What is Polio (Poliomyelitis)?

What is Polio (Poliomyelitis)?

Polio is a very contagious disease caused by poliovirus, which primarily affects children under 5 years of age. The virus enters the body through the mouth and multiplies in the intestines and occasionally reaches the motor neurons in the spinal cord through the blood, destroying these neurons. As a result of the death of motor neurons, weakness and paralysis of the muscles concerned appear. The vast majority of polio is asymptomatic or mild; about 90% of those infected have no symptoms or only develop cold-like complaints. The most severe course of the disease is the paralytic form: about every 200-2000 infections, muscle paralysis develops. Paralysis is usually asymmetric, loose (atnic) type and most often affects the legs. Although the disease has decreased by 99% thanks to intensive vaccination efforts in Turkey and around the world, the threat remains until the last virus disappears.

Causes of the disease and ways of transmission

Polio is caused by an RNA virus called poliovirus. The virus is transmitted through feces or oral secretions; the most common route of transmission is through ingestion of contaminated water or food through the mouth. The infected person can shed the virus for weeks through their feces, so person-to-person contact or shared items can spread through water sources. Polio is very contagious; people who get sick or even show no symptoms can spread the virus around and make other children sick. Therefore, the use of clean water, hand hygiene and good sanitation reduce the risk of polio transmission. Intensive travel and migrations, especially in unvaccinated communities, are factors that facilitate the spread of the disease.

Symptoms and Course

Polio usually occurs after an incubation period of 7—10 days (4—35 days interval). Most infection is mild: up to 25% of people experience flu-like symptoms such as fever, sore throat, headache, mild vomit-palpitations. This is called aseptic form of meningitis and usually resolves within 1-2 weeks. But when the virus takes hold of the nervous system, serious symptoms develop. First of all, high fever, contraction of the back muscles, neck stiffness, severe head and throat pain can be observed. Sudden weakness and paralysis of the muscles of the arms or legs appear within a few days following these first symptoms. In paralyzed muscles there is a loss of movement and sensation, reflexes decrease. Paralysis usually begins in the legs and can be unilateral; in severe cases, it can affect multiple limbs and respiratory muscles. In polio, 1 in every 5—10 people who develop a stroke develops life-threatening respiratory failure due to involvement of the respiratory muscles. About two-thirds of those who suffer from paralytic polio remain with permanent muscle weakness. In addition, many children who suffer from stroke may experience symptoms of “post-polio syndrome” such as muscle weakness, sudden fatigue or pain after many years (15—40 years).

Diagnostic Methods

Suspicion of polio is usually made with sudden-onset flakid paralysis (loose paralysis). Laboratory examination is essential for an accurate diagnosis. In stool samples taken from the suspected patient, poliovirus is searched. The virus can be detected in the feces in the first few weeks of infection, and therefore stool samples taken for several days in a row are tested. In addition, a throat swab can be searched for the virus in the first week of illness; cerebrospinal fluid (CSF) is usually not diagnostic, but can be taken to rule out other diseases. Depending on the type of virus detected by PCR and culture methods, it is understood that it is wild or vaccine-derived. When poliomyelitis is diagnosed, the relevant health organization and public health authorities should be notified.

Treatment Process

There is no known specific treatment for polio; treatment is entirely supportive. Shape: Observation of a child with respiratory paralysis in the 1960s while providing respiratory support in an iron lung (Emerson ventilator). Today, mechanical ventilators are used for similar purposes. The patient's fever is reduced, fluid intake and nutrition are ensured, muscle pain is controlled with painkillers. Physical therapy and exercise programs are applied to prevent damage to the muscles developed in paralysis. Thanks to this, it is aimed at strengthening the muscles, maintaining joint movement and increasing functional independence. If the respiratory muscles are affected, ventilator support may be required in intensive care. Special orthoses or prostheses can also be used to help paralyzed children move. All these approaches are carried out by the multidisciplinary team in the treatment of the child (pediatric neurology, physiotherapy, rehabilitation). Regular follow-up and surgical intervention can be planned for muscle deformities that may develop.

Vaccines and Methods of Prevention

The most effective way to prevent polio is vaccination. There are two types of vaccines available: Salk IPV (inactivated polio vaccine) and Sabin OPVÉ (live attenuated vaccine given by mouth). Both vaccines are effective and safe. The polio vaccine, administered in multiple doses, provides immunity at a level that will protect the child for life. In our country, polio vaccination is routinely given in infancy and preschool from birth. In addition, additional vaccination campaigns are organized at certain intervals under the leadership of the World Health Organization for collective protection. Proper hygiene measures also reduce contagion: it is important to use clean drinking water, to acquire the habit of washing the toilet and hands, to avoid the consumption of raw food. When the majority of society is vaccinated, it cannot find a new host to transmit the virus, thus stopping the spread of the disease. It is therefore vital that vaccinations are not disrupted and routine immune levels are kept high unless polio has yet been completely eradicated.

Living with the Disease: A Guide for Families

Most children with polio can return to social life after treatment, but some may need long-term support. Physical therapy and rehabilitation play a critical role in this process. Regular physiotherapy exercises promote muscle strengthening, maintaining joint mobility and gaining independence in daily activities. Using assistive devices for the patient, such as a special orthosis, a cane or a wheelchair, makes walking easier. It is useful to avoid overload, especially when using paralyzed muscles, to rest when tired.

The attendance of children with polio in school and participation in social life should be encouraged. The teacher and the immediate environment can help them move in harmony with their rehabilitation program. Families should work closely with relevant specialists to understand the child's condition and provide support. Psychological support is also important: Both the sick child and the family may experience anxiety and stress throughout the process; if necessary, psycho-social support (psychologist, support groups) should be sought.

Years later, sometimes “post-polio syndrome” can develop. This is manifested by symptoms such as new muscle weakness, extreme fatigue, muscle cramps and shortness of breath in people who have had polio before. If such complaints arise, a neurologist should definitely be consulted, muscle and respiratory functions should be monitored.

A lifelong coping process can also occur for a child or adult with polio. Families should receive the necessary support in the education and rehabilitation of the child, in cooperation with health institutions and social services. It is also important not to neglect other vaccinations, to maintain the overall health of the child. It should be remembered that although today there are very few children who contract polio, the risk does not disappear completely unless measures to combat the disease are abandoned.