Polio (also called poliomyelitis) is a contagious, historically devastating disease that was virtually eliminated from the Western hemisphere in the second half of the 20th century. Although polio has plagued humans since ancient times, its most extensive outbreak occurred in the first half of the 1900s before the vaccination, created by Jonas Salk, became widely available in 1955.

At the height of the polio epidemic in 1952, nearly 60,000 cases with more than 3,000 deaths were reported in the United States alone. However, with widespread vaccination, wild-type polio, or polio occurring through natural infection, was eliminated from the United States by 1979 and the Western hemisphere by 1991.

Signs and Symptoms

Polio is a viral illness that, in about 95% of cases, actually produces no symptoms at all (called asymptomatic polio). In the 4% to 8% of cases in which there are symptoms (called symptomatic polio), the illness appears in three forms:

• a mild form called abortive polio (most people with this form of polio may not even suspect they have it because their sickness is limited to mild flu-like symptoms such as mild upper respiratory infection, diarrhea, fever, sore throat, and a general feeling of being ill)
• a more serious form associated with aseptic meningitis called nonparalytic polio (1% to 5% show neurological symptoms such as sensitivity to light and neck stiffness)
• a severe, debilitating form called paralytic polio (this occurs in 0.1% to 2% of cases)

People who have abortive polio or nonparalytic polio usually make a full recovery. However, paralytic polio, as its name implies, causes muscle paralysis - and can even result in death. In paralytic polio, the virus leaves the intestinal tract and enters the bloodstream, attacking the nerves (in abortive or asymptomatic polio, the virus usually just stays in the intestinal tract). The virus may affect the nerves governing the muscles in the limbs and the muscles necessary for breathing, causing respiratory difficulty and paralysis of the arms and legs.

Contagiousness

Polio is transmitted primarily through the ingestion of material contaminated with the virus found in stool (poop). Not washing hands after using the bathroom and drinking contaminated water were common culprits in the transmission of the disease.

Prevention

In the United States, it's currently recommended that children have four doses of inactivated polio vaccination (IPV) between the ages of 2 months and 6 years.

By 1964, the oral polio vaccine (OPV), developed by Albert Sabin, had become the recommended vaccine. OPV allowed large populations to be immunized because it was easy to administer, and it provided "contact" immunization, which means that an unimmunized person who came in contact with a recently immunized child might become immune, too. The problem with OPV was that, in very rare cases, paralytic polio could develop either in immunized children or in those who came in contact with them.

Since 1979 (when wild polio was eliminated in the United States), the approximately 10 cases per year of polio seen in this country were traced to OPV.

IPV is a vaccine that stimulates the immune system of the body (through production of antibodies) to fight the virus if it comes in contact with it. IPV cannot cause polio.

In an effort to eradicate all polio, including those cases associated with the vaccine, the Centers for Disease Control and Prevention (CDC) decided to make IPV the only vaccine given in the United States. Currently, the CDC and American Academy of Pediatrics (AAP) recommend three spaced doses of IPV given before the age of 18 months, and an IPV booster given between the ages of 4 to 6, when children are entering school.

If you're planning to travel outside the United States, particularly to Africa and Asia (where polio still exists), be sure that you and your child receive a complete set of polio vaccinations.

Duration

Although the acute illness usually lasts less than 2 weeks, damage to the nerves could last a lifetime. In the past, some patients with polio never regained full use of their limbs, which would appear withered. Those who did fully recover might go on to develop post-polio syndrome (PPS) as many as 30 to 40 years after contracting polio. In PPS, the damage done to the nerves during the disease causes an acceleration of the normal, gradual weakness due to aging.

Treatment

In the height of the polio epidemic, the standard treatment involved placing a patient with paralysis of the breathing muscles in an "iron lung" - a large machine that actually pushed and pulled the chest muscles to make them work. The damaged limbs were often kept immobilized because of the confinement of the iron lung. In countries where polio is still a concern, ventilators and some iron lungs are still used.

Historically, home treatment for paralytic polio and abortive polio with neurological symptoms wasn't sufficient. However, asymptomatic and mild cases of abortive polio with no neurological symptoms might have been treated like the flu, with plenty of fluids and bed rest.

The Future of Polio

The World Health Organization (WHO) is working toward eradicating polio throughout the world. Significant strides have already been made. In 1988, 355,000 cases of polio in 125 countries were reported. By the end of 2004, there were just 1,255 cases.

Six countries (Afghanistan, Egypt, India, Niger, Nigeria, and Pakistan) still have polio circulating, and the virus could be introduced to other countries. If the polio virus is imported into a country where not enough people have been immunized, there's the risk that it could spread from person to person. That's what has happened in some countries in Africa and Asia. So until it has been eliminated worldwide, it's important to continue vaccinating kids against polio.

