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 nonfunctional. However, there is a vaccination against polio, so this disease has been very rare in Germany since the 1960s.
What is polio?
Polio (poliomyelitis), or simply polio, is a highly contagious infectious disease transmitted by poliovirus types I, II, and III. After contracting the disease, paralysis may remain or even lead to death. Normally, the viral disease is always febrile. The paralyses are caused by the spinal cord, which is affected by the polioviruses and controls the movements. In principle, polio has become rare in industrialized countries since about 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 steadily declining. In more than 95 percent of 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
Polio (poliomyelitis) is contracted through RNA viruses from the poliovirus group. These are highly contagious and are transmitted fecal-orally. The infection is comparable to the transmission of hepatitis A, i.e. one becomes infected by ingesting contaminated drinks or food. Infection by coughing, sneezing or kissing, on the other hand, is rare. The incubation period is quite long for polio; it can take three to 35 days to break out. The disease progresses in two phases. After infection, the viruses multiply in the body and nonspecific symptoms of illness occur, such as headache, pain in the limbs, loss of appetite, diarrhea, fever, and difficulty swallowing. After this first phase of illness, a symptom-free interval occurs and the viruses invade the central nervous system, triggering the second phase of illness. Symptoms of this phase then include muscle pain in general, especially back pain, paralysis, increased sensitivity to stimuli, and meningitis.
Symptoms, complaints, and signs
Even though poliomyelitis is largely under control in this country due to oral vaccination, many people still suffer from the late effects of early childhood polio. The early symptoms of polio can be nonspecific and undramatic. Only in a few infected people does poliomyelitis take a severe course. Dangerously, post-polio syndrome with significant symptoms can occur many years after the actual infection. The symptoms of polio infection may be absent or result in mild abortive poliomyelitis. In this case, nonspecific complaints such as increased temperature, headache and pain in the limbs, loss of appetite, sore throat or diarrhea are usually present. About five out of one hundred infected persons show such symptoms at all. Two forms of polio can occur in more 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 results in permanent paralysis of the extremities. In addition, severe back pain may occur, as well as varying degrees of discomfort in the respiratory, swallowing, speech, and eye muscles. Fatal respiratory paralysis may occur.
Course of the disease
There are three different courses of polio (poliomyelitis). They differ in the type and intensity of symptoms and, most importantly, whether or not the central nervous system is attacked. In the minor, so-called subclinical course, the signs of the disease are rather slight. After six to nine days, the disease breaks out in the form of fever, nausea, headache and sore throat. Overall, the course is milder and the central nervous system is not infected. In the non-paralytic course (which occurs in about one percent of all polio-infected persons), the affected person has fever, back and muscle pain, and neck stiffness.In this disease process, the central nervous system is affected, but the course of the disease is milder than in the paralytic process. In this case, the affected person suffers from paralysis, especially of the legs. These paralyses may remain even after the disease is over. In two to 20 cases, patients suffering from a course of the disease with paralysis die.
Complications
Complications of poliomyelitis are wide-ranging in their severity. With consistent physiotherapeutic treatment, signs of paralysis may resolve completely by two years after the acute phase. Often, however, impairments of the muscles remain despite therapy. In some cases, paralysis affects not only the leg muscles but also the trunk muscles. Over time, a severe scoliosis of the spine occurs because it is not sufficiently stabilized by the weak muscles. As a result, breathing can be significantly impaired. If no appropriate therapy takes place during convalescence, the dysfunction of affected muscles remains much more pronounced. Corresponding effects on the musculoskeletal system, such as joint malpositions, circulatory disorders, osteoporosis, respiratory and swallowing problems, turn out to be more severe. Paralyzed extremities often grow in a restricted manner, which leads to leg length discrepancies, pelvic obliquity and scoliosis in later life. Orthopedic aids such as crutches, splints and hand-operated wheelchairs put additional strain on healthy joints after many years of use. Furthermore, a history of polio must be taken into account for any subsequent general anesthesia. The dosage must be adjusted accordingly to avoid waking problems after anesthesia. The most frequent late consequence is post-poliomyelitis syndrome. In this case, extreme fatigue and the sudden appearance of new paralyses occur years or decades after the disease has been overcome. Muscles that were previously unaffected may also become diseased.
When should you see a doctor?
