Poliomyelitis in adults: causes, symptoms, treatment. Polio - what is this disease? Causes, symptoms and treatment of polio

Today there are many different diseases that a person rarely encounters. However, the state continues to vaccinate children. So, poliomyelitis: what kind of disease is it, what are its features, and is it necessary to vaccinate babies against this disease today? Let's talk about this further.

Basic information about the disease

First you need to understand what exactly will be discussed. Poliomyelitis - what kind of disease is it? Initially, it should be noted that this is an infectious disease. It is caused by an intestinal virus that lives in the human body in the intestines or pharynx. But its danger is that it is capable of affecting the spinal cord and brain. It should also be noted that poliomyelitis is popularly called infantile spinal paralysis. They are mainly affected by babies aged from several months to 6 years. The muscles of the child are most often affected.

Transmission methods

Polio - what is this disease, how is it transmitted?

This is a highly contagious disease. :

• by air;
• through dirty hands;
• with water or food;
• together with faeces (for example, when changing a baby's diaper).

The virus enters the human body through the respiratory tract - nose or mouth, from where it moves directly into the small intestine. There he settles during the incubation period. After that, the virus enters the bloodstream, where antibodies should be developed against it. In most cases, this is what happens. The child suffers an illness, after which he develops a lifelong persistent immunity to this problem.

It is important to note that the virus itself is very tenacious. In the external environment, it can be stored for six months, it tolerates both drying and freezing well.

A bit of history

This childhood disease (poliomyelitis) was considered the scourge of mankind until the middle of the last century. Especially often it struck the inhabitants of Europe, causing a huge number of child deaths. However, in the 50s, scientists managed to invent an effective vaccine, and polio ceased to be a fatal disease. On the territory of the former Soviet Union, doctors completely coped with this problem before 1961. However, some time ago, in 2010, a new outbreak of poliomyelitis was recorded in Tajikistan, where almost 700 people fell ill at once. Moreover, 26 cases were fatal. At the same time, the virus entered the territory of Russia, where even now it infects unvaccinated children from time to time.

About a living and non-living virus

What diseases does poliomyelitis add to the list? Infectious diseases, which are characterized by formidable complications and can be fatal. That is why recently doctors have strongly advised parents to vaccinate their children. But there is also one nuance here. The poliomyelitis virus that entered the territory of the state is considered "wild". And those vaccines that were used earlier, with this virus, are ineffective.

Until 2014, a vaccine with non-living cell structures was used. It was called inactivated. Now scientists have agreed that such prevention is ineffective. That is why it is now more important to use a "live" vaccine. At the same time, pediatricians note that two vaccinations, which are given before the first year of life, will be carried out with the still inactivated drug, as was done before.

On the dangers of a "live vaccine"

The name "live vaccine" often scares many parents. After all, no one wants to deliberately infect their child. Is it really as dangerous as it might seem at first glance? Doctors say that there is no risk of illness after such vaccination. Moreover, it also protects against all complications, since the body becomes resistant to all strains of the virus. But still, children with HIV infection and those who have weakened immunity from birth are not vaccinated with such a vaccine.

On the curability of the disease

What else do you need to know about a disease like polio? The medical history of each patient is different. After all, it all depends on how exactly it proceeded.

1. In most cases, and this is more than 90%, polio is asymptomatic. The child does not feel anything, his activity is at the usual level. Moreover, such children are carriers of the disease.
2. In about 5% of cases, the baby may feel mildly unwell. It can be muscle weakness, loss of strength.
3. In about 1-2% of cases, children develop meningitis against the background of poliomyelitis, which, by the way, does not lead to paralysis.
4. And in less than 1% of cases, babies have paralysis.

Also, doctors say that after paralysis, a child can recover both partially and completely. This will happen for about a year after recovery. During this time, the baby can bounce back.

About the types of disease

Having figured out what poliomyelitis is, what kind of disease it is, it is necessary to consider the main forms of the disease. There are three of them, they differ in clinical pictures.

1. Abortive form. It occurs most often. Symptoms are similar to other diseases. It manifests itself acutely, the symptoms disappear after 3-5 days. In this case, poliomyelitis is not diagnosed immediately, because the clinical picture is very similar to the flu, colds, intestinal disorders.
2. Meningeal form. The course of this type of disease is more severe, because the lining of the brain is affected, where the virus enters.
3. Paralytic form. In this case, the spinal cord is damaged, and in rare cases, the brain.

Symptoms also vary depending on the type of disease.

Polio Symptoms

How is polio disease manifested? Symptoms are what will help to recognize a dangerous ailment. As already mentioned above, most often it is the abortive form of the disease. In this case, everything starts very sharply: the temperature rises, there may be a slight cough and nasal congestion. There is also increased sweating, nausea, diarrhea, and abdominal pain. But it should be noted that in even more cases, the child practically does not feel anything and the illness for the baby passes imperceptibly and without consequences.

With the meningeal form, everything is much more complicated and dangerous. When the inflammatory process affects the patient's lining of the brain, severe headaches can occur that cannot be removed with medication. Often, patients have vomiting, which is completely unrelated to food intake and, as a result, does not bring the desired relief. Also, doctors sometimes diagnose other meningeal symptoms.

The most dangerous and severe is the paralytic form of poliomyelitis. However, it is rare. Symptoms depend on the options for the course of the disease:

• In the spinal version, the patient will have a sluggish flow, which may asymmetrically cover the limbs. There are also muscle pains, muscle tremors, urinary incontinence, or constipation.
• Bulbar paralysis is the most dangerous. With this form, that part of the spinal cord is affected, which is responsible for the work of the respiratory and cardiovascular systems. Symptoms may include: nasal congestion, shortness of breath, difficulty speaking, or high or low blood pressure. It should also be noted that if, with such a variant of the disease, the patient is not provided with proper medical care, everything can end in death within 2-3 days.
• The pontine variant differs in that in this case the nucleus of the facial nerve is affected. The forecast is favorable.

External manifestation of the disease

What does polio disease look like? Patient photos are very different. It all depends on the form of the disease. As already mentioned above, most often this problem will not affect the patient's appearance at all. Sometimes there may be a back or a face that will last a lifetime. In rare cases, children become disabled. So the polio disease can be very different, photos of patients are another confirmation of this. You cannot treat the problem simply and carelessly, even if the percentage of severe cases is very low.

About vaccination

What should you do to avoid getting polio? Doctors advise all children to get vaccinated on time. There are two ways:

• With an inactivated vaccine. In this case, the child is given an injection.
• With the help of a live attenuated vaccine, which is given by mouth in the form of drops. They have a slight salty flavor.

After the procedure, the body acquires strong immunity from poliomyelitis. The child will never get infected.

Often parents ask pediatricians the question: "Is it possible to be vaccinated after an illness against polio or not?" The answer is unequivocal: no. Why is it so? It's simple. A person can become immune to polio in two ways:

• after vaccination;
• after an illness.

So polio vaccination after illness is a completely useless action. And any doctor will not vaccinate a patient who has already been ill.

Diagnosis of the disease

How can this disease be recognized? In most cases, this cannot be done with a simple examination, relying only on symptoms alone. The doctor makes the final diagnosis only after the laboratory tests. In the first couple of weeks, the virus can be "seen" in the discharge from the nasopharynx, after this time the virus is identified in the feces. Other materials for research are blood, cerebrospinal fluid.

Treatment of the disease

We figured out how long after an illness it is possible to vaccinate against polio (and whether it is necessary), what are the features of the disease. Next, I want to talk about how you can deal with this problem. Initially, it should be noted that it is categorically impossible to be treated at home for poliomyelitis, regardless of the form of the disease. Alternative methods will not help in this case. Only medication will give the desired effect.

There is no single cure for poliomyelitis, doctors help the patient in a complex, using different medications along with physiotherapy procedures. This significantly speeds up the patient's recovery process. What medications are relevant in this case:

• The drug "Paracetamol". It has both antipyretic and analgesic effects.
• Anti-inflammatories such as Ibuprofen or Aspirin.
• If you have problems with stool, laxatives and rehydration medications may be prescribed. These are such medications as "Regidron" or "Smecta".

At the same time, various physiotherapy procedures will be very useful, the purpose of which is to restore the functionality of the limbs. During the acute phase, special pillows are placed under the joints of patients to prevent body parts from deforming. Splints may be applied to reduce pain. At a certain stage of recovery, patients can rigidly fix their limbs to stabilize work and restore shape, and not only to reduce pain, as is done at the stage of the acute course of the disease.

If we talk about physiotherapy, then in this case the following procedures may be useful:

• hydrotherapy, or water treatment;
• magnetotherapy, when the body is exposed to magnetic fields;
• electrical stimulation is the stimulation of muscles using a low-frequency current;
• physical exercises of various complexity.

What else do you need to know about a problem like polio? Patient history is different, it all depends on the form of the disease, individual characteristics of the body, immunity and the correctness of treatment.

Nuances important for polio

Having figured out whether it is possible to be vaccinated against poliomyelitis after an illness, and how this disease generally proceeds, it should be noted that bed rest is very important for this problem. First of all, it is needed in order to reduce the risk of developing a paralytic form. Secondly, it provides optimal conditions for the work of a weakened organism. As for nutrition, there are no strict restrictions. If there are malfunctions in the intestines, then you need to adjust the diet, consuming exclusively boiled or steamed dishes.

Consequences and complications of the disease

Why is poliomyelitis dangerous? The consequences of the disease with this viral problem can be very different. So, among the complications most often happens:

• Respiratory failure. It occurs when the respiratory muscles are affected.
• Myocarditis (an inflammatory process in the heart muscle) that interferes with the work of the heart.
• Various intestinal lesions. Intestinal obstruction, bleeding, and indigestion may develop.

All these complications are very dangerous and can be fatal.

What diseases can occur after poliomyelitis? The most diverse - from acute respiratory viral infections and tonsillitis to intestinal disorders. In most cases, this is not directly related to the transferred disease, but rather the reason is weakened immunity. But there is also such a thing as post-poliomyelitis syndrome. It is characterized by:

• muscle weakness and pain;
• fast fatiguability;
• gait disturbances;
• swallowing disorders;
• dyspnea.

