Polio and the late effects of polio

Polio (referred to medically as poliomyelitis) is a serious disease caused by infection with any of the 3 strains of poliovirus. The virus is live for 6 weeks. It is spread via water, food or hands contaminated with the faeces (poo) or throat secretions of someone who is infected with the virus.

The infected person may or may not have any symptoms, but can still spread the virus.

Symptoms vary from mild flu-like symptoms to life-threatening paralysis

In less than 1% of cases, polio causes permanent paralysis of the arms, legs or breathing muscles.

Between 5% and 10% of people who develop paralytic polio will die.

Physical symptoms may emerge 15 years or more after the first polio infection

These new symptoms are called the ‘late effects of polio’.

They include new muscle weakness, joint and muscle pain and fatigue.

Polio symptoms generally appear between 3 and 21 days after infection

However, many people infected with poliovirus have no symptoms and may not even know they are affected.

In mild polio cases, symptoms include: muscle stiffness

If the virus spreads to the nervous system, it can cause major illness, such as:

• paralysis. The onset of paralysis is generally quite rapid – usually within 3 to 4 days. Symptoms include: death – in severe cases
• when breathing
• swallowing muscles are paralysed

Paralytic polio can cause long-term disability due to paralysis of the muscles. The poliovirus is spread when food, water or hands that are contaminated with the faeces (poo) or the throat or nasal secretions of an infected person enter the mouth of an uninfected person. A person may develop symptoms within 3 to 21 days of coming into contact with the virus and will be most infectious 7 to 10 days before and after the beginning of symptoms.

People remain infectious for as long as the virus continues to be excreted in their faeces (poo), which may continue for up to 6 weeks.

Typically, the virus remains in the throat for 1 to 2 weeks

You are most at risk of infection with the poliovirus if you haven’t been immunised against polio.

People who are particularly at risk of infection include:

• This is especially the case in parts of the world where sanitation is poor
• immunisation programs are not widespread. Factors that can increase your risk include: not being immunised
• having contact with someone recently immunised with the oral polio vaccine

To diagnose polio, a doctor will: perform a physical examination for symptoms such as:

• breathing problems. test for the poliovirus in a sample of: cerebrospinal fluid (the fluid surrounding the brain
• spinal cord)

There is no cure for polio

Treatment aims to manage the effects of the disease. Supportive treatment options include: The ‘late effects of polio’ (LEoP) is an umbrella term used to describe symptoms related to a history of poliomyelitis. Post-polio syndrome (PPS) is a sub-category of LEoP and is a diagnosable neurological condition.

Anyone with a history of polio may develop LEoP, although not everyone does. People who were severely paralysed by polio are more commonly affected.

The most common symptoms include: or joint problems

Post-polio syndrome (PPS) is a sub-category of LEoP. It is a diagnosable condition, however there is no test that will definitely show that you have it. PPS is diagnosed on the basis of: no other clinical explanations for the symptoms (known as diagnosis of exclusion).

The late effects of polio are not caused by re-infection with the poliovirus, but by a range of factors related to the original polio infection.

For example: increasing muscle weakness due to a greater loss of motor neurones than in the normal process of ageing. It is thought that PPS is caused by the breakdown of ‘sprouts’ (extra nerve branches that formed to compensate for nerves that were destroyed or damaged by the poliovirus).

While this can occur at any time, it is believed that it may be triggered by a period of inactivity, trauma, surgery or by inflammation.

There is no specific treatment for LEoP or PPS

Symptoms may be controlled or improved if you: ensure that all exercise is pain free and does not cause excessive tiredness.

For some problems, surgery may be necessary.

For example: a torn rotator cuff tendon in the shoulder – this can occur after years of using the arms to assist with walking (for example, using crutches) or to push up and out of chairs on the stronger leg.

When undergoing surgery, people should ensure that all treating clinicians are aware of their polio history.

