The debilitating disease, Polio, is a
viral infection of the brain stem. There are three different types: one
type causes partial or complete paralysis of the lower extremities; a
second causes partial or complete paralysis of the lungs; and the third
affects the brain. A vaccine was found in the 1950s by Dr. Jonas Salk, by
incorporation of a live virus which has been successful in treating types
1-3. The difference between the various types of Polio are determined by
the way in which they are contracted.
A few of the more common symptoms of Post-Polio Syndrome (PPS)** are:
|
Extreme Fatigue |
Muscle Pain |
Insomnia |
Depression |
|
Breathing Problems |
Sleeping Problems |
Swallowing
Problems |
Cold Intolerance |
|
Stress |
Curvature of the
Spine |
Sleep Apnea |
Restless Leg
Syndrome |
** Symptoms and the definitions thereof
found
here.
Poliomyelitis and the Epidemics
Poliomyelitis, a neuromuscular disease
also known as infantile paralysis, is caused by the poliovirus
of which there are three types. Infection occurs by fecal/oral
contamination. The virus replicates in the gastrointestinal
tract and is carried by the blood throughout the body. In
1%-2% of the infections, the poliovirus invades the nerve
cells (motor neurons) of the spinal cord. When it does,
muscles connected to the damaged or destroyed nerve cells can
no longer properly function, resulting in weakness or
paralysis of the limbs, and, possibly, the muscles controlling
speech, swallowing, and breathing.
Poliomyelitis dates back to at least 1350
BC. Major epidemics occurred in Stockholm, Sweden (1887, 1905,
1911) and in Vermont, United States (1894). In 1916, the great
New York epidemic killed 6,000 people and left 27,000
disabled. The number of cases reported during the '40s ranged
from a low of 4,167 in 1942 to a high of 42,033 in 1949. The
largest number of cases ever reported in the United States was
over 58,000 in 1952.
The vaccine developed by Jonas E. Salk,
using killed or inactivated poliovirus (IPV), was made
available by injection in 1955. The oral polio vaccine (OPV),
developed by Albert B. Sabin using the live but weakened
poliovirus, was approved for use in 1962.
Acute Poliomyelitis in the World Today
As of August 2002, there were 483
confirmed cases of acute poliomyelitis reported to authorities
worldwide. It should be noted that not every case is reported.
The World Health Organization (WHO) target date for worldwide
certification is 2005. Certification is the process that
verifies that a region is polio-free. To date, the Region of
the Americas (36 countries), the Western Pacific Region (37
countries and areas including China), and the WHO European
Region (51 countries) have been certified polio-free. Acute
poliomyelitis is now found only in parts of Africa and South
Asia. A main resurgence of polio occurred in Northern India in
late 2002 with 1,554 cases detected nationwide.
The last case of acute poliomyelitis in
the Western Hemisphere caused by the wild poliovirus (that
naturally occurs in the environment) was reported in Peru in
1991. During the last half of 2000, seven laboratory-confirmed
cases of poliomyelitis were reported in the Dominican Republic
and Haiti. The isolated virus is unusual because it was
derived from the oral poliovirus vaccine (OPV). Mass
vaccination campaigns have been conducted in both of these
nations.
All of the new cases of poliomyelitis
reported since 1979 in the United States have been caused by
the oral polio vaccine (OPV), the "live" vaccine. The number
of vaccine-associated cases confirmed in 1995, 1996, 1997, and
1998 was 6, 5, 3, and 1, respectively. As a result of these
cases, The National Childhood Vaccine Injury Act of 1986
(PL-99-660) created a no-fault compensation alternative to
suing manufacturers. The Centers for Disease Control and
Prevention and the Federal Drug Administration developed a
Vaccine Adverse Event Reporting System (VAERS) to collect data
on the reactions to all vaccines.
In an effort to decrease the number of
vaccine-associated cases of polio caused by an all-OPV
schedule, the United States Advisory Committee on Immunization
Practices (ACIP) changed its policy on polio vaccination in
early 1997, and again, in June 1999. The recommended IPV-only
immunization schedule took effect January 1, 2000. No cases of
acute poliomyelitis have been reported in the United States
since 1999.
The WHO recommends an all-OPV schedule in
the mass campaign to eradicate the poliovirus from the world.
Denmark uses a sequence of IPV and/or OPV.
France, The Netherlands, and Canada use IPV exclusively.
Australia, Germany, New Zealand, Switzerland, and the United
Kingdom use the OPV (except for special cases).
The Late Effects of Poliomyelitis
The World Health Organization estimates
there are up to 20,000,000 survivors of poliomyelitis living
in the world today.
Preliminary
numbers
from a National Health Interview Survey (1996) estimate that
there are 1,000,000 survivors of polio in the United States.
Of the 1,000,000 survivors of polio in
the United States, 450,000 are living with the effects of
permanent paralysis, ranging from unequal leg lengths
resulting in a limp to paralysis of the breathing muscles
resulting in the use of a ventilator.
