Poliomyelitis INTRODUCTION Came from the Greek word: POLIO= grey, MUELLOS= marrow Poliomyelitis is an acute highly infectious

disease of children caused by a virus. It is n infection of the intestine transmitted by feco-oral route but in about one percent of the cases, it affects the nervous system, also mainly the spinal cord. Clinically it is characterized by a sudden onset of fever, associated with constitutional signs and symptoms followed by the rapid onset of lower motor neuron type of paralysis (flaccidity) either of a group of muscles or of a limb. Agent Factors Causative agent is a RNA virus, belonging to the group Picarnovirus and the family Enterovirus. There are 3 types of Polio virus namely: Type 1 (Brunhilde), Type 2 (Lansing) and Type 3 (Leon). Type 1 is responsible for the extent of 80-90%. Type 3 causes paralysis less frequent and type 2 causes rarely. They an survive outside the human body for fairly long periods (4 months in water and 6 months in life). The half life of the excreted virus in the sewage is only 48 hours and spread of infection in sewage can occur only during this period. Even though it can survive the human host it multiplies only in the unimmunized human gut. They are readily destroyed by heat at 50 C and inactivated by U-V radiation, formalin, and chlorine and drying. Therefore freeze dried vaccine cannot be prepared. They survive for years at sub-zero temperature. Reservoir of Infection Human reservoir is the only host. Therefore, poliomyelitis is a disease of human beings only. Such a human reservoir may be an active clinical case or carrier. The carrier of Poliomyelitis is temporary, healthy carrier, incubatory carrier and there is no chronic carrier state. Infective Materials Throat secretion and feces of a diseased individual in the early stag and only feces in the later stage. Period of Infectivity The cases are infectious on week before and about 3 weeks after the onset of the disease. Host Factors Age- the incidence maximum is 6 months to 3 years old. Sex Incidence-more common in male children in a ratio of 3:1 Environmental factors Majority cases occur during June-September, lowest transmission season is November-March. Overcrowding, poor sanitation and contamination o food and water are the main favorable factors for the transmission of he virus. Risk Factors (Provocative Factors): 1. Effect of infections: Injections like DPT, especially during the stage of viremia, increases the vascularity of that part of the spinal cord, sub serving the site of injection associated with irritation of injection, predisposing the virus to affect the spinal cord. 2. Effect of fatigue, trauma, and exercise: these factors during the stage of viremia, also predispose for the early onset of the disease. 3. Surgery in head and neck region: (Tonsillectomy, Adenoidectomy) tend to prevent or reduce the formation of IgA (local antibodies) in the pharynx, thereby allowing the virus to have an access to the CNS, resulting in bulbar rather than spinal form of poliomyelitis. Modes of Transmission Acute stage- disease is transmitted by both droplet and fecooral route. After the acute tage. It is then transmitted by fecooral route through 6 Fs: fecal contamination of fluids, foods,

