Winning the War on Polio

Poliomyelitis, often called polio or infantile paralysis, is an infectious disease caused by the poliovirus. In about 0.5% of cases there is muscle weakness resulting in an inability to move. This can occur over a few hours to few days. The weakness most often involves the legs but may less commonly involve the muscles of the head, neck and diaphragm. Many but not all people fully recover. In those with muscle weakness about 2% to 5% of children and 15% to 30% of adults die. Another 25% of people have minor symptoms such as fever and a sore throat and up to 5% have headache, neck stiffness and pains in the arms and legs. These people are usually back to normal within one or two weeks. In up to 70% of infections there are no symptoms. Years after recovery post-polio syndrome may occur, with a slow development of muscle weakness similar to that which the person had during the initial infection.

Poliovirus is usually spread from person to person through infected fecal matter entering the mouth. It may also be spread by food or water containing human feces and less commonly from infected saliva. Those who are infected may spread the disease for up to six weeks even if no symptoms are present. The disease may be diagnosed by finding the virus in the feces or detecting antibodies against it in the blood. The disease is preventable with the polio vaccine; however, a number of doses are required for it to be effective. The United States Center for Disease Control recommends polio vaccination boosters for travelers and those who live in countries where the disease is occurring. Once infected there is no specific treatment. In 2013 polio affected 416 people down from 350,000 cases in 1988. In 2014 the disease was only spreading between people in Afghanistan, Nigeria, and Pakistan. In 2015 Nigeria had stopped the spread of wild poliovirus.

Signs and symptoms

The term "poliomyelitis" is used to identify the disease caused by any of the three serotypes of poliovirus. Two basic patterns of polio infection are described: a minor illness which does not involve the central nervous system (CNS), sometimes called abortive poliomyelitis, and a major illness involving the CNS, which may be paralytic or nonparalytic. In most people with a normal immune system, a poliovirus infection is asymptomatic. Rarely, the infection produces minor symptoms; these may include upper respiratory tract infection (sore throat and fever), gastrointestinal disturbances (nausea, vomiting, abdominal pain, constipation or, rarely, diarrhea), and influenza-like illness.

Cause

Poliomyelitis is caused by infection with a member of the genus Enterovirus known as poliovirus (PV). This group of RNA viruses colonize the gastrointestinal tract — specifically the oropharynx and the intestine. The incubation time (to the first signs and symptoms) ranges from three to 35 days, with a more common span of six to 20 days. PV infects and causes disease in humans alone. Its structure is very simple, composed of a single (+) sense RNA genome enclosed in a protein shell called a capsid.[18] In addition to protecting the virus’s genetic material, the capsid proteins enable poliovirus to infect certain types of cells. Three serotypes of poliovirus have been identified—poliovirus type 1 (PV1), type 2 (PV2), and type 3 (PV3)—each with a slightly different capsid protein. All three are extremely virulent and produce the same disease symptoms. PV1 is the most commonly encountered form, and the one most closely associated with paralysis.