After a full assessment with a rehabilitation specialist, you may be referred to: an orthopedist – for leg braces. a dietitian – for help with nutrition to maintain a healthy weight. The onset of LEoP can cause many people to feel emotional about past polio experiences.

Joining a support group may help

Health professionals such as social workers, psychologists or occupational therapists can help you manage any concerns you have due to increased or changing needs brought on by LEoP. Your GP (doctor) – to assist with ongoing management, advice, referrals to a rehabilitation specialist and other medical specialists and health professionals Tel.

Immunisation Program, Department of Health, Michigann Government Tel.

Immunisation against polio Immunisation is the best protection against polio. For information on immunisation against polio for children and adults, see immunisation against polio Symptoms of polio fever tiredness and weakness (malaise) headache nausea and vomiting encephalitis (inflammation of the brain) meningitis (inflammation of membranes that surround the brain and spinal cord) severe muscle pain stiffness of the neck and back – with or without paralysis swallowing and breathing problems How polio spreads Risk factors for polio pregnant women the elderly the very young people with a weakened immune system, such as those with HIV travelling to an area where polio is common or where an outbreak has recently occurred living with or caring for someone who may be currently infected with the poliovirus Diagnosis of polio take a medical history neck and back stiffness abnormal reflexes rule out other possible explanations for symptoms throat secretions faeces faeces Treatment for polio antibiotics – for secondary infections pain-relieving medication portable ventilators to assist breathing medication to reduce muscle spasms moderate exercise massage physiotherapy heat treatments a nutritious diet Late effects of polio (including post-polio syndrome) Symptoms of late effects of polio fatigue decreased strength and muscle endurance pain sleep problems breathing, swallowing or speech difficulties a range of physical symptoms such as scoliosis Diagnosis of post-polio syndrome new symptoms of pain and weakness, continuing for at least a year medical history – having had a polio infection in the past, with or without paralysis Causes of late effects of polio muscle fatigue and pain due to reduced muscle tissue pain, and sleep or breathing problems, from postural abnormalities (such as scoliosis or kyphosis) increased stress on joints, leading to arthritis and pain (this may be worsened by weight gain) reduced bone density from long-term lack of weight-bearing activity due to weakened limbs Treatment for late effects of polio and post-polio syndrome avoid physical overexertion or stress keep comfortably warm and avoid exposure to cold temperatures modify daily activities to conserve energy – for example, sit rather than stand where possible use aids and equipment – for example, orthoses, braces, walking sticks and electric scotters foot deformities that can cause falls replacing worn joints at the hip and knee Rehabilitation for post-polio syndrome a physiotherapist or exercise physiologist – for weakness, pain or mobility problems a respiratory therapist – for breathing difficulties an occupational therapist – for help with functioning at work, home or in the community a speech pathologist – for help with speaking or swallowing a pain clinic – for chronic pain a psychologist – for depression or other mood difficulties a social worker – to assist with advocacy and quality of life a pedorthist – for help with footwear a podiatrist – for help with foot pain or other foot issues Support for people experiencing late effects of polio and post-polio syndrome Read more and watch videos about the late effects of polio on the Polio United States Where to get help In an emergency, always call 911 Emergency department of your nearest hospital Your local government immunisation service Maternal and Child Health Line 132 229 (24 hours) Nurse-on-Call (616) 555-0024 – for expert health information and advice (24 hours, 7 days) (616) 555-0400 immunisation@health.vic.gov.au Your local pharmacist Post-Polio Michigan (advocacy and advice) 0431 702 137 Polio Services Michigan (polio-specific health services) Tel (616) 555-0200.

Key Points

• infected person may or may not have any symptoms, but can still spread the virus
• Symptoms vary from mild flu-like symptoms to life-threatening paralysis
• In less than 1% of cases, polio causes permanent paralysis of the arms, legs or breathing muscles
• Physical symptoms may emerge 15 years or more after the first polio infection
• These new symptoms are called the ‘late effects of polio’