. This paralysis can also remain after the illness. In two to 20 cases, patients who suffer from a progressive form of the disease with paralysis die.

Complications

Complications of poliomyelitis are widely diversified in their manifestation. With consistent physiotherapeutic treatment, symptoms of paralysis can completely regress up to two years after the acute phase. However, despite therapy, muscle impairments often remain. In some cases, not only the leg muscles but also the trunk muscles are affected by paralysis.

Over time, severe scoliosis of the spine develops, as it is not sufficiently stabilized by the weak muscles. As a result, breathing can be significantly affected. If no appropriate therapy takes place during convalescence, the dysfunction of the affected muscles remains much more pronounced. Corresponding effects on the musculoskeletal system such as joint misalignments, circulatory disorders, osteoporosis, breathing and swallowing difficulties are more serious.

Paralyzed extremities often grow restricted, which later leads to leg length discrepancies, a tilted pelvis and scoliosis. Orthopedic aids such as crutches, splints and manual wheelchairs put additional strain on healthy joints after many years of use. In addition, a history of polio must be taken into account for each subsequent general anesthetic.

The dosage must be adjusted accordingly in order to avoid problems waking up after anesthesia. The most common late effect is the post-poliomyelitis syndrome. Years or decades after the illness has been overcome, extreme tiredness and the sudden onset of new paralysis occur. Muscles that were not previously affected can also become diseased.

When should you go to the doctor?

A doctor is required for symptoms such as paralysis, restricted mobility, joint problems and body aches. Being unable to move around unaided is a worrying condition. In particular, asymmetrical paralysis of the limbs are signs of a serious illness. Since poliomyelitis can lead to death in severe cases without medical care, a doctor should be consulted as soon as the first irregularities appear.

If there is a refusal to eat or drink, problems with the digestive tract, diarrhea or nausea, a doctor should be consulted. In the case of a headache or a general feeling of pain throughout the body, examinations are necessary to clarify the cause. Back pain, changes in breathing, and increased irritability are red flags that should be followed up. If breathing stops or anxiety occurs due to shortness of breath, it is advisable to consult a doctor. Consultation of a doctor is necessary as soon as persistent irregularities of the muscular system occur.

If there was no physical overexertion, this is considered unusual and should be examined. If you have a fever, sore throat or stiff neck, see a doctor. If circulatory disorders occur, if there is a general feeling of illness or if you have problems chewing, swallowing or speaking, you should see a doctor. Problems with the eye muscles or the heart rhythm must be presented to a doctor as soon as possible.

Treatment & Therapy

On the one hand, infant paralysis (poliomyelitis) can be diagnosed by the visible symptoms such as signs of paralysis. However, it is also possible to detect the virus in faeces, throat secretions or brain fluid. If the patient is in the first phase of polio, many feverish infections are possible because of the non-specific symptoms.

Even if paralysis has already occurred, there are other diseases that resemble the course of polio. Only the symptoms of polio can be treated, i.e. the symptoms are alleviated with medication. So far it has not been possible to fight the virus directly.

If polio is suspected, strict bed rest is usually required. Otherwise, physiotherapy is recommended and in the event of signs of paralysis, the person concerned is positioned alternately to relax the muscles. Vaccination against polio is also possible.

Outlook & Forecast

The prognosis for polio is usually good. This disease can heal spontaneously. These occur in a period of up to two years after infection. Nevertheless, medical care should always be sought for a good prognosis, since the disease is associated with complications in many of those affected. Without treatment, the risk of a severe course of the disease increases. This can lead to the premature death of the patient. There is also the possibility of lifelong impairments and secondary diseases.

With a sufficient and comprehensive treatment, individual therapy methods are used. These depend on the extent of the symptoms and the stage of the disease at the time of diagnosis and the start of treatment. In addition to the administration of medication, physiotherapeutic support is also used to alleviate the movement impairments. In addition, possible late effects of polio are limited in this way. Displacements of the spine or differences in the length of the limbs should be avoided.

An unfavorable course of the disease is given as soon as the cranial nerves of the person concerned are affected. In these cases, the prognosis is poor. Polio shows a significantly increased mortality rate in the sick patients. Up to twenty percent of those affected die prematurely.

Aftercare

Polio is an infectious disease caused by poliovirus. In technical terms, this is called poliomyelitis, or polio for short. This term is made up of the words “polio” and “myelitis”, which together describe the inflammation of the spinal cord caused by the polioviruses. Although the term suggests that only children can get poliomyelitis, adults are also often affected.

In many cases, polio is asymptomatic, but it can also lead to severe, permanent paralysis of varying degrees. It becomes particularly dangerous when the viruses affect the respiratory function. In the past, it was very common for affected people to be placed in the so-called “iron lung” in order to be able to breathe at all.

The polioviruses are transmitted through human contact, so it is a so-called contact infection. The original plan was to completely eradicate poliomyelitis within the 21st century, however, due to political, geographic and global implications, this plan has not worked. As a result of the African civil war in 2012, there were almost 200 new infections, including in Nigeria, Afghanistan, Pakistan and Chad. However, there are also individual infections within the EU, such as in Ukraine in 2015, where only about half of all children are vaccinated.

The only effective remedy against polio is preventive, comprehensive vaccination. In the past, this step was done by means of an oral vaccination, nowadays children in the third month of life are given a basic vaccination, which is refreshed after ten years. In the case of persons at risk, further vaccinations can be carried out later if necessary. The STIKO (“Standing Vaccination Commission”) recommends a combination vaccination against polio (child paralysis), tetanus (lockjaw), diphtheria (infectious disease) and pertussis (whooping cough).

You can do that yourself

In the acute phase of polio, the bed rest prescribed by the doctor must be strictly observed. A muscle-relaxing position counteracts muscle cramps in the event of signs of paralysis, and warm, moist compresses can relieve pain. Light physiotherapy under supervision is already useful at this stage and should be continued consistently after the illness.

Permanent paralysis or joint damage to the spine or extremities require an adjustment of everyday life to the changed circumstances. Many mobility restrictions can be compensated for by aids such as walking splints, walkers or wheelchairs, and a barrier-free living space makes it easier to maintain the usual daily routine. In many cases, it is also possible to remain in professional life. It is important not to overtax the body and to pay attention to its signals. Sufficient sleep and regular rest breaks ensure the necessary recovery, unnecessary stress and excessive physical exertion should be avoided.

Post-polio syndrome, in particular, tends to worsen with exertion. Exploring your own limits must therefore be done with extreme caution. Mentally, the illness is processed better if limitations are not viewed as a weakness, but are accepted as a given. For many sufferers, it is helpful to talk to other sufferers in a self-help group or to talk to a psychotherapist.