This is a neurological ailment that can occur even 10 years after the illness suffered in childhood. The exact cause of its occurrence is still unknown to doctors.

Poliomyelitis was halted by the universal efforts of the governments of many countries of the world. But it is not yet possible to completely exclude the disease from the list of existing serious diseases. In this article, we will talk about what this dangerous disease is, how to recognize it and how to treat it.

What it is?

Poliomyelitis is a viral inflammation of cells in the gray matter of the spinal cord. The disease is most often childhood and highly contagious. The spinal cells are attacked by the poliovirus, which leads to paralysis. As a result, the nervous system ceases to function normally.

Usually, there are no visible symptoms in poliomyelitis, only when the virus enters the central nervous system, it causes paralysis and paresis.

The study of the disease began in the 19th century, and in the middle of the 20th century, poliomyelitis became a national disaster in many countries, including Europe. The poliomyelitis vaccine was developed independently by American and Soviet scientists. In recent years, countries have announced that they are polio-free. Outbreaks of the disease from time to time are observed only in three states - Nigeria, Afghanistan and Pakistan.

In 2015, two cases were recorded in Ukraine. Doctors have every reason to believe that polio can spread in this country due to the fact that, according to statistics, only half of Ukrainian children received the vaccine against the disease. In Russia, the situation is under control, but it tends to deteriorate. This is primarily due to the influx of migrants, including from neighboring Ukraine.

Causes of occurrence

Poliomyelitis is caused by a picornovirus from the enterovirus family. The virus is quite stable, for example, in an aquatic environment, it can live without loss of its properties for up to 100 days, and in human feces - up to six months. The virus is not afraid of low temperatures, and also perfectly repels the attacks of gastric juice, passing through the human food tract. Boiling water, sunlight, chlorine can destroy the virus.

A child can become infected from a sick person or carrier who has no visible symptoms.

Through the mouth, the virus is released into the environment for several days, and with feces - for weeks or even months. Thus, two ways of infection are possible - airborne and alimentary (through dirty hands, with contaminated food). The ubiquitous flies make a significant contribution to the spread of this virus.

After entering the child's body, the poliovirus begins to multiply in the lymphoid tissue of the tonsils, intestines and lymph nodes. Gradually, it enters the bloodstream, and from there - into the spinal cord and central nervous system.

The incubation period ranges from 3 days to one month, most often from 9 to 11 days. At the end of the period, the first signs of the disease may appear, or they may not appear, and then it will be possible to recognize poliomyelitis only by the results of laboratory tests.

Most often, cases of poliomyelitis are recorded in summer and autumn.At risk are children from six months to seven years. In the first few months of life, the child does not face polio at all, since the maternal innate immunity reliably protects the baby from this type of enterovirus.

After illness, persistent lifelong immunity is developed to the polivirus.

Symptoms and signs by form

Most children do not get polio even after the incubation period. Symptoms will depend on the form of the disease and the state of the child's immunity.

Hardware

There are no symptoms. Paralysis does not develop. Found only in blood tests. Antibodies to poliovirus are markers.

Visceral

The most common form. At the end of the incubation period, at the very beginning of the disease, there may be symptoms of the most common viral infection - sore throat, headache, fever, sometimes diarrhea and nausea.

The disease subsides in about a week. Paralysis does not develop.

Non-paralytic

With it, all the symptoms of a viral infection appear (sore throat, fever, abdominal pain), but more pronounced than with the visceral form.

There is tension in the occipital muscles, neurological manifestations. The disease is accompanied by severe headache, but does not cause paralysis.

The child recovers in 3-4 weeks.

Paralytic

If the child runs his fingers along the spine, he will experience severe pain. If you ask a child to touch his own knees with his lips, he will not succeed. A baby is sitting with this form of ailment with the torso tilted forward and with an emphasis on both hands, in the so-called tripod position. This form can cause paralysis. Usually, paralysis occurs when one fourth of the nerve cells die.

Complete paralysis is rare and occurs in only 1% of cases. But partial paresis of individual muscles are more common. Paralytic manifestations do not come immediately, but as the temperature decreases, closer to recovery. Most often, the muscles of the legs atrophy, less often the respiratory system or trunk.

Diagnostics

The symptoms of poliomyelitis are very similar to the clinical manifestations of many diseases caused by enteroviruses and herpes viruses. That is why, when symptoms of ARVI appear, it is important to call a doctor so as not to waste time and detect the disease, if any. This will help the methods of laboratory diagnostics.

Blood, a nasopharyngeal swab and a stool sample will be sent to the laboratory. It is in them that the virus can be detected.

First of all, the doctor will need to distinguish poliomyelitis from similar traumatic neuritis, Guillain-Barré syndrome, and transverse myelitis. Poliomyelitis is characterized by high fever at the onset of the disease, descending paralysis, and decreased tendon reflexes.

If a child is suspected of poliomyelitis, he must be hospitalized in an infectious diseases hospital.

Consequences and complications

Dead cells of the spinal cord are gradually replaced, scarred, therefore, the functions of the part of the body for which they were responsible are partially lost. The spinal form of paralysis, in which the thoracic, cervical and lumbar regions are affected, threatens with flaccid paralysis of the limbs.

With bulbar poliomyelitis, the cranial nerves are affected, so the complications will be localized higher - basically, the process of swallowing, the reproduction of sounds by the vocal apparatus is disturbed. The most dangerous is considered paralysis of the respiratory muscles, this can lead to death.

Both facial nerves and the brain can be affected if the virus reaches the central nervous system. The latter is fraught with the development of lifelong persistent paralysis.

The prognosis for non-paralytic poliomyelitis is favorable.

With paralytic pathology, to one degree or another, they remain with the child for life. However, a competent and responsible approach to rehabilitation allows avoiding disability in case of mild injuries and restoring motor functions in full or almost completely.

Treatment

Despite the fact that mankind has worked hard to create a vaccine against poliomyelitis, no drugs have been developed against this disease. The virus is completely insensitive to antibiotics, and antiviral drugs are not able to slow down its progress.

The only protector of the child at this moment is his own immunity.Only he is able to develop antibodies that can deal with the virus before it infects the brain and kills a large number of spinal cord cells.

All therapy is reduced to the fact that the child is provided with symptomatic help. When the temperature rises, they give antipyretic drugs, for muscle pains, they give painkillers and anti-inflammatory drugs.

The onset of paralysis is closely monitored by doctors in the hospital, when neurological disorders and seizures appear, the child is prescribed muscle relaxants - drugs that relax muscles, an anticonvulsant treatment regimen.

If the respiratory function is damaged, resuscitation assistance is provided with the connection of the child to a ventilator.

During treatment, the child is shown a plentiful warm drink, bed rest and complete rest.

The recovery period deserves more attention. It will be in it that it will be decided whether the paralysis will remain or will pass, the child will receive a disability or not. Rehabilitation after poliomyelitis begins with limiting the child's physical activity and physical activity. Muscles should not be strained to limit the paralyzed zones.

Then the load is gradually increased. The child is prescribed:

remedial gymnastics (exercise therapy);

hydrotherapy;

electrical stimulation of paralyzed or atrophied muscles;

massotherapy.

All these measures are needed exclusively in combination, and the rehabilitation period promises to be slow. The task of this stage is not even to restore the functions of dead brain cells, but to stimulate compensatory mechanisms - healthy cells must take over part of the functions of their dead brothers. If this can be achieved, the forecasts are more favorable.

During this period, hormones, enzymes, vitamins, calcium and magnesium preparations can be prescribed, since these substances provide faster contact during nerve impulses between the brain, nerve cells and muscles.

Can adults get sick?

Despite the fact that poliomyelitis is traditionally considered a childhood disease, adults can also become infected with this disease. Their disease is more severe, and the consequences are always more pronounced and dangerous than in children. Adults are also more likely to die.

Prevention

Non-specific disease prevention includes standard hygiene requirements - the child should wash his hands after returning from a walk and before eating,adults must fight flies as they carry poliovirus.

Children with suspicion of this disease are isolated in special hospitals, and in the kindergarten or school that they attend, they are quarantined for 21 days. During these three weeks, medical workers closely monitor the slightest changes in the well-being and condition of other children, measure their temperature every day, and examine the tonsils.

Vaccination and the consequences of vaccinations

The most effective prevention against this ailment is vaccinations. Today in Russia two types of vaccines are used: one contains live, but highly weakened polioviruses, the second - completely inactivated viruses killed by formalin.

Vaccination against poliomyelitis is included in the list of mandatory in the Russian Federation, it is included in the National Calendar of Preventive Vaccinations and is free of charge.

The first wave of vaccinations begins at a very early age. The vaccine in the form of oral drops is given to a child at 3 months, at 4.5 months and at 5 months. Then the drops will be given to the child at a year and a half, at 6 years old and at 14 years old.

Very often, pediatricians combine polio vaccination with DTP vaccination (against whooping cough, diphtheria and tetanus), however, provided that the child is older than 2 years at that time.

Vaccination can be not only in the form of drops, but also in the form of a solution for injection, but such vaccines are produced only abroad (in France, Belgium) and are purchased by the Russian Ministry of Health annually.

Multicomponent vaccines, which immediately combine components against pertussis, tetanus, diphtheria and polio, are also produced by foreign pharmaceutical companies.

Domestic vaccines are offered free of charge in the children's polyclinic. If the parents have a desire to vaccinate the baby with an imported drug, then they will have to pay for it.

It is not recommended to feed the child abundantly before vaccination; it is important that on the eve of a visit to the clinic, he empties his intestines. At the time of vaccination, the baby should be healthy, he should not have a fever and other symptoms of possible diseases.

After vaccination, the child is not fed or watered for an hour.

Vaccination is not dangerous for children's health, although sometimes it can cause certain unpleasant consequences, in particular, diarrhea. It is temporary and is not dangerous for the child.