A doctor is needed if symptoms include paralysis, mobility limitations, joint pain, and limb pain. If the affected person can no longer move around without assistance, this is a worrisome condition. In particular, asymmetric paralysis of the limbs is a sign of a serious condition. Since polio can lead to death in severe cases without medical care, a doctor should be consulted early at the first signs of irregularity. If there is a refusal to take in food or fluids, discomfort of the digestive tract, diarrhea or nausea, a doctor should be consulted. If there is a headache or a general feeling of pain throughout the body, examinations are necessary to determine the cause. Back discomfort, changes in breathing, and increased irritability are warning signs that should be investigated. If breathing stops or anxiety occurs due to shortness of breath, a doctor’s visit is advised. Consultation with a physician is necessary as soon as persistent irregularities of the muscular system occur. If no physical exertion took place, this is considered unusual and should be investigated. In case of fever, sore throat or stiffness of the neck, a doctor should be consulted. If circulatory problems occur, a general feeling of illness is present, or if chewing, swallowing, or speech problems develop, a doctor should be consulted. Problems with eye muscles or heart rhythm should be presented to a doctor as soon as possible.
Treatment and therapy
On the one hand, polio (poliomyelitis) can be diagnosed by the visible symptoms such as signs of paralysis. However, it is also possible to detect the virus from feces, pharyngeal secretions, or cerebrospinal fluid. If the patient is in the initial disease phase of polio, many febrile infections are possible because of the nonspecific 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 by means of medication. It is not yet possible to combat the virus directly. If polio is suspected on its own, strict bed rest is usually required. Otherwise, physiotherapy is recommended and, in the case of paralysis symptoms, the affected person is alternately positioned in order to relax the muscles. Vaccination against polio is also possible.
Outlook and prognosis
The prognosis for polio is usually favorable. Spontaneous recoveries may occur with this disease. These occur in a period of up to two years after infection. Nevertheless, medical care should always be sought for a good prognosis, as the disease is associated with complications in many affected individuals. Without treatment, the risk of a severe course of the disease increases. This can lead to the premature death of the affected person. In addition, there is the possibility of lifelong impairments and secondary diseases. With sufficient and comprehensive treatment, individual therapy procedures are applied. 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 achieve relief of the movement impairments. In addition, possible late effects of polio are limited in this way. Shifts of the spine or differences in limb lengths are to be avoided. An unfavorable course of the disease is given as soon as the cranial nerves of the affected person are affected. In these cases, the prognosis is considered poor. Polio shows a significantly increased mortality rate in patients with the disease. Premature death occurs in up to twenty percent of affected individuals.
Follow-up
Polio is an infectious disease caused by polioviruses. In technical language, it is referred to as poliomyelitis, or polio for short. This term is made up of the words “polio” and “myelitis,” which when combined describe the inflammation of the spinal cord caused by the polioviruses. Although the term suggests that only children can contract poliomyelitis, adults are also frequently affected. In many cases, poliomyelitis progresses without symptoms, but it can also lead to severe, permanent paralysis with varying degrees of severity. It becomes particularly dangerous when the viruses affect the respiratory function. In the past, it was very common for affected people to then 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 did not work. For example, due to the African civil war, there were nearly 200 new infections in 2012, including in Nigeria, Afghanistan, Pakistan and Chad. However, even within the EU, there are still isolated infections, such as in Ukraine in 2015, where only about half of all children are vaccinated. The only effective remedy against polio is preventive nationwide vaccination. In the past, this was done by oral vaccination, but nowadays children are given a basic vaccination in the third month of life, which is refreshed after ten years. In the case of persons at risk, further vaccinations can be given later if necessary. The STIKO (“Standing Vaccination Commission”) recommends here a combination vaccination against polio (polio), tetanus (tetanus), diphtheria (infectious disease) and pertussis (whooping cough).
What you can do yourself
In the acute phase of polio, the bed rest prescribed by the doctor must be strictly observed. Muscle-relaxing positioning counteracts cramping of the muscles during paralysis symptoms, and warm moist compresses can relieve pain. Light physiotherapy under supervision is already useful at this stage and should be continued consistently after the disease. Permanent paralysis or joint damage to the spine or extremities requires adaptation of everyday life to the changed conditions. Many movement restrictions can be compensated for by aids such as walking splints, rollators or wheelchairs, and a barrier-free living space makes it easier to maintain familiar daily routines. In many cases, it is also possible to remain in working life. It is important not to overtax the body and to pay attention to its signals.Sufficient sleep and regular rest provide the necessary recovery; unnecessary stress and excessive physical exertion should be avoided. Post-polio syndrome in particular tends to worsen under stress. Testing one’s own limits must therefore be done extremely carefully. Psychologically, the disease is better coped with if limitations are not seen as weaknesses but accepted as a given. For many sufferers, it is helpful to exchange views with other sufferers in a self-help group or to seek discussion with a psychotherapist.