fruits, fomites (utensils), fingers and flies. Paralytic Poliomyelitis-is characterized by sudden onset of fever and associated symptoms such as headache, vomiting, malaise and anorexia. Next day, fever is associated severe myalgia (muscular pain) in the limbs, followed by asymmetrically distributed lower motor neuron type of flaccid paralysis. Usually one leg is paralyzed. Paralysis continues until the temperature returns to normal. There is no sensory loss. Deep tendon reflexes are diminished or absent. Full extent of paralysis is reached within 2-3 days. Very rarely, damage occurs to the brain, resulting in 2 forms: 1. Polio-encephalitis- high fever is associated with convulsions, altered consciousness, restlessness, irritability, rapidly followed by coma and death. There may be upper motor neuron type of damage. 2. Bulbar Poliomyelitis characterized by fever, weakness f swallowing and coughing indicating paralysis of the pharynx, there will be collection of mucus and saliva in the throat, inability to swallow threatens the life. Once the acute stage has passed, recovery in pharyngeal paralysis is good but slow provided they are kept alive during the first ten days. Diagnosis Isolation of wild poliovirus from the stool is the best way to confirm the diagnosis of paralytic poliomyelitis. Arise in titer of complement fixing antibodies is confirmative. Management Since there is no treatment polio cases require general supportive care and skilled management as follows: Isolation Absolute bed rest (acute phase) there should not ne any stress on the affected muscle Change of posture or position Q2 3Hours Symptomatic treatment with paracetamol to relieve pain and fever Prophylactic oral antibiotics to prevent secondary infection. Massage and injections during the acute phase is contraindicated for but 6 weeks Splints is provided to the limbs to prevent deformity Maintenance of fluids and electrolyte balance Physiotherapy is recommend only after the acute phase of about 6 weeks because stress and strain in the acute phase worsens the disease Hydrotherapy (treatment in swimming pool) the limbs are felt lighter in water and thereby the patients gets great psychological uplift, but actually there is no muscular recovery. Prevention and Control Since there is no treatment, elimination of reservoir is not possible. Different modes of transmission can be broken by construction of sanitation barrier. However, protection of susceptible by immunization is the only sole and most effective method of preventing poliomyelitis. Since it is a disease of mainly children, and the susceptibility being universal, all children must be immunized during their infancy period preferably before 6 months of age. Two Types f Vaccines 1. Inactivated polio vaccine a liquid killed vaccine. Contains the 3 types of polio viruses killed by formalin to be administered IM. Primary course consist of 4 doses, first 3 doses are given with an interval of 4 6 weeks, starting from as early as 6 weeks o infancy and the 4th dose s given about 6 12 months after 3rd dose. Immunity last for a few years. Additional dose is given at the time of school entry, and then booster dos is given once in 5 years until the age of 18 years old. 2. Oral Polio Vaccine it is a live liquid vaccine containing attenuated all the 3 types of polio virus it is also called as trivalent vaccine. Thus the child is protected against all 3 types of viruses. SUMMARY

Poliomyelitis (polio) is a highly infectious viral disease, which mainly affects young children. The virus is transmitted through contaminated food and water, and multiplies in the intestine, from where it can invade the nervous system. Many infected people have no symptoms, but do excrete the virus in their feces, hence transmitting infection to others. Initial symptoms of polio include fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs. In a small proportion of cases, the disease causes paralysis, which is often permanent. Polio can only be prevented by immunization. REFERENCES:

Suryakantha, AH. (2010), Water-borne Diseases (Poliomyelitis), Community Medicine with Recent Advances p. 374-381

Translation Polio Mode of Transmission (Paamagi sa diin makuha ang Sakit) ???? Makuha ang sakit paagi sa kontaminado nga tubig, pagkaon, prutas, mahigko nga kamot , mga kagamitan sa pagkaon kag langaw. Paralytic Poliomyelitis: Una nga adlaw makbagta sa hilanat, palanakit sang lawas, pag suka, wala gana magkaon kag sakit sang uo. Sa masunod nga adlaw: hilanat kag mga kaupod nga symptoma kaangay sang panalakit sang lawas kag paa ukon pagkaparalisa sang isa ka parte sang lawas. Ang pagka paralisa sang lawas magapadayon asta mag nubo ukon magtahaw na ang hilanat. Ang pagkaparalisa sang lawas magalabot sam2 asta 3 ka adlaw. 2 ka klase sang halit sa utok? Halit nga nagakaigo sa utok/ulo (Malaka lang nga gakatabo) Polio encephalitis: Mataas nga hilanat, kumbulsyon, pagka irritable, pagka comatose kag kamatayon. Bulbar poiliomyelitis: Hilanat, palanglapyo, budlay magtulon kag mag ubo tungod sa pagkaparalisa sang tutunlan, bangod sini, gatingob ang laway kag gatabon sa tutunlan nga mangin kabangdanan sa pagkamatay. Diagnosis: Paano bala mabal.an kung ang isa ka tao may polio Paagi sa pag examine sang tae/higko kag pagkumpirma sang virus Management: Paano Wala sang nagakaigo nga bulong para sa polio, ang maubra lamag naton amo ang pagsunod sa mga nagakaigo nga pag atipan sining mga tao 1. Isolation ukon ihiwalay sa iban nga miyembro sang pamilya nga possible