In one case in a million, the administration of a live vaccine causes polio. If a vaccinated child falls ill, then the probability of paralysis is estimated at only 1%.

Sometimes the child may react to the vaccine with a slight allergic reaction, such as hives. The vaccine usually does not cause fever.

After vaccination, you can walk, and swim, and lead the most ordinary way of life. But with the introduction of new products into the child's diet after vaccination, it is better to abstain for at least a week.

Contraindications to vaccination

Children who reacted to the previous vaccination with violent manifestations from the nervous system, who had neurological disorders after the vaccination, are exempted from the vaccination. Children with HIV infection and other causes of immunodeficiency are not vaccinated either.

If the child is sick or has been ill recently with any viral infection, the vaccination is temporarily postponed. Moreover, other diseases not caused by viruses are not grounds for canceling the next vaccination.

You should not refuse this vaccination, since polio is a dangerous disease that can make a child disabled, despite the level of development of modern medicine, its capabilities and timely provision of qualified assistance.

For more information on poliomyelitis, see the next program of Dr. Komarovsky.

Polio is an acute viral infection that can penetrate the mucous membranes of the gastrointestinal tract and affect the motor neurons of the spinal cord and medulla oblongata, which leads to the development of paralysis of varying severity.

The name of this ailment, derived from Greek words polios - gray and myelos - the spinal cord, clearly characterizes the main lesions that occur during the disease, since the virus causes severe structural damage to the gray matter of the spinal cord. This leads to disruption of the motor sphere, and also provokes various degenerative disorders in the affected limbs. The resulting muscle atrophy is associated with a decrease or disappearance of the innervation, which regulates the function of nutrition and muscle growth. Since the poliomyelitis virus most often affects children, developing atrophy is accompanied by severe deformity of the limbs ( mostly lower) and their noticeable developmental lag.

Mostly children under 10 years of age get sick. According to statistics in endemic areas, 80% of diseases are recorded in children under the age of 4 years. Infection cases are equally common in urban and rural areas.

It should be borne in mind that in the overwhelming majority of cases, poliomyelitis does not cause any severe neurological disorders and proceeds as a latent infection. Clinical manifestations occur only in 0.5-1% of the total number of infected. However, all infected people secrete the virus within two to three weeks after the onset of the disease. Death is rare and is usually associated with respiratory failure caused by paralysis of the respiratory center.

Poliomyelitis was identified as a separate disease in the 19th century, but references to a disease with similar symptoms are found in medical writings dating back to several centuries BC. The study of poliomyelitis was begun in 1840, and its isolation into a group of separate diseases was made 20 years later. The viral nature of the disease was identified at the beginning of the 20th century ( 1908 year). Laboratory diagnosis of the disease was developed in the 1950s, and the first effective vaccine was proposed in 1953.

In the 20th century, several epidemiological outbreaks of poliomyelitis were recorded, in connection with which in 1988 the World Health Organization decided to start a program to eradicate the polio virus through vaccination. At the moment, the incidence of this disease has decreased by more than 99%, and 3 world regions ( North and South America, West Pacific and Europe) are declared as zones where the virus has been eradicated. In Southeast Asian countries, although cases are still occurring, the overall infection rate has been significantly reduced.

The difficulties associated with the virus eradication program are caused by the inability to cover some regions with routine vaccines, difficulties in introducing new types of vaccines into the vaccination schedule, as well as insufficient funding for this program.

Interesting Facts

• another name for poliomyelitis is "Heine-Medina disease" in honor of the scientists who singled out this disease as a separate disease, and who compiled a description of the classic clinical picture;
• in the Egyptian mummy, which is about 5 thousand years old, the deformity of the limbs indicates possible poliomyelitis;
• in one of the temples of the Goddess of Fertility, located in Egypt, a priest is depicted with a lesion of the lower limb characteristic of poliomyelitis;
• a painting by the 14th century Dutch artist Pieter Bruegel depicts a beggar in a specific pose, presumably due to polio;
• the first recorded epidemic of poliomyelitis occurred in 1834 on Saint Helena;
• as a result of excavations in Greenland, remains were found dating from the 5th-6th centuries BC, with changes in the bones specific to poliomyelitis;
• in 1908, Karl Landsteiner managed to infect a monkey with polio by injecting it with tissue fragments from people who died from this disease;
• the first polio vaccine, consisting of fragments of killed viral particles, was applied in 1954;
• the use of an oral vaccine based on a live attenuated virus began in 1958.

The causative agent of poliomyelitis

The causative agent of poliomyelitis is a virus of the genus Enterovirus families Picovrnaviridae... The structure of the virus is represented by a single-stranded RNA molecule that contains the genetic information of the pathogen, a number of proteins that form a shell around the RNA. The viral cap does not contain lipids ( fats), so it is fairly resistant to solvents and low pH ( acidic environment). The size of the virus is about 27 - 30 nm, the shape is spherical.

The polio virus is stable in the external environment and can persist for 3 months in water and for 6 months in feces. At low temperatures, the virus is able to maintain its infectious properties for a long time. However, it quickly dies when boiled, under the influence of ultraviolet radiation, when exposed to most disinfectants ( except ethyl alcohol).

Based on the differences in the protein structure, 3 strains of this virus were isolated ( I, II, III). Infection or vaccination with one of the strains causes the development of a specific immune response that provides lifelong protection against re-infection. However, this immunity does not protect against infection with another strain of the polio virus, that is, it is not cross-linked. In the vast majority of cases, infection associated with paralytic complications is caused by the polio virus type I.

Man is the only natural carrier of this virus. In some conditions, primates can be infected, but they cannot act as a source of infection.

The poliomyelitis virus, like all viruses of the genus Enterovirus, is able to infect the mucous membranes of the gastrointestinal tract, which are the entrance gate for infection. After entering the cells of the digestive tract, the virus begins to multiply by using human cellular structures. In the process of development, after a sufficient accumulation of viral particles in the host cell, the pathogen is released, followed by damage to the intestinal lymphoid tissue. On 3 - 5 days after infection, a short stage of viremia occurs, that is, the release of the virus into the blood. During this period, in most cases, specific antibodies are formed, which successfully block the development of the pathogenic agent and destroy it, which as a result leads to the development of an asymptomatic form of the disease. However, in rare cases, massive viremia occurs, which can lead to the development of a more severe form of the disease. At this stage, the poliomyelitis virus, unlike other enteroviruses, is able to penetrate the nervous tissue, or rather, the nerve cells of the gray matter of the spinal cord and brain. The exact mechanism of infection of the central nervous system is still unclear. It is believed that the penetration of the virus is due to its passage through the peripheral nerve endings from the muscles, where it is carried with the blood stream.

The poliomyelitis virus primarily affects motor and autonomic neurons. These cells are responsible for the control of regional reflexes, voluntary muscle movements, as well as for the regulation of the autonomous functions of the internal organs of the corresponding segments. The inflammatory process caused by it is associated with the active migration of immune cells, which secrete biologically active substances in the focus of inflammation, which negatively affects the nerve cells. Clinically, the severity of the inflammatory response is of much greater importance than its segmental distribution ( which in most cases is the same).

The poliomyelitis virus can cause inflammation in the posterior horns of the spinal cord ( part responsible for the perception and transmission of information about sensitivity). Nevertheless, despite the involvement of these structures, there is no sensitive deficit in poliomyelitis.

Poliovirus is only present in the spinal cord during the first few days. This is proved by the possibility of its isolation from these structures during this period. After this period, the virus is not detected, however, the inflammatory reaction continues and can last for several months, causing more and more neuronal damage.

The causes of poliomyelitis

Poliomyelitis develops as a result of human infection with the polio virus. As mentioned above, humans are the only natural source of infection. Thus, it is possible to become infected with polio only from another person who is either sick at the moment or is in the process of isolating the virus. However, it should be understood that due to its good resistance to environmental factors, the virus can enter the body of another person not only during any close contact, but also through a number of other ways.

Transmission methods

In the transmission of infection, a distinction is made between the mechanism and routes of transmission. The transmission mechanism is a way of moving the pathogen from the moment of its release into the external environment until the moment it enters the body of a susceptible person. The transmission path is a factor that ensures contact of the pathogen with the entrance gate of the infected person.

The mechanism of transmission of infection in poliomyelitis is fecal-oral, which means that the patient excretes the pathogen of poliomyelitis along with feces, urine and vomit, and that infection occurs when fragments of these substances enter the gastrointestinal tract of another person.

Poliomyelitis is characterized by the following transmission routes:

• Food route.The food route of transmission of the poliomyelitis virus is the most important in epidemiological terms. Transmission of infection occurs as a result of contamination of food with particles of the virus, which can be introduced if personal hygiene is not observed, with insufficient sanitary and hygienic control.
• Waterway.The waterway assumes that the virus enters the body through the ingestion of contaminated water. However, with poliomyelitis, due to the characteristics of the pathogen, this path is quite rare. However, with significant contamination of water sources with sewage, sewage and other sewage, it can serve as a source of infection.
• Household way.The household route of transmission involves infection through household items. Contact with objects contaminated with viral particles does not in itself pose a danger in the case of this infection, however, with insufficient personal hygiene, the virus from the skin of the hands can get onto the mucous membranes of the mouth, that is, into an environment favorable for its development.

In some cases, the possibility of aerosol transmission of infection is also isolated, that is, together with particles of saliva and sputum released when coughing, sneezing, talking. However, this route of transmission is important only in the initial stages of the disease and is dangerous only under the condition of fairly close contact.

Susceptibility of people

Susceptibility to infection is the body's ability to respond to the introduction of an infectious agent into it with various manifestations, be it carriage, asymptomatic course, or full-fledged disease.

Poliomyelitis is characterized by a fairly high natural susceptibility of people. In the overwhelming majority of cases, there is a virus carrier, which is not accompanied by any pathological changes or clinical symptoms. Cases of symptomatic disease are quite rare, and cases of paralytic course are noted in only one to ten cases out of a thousand.