The occurrence of new muscle weakness and
atrophy, many years after acute poliomyelitis, was first
reported in the medical literature in 1875.
In the late '70s, polio survivors started
to report that they were "tiring more easily" and that they
were in search of physicians who were knowledgeable about
poliomyelitis. The sheer weight of numbers of polio survivors
from the epidemics of the '40s and '50s compelled medical
professionals to begin to address the problem.
The triad of major symptoms includes
inordinate fatigue, new muscle weakness with or without loss
of muscle bulk, and muscle pain with possible muscle
twitching. Other symptoms include sleeping problems, breathing
difficulties, decreased ability to tolerate cold temperatures,
joint pain, and a noticeable decline in the ability to carry
out customary activities.
Research suggests that 120,000-180,000
polio survivors may be developing "post-polio syndrome." The
diagnosis is based on the following general criteria: prior
episode of paralytic polio; period of functional stability;
gradual or abrupt new weakness usually accompanied by the
health problems listed above; exclusion of other medical,
orthopedic, and neurological conditions that may cause the
same symptoms.
Nerve cells damaged by the poliovirus
during the acute stage of poliomyelitis left the accompanying
muscles orphaned and paralyzed. During recovery, the surviving
nerve cells "sprouted"
and reconnected to the orphaned muscles. The nerve and muscle
combination is called a motor unit, and the most widely
accepted explanation of the new weakness is a dysfunction of
the motor unit.
For diagnosed post-polio syndrome, the
current treatment, which must be unique to each individual, is
the management of the symptoms. The specific cause(s) of the
symptoms need(s) to be identified and treated and/or
eliminated. Many times the cause is overuse; however, disuse
also can result in new weakness.
Although some physicians use exacting
criteria for the diagnosis of "post-polio syndrome," many
physicians and polio survivors alike acknowledge that aging
polio survivors will encounter
"wear and tear" musculoskeletal problems. Thus,
whatever the cause and whatever the label of the diagnosis,
there are consequences to living long-term with the late
effects of poliomyelitis.
Surveys of polio survivors cite the
following lifestyle changes as the most beneficial: adopting
energy conservation techniques, employing household help,
buying special equipment, modifying the home, cutting back on
work, and implementing a general conditioning exercise
program.
Polio survivors are advised to examine
their daily schedules, both at work and at home, and modify,
if necessary, the intensity and timing of their activities by
utilizing appropriate
energy-saving techniques and equipment.
The role of exercise is controversial.
Recent research indicates that supervised, low intensity,
interval exercise can increase strength with no apparent
damage. Polio survivors are best advised to heed their bodies'
warning signs of pain. The general recommendation is to avoid
activity that causes pain and fatigue after ten minutes.
Limited research has been conducted on
medications
to address muscle fatigue. No medicine
has been found in controlled studies to provide consistent and
significant benefits.
In 1987, the Social Security
Administration acknowledged the late effects of poliomyelitis
and issued criteria for the evaluation of the ability of polio
survivors to continue employment in its
Program Operations Manual System (POMS).
The listing number is DI 24580.010E.3.
On July 1st, 2003, the Social
Security Administration updated the listing. It is now
called
DI 24580.010 Evaluation of
Post-Polio Sequelae.
Polio survivors are also susceptible to
all the other diseases that affect the general population. One
study revealed that 35% of the individuals complaining of
post-polio problems had another medical condition such as
diabetes; other secondary conditions included obesity and
elevated cholesterol.
In treating other
conditions, polio survivors should be aware that the side
effects of some medications are weakness and fatigue; taking
those medications can noticeably increase post-polio symptoms.
Also, the recovery time after injury, surgery, and other
illnesses is reported by polio survivors to be longer. Polio
survivors facing surgery should seek a consultation with the
anesthesiologist
(READ
MORE) to discuss prior medical history
related to poliomyelitis.
Many survivors express concern over the
lack of knowledge and adequate assistance from medical
professionals about issues related to poliomyelitis. Through
the networking efforts of many, more professionals are gaining
expertise and do provide sound advice. However, polio
survivors must educate themselves, be resourceful, and work in
collaboration with open-minded health professionals.
To assist with the education of
polio survivors and health professionals, Post-Polio Health
International (PHI) has available the
Handbook
on the Late Effects of Poliomyelitis for Physicians and
Survivors
(Revised edition,
1999). PHI also publishes the quarterly
Post-Polio Health
(formerly Polio Network News) and
compiles an annual
Post-Polio Directory
of clinics, health professionals, and
support groups.
For more information on Post Polio, we invite our visitors to
check out
Post-Polio Health International. PHI is one of the leading
sources for information about Post Polio and the options
available to victims and their families. In addition,
Easter Seals, one of Post Polio's biggest advocates has a
vast amount of information on resources available to victims
and survivors.
All information on this page was found on
the
Post-Polio Health
International
Website.
