Poliomyelitis

Kiran Thakur MD (Dr. Thakur of Johns Hopkins Hospital has no relevant financial relationships to disclose.)
Temitope Lawal FMCP (Dr. Lawal of Lagos University Teaching Hospital has no relevant financial relationships to disclose.)
Joseph R Zunt MD MPH (Dr. Zunt of the University of Washington has no relevant financial relationships to disclose.)
Karen L Roos MD FAAN, editor. (Dr. Roos of Indiana University School of Medicine has no relevant financial relationships to disclose.)
Originally released January 8, 2015; expires January 8, 2018

This article includes discussion of poliomyelitis, acute anterior poliomyelitis, Heine-Meden disease, and paralytic poliomyelitis. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Poliovirus is an acute enteroviral infection spread from person to person, primarily via the fecal-hand-oral route, that has afflicted humanity for centuries. Although most patients who acquire the infection are asymptomatic, those afflicted may develop a variety of neurologic manifestations, including aseptic meningitis, polioencephalitis, bulbar poliomyelitis, and paralytic poliomyelitis. In paralytic poliomyelitis, muscle weakness is preceded by intense myalgias of the involved limbs and axial skeleton. Following recovery, as many as 20% to 30% of individuals who develop paralytic poliomyelitis may suffer from post-polio syndrome, which produces muscle weakness, pain, atrophy, and fatigue many years after acute illness. There has been a large worldwide effort for poliomyelitis eradication. Polio cases have decreased by over 99% since 1988, from an estimated 350,000 cases in more than 125 endemic countries to 406 reported cases in 2013. Poliomyelitis due to wild type virus has now been eliminated from the Americas, Europe, and Western Pacific, whereas cases in Africa and Asia have markedly decreased. Although great strides have been made, poliomyelitis remains and is rising in regions, including Nigeria, Afghanistan, and Pakistan, and there is a risk for new outbreaks to occur.

Key points

 

• Poliovirus is an acute enteroviral infection that is spread from person to person, primarily via the fecal-hand-oral route.

 

• Neurologic manifestations of poliomyelitis include aseptic meningitis, polioencephalitis, bulbar poliomyelitis, and paralytic poliomyelitis.

 

• As many as 20% to 30% of individuals who develop paralytic poliomyelitis may suffer from post-polio syndrome, which includes new muscle weakness, pain, atrophy, and fatigue many years after the acute illness.

 

• There has been a large worldwide effort for poliomyelitis eradication, with a decrease of polio cases by over 99% since 1988. Though great strides have been made, there remains a high risk for new outbreaks.

Historical note and terminology

Poliomyelitis has afflicted humans for centuries, with the first descriptions in the second edition of “A Treatise on Diseases of Children” published in 1789 (Lockhart 1837; Paul 1971). Major contributions to the understanding of the disease were made by the German orthopedist Heine, who described the clinical features of acute poliomyelitis (Heine 1840). In 1870, Charcot and Joffroy recognized that spinal anterior horn cell damage caused flaccid paralysis, and in 1908, the etiological agent of poliomyelitis was first described in monkey experiments (Charcot 1872; Landsteiner and Popper 1908). The existence of more than one type of poliovirus was first inferred by Burnet and Macnamara in 1931, when they demonstrated that monkeys who had recovered from infection with a strain recovered in Melbourne subsequently developed disease when given the virulent mixed virus strain (Burnet and Macnamara 1931). In 1949, the 3 antigenic poliovirus types (poliovirus 1, poliovirus 2, poliovirus 3) were identified (Bodian et al 1949; Kessel and Pait 1949).

The first recorded outbreaks of poliomyelitis occurred in the mid-and late nineteenth century in northern Europe and later in North America. Larger outbreaks followed in Europe and North America. It was not until the development of the first successful inactivated poliovirus vaccine (IPV) in the 1950s by Salk that the incidence of polio epidemics started to decrease. In 1954 and 1955, Salk IPV was successfully tested in a monumental controlled trial involving more than 1.8 million U.S. schoolchildren.

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