Risk factors

Several factors preceding infection can influence the risk of infection as well as the severity of the disease.

The following risk factors are relevant for polio:

• Age. Polio is much more common among children and adolescents. This is due both to their greater susceptibility to this infection, and to the greater chances of coming into contact with infected materials.
• Floor.Before puberty, the risk of infection is the same for boys and girls ( however, the disease is more common among boys). The risk of infection in women of childbearing age without immunity increases with age. In addition, post-poliomyelitis syndrome ( progressive muscle weakness that occurs 20 to 30 years after illness) is more common among women.
• Pregnancy.Pregnant women are at greater risk of contracting polio with more severe disease.
Exercise increases the frequency and severity of clinically apparent paralytic poliomyelitis. Exercise in the incubation period and in the first stage of the disease does not have any effect on the course of the disease, however, physical activity during the first 3 to 4 days after the onset of the second stage of the disease can have an extremely adverse effect.
• Recent intramuscular injections. Clinical studies show that the development of paralytic poliomyelitis is more likely to affect the limb into which intramuscular injections were made within 2 to 4 weeks before the onset of the disease.
• Removal of tonsils. Removal of tonsils ( tonsillectomy), taken shortly before contracting polio, increases the risk of brain stem damage. This is due to the fact that in the area of \u200b\u200boperation are the nerve fibers of the ninth and tenth pairs of cranial nerves, which originate in the medulla oblongata.

Live attenuated virus

There are two main types of polio vaccines today, one of which uses a live attenuated virus. This vaccine has several advantages over the one in which inactivated ( killed) virus, but in some cases it can cause the development of polio. For this reason, some countries have abandoned the use of a live vaccine.

It should be understood that the risk of developing paralytic poliomyelitis associated with vaccination is extremely low, and this disease occurs in about one case in 2.6 million vaccines used.

A live weakened virus is administered orally through the mouth, which allows the virus to pass naturally and cause the synthesis of not only plasma antibodies ( in the blood), but also secretory antibodies that protect against subsequent penetration of the virus through the mucous membrane of the gastrointestinal tract.

Post-vaccination poliomyelitis develops within one to two weeks after the first dose. In most cases, the occurrence of this ailment is associated with the existing immunodeficiency in the person being vaccinated.

In what period is the patient dangerous to others ( contagious)?

A polio patient becomes contagious within a fairly short period of time. In the mucous membrane and secretions of the nasopharynx, the virus is detected already 36 hours later, and in the feces - 72 hours after infection. A person poses the greatest epidemiological danger during the first week of the disease, however, in some cases, the release of the virus is noted for 1.5 - 2 months after recovery ( but in doses insufficient for infection). Longer virus isolation is excluded.

As a rule, patients cease to be contagious within 2 to 3 weeks after the onset of the disease. However, due to the large number of cases of asymptomatic course of the disease, children who at first glance are completely healthy can be carriers of the virus. This greatly complicates the epidemiological control of the disease.

If poliomyelitis is detected, hospitalization of the patient is mandatory. To reduce the risk of infection, the infected person is isolated for 40 days or more, depending on the timing of the disappearance of the signs of acute infection.

Since polio is transmitted mainly through food, it is extremely important to practice personal hygiene and wash hands thoroughly after caring for a sick person to reduce the risk of infection. Household items and utensils of the patient can be contaminated with viral particles, so it is extremely important to carefully handle and disinfect them.

Polio Symptoms

The incubation period, that is, the time during which the virus multiplies and accumulates in an amount sufficient for the appearance of a clinical picture, with poliomyelitis is, on average, 9 to 12 days, but in some cases it can be from 5 to 35 days. This period reflects the time from infection to the onset of the first clinical symptoms.

The manifestation of poliomyelitis can be different and vary greatly in severity. In almost 95% of cases, an asymptomatic course of the disease occurs, in which there are no external manifestations of the disease. This form of the disease can only be recognized by carrying out a series of laboratory tests with the isolation and identification of a virus or antibodies.


Depending on the clinical manifestations, it is customary to distinguish between the following forms of poliomyelitis:

• Abortive form characterized by general nonspecific signs of a viral infection, which disappear within 3 to 5 days.
• Meningeal form occurs with inflammation of the meninges caused by the penetration of a virus. It is characterized by a more severe course.
• Paralytic form occurs when the motor neurons of the gray matter of the spinal cord, medulla oblongata, and in rare cases - the cerebral cortex are damaged.

Abortive form

Abortive poliomyelitis occurs most frequently. It is characterized by an acute sudden onset with an increase in body temperature, malaise, and a number of other non-specific manifestations. On the basis of the clinical picture in the abortive form of poliomyelitis, a diagnosis cannot be made, since such a course is similar to other viral diseases.

Symptoms of abortive poliomyelitis

Symptom	Characteristic	Mechanism of occurrence
Increased body temperature	An increase in body temperature is the first symptom of an illness. Chills often precede it. Usually, the body temperature rises to 38 - 38.5 degrees. Fever lasts for 3 to 7 days, but 2 to 3 days after the temperature has returned to normal, it may rise again.	An increase in body temperature is associated with the direct effect of viral particles on the structures responsible for thermogenesis, as well as with the effect of biologically active substances released from immune cells on the brain structures.
Runny nose	Mild nasal congestion with watery discharge occurs.	A runny nose occurs due to the defeat of the virus of the cells that form the mucous membrane of the nasal passages with the subsequent development of the inflammatory process. Biologically active substances released during inflammation cause vasodilation, which leads to the formation of serous exudate, which, mixing with a large amount of mucus, forms a watery discharge.
Cough	There is a short cough, which is uncharacteristic for sputum production.	The cough occurs due to the multiplication of the virus in the cells of the mucous membrane of the upper respiratory tract, which irritates the nerve endings and leads to a reflex cough ( act aimed at eliminating the irritant from the respiratory tract).
Nausea	Nausea is usually associated with food intake. In some cases, it may be accompanied by vomiting.	Nausea occurs due to the fact that the polio virus attacks the cells of the gastrointestinal tract with the development of an inflammatory response. As a result, there is a reflex irritation of the nerve endings, which forms a feeling of nausea.
Diarrhea	Diarrhea ( diarrhea) characterizes more frequent and loose stools. The stool may be frothy with mucus.	Diarrhea is caused by inflammation of the intestinal mucosa. This leads to impaired absorption of water from the intestinal lumen, to increased fluid exudation from the vessels into the intestinal lumen, as well as to a reflex increase in peristalsis ( movement) intestines. As a result, the transit of intestinal contents is accelerated and loose and frequent stools appear.
Pronounced sweating	Polio is characterized by sweating in the scalp and neck.	Sweating is a consequence of chills when the temperature rises, as well as the result of a violation of the activity of the autonomic nervous system.
Dry and sore throat	A sore throat with polio is usually mild, but it can cause some discomfort. When a secondary infection is attached, the pain increases significantly, and purulent foci appear.	Dry and sore throat is the result of an inflammatory reaction at the level of the pharyngeal lymphatic ring ( tonsils).
Abdominal pain	Abdominal pain is usually dull, aching in nature, with different localization.	The painful sensation arises due to an inflammatory reaction developing in the intestinal wall and the underlying lymphoid tissue, as well as due to the acceleration of peristalsis and the occurrence of diarrhea.

Meningeal form

Meningeal poliomyelitis occurs when an inflammatory process triggered by a virus affects the meninges.

The meninges are protective structures around the brain and spinal cord. The pia mater is involved in the synthesis and absorption of cerebrospinal fluid - the cerebrospinal fluid that circulates inside the brain. These structures are rather well supplied with blood and innervated.

With the defeat of the meningeal membranes, symptoms characteristic of the abortive form of poliomyelitis are noted, which, however, in most cases are more pronounced and are combined with a number of more specific signs indicating damage to the meninges.

Signs of meningeal poliomyelitis

Symptom	Characteristic	Mechanism of occurrence
Headache	Extremely severe headache with various localizations is noted. The pain is not relieved by rest or with pain medication.	Headache occurs due to irritation of the inflammatory process of the nerve endings located in the thickness of the meninges. In addition, inflammation of the meninges reduces the outflow of cerebrospinal fluid, the excess of which increases pressure in the brain and causes pain.
Vomiting	Vomiting in meningeal polio is not food-related and does not provide relief.	Vomiting with meningitis of central origin, that is, it occurs due to irritation of the center of vomiting, located in the brain.
Meningeal symptoms	Meningeal symptoms are identified during physical examination. With polio, they can be of varying degrees of severity.	Meningeal symptoms are signs of inflammation and irritation of the meninges. Due to reflex muscle contraction, movements that irritate the meninges are not possible.

Identification of meningeal symptoms is based on the implementation of movements in which there is some stretching of the meninges.

In clinical practice, it is customary to identify the following meningeal symptoms:

• Kernig's symptom. Kernig's symptom is detected by bending the leg at the hip and knee joints at right angles. An attempt to further extend the leg in the knee joint is impossible due to reflex contraction of the thigh muscles and acute pain.
• Brudzinsky's symptom.There are upper, middle and lower Brudzinski symptoms. The upper symptom is detected with a passive tilt of the head forward, if this causes flexion of the lower extremities in the knee joint and their pulling up to the stomach. An average symptom is detected when pressing on the pubic bone, if this causes the lower limbs to bend and pull them up to the stomach. The lower Brudzinsky symptom is detected when examining Kernig's symptom. If, during the flexion of one lower limb, involuntary flexion and pulling up to the stomach of the other is noticed, then a meningeal symptom is stated.
• Stiff neck.Stiffness of the occipital muscles is detected by passive forward movement of the head. If the patient's chin is not in contact with the chest, then irritation of the meninges is assumed. In some cases, with a strongly pronounced inflammatory process, due to the reflex contraction of the occipital muscles, the patient's head is thrown back even at rest.

The meningeal form of poliomyelitis can be extremely difficult, however, as a rule, the outcome of this disease is favorable.