Reviewed by: Barbara P. Homeier, MD
Date reviewed: December 2004
Originally reviewed by: Joel Klein, MD

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Total cases	in 2006	compared to same period in 2005
Globally	1353	1273
- in endemic countries:	1250	506
- in non-endemic countries:	103	767

Case breakdown by country

Country	Cases	Compared to same period in 2005	Date of onset of most recent case
Nigeria	847	451	27 August 2006
India	352	30	1 September 2006
Somalia	31	2	19 July 2006
Afghanistan	28	4	7 September 2006
Pakistan	23	17	17 September 2006
Namibia	20	0	26 June 2006
Bangladesh	15	0	22 August 2006
Ethiopia	14	16	18 July 2006
Niger	10	4	12 July 2006
DRC	7	0	19 June 2006
Indonesia	2	240	20 February 2006
Nepal	2	0	1 August 2006
Yemen	1	470	2 February 2006
Angola	1	7	27 June 2006

 

From http://www.polioeradication.org/casecount.asp

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• Polio [PO-lee-oh] is a viral disease that can damage the nervous system and cause paralysis.
• The polio virus enters the body through the mouth, usually from hands contaminated with the stool of an infected person.
• Polio is preventable by immunization.
• Since polio immunization has become widespread in the United States, cases of polio are rare. However, polio remains a problem in many parts of the world.

 

What is polio?

Polio, short for poliomyelitis, is a disease that can damage the nervous system and cause paralysis. Since polio immunization has become widespread in the United States, cases of polio are rare. However, polio remains a problem in many parts of the world.

 

What is the infectious agent that causes polio?

Polio is caused by any of three polio viruses.

 

Where is polio found?

Before the availability of polio immunization, polio was common worldwide. However, with strong immunization programs and efforts to rid the world of polio, circulation of polio viruses is limited to a decreasing number of countries. The greatest risk is now in the Indian subcontinent and, to a lesser extent, in West and Central Africa.

 

How do people get polio?

The polio virus lives in the throat and intestinal tract of infected persons. The virus enters the body through the mouth, usually from hands contaminated with the stool of an infected person. Objects, such as eating utensils, can also spread the virus. Food and water are not thought to play a major role in the spread of polio.

 

What are the signs and symptoms of polio?

The polio virus attacks the nerve cells that control muscle movements. Many people infected with the virus have few or no symptoms. Others have short-term symptoms, such as headache, tiredness, fever, stiff neck and back, and muscle pain.

More serious problems happen when the virus invades nerves in the brain and causes paralysis of the muscles used in swallowing and breathing. Invasion of the nerves in the spinal cord can cause paralysis of the arms, legs, or trunk.

 

How soon after exposure do symptoms appear?

Symptoms usually start 7 to 14 days after exposure to the virus. Infected persons are most contagious from a few days before to a few days after the start of symptoms. However, persons with polio can spread the infection for as long as the virus is in their throat or stool. The virus can be found in the throat for about 1 week after infection and in the stool for 6 weeks or longer.

 

How is polio diagnosed?

Polio is diagnosed by a blood test or culture.

 

Who is at risk for polio?

Polio is most common in infants and young children, but complications occur most often in older persons.

 

What complications can result from polio?

Complications include paralysis, most commonly of the legs. Paralysis of the muscles that control breathing and swallowing can be fatal.

In very rare cases, the oral vaccine used to prevent polio can cause polio paralysis in persons who are vaccinated (1 in every 8.1 million doses) and in people who are close contacts of a vaccinated person (1 in every 5 million doses). About 8 to 9 cases of paralytic polio caused by the oral vaccine have been reported in the United States yearly.

 

What is the treatment for polio?

There is no treatment for polio. A polio patient must receive expert medical care, especially at the beginning of the illness.

 

How common is polio?

In the United States, the last case of "wild" polio was in 1979. Wild polio is naturally circulating polio that is not caused by the oral polio vaccine. Except for an occasional importation, all cases of paralytic polio since 1979 have been caused by the oral polio vaccine. However, thousands of polo infections still occur in other parts of the world. Most cases are reported from Asia and Africa.

 

How can polio be prevented?

Two types of polio vaccine are available: oral polio vaccine (OPV) and inactivated polio vaccine (IPV).

OPV is made with a live but weakened virus. OPV protects vaccinated persons directly. OPV also protects other susceptible persons who are indirectly "vaccinated" as the vaccine virus spreads in the community. Because of wide use of OPV, no cases of paralytic polio caused by naturally circulating polio virus have been reported in the United States since 1979.

IPV is given by injection. It protects vaccinated persons as well as OPV, but it is not believed to be as effective as OPV in preventing the spread of polio virus among non-vaccinated persons. However, IPV is not known to cause polio disease.

As of January 1997, the recommended schedule for polio vaccination for children was two doses of IPV at 2 and 4 months of age, followed by two doses of OPV at 12-18 months and 4-6 years. This schedule is expected to reduce the small number of polio cases caused by the oral vaccine.

Schedules containing all OPV or all IPV can still be used, too. IPV can be given at 2, 4, and 12-18 months, and 4-6 years. OPV can be given at 2, 4, and 6-18 months, and 4-6 years. Parents and doctors can choose among the three schedules.

Booster doses of polio vaccine are also recommended for persons traveling to areas of the world where polio is still a problem.

As is the case with all immunizations, there are important exceptions and special circumstances. Health-care providers should have the most current information on recommendations about polio vaccination.

 

This fact sheet is for information only and is not meant to be used for self-diagnosis or as a substitute for consultation with a health-care provider. If you have any questions about the disease described above, consult a health-care provider.

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