mahalitan 2. Pagpahuway, bastante nga tiempo sang pagahuway, ang parte nga paralisado indi dapat pagi.stress 3. Pagbaylo sang posisyon kada 2 ka oras 4. Pagpainom sang paracetamol kung gabatyag sakit kag hilanat 5. Pagreseta sang doctor sang antibiotic para kontra impeksyon 6. Indi pag masahehon ang lawas sa sulod sang anum ka semana sa nahauna nga phase sang sakit 7. Butangan sa suporta ukon splint ang parte sang lawas nga apektado para indi ma deform 8. Balanse kag eksakto nga kunsumo sang tubig 9. Hydrotherapy ukon paglangoy sa swimming pool Prevention and Control (paano bala ini matapna) Wala sang nagakaigo nga bulong para sa polio. Ang aksyon nga mahimo sang mga tao amo ang pag paninlo sang palibot kag panimalay. Ang mabakod nga panlaban sa polio amo ang pagpa bakuna. Ang polio common nga sakit sang mga bat kag lapsag, muna na gina rekomenda ang pagpa bakuna bag.o mag anum ka bulan ang bata. 2 ka klase sang polio vaccine 1. Inactivated polio vaccine: liquido, ginahatag sa pama agi sang injection. Ini ginahatag 4 ka beses. Ang una nga 3 ka dose ginahatag kada 4 6 ka semana, umpisa sa ika 6 nga bulan sang bata. Ang ulihi kag ika apat nga dose ginahatag matapos ang 6 asta 12 ka bulan sang pangatlo nga dose. Tinuig ang epekto sang bakuna. Dugang nga dose ang ginahatag sa bata kung ini ma eskwela na, edad 6 ukon 7 ka tuig. Masunod ang booster dose nga ginahatag kada 5 ka tuig asta mag edad 18. 2. Oral polio vaccine: liquid, ang klase sang bakuna nga ginahatag sa sentro. Summary

Ang polio isa ka sakit ang naga apekto sa mga kabataan. Ang virus gahalit sa tao paagi sa kontaminado nga tubig ukon pagkaon. Gadamo ining mga virus sa aton tinae kag galapta sa bilog nga lawas. Ang mga una nga symptomas sang polio amo ang hilanat, pagkakapoy, pagsuka, palanig.a sang batok kag palanakit sang paa kag batiis. Malaka ang pagkaparalisa san a nari sari nga kaso sang polio. Matpna ini sa pagpa bakuna.

sakit. Infective materials (Mga kuntaminado nga bagay) Body fluids ukon lawas sang tao a kumpirmado nga napatay bangud sa polio. Period of infectivity (kalawigon sang pagka lalaton) Isa ka semana bag.o ukon 3 ka semana pagkatapos sang impeksyon Host factors (sin.o ang apektado) Mga lapsag kag bata naga edad 6 ka bulan tubtob 3 ka tuig Laban sa mga lalake kaysa babae (3:1) Environmental factors (san.o kag diin nagakatabo) Madamo ang kaso sang polio sa tinion sang Hunyo asta Setyembre, manubo ang mga kaso humalin Nobyembre tubtob Marso. Ang numero uno nga kabangdanan sini amo ang magutok nga lugar, mahigko nga pagsinirayo kag kontaminado nga pakgaon kag tubig. Risk factors: ano ang makahalit or ano ang makatuga Effect of injections or epekto sang injection: Epekto sang trauma, pagkakapoy ukon ehersisyo Pagpa opera sa ulo ukon liog INCOMPLETE due to untranslatable WORDSSS

Translation 101 Poliomyelitis Introduction Ang Polio isa ka sakit naghalin sa isa ka virus nga naga apekto sa mga kabataan. Impeksyon sa tinae nga nagalapta sa utok tungod sa kuntaminado nga pagkaon ukon tubig. Ang mga symptoma kaangay sang mataas nga hilanat kag iban pa, may epekto man nga pagkaparalisa. Agent Factors Dugo ilong ko di, as is lang ah. Reservoir of Infection (Ang ginhalinan kag ang gina igo sang impeksyon) Mga tao lamang ang gina apektuhan sang sini nga