Paralytic form

Paralytic form of poliomyelitis is quite rare, but it is extremely dangerous in terms of possible consequences. Depending on the clinical picture, several variants of the paralytic form are distinguished, which depend on the signs of damage to which part of the brain prevail in the clinical picture.

There are the following variants of the paralytic form of poliomyelitis:

• Spinal option.The spinal variant is characterized by flaccid peripheral paralysis, which asymmetrically covers the limbs.
• Bulbar option.The bulbar option is the most dangerous, since with this form of the disease, the brain stem is affected, in which the centers that regulate the activity of the cardiovascular and respiratory systems are located.
• Pontinny option.The pontine variant of the disease has a favorable prognosis and is characterized by damage to the motor neurons of the facial nerve. As a result, one-sided paralysis of the facial muscles occurs.

The clinical picture of the paralytic form of poliomyelitis consists of the symptoms of the abortive form of the disease, to which signs of meningitis and movement disorders join 3 to 5 days after the normalization of the condition.

Spinal paralysis symptoms

Symptoms	Characteristic	Mechanism of occurrence
Flaccid paralysis	Most often, unilateral asymmetrical flaccid paralysis occurs. The lower extremities are usually involved, but any muscle group can be affected. Often there is paralysis of one lower limb, followed by paralysis of one upper limb. The defeat of four limbs at once is almost not recorded among children and adolescents. An increase in muscle weakness in the morning hours is characteristic.	The occurrence of flaccid paralysis is associated with a violation of the transmission of a nerve impulse from a second-order neuron, which is located in the anterior horns of the spinal cord, to muscles. As a result, the muscles lose the controlling influence of the central nervous system, and their nutrition is disrupted. As a result, severe muscle weakness and decreased tone occurs with the disappearance or weakening of tendon reflexes and with gradual muscle atrophy.
Amyotrophy	Muscle atrophy occurs gradually with a protracted course of the disease or with non-regenerating paralysis.	Muscle atrophy is a consequence of a violation of their innervation. Since without proper innervation the muscles lose their stimulating effect and their tonic contraction is eliminated, a gradual involution of unused tissue occurs.
Muscle tremors	Contraction of individual muscle fibers occurs, which the patient may feel or notice as some movement under the skin.	Muscle trembling occurs due to a violation of the innervation and blood supply of individual muscle fibers, which, under the influence of a number of factors, begin to contract chaotically.
Areflexia	Tendon reflexes disappear in the affected limb.	The disappearance of tendon reflexes is caused by damage to the motor neuron of the anterior horns of the spinal cord, which closes the reflex chain. As a result, irritation of the tendon is perceived by the central nervous system, however, due to the absence of an "executive link", muscle contraction does not occur.
Muscle pain	In the initial stages, pain may occur in the affected limbs and muscle groups.	Muscle pain is associated with impaired innervation and muscle nutrition.
Constipation	Constipation occurs some time after the onset of paralysis and is replaced by diarrhea characteristic of the initial stage of the disease.	Constipation occurs due to a violation of the innervation of the muscles of the gastrointestinal tract with the development of intestinal paralysis.
Urinary Disorders	Urinary incontinence usually occurs.	Urinary incontinence is associated with paralysis of the sphincter muscles of the bladder, which most often occurs together with the defeat of the muscles of the lower extremities.

In some cases, paralysis in the spinal variant can be ascending, that is, it can spread from the lower extremities to the muscles of the abdomen, back, neck, arms. The spread of paralysis stops when the body temperature returns to normal.

Bulbar paralysis symptoms

Symptoms	Characteristic	Mechanism of occurrence
Swallowing disorder	Swallowing of both solid and liquid food is impaired. During drinking, liquid can enter the nasal cavity.	Swallowing disorder is associated with paralysis of the muscles of the soft palate, which performs the function of pushing the food bolus and isolates the nasopharynx from the oropharynx during swallowing. Paralysis of these muscles is associated with damage to the nuclei of the cranial nerves, which are located in the medulla oblongata.
Nasal congestion	Not accompanied by redness of the mucous membrane. Discharge is usually absent.	Nasal congestion at this stage of the disease is not associated with an inflammatory process in the nasal mucosa, but with paralysis of the muscles of the soft palate, which causes difficulty breathing and a feeling of nasal congestion.
Dyspnea	Labored breathing ( dyspnea) initially mild, but over time, shortness of breath can progress and cause respiratory arrest.	There are two mechanisms for the development of shortness of breath. The first mechanism is responsible for a milder form of breathing disorder and arises from paralysis of the muscles of the soft palate, which makes it difficult for air to pass into the upper respiratory tract. The second mechanism is responsible for extremely severe forms of shortness of breath, which are often fatal. It develops when the respiratory center of the medulla oblongata is damaged with paralysis of the diaphragm and respiratory muscles.
Speech impairment	The phonation of sounds is disturbed, the patient speaks "in the nose".	Violation of sound phonation is also associated with damage to the muscles of the soft palate and pharynx.
Change in heart rate	May occur as bradycardia ( slow heartbeat) and tachycardia ( increased heart rate).	The change in heart rate is associated with damage to the center of the medulla oblongata, which regulates the activity of the heart muscle.
Rise and fall in blood pressure	There is a jumping arterial pressure - the high pressure is periodically replaced by the low one.	Changes in blood pressure are associated with damage to the vasomotor center of the medulla oblongata.
Psychomotor agitation	Patients are agitated, anxious, and have difficulty making contact. Sometimes excitement is replaced by lethargy and coma.	Psychomotor agitation is associated both with direct damage to the brain structures, and with the mental impact of the disease, the influence of which increases with the progression of paralysis ( in particular, paralysis of the respiratory muscles), which causes a pronounced feeling of fear and anxiety.

Bulbar paralysis is an extremely severe form of the disease. Without proper medical care, death can occur within 2 to 3 days from the onset of paralysis.

Pontine paralysis symptoms

Symptoms	Characteristic	Mechanism of occurrence
Loss of facial movements	Mimic movements are weakened or completely disappear on one side of the face. The corner of the mouth is down. The oral slit is somewhat skewed ( due to overtightening by healthy muscles).	The motor nuclei of the facial nerve are located in the bridge, which controls the movements of the facial muscles. When they are damaged, mimic movements are lost, the muscles on the affected side lose their tone.
Gaping palpebral fissure	The gaping of the palpebral fissure occurs due to the inability to close the eye from the affected side. In this case, a strip of sclera is visible through the palpebral fissure.	Closing the eye is carried out during the contraction of the circular muscle of the eye, innervated by the facial nerve, the motor part of which is affected in pontine poliomyelitis.

In contrast to the defeat of the facial nerve caused by other causes, with the pontine variant of poliomyelitis, there is no pain in the innervation of the facial nerve, there is no pronounced lacrimation on the affected side, and there are no disturbances in taste perception.

Separately, mention should be made of the lesion of the gray matter of the brain - polioencephalitis. This form of the disease is extremely rare and is the only form of poliomyelitis that is characterized by generalized seizures. In contrast to the spinal form of the disease, spastic paralysis can be observed with polioencephalitis. This type of paralysis is associated with the elimination of the controlling influence of first-order motor neurons located in the cerebral cortex. This leads to excessive activity of the spinal cord neurons, which is manifested by spasm of skeletal muscles in the affected areas, an increase in their tone, and an increase in tendon reflexes.

The paralysis that occurs with polio can be of varying duration and intensity. In the vast majority of cases, complete recovery of motor function after poliomyelitis does not occur.

Diagnosis of poliomyelitis

The diagnosis of poliomyelitis is based on laboratory tests. In the first week of illness, the polio virus can be isolated from the secretion of the nasopharynx, and starting from the second - from the feces. Unlike other enteroviruses, the causative agent of poliomyelitis is rarely isolated from the cerebrospinal fluid.

If it is impossible to isolate and study the virus, a serological analysis is carried out, which is based on the isolation of specific antibodies. This method is quite sensitive, but it does not distinguish between post-vaccination and natural infections.

Polio treatment

To date, there is no specific antiviral drug that is effective against poliomyelitis. Nevertheless, the use of symptomatic drugs in combination with physiotherapy can speed up the process of recovery and recovery, as well as reduce the risk of complications.

Should poliomyelitis be treated with medication?

Treatment of poliomyelitis is based on the use of a number of drugs, which, despite their ineffectiveness against the pathogen, can significantly improve the general condition of the patient, reduce his negative experiences and symptoms, and improve the prognosis of the disease.

Drugs Used to Treat Polio

Group of drugs	Main representatives	Mechanism of action	Mode of application
Antipyretic	Paracetamol	Blocks the enzyme cyclooxygenase-3, which is present in the tissues of the brain. Due to this, the production of prostaglandins ( biologically active substances), causing an increase in body temperature, and the threshold of excitability of the center of thermoregulation of the hypothalamus also increases.	The drug is taken orally ( tablets) and rectally ( rectal suppositories). The dosage regimen depends on age. Adults and children over 12 years old can take 0.5 - 1 gram of the drug 4 times a day ( maximum dose - 4 grams). Children aged 6 to 12 are advised to take 240 - 480 mg in a single dose. Children under 6 years old - at a dose of 120 - 240 mg. For children under one year old, the drug is prescribed in a dose of 24 - 120 mg.
Pain medications	Paracetamol	Blocking the enzyme cyclooxygenase-3 and reducing prostaglandin synthesis in the brain reduces the transmission and perception of pain.	The same dosage regimen as for the antipyretic effect.
Non-steroidal anti-inflammatory drugs	Ibuprofen, Aspirin, Diclofenac, Meloxicam	They block the enzymes cyclooxygenase-1 and 2, which are branched for the synthesis of biologically active substances in the inflammatory focus. Thanks to this, they have a pronounced anti-inflammatory effect. As well as paracetamol, they have analgesic and antipyretic effects.	The dosage regimen is determined individually, depending on the severity of the inflammatory process, age, and the presence of contraindications.
Laxatives	Flax seeds, castor oil, lactulose, sodium sulfate	They cause softening of feces, an increase in their volume, mechanical irritation of the intestinal mucosa with acceleration of peristalsis.	Laxatives are prescribed for constipation against the background of paralytic bowel disease. The dosage and the choice of the drug is carried out exclusively by the doctor after a thorough examination.
Rehydrates and regulators of water and electrolyte balance	Regidron, Hydrovit, Ringer's solution, Ringer's lactate solution	Replenish fluids and electrolytes lost during vomiting and diarrhea.	If the patient is able to drink, then oral rehydration is prescribed using the drugs Regidron or Hydrovit. If the patient is exhausted or unable to drink on his own, fluids are replenished by intravenous infusion of saline - Ringer's solution or other drugs.

