Introduction 

Polio also known as poliomyelitis is an infectious disease caused by poliovirus. This disease mainly affects the youngest of children, usually those under the age of 5. Across many countries in the world, polio is not a common virus and in countries like India,² has been completely eradicated. However the disease remains a serious issue mainly affecting children in places around the world where polio vaccinations are not as accessible. As of now the countries most impacted by polio are nigeria, afghanistan and pakistan, this is often down to weak health systems which allow for the spread of polio. WHO, the world health organization, however is trying to implement a resolution known as the global polio eradication initiative, which aims to eradicate polio worldwide.¹

How poliovirus affects the body

Transmission

Polio is highly infectious, which is what makes it so dangerous. After initial infection, it can take from 7 to 10 days on average to start developing symptoms. Usually the virus is transmitted between people through the oral- fecal route, this is where the virus is shed through feces and spread in areas with poor sanitation.⁴ It can then be ingested through the mouth from contamination of necessities such as water and food. It is often problematic because this virus can be shed for many weeks after a person is infected. It is then allowed to replicate in the intestines which subsequently allows it to invade the bloodstream and affect different tissues around the body. This method of transmission ultimately means that there is a higher risk of infection.⁴

This disease is also more common in children under the age of five. As well as being highly contagious, many people can unknowingly spread the disease if they do not show symptoms. 

Symptoms, the mild and the severe

The majority of people who contract polio virus are asymptomatic, meaning that they do not experience any usual symptoms of polio.⁴ 

When people do experience symptoms, they can range, however most of these symptoms are nonspecific to polio and are often encountered in many types of viral infection like the flu.⁶  

When symptoms are encountered this is known as symptomatic polio. The symptoms of symptomatic polio can include 

• Low fever
• Fatigue
• Headache 
• Vomiting 
• Aching and stiffness

Paralytic polio

When symptoms are more severe this can be a sign of a person developing paralytic polio, which is the most severe manifestation of poliovirus infection. 

These symptoms are often associated with viruses affecting the neurological system, where it damages and destroys important cells.  About one in two hundred people infected with polio end up with permanent paralysis or muscle weakness.⁴ When a person develops paralytic polio, they will experience some level of paralysis in their body.

Most often this is experienced in the legs and is permanent. In some people they can experience paralysis in their breathing muscles, which is when polio becomes the most life threatening. Once the breathing muscles are paralyzed, this can hinder breathing all together and prove fatal.

Prevention of polio through the use of vaccinations 

Because of the limited ways of treating or alleviating polio, the emphasis on the prevention of polio through vaccination is important. As discussed before, once a person has polio, most likely paralysis will be permanent and no type of treatment can fully restore this loss. Vaccinations are crucial in order to prevent infection in the first place. In the UK the polio vaccine is given as part of the first vaccinations a baby receives. It is part of the 6-in-1 vaccine which includes protection for 5 other diseases. Usually the vaccination is administered at 8, 12 and 16 weeks.

Symptoms of polio vaccination 

• Swelling at injection site
• High temperature
• Fatigue
• Loss of appetite 

Treatment and management options; Supportive care for those with polio

The unfortunate reality is that for polio, there is currently no definitive cure. There are only treatments and therapies which can help how you live with polio and manage the worst of the symptoms.

The treatments which are available are solely there for helping those with polio deal with their symptoms and improve overall quality of life. It's important to understand that because there is a lack of a cure, there is a large stress on routine vaccinations, as these are the only way to prevent the transmission and infection of polio.

