Polio and Post-Polio Syndrome

AFL 6/9/02

Polio Overview
Epidemiology
-Enterovirus, transmitted via fecal-oral route, 3 antigenically distinct strains, with no cross
immunity between them
-Epidemics in summer and fall especially in temperate areas.
Last case in the US in 1979
Eradicated in the Western Hemisphere, with last case in 1991, however, vaccine associated
outbreak in 2000 in Haiti and the DR.
-Endemic areas- south Asia and sub-saharan Africa
-Incubation 5-35 days. 95% of infections asymptomatic
Types of infection:
-Minor- bortive polio Fever, HA, N/V, diarrhea, sore throat
-Non paralytic- signs of meningeal irritation and muscle spasms, in addition to above sx
-Paralytic- 0.1% of all plio. Paralysis occurs at any time during febrile period.
Spinal :polio involves muscles supplied by spinal nerves. Shoulder girdle paralysis
preceds intercostal and diaphramatic involvement.
Bulbar :cranial nerves, respiratory and vasomotor involvement. Diplopia, facial
weakness, dysphagia, dysphonia, weakness of SCM and traps, respiratory paralysis. Mortality of
50%
DDx; similar to other enteroviral meningitides (dx is serological) and to Fisher variant of GBS
(descending)
Tx: Supportive. Larger muscle groups are less likely to recover
Post Polio Syndrome
-Occurs after intial acute polio attack , mean time 28.8 yrs after first symptoms of polio infection
-Distinct from ALS in that weakness is not due to loss of whole motor neurons but is a
dysfunction of surviving motor neurons that causes a slow distintegration of individual nerve
axons
-2 etiologies debated- ongoing disintegration of injured motor neurons versus true recrudescence
or persistence of infection.
->Evidence of increased production of polio-specific IgM and IL-2 in CSF in 58% of pts
with post polio syndrome (36 pts with post polio, control 67 pts, of which 13 had had polio and
18 with ALS, none with new weakness) NEJM 325:749-755
Polio Vaccination
-OPV- oral polio vaccination (Sabin), Live vaccine, associated with rare cases of vaccine
associated paralytic polio. Available in 1960s
-IPV- inactivated polio vaccine (Salk), injection, available in 1955
-Since 1/2000, Advisory Committee on Immunization Practices (ACIP) of the CDD
recommended only using IPV (inactivated vaccine), due to concern over vaccine associated
paralytic poliomyelitis
-From 1980-88, 152 case of polio, 144 thought to be 2o to OPV (activated)
-Risk- estimated one in 2.4 million
-All IPV is not believed to result in less protection
-Polio vaccination in adults recommended if:
Traveling to endemic polio region
Unvaccinated and children are going to receive OPV
Lab workers and healthcare workers who are exposed to polio
-Vacc schedule is IPV at 0, 8wks, and 6-12 months.