Non-drug treatment for polio

Non-drug treatment involves the use of various methods of physical impact on the affected limbs in order to optimize the process of their functional recovery.

In the acute phase of the disease, special pillows are used, which are placed under the joints of the affected limbs in order to give the limbs a natural position. Sometimes a splint is applied to the limb, which reduces pain and prevents deformation. Different types of splints can be used depending on the paralyzed muscle group.

In the recovery stage, physiotherapy and splinting are used. Physiotherapy helps to activate the regenerative potential of the body, eliminates a number of adverse symptoms, and also slows down the processes of atrophy and deformation of the limbs.

Physiotherapy can include the following methods of exposure:

• hydrotherapy;
• physical exercise;
• magnetotherapy;
• electrical stimulation.

In contrast to the acute stage of the disease, splinting during the recovery stage is aimed at stabilizing the limb and ensuring its maximum mobility in order to accelerate recovery.

Nutrition for polio ( diet)

The choice of diet for poliomyelitis depends on the specific clinical situation. Since with the abortive form of the disease, which is most common, diarrhea usually occurs, nutrition should be aimed at eliminating structural and functional disorders, as well as preventing putrefactive processes in the intestines. For this purpose, light foods are prescribed that do not cause an increase in the secretory activity of the gastrointestinal tract.

• decoctions of rice, semolina or oatmeal with the addition of butter or vegetable oil;
• meat puree;
• pureed cottage cheese;
• mashed porridge;
• steamed meatballs and cutlets;
• boiled fish.

During the period of vomiting and diarrhea, you should consume plenty of fluids ( best balanced rehydrating agents), as this allows you to replenish lost water and electrolyte stores.

With paralytic poliomyelitis, constipation often develops, which requires a completely different diet.

To normalize bowel function, it is recommended to consume the following foods:

• raw, boiled or baked vegetables, fruits, berries, seaweed, wholemeal bread, since they are all rich in vegetable fiber;
• cane and beet sugar, honey, jam;
• dairy products;
• kvass;
• herring;
• corned beef;
• fish caviar;
• butter, sunflower, olive oil.

Since poliomyelitis, in addition to stool disorder, is accompanied by a significant violation of the general condition, fever, intoxication, it is necessary to add foods rich in vitamins and protein to the diet.

Is bed rest necessary for polio?

Bed rest for poliomyelitis is necessary during the acute stage of the disease, since, firstly, it reduces the risk of developing a paralytic form of the disease, and secondly, it provides optimal conditions for the body to work. With the development of paralysis, periodic exercise is recommended ( if possible), passive movements in the joints ( to reduce the risk of joint atrophy), as well as a change in body position in bed ( for the prevention of bedsores).

Can poliomyelitis be treated at home?

Polio is a disease that cannot be treated at home. The correct therapeutic approach requires mandatory hospitalization. This is due, firstly, to the fact that it is easier to carry out epidemiological control in a hospital setting, and secondly, to the fact that the hospital has all the necessary equipment that a patient may need. Quick access to a mechanical ventilation apparatus, which is in the intensive care units of most hospitals, can play a decisive role in the development of respiratory failure against the background of paralysis of the respiratory muscles provoked by poliomyelitis.

Treatment at the recovery stage is also possible at home, since during this period the risk of developing any complications dangerous to a person's life is minimal.

Consequences of polio

Poliomyelitis is a rather dangerous viral disease that can cause the development of a number of serious complications and some consequences that appear after a certain period of time after infection.

Complications of poliomyelitis

The most dangerous complication of poliomyelitis is respiratory failure caused by damage to the respiratory muscles ( including the diaphragm and intercostal muscles), as well as due to blockage of the airways due to damage to the nuclei of the cranial nerves.

In some cases, inflammation of the heart muscle is noted ( myocarditis), which is accompanied by a violation of the pumping function of the heart. However, myocarditis in poliomyelitis rarely causes any specific external manifestations.

Gastrointestinal disorders such as bleeding, paralytic ileus, and acute gastric dilatation can complicate the course of paralytic poliomyelitis.

Post-polio syndrome

Post-polio syndrome is a neurological disorder associated with poliomyelitis, but occurs several decades after infection. The greatest risk of developing post-polio syndrome occurs in the period 25 - 35 years after the initial disease.

The exact cause of the occurrence is unknown, but it is assumed that this syndrome develops as a result of a gradual disruption of the compensatory potential of the nervous tissue, thanks to which the motor deficit that arose after acute poliomyelitis was compensated. It is possible that a latent virus located in the nervous tissue and causing the destruction of neurons after its reactivation also plays a role in the development of post-polio syndrome.

For post-polio syndrome, the following symptoms are characteristic:

• fast fatiguability;
• muscle weakness;
• muscle pain;
• violation of gait;
• dyspnea;
• swallowing disorder.

Usually the muscles involved are the same muscles that were affected during the initial infection, but weakness can occur in other limbs as well. New symptoms progress, gradually leading to the patient's disability.

Prevention of poliomyelitis

To prevent poliomyelitis, two types of vaccines are used - inactivated vaccine ( IPV), used parenterally ( by injection), and live attenuated vaccine ( OPV) applied inside ( through the mouth).

Inactivated poliovirus vaccine

IPV was the first commercially available polio vaccine developed. Its widespread use began in 1950. This vaccine is obtained by exposing the virus to a formalin solution for 12-14 days, which leads to its complete death.

After the introduction of this vaccine, the virus particles are captured by immune cells, which begin to produce specific antibodies that provide subsequent protection against infection. In order to increase the protective potential, this vaccine is prescribed three times with an interval between appointments of one month. In some regions, re-vaccination is used, which allows better control of the epidemiological situation and provides more reliable protection against infection.

Under the influence of IPV, secretory antibodies ( antibodies synthesized on the surface of the mucous membrane of the gastrointestinal tract). For this reason, after vaccination with an inactivated vaccine, although the person is protected from the virus, there is still some risk of infection with the "wild" polio virus. In this case, the virus can multiply in the cells of the intestine for some time without causing any external manifestations.

Live attenuated poliovirus vaccine

Live attenuated poliovirus vaccine has great immune potential and is extremely effective. However, due to the fact that its use is associated with some risk of developing post-vaccination poliomyelitis, in some regions it was abandoned.

A weakened virus is obtained by re-growing it on a monkey cell culture - in an environment to which the virus is not adapted, and on which, after several generations, it loses its pathogenic properties.

Oral ingestion of this type of vaccine mimics the natural route of the virus. Its penetration into the cells of the gastrointestinal tract triggers the production of secretory immunoglobulins, which form a defense against the virus within the mucous membrane. The use of 3 consecutive doses allows to achieve high titers of protective antibodies in the blood of vaccinated people.

Indications and contraindications after vaccination against poliomyelitis. Complications after the vaccine

Answers to frequently asked questions

Can you get polio again?

Re-infection with polio is not possible. This is due to the fact that after the transferred infection, a persistent lifelong immunity is formed, which provides protection against infection.

Immunity is a special system of the body that is aimed at recognizing foreign elements and recognizing its own tissues. This function is carried out by reading antigenic information encoded in the structure of proteins and other surface macromolecules.

Depending on the method of implementation of protection, the following types of immunity are distinguished:

• Humoral immunity. Humoral immunity is formed by immunoglobulins or antibodies dissolved in the blood. Distinguish between congenital ( genetically determined) and acquired humoral immunity ( formed after vaccination or illness). The formation of antibodies occurs during antigenic stimulation, that is, when there are particles of a pathogenic agent in the body that can trigger an immune response. Initially, immunoglobulins of the IgM type are synthesized, which are responsible for short-term protection, but after a while they are replaced by antibodies of the IgG class, which are considered antibodies of long-term immunity and can be present in the body for several years and even for life. The function of antibody synthesis is carried out by special immune cells - B-lymphocytes, which, after absorption and destruction of the pathogen or its antigenic fragments, migrate to the bone marrow and lymphoid organs, turning into plasma cells, the main function of which is to produce the corresponding protective antibodies upon subsequent encounter with this antigen.
• Cellular immunity.Cellular immunity is carried out by T-lymphocytes and the macrophage system, that is, immune cells that have the ability to absorb and destroy foreign cells and viruses. Among T-lymphocytes, there are helper cells, which are necessary for the coordination of the immune response, memory cells, which are necessary for the formation of a specific immune memory, and directly cytotoxic lymphocytes or killer cells, the main function of which is to destroy foreign cells. Cellular immunity, like humoral immunity, is based on antigen recognition.

It must be understood that there is no clear separation between these two types of immunity, as they work together. Immune cells that form cellular immunity are not only capable of destroying foreign particles, but also capable of processing their antigens and exposing them to the surface, which facilitates further activation of humoral immunity and accelerates the synthesis of antibodies. On the other hand, recognition and phagocytosis ( absorption) pathogenic agents associated with specific antibodies occurs much faster.

From a clinical point of view, the following types of immunity are distinguished:

• Sterile immunity. Sterile immunity protects the body from potential infection, even when the pathogen is absent from the body.
• Non-sterile immunity. Non-sterile immunity is characterized by the fact that antibodies to pathogenic agents are produced only if they are present in the body.

The immunity formed against the polio virus is sterile ( that is, it works constantly) and life ( in most cases). Thus, as long as the immune system of a person who has in any way been immunized against the polio virus fulfills its function, its re-infection is impossible.