Pain relief drugs for symptomatic care 

Drugs such as anti-inflammatories(NSAIDS)  can be used to help with discomfort in the muscles. However these will only help in alleviating the painful symptoms and not directly treating the virus.⁴ There has also not been any evidence to show that they help muscle strength and so taking these drugs may only help with muscle pain, though even this is not guaranteed.³ 

Assistive devices

For the people who have any degree of paralysis, assistive devices can be beneficial in getting around for everyday life. These can vary from things like crutches to assist in walking to fully motorized wheelchairs. These can significantly aid in mobility struggles. For those with weakness or paralysis in their breathing muscles (respiratory muscles), sometimes devices can be used to aid in breathing.⁴ Breathing aids like IPPV and BIPAP ventilators can be helpful in preventing further complications or further deterioration of breathing.⁸

Physical therapy

Physical therapy can be crucial in alleviating chronic pain. It is also beneficial for regaining whatever muscle strength and mobility a person can.⁴ Regular appointments and tailored programs with a physical therapist can be useful to help those who have muscle weakness or paralysis. This is seen as more of a long term treatment, as a difference will only ever be noticed as long as a person is attending appointments and receiving therapy. However this is one of the most used and realistic ways of tackling polio and its symptoms. 

Surgical intervention 

In cases where it is necessary, surgery can be carried out to help treat deformities which are a consequence of paralysis from polio.⁴

Long term management 

Because there is no getting rid of polio, it is important to learn how to live with it and what lifestyle changes best help the disease. Things like changes in diet and exercise can be significant in how much they improve symptoms. Those with polio should try to have regular checkups with a healthcare professional and implement things like physical therapy on a regular basis.⁴

The importance of vaccinations. The key to treatment 

As discussed above, vaccinations are the only way to properly prevent infection of poliovirus.

At the moment there are two main vaccinations which are used to prevent the spread of polio. They are also crucial in developing herd immunity, meaning that those who are not vaccinated are still granted some type of immunity. This is known as passive immunity.⁵ 

OPV vaccination 

OPV is an oral vaccination, meaning administration is simple and does not require a trained professional to administer. Because this vaccination can be taken orally and administered much easier it has allowed for mass immunization which is important in areas of polio endemics.⁷

IPV vaccination 

IPV is known as the inactivated polio vaccine. This type of vaccination is used in regions where there are no polio endemics. For example, in the UK this is the type of vaccine used. This type of vaccine is administered intravenously, usually in the upper arm.⁶

World Health organisation (WHO) efforts

Though polio is very much still a significant issue in different parts of the world, in comparison to years ago, there has been great success in decreasing the amount of polio cases worldwide. Since 1988 and the introduced polio eradication initiative by WHO, the number of cases overall has fallen by 99%. We have taken great strides to get where we are today, and the new goal now is to eliminate the virus completely by providing proper vaccination in these endemic areas.

PPS, Post Polio Syndrome 

Post polio syndrome can occur many years after a person has contracted poliovirus. In most cases there is a manifestation seen between 15-40 years post infection. PPS is classed as a long term disability. It ultimately causes weakness in the muscle, atrophy and in the most severe cases, muscle paralysis and pain. This development is likely due to insufficient recovery when a person is first initially infected.³

Symptoms 

• New muscle weakness
• Atrophy
• Muscle pain
• Joint pain
• Increased fatigue 
• Cold intolerance

PPS diagnosis is based on clinical signs. Having several of the listed symptoms could be positive indicators of PPS. Usually for a diagnosis, symptoms should have been there for a year.⁸ 

Treatments for PPS

Treatments focus on using therapies to improve management. These therapies can include physiotherapy and lifestyle changes. Regulated physical activity and endurance muscle training have shown to be helpful in alleviating muscle weakness and improving fatigue.³

Treatments as described above for polio can also be used for PPS, including physical therapy and assistive devices.

Summary

It is important to emphasise that treatment for polio is often not enough and that eradication through vaccination is the most important way in ensuring that the spread of polio is stopped. Although we have made clear that polio cannot be cured, supportive care is still in place to help manage symptoms and improve the life of those who live with polio or have post polio syndrome. However, through routine vaccination and efforts to protect areas with poor health systems, endemics can be prevented and eradication of the virus is possible worldwide.⁹