A person can acquire immunity to the polio virus in the following ways:

• After an illness. If a person has been ill with the "wild" polio virus, specific antibodies and cells responsible for their synthesis are formed in his body, which persist throughout his life. In subsequent encounters with the virus, the immune system is activated within a matter of hours and carries out the complete destruction of the pathogenic agent without the development of signs of the disease.
• After vaccination. During vaccination, a weakened or inactivated virus is injected into the body, which triggers the same response as a wild virus during an illness, but which does not come with the same risks and symptoms.

It should be understood that, as mentioned above, protection from re-infection is possible only with a normally functioning immunity. If there is any malfunction in the immune system, re-infection becomes hypothetically possible.

Immunity function is impaired in the following situations:

• HIV AIDS. HIV is a serious infection that attacks and inactivates immune cells and thus opens the way for other infectious agents.
• Diseases of the bone marrow. Since the synthesis of cells that form immunity occurs in the bone marrow, any pathologies in which the function of this organ is impaired can lead to a state of reduced immunity.
• Toxic or radiation effects on the bone marrow. Long-term poisoning or exposure to radiation can cause dysfunction of the bone marrow with a decrease in immune potential.
• Taking drugs that suppress immunity. A number of drugs that are used to treat malignant neoplasms, as well as steroidal anti-inflammatory drugs, can weaken the immune system to one degree or another.
• Other pathologies of the immune system. There is a fairly extensive list of pathologies that can become a causal dysfunction of the human immune system.

What do people with polio look like?

At the stage of acute illness, patients with poliomyelitis are not characterized by any specific external manifestations. With the development of the paralytic form of the disease, dynamic disturbances in the movements of the arms and legs can be noticed, which, however, are not visible at rest. Over time, in the absence of medical treatment, groups of paralyzed muscles atrophy, which leads to a noticeable and significant deformation of the limb.

The appearance of patients with poliomyelitis largely depends on which limbs and which muscle groups were affected, on the aggressiveness of the disease, on the correctness of medical care at the recovery stage and on the duration of the disease.

The appearance of patients with poliomyelitis

Affected limbs	Description	Characteristic appearance
Lower limb	There is a significant deformation of one of the lower extremities with a decrease in its diameter compared to a healthy one, as well as a slight decrease in its length. In some cases, the bones can be significantly deformed, bent. The joints are usually well visible, sometimes deformed.
Both lower limbs	Both lower limbs are disproportionately thinned, reduced in volume. Usually, both limbs are shortened. There are various options for deformation of bones and joints.
Upper limb	With the defeat of the upper limb, its significant thinning is observed, followed by shortening. Deformation of the bone is less pronounced than with the defeat of the lower extremities. When both hands are affected, asymmetric deformity with disproportionately thin limbs is observed.
Spine and pelvic region	The polio virus rarely affects the muscles of the back and pelvis. The deformation of the bone skeleton of these areas is due to the fact that with a unilateral lesion of the lower limb with its shortening, the weight distribution and posture change when standing and walking, which over time leads to significant scoliosis ( lateral spinal deformity). This complication can be avoided by wearing special shoes or tires.

It should be noted that all the changes described above are not specific to poliomyelitis. They can develop with many other neurological pathologies, as well as with congenital anomalies.

It must be understood that people who develop the described changes in the limbs and joints are not contagious. At such stages, their body is completely cleared of the virus, and they do not pose any epidemiological threat. Structural changes in the limbs are due to the fact that the damage caused by the virus in the anterior horns of the spinal cord is irreversible.

Poliomyelitis (infantile paralysis, Heine-Medina disease) - an acute infectious disease caused by a virus with tropism to the anterior horns of the spinal cord and motor nuclei of the spinal cord, the destruction of which causes muscle paralysis and atrophy.

Sporadic diseases are more common, but epidemics have occurred in the past. The number of healthy carriers and persons with an abortive form, when recovery occurs before the development of paralysis, significantly exceeds the number of patients in the paralytic stage. It is healthy carriers and persons with an abortive form that are the main carriers of the disease, although it is possible to get infected from a patient in the paralytic stage. The main routes of transmission are personal contact and faecal contamination of food. This explains the seasonality with the maximum incidence in late summer and early autumn. At the age of 5 years, susceptibility decreases sharply. The incubation period is 7-14 days, but it can last 5 weeks. In the past 20 years, there has been a sharp decline in the incidence in those countries where prophylactic vaccines are carried out (first the Salk vaccine and the British vaccine and subsequently the oral attenuated Sibin vaccine).

What provokes / Causes of Poliomyelitis:

Three virus strains have been isolated: types I, II and III. The virus can be isolated from the mucous membrane of the nasopharynx of patients in the acute stage, healthy virus carriers, convalescent, as well as from feces. In humans, the most common route of infection is through the digestive tract. The virus reaches the nervous system along vegetative fibers, spreading along axial cylinders in peripheral nerves and in the central nervous system.

Pathogenesis (what happens?) During Poliomyelitis:

It is believed that it can spread through the blood and lymphatic system. The site of introduction of the virus can become the pharynx, especially the bed of the tonsils after tonsillectomy. The virus is resistant to chemical agents, but sensitive to heat and drying. It can be grown in monkey kidney cell culture. Specific serological tests are used, including complement fixation and antibody neutralization tests.

Pathomorphology. The spinal cord is swollen, soft, its vessels are injected, in the gray matter there are small areas of hemorrhage. Histologically, the changes are most pronounced in the gray matter of the spinal cord and medulla oblongata. In the ganglion cells of the anterior horns, various changes are noted - from mild chromatolysis to complete destruction with neuronophagy. The essence of inflammatory changes consists in the formation of perivascular muffs, mainly from lymphocytes with fewer polynuclear cells, and diffuse infiltration of gray matter by these cells and cells of neuroglial origin.

Recovery is characterized by the return to normal of those ganglion cells that were not very severely damaged. Other cells disappear completely. A small number of cells, secondary degeneration of the anterior roots and peripheral nerves are found in the anterior horns. In the affected muscles - neurogenic atrophy of varying degrees, an increase in connective and adipose tissue.

Polio Symptoms:

There are 4 types of reactions to the polio virus:

1. development of immunity in the absence of symptoms of the disease (subclinical or implicit infection);
2. symptoms (in the stage of viremia), which are in the nature of a general moderate infection without involvement of the nervous system in the process (abortive forms);
3. the presence in many patients (up to 75% during the epidemic) of fever, headache, malaise, there may be meningeal phenomena, pleocytosis in the cerebrospinal fluid, but paralysis does not develop;
4. development of paralysis (in rare cases).

In the subclinical form, there are no symptoms. In the abortive form, the manifestations are indistinguishable from any common infection. Serologic tests are positive.

The virus can be isolated. In other variants of the course of the disease, a pre-paralytic stage can be observed, which can sometimes turn into the stage of paralysis.

Pre-paralytic stage. During this stage, two phases are distinguished. In the first phase, fever, malaise, headache, drowsiness or insomnia, sweating, throat hyperemia, gastrointestinal disturbances (anorexia, vomiting, diarrhea) are observed. This phase of minor illness lasts 1-2 days. Sometimes it is followed by a temporary improvement with a decrease in temperature for 48 hours or the disease passes into the phase of "big illness", in which the headache is more pronounced and is accompanied by pain in the back, extremities, increased muscle fatigue. In the absence of paralysis, the patient recovers. In the cerebrospinal fluid, the pressure is increased, pleocytosis is noted (50-250 in 1 μl). Initially, there are both polymorphonuclear cells and lymphocytes, but after 1 week, only lymphocytes. The level of protein (globulins) is moderately increased. The glucose content is normal. During the 2nd week, the protein level rises.

Paralytic stage. In the spinal form, the development of paralysis is preceded by fasciculations. There are pains in the extremities, increased sensitivity of muscles to pressure. Sometimes the preparative stage lasts up to 1-2 weeks. Paralysis can be widespread or localized. In severe cases, movements are impossible, with the exception of very weak ones (in the neck, trunk, limbs). In less severe cases, attention is drawn to the asymmetry, "spotting" of paralysis, muscles can be severely affected on one side of the body and preserved on the other. Usually, paralysis is most pronounced during the first 24 hours, less often the disease gradually progresses. In "ascending" forms, the paralysis spreads upward (from the legs), and a life-threatening situation can arise due to respiratory failure. Possible "descending" forms of paralysis. It is necessary to monitor the function of the intercostal muscles and the diaphragm. Test to detect respiratory paresis - loud counting in one breath. If the patient cannot count up to 12-15, then there is severe respiratory failure, the forced breathing volume should be measured to determine the need for auxiliary breathing.

Improvement usually begins by the end of the 1st week after the onset of paralysis. As with other neuronal lesions, there is a loss or decrease in tendon and cutaneous reflexes. Sphincter disorders are rare, sensitivity is not impaired.

With the stem form (polioencephalitis), there are facial paralysis, paralysis of the tongue, pharynx, larynx, and less often paralysis of the external eye muscles. Dizziness, nystagmus are possible. There is a great danger of involving vital centers in the process. It is very important to distinguish respiratory disturbances caused by the accumulation of saliva and mucus with paralysis of the pharyngeal muscles from true paralysis of the respiratory muscles.

Diagnostics of the Poliomyelitis:

Sporadic cases must be differentiated from myelitis of a different etiology.

In adults, poliomyelitis should be differentiated from acute transverse myelitis and Guillain-Barré syndrome. However, in the first case, flaccid paralysis of the legs is combined with extensor plantar reflexes, sensory disturbances, loss of control over the sphincters, in the second, paresis are localized proximally, distributed asymmetrically, the protein content in the cerebrospinal fluid is increased, but pleocytosis is rarely detected. The bulbar form should be differentiated from other forms of encephalitis. The diagnosis of other forms of viral encephalitis usually depends on the results of serologic tests and virus isolation.

Poliomyelitis Treatment:

The mortality rate during epidemics is quite high. The cause of death is usually respiratory disorders in bulbar forms or ascending paralysis, when the intercostal muscles and the diaphragm are involved. The mortality rate has become significantly lower with the use of mechanical ventilation. With the cessation of the progression of paralysis, recovery is possible. A favorable sign is the presence of voluntary movements, reflexes and muscle contractions caused by nerve stimulation within 3 weeks after the development of paralysis. The beginning improvement can continue throughout the year. sometimes more. However, persisting manifestations of peripheral paralysis and paresis can lead to disability of patients.

If poliomyelitis is suspected, it is necessary to immediately create the patient complete rest, since physical activity in the preparative stage increases the risk of developing severe paralysis. Three categories of patients can be distinguished (without respiratory and bulbar paralysis; with respiratory paralysis, but without bulbar paralysis; with bulbar disorders) and, depending on this, conduct treatment. In the treatment of patients without respiratory disorders, intramuscular administration of ribonuclease, as well as convalescent serum, is indicated. In the acute stage, give a sufficient amount of liquid. A lumbar puncture is necessary for diagnostic purposes and can also relieve headaches and back pain. Analgesics and sedatives (diazepam) are used to relieve pain and reduce anxiety. The only acceptable form of activity is light passive movements. Antibiotics are prescribed only to prevent pneumonia in patients with respiratory distress.

Treatment after the development of paralysis is divided into stages:

1. in the acute stage with pain and increased muscle sensitivity (3-4 weeks);
2. in the recovery stage with continued improvement in muscle strength (6 months - 2 years);
3. in the residual stage (movement disorders remain).

In the acute stage, the main goal is to prevent stretching of the affected muscles and contracture of the antagonists, which may require long-term treatment. The patient should lie in a soft bed, the limbs should be in such a position that the paralyzed muscles are relaxed (not stretched) with pillows and sandbags. When recovering, physical exercises are very important, which the patient performs with assistance, in a bath or in apparatus with support with straps and straps. In the later stages, in the presence of contractures, tenotomy or other surgical interventions are performed. Prescribe proserin, dibazol, vitamins, metabolic agents, physiotherapy.

In case of respiratory failure, mechanical ventilation is sometimes necessary for weeks or even months.

With bulbar paralysis, the main danger is the ingress of fluid and secretion into the larynx. Difficulty feeding patients is aggravated by dysphagia. The correct position of the patient (on his side) is important, and every few hours he should be turned on the other side; the foot end of the bed is raised 15 °. This position can be changed for grooming or other purposes, but not for long. The secret is removed by suction. After 24 hours of fasting, the patient should be fed through a nasogastric tube.

Poliomyelitis Prevention:

All secretions, urine, feces of patients may contain a virus. Therefore, patients are recommended to be isolated for at least 6 weeks. In feces, the virus is detected after 3 weeks in 50% of patients and after 5-6 weeks - in 25%. Children in the home where there is a sick person should be isolated from other children for 3 weeks after the patient is isolated. Modern immunization is a more successful measure to limit the spread of epidemics. Sibin's vaccine (1-2 drops on a piece of sugar) creates immunity for 3 years or more.

Which doctors should you contact if you have Polio:

Are you worried about something? Would you like to know more detailed information about Polio, its causes, symptoms, treatment and prevention methods, the course of the disease, and diet after it? Or do you need an inspection? You can make an appointment with the doctor - clinic Eurolab always at your service! The best doctors will examine you, study the external signs and help determine the disease by symptoms, advise you and provide the necessary assistance and diagnose. you also can call a doctor at home... Clinic Eurolab open for you around the clock.

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• Non-paralytic poliomyelitis:
  • ​ symptoms of intoxication (signs of body poisoning with toxins of the pathogen) - low body temperature 37.5 - 38.5 ° C, headache, malaise;
  • signs of a cold - cough, sore throat, runny nose;
  • dyspeptic symptoms - abdominal pain, nausea, vomiting, loose stools;
  • proceeds easily and ends in 3-7 days.

• Meningeal form:
  • ​ begins acutely - with a rise in body temperature to 38-39 ° C, which decreases after 1-3 days, and then rises again to high values;
  • cold symptoms - coughing, mucous discharge from the nose;
  • signs of damage to the nervous system appear on the 2-3 day of illness - drowsiness, lethargy, headaches, vomiting;
  • positive meningeal symptoms: rigidity of the occipital muscles (the inability to lie on the back with the chin to touch the chest due to increased muscle tone), Kernig's symptom (a patient who is lying on his back bends his leg at the knee and hip joints at an angle of 90 °, and then try to straighten it in the knee joint - this cannot be done due to muscle tension).

• Paralytic poliomyelitis -there are 4 periods of the disease: preparative, paralytic, restorative and residual.
  • Preparalytic period:
    • ​ high body temperature 38.5 - 39.5 ° C;
    • weakness, malaise;
    • headaches;
    • runny nose;
    • a sore throat;
    • there may be vomiting, loose stools, or constipation;
    • then for 2-3 days the body temperature returns to normal - and again a sharp deterioration in the condition. The second wave of rise in body temperature to 39-40 ° C;
    • severe headaches, pain in the back, arms, legs, twitching and twitching of muscles, impaired consciousness;
    • the duration of the period is 4-5 days.
  • Paralytic period:characterized by the sudden development of paralysis (lack of active movements) of the muscles of the limbs, more often the legs, sometimes paralysis of the muscles of the neck and trunk develops, sudden pain in the muscles, sensitivity is not disturbed. Paralysis of the diaphragm and respiratory muscles are dangerous by impaired breathing and blood circulation, such patients die from respiratory arrest. The duration of the period is up to 1-2 weeks.
  • Recovery period: at the beginning of the period, the paralyzed muscles are actively restored, then the pace slows down. The period lasts up to 1-3 years.
  • Period of residual effects (residual):
    • ​ muscle atrophy (reduction in muscle size), contractures (limitation of mobility) develop;
    • deformities of the trunk and limbs.

Incubation period

3 to 35 days (average 7-12 days).

Forms

• Non-paralytic (a form of poliomyelitis without damage to the nervous system):
  • carriage of viruses - there are no signs of the disease, but the virus is detected by the virological method in feces or nasopharyngeal swabs;
  • abortive (minor illness) - proceeds without damage to the nervous system;
  • meningeal form - appears with signs of damage to the membranes of the brain and spinal cord (headaches, positive meningeal symptoms), but proceeds without muscle paralysis.
• Paralytic (a form of poliomyelitis with damage to the nervous system):
  • spinal (paralysis of the arms, legs, trunk, neck);
  • bulbar (violation of swallowing, breathing, speech, heart function);
  • pontine (violation of the sensitivity of the muscles of the face);
  • encephalitic (brain damage);
  • mixed (combination of several forms, for example, ponto-spinal).

The reasons

• The virus enters the environment with feces and mucus from the patient's nasopharynx.
• The source of infection can only be a sick person or a virus carrier.
• The virus is transmitted from person to person through alimentary (through dirty hands, contaminated food, water) and airborne droplets (when talking, sneezing, coughing) routes.

Polio treatment

• There is no specific treatment.
• Hospitalization of the patient.
• Providing the patient with physical and mental rest.
• Pain relievers and diuretics.
• In case of respiratory failure - artificial ventilation.
• If swallowing is impaired, tube feeding.
• According to indications - corticosteroid drugs, which have an anti-inflammatory effect.
• In the preparative stage, immunoglobulin is used.
• During the recovery period:
  • physiotherapy exercises, massage;
  • b vitamins (B12, B6);
  • nootropic agents for improving metabolic processes in the brain and spinal cord;
  • physiotherapy - paraffin, UHF;
  • spa treatment.

Complications and consequences

• Damage to the respiratory system - pneumonia (inflammation of the lungs), atelectasis of the lungs (a condition of the lung when it cannot fully expand, this leads to the collapse of all or part of the lung, which causes respiratory failure).
• Lesion of the gastrointestinal tract (gastrointestinal bleeding, mucosal ulcers).
• Vaccine-associated poliomyelitis is caused by strains of the virus from the vaccine. Very rare. Typical symptoms of vaccine-associated poliomyelitis:
  • flaccid paralysis (lack of active movements) or paresis (weakening of active movements), but sensitivity is not impaired;
  • 2 months after the onset of the disease, residual effects occur: muscle atrophy (reduction in muscle size), contractures (limitation of mobility) develop;
  • the disease does not progress, that is, if paralysis of the muscles of the foot has developed, then the paralysis will not spread to other parts of the leg;
  • the virological method allows you to identify the vaccine strain of the virus;
  • serological method: determination by ELISA (enzyme-linked immunosorbent assay) of an increase in antibody titer by 4 or more times.

Prevention of poliomyelitis

• Vaccine prophylaxis:
  • at 3 months, the first vaccination is given to all children with an inactivated vaccine;
  • at 4.5 months, a second vaccination with an inactivated vaccine is carried out;
  • at 6 months, the third live vaccination is given. Children from closed preschool institutions, as well as children with congenital immunodeficiency diseases and malformations of the gastrointestinal tract, receive an inactivated vaccine;
  • at 18 months, the first revaccination with a live vaccine is carried out. Children from closed preschool institutions, as well as children with congenital immunodeficiency diseases and malformations of the gastrointestinal tract, receive an inactivated vaccine;
  • at 20 months, a second revaccination with a live vaccine is carried out. Children from closed preschool institutions, as well as children with congenital immunodeficiency diseases and malformations of the gastrointestinal tract, receive an inactivated vaccine;
  • at the age of 14, the third revaccination with a live vaccine is carried out. Children from closed preschool institutions, as well as children with congenital immunodeficiency diseases and malformations of the gastrointestinal tract, receive an inactivated vaccine.

• Isolation of the patient.
• In the children's institution where there was a polio patient, quarantine is established for three weeks.
• Wet cleaning of premises with disinfectants. Compliance with the rules of personal hygiene (wash your hands more often, drink only boiled water).