Polio

Certain groups are more susceptible to poliovirus infection, particularly:

• Individuals not vaccinated against polio
• Children, especially those with poor immune function
• Pregnant women
• Those with a weakened immune system
• Travelers to polio-endemic countries such as Pakistan or Afghanistan
• People who have undergone tonsil removal
• Lab professionals handling poliovirus samples

Polio diagnosis begins with a physician collecting the patient’s health history and performing a thorough physical evaluation. This may include:

Medical History

The doctor may ask about recent travel to polio-endemic areas or contact with infected individuals.

Physical Examination

The healthcare provider will assess for signs of muscle weakness or neurological involvement, including testing reflexes and the ability to move limbs while lying flat. Respiratory muscle function is also evaluated, as polio may impair breathing.

Lab Tests for Confirmation

• Virus Detection and Isolation:
• The most accurate way to confirm poliovirus is by isolating it through stool or throat swab cultures. Ideally, two samples are taken at least 24 hours apart to improve detection.
• Cerebrospinal Fluid (CSF) Analysis:
• A spinal tap may be done to collect CSF, which is examined for signs of infection.
• Blood Tests:
• Blood may be checked for antibodies produced in response to poliovirus.
• Electromyography (EMG):
• EMG measures electrical activity in muscles and helps detect nerve or muscle damage. It is also used to differentiate PPS from other causes of muscle weakness.
• Poliovirus Fingerprinting:
• Genetic analysis using oligonucleotide mapping or sequencing helps determine whether the virus is naturally occurring (wild-type) or derived from the vaccine through mutation.

Specialists to Consult

As there is currently no cure for polio, treatment is centered on symptom management and enhancing the patient’s quality of life. Individuals with polio are typically treated by a team of medical professionals, often referred to as a multidisciplinary team (MDT).

The MDT generally includes the following specialists:

• General Physician: Responsible for the initial assessment, diagnosis through clinical examination, and ordering relevant tests.
• Neurologist: Expert in disorders of the nervous system, including polio-related complications.
• Mobility Specialist: Provides guidance on using assistive devices like wheelchairs and walking aids.
• Physiotherapist: Works on improving movement, strength, and coordination.
• Respiratory Consultant: Manages respiratory issues that may arise due to muscle weakness.
• Rehabilitation Consultant: Specializes in handling complex physical impairments and planning long-term rehabilitation.

While polio cannot be cured, it is entirely preventable through vaccination.

Children usually receive a series of four doses of the polio vaccine at the following intervals:

1. First dose at 2 months
2. Second dose at 4 months
3. Third dose between 6 and 18 months
4. Booster dose between 4 and 6 years

Adults who were not vaccinated as children can still receive immunization. The adult schedule generally involves:

• Two initial doses spaced 1–2 months apart
• A third dose administered 6–12 months after the second

There are two kinds of polio vaccines:

• Inactivated Polio Vaccine (IPV): Contains virus that has been killed and is administered through injection. It targets all three poliovirus strains (types 1, 2, and 3).
• Oral Polio Vaccine (OPV): A live, weakened form of the virus given orally. It helps build intestinal immunity and stops virus transmission.

Although there is no definitive cure for polio, supportive care is essential in helping patients recover and preventing complications. Key approaches include:

Pain Management

• Over-the-counter medications like paracetamol, ibuprofen, or aspirin can reduce pain. For persistent discomfort, doctors may prescribe stronger medications like gabapentin. Long-term use should be avoided due to potential side effects.

Rest and Exercise

• Light physical activity can help preserve muscle strength and prevent deterioration. For patients with post-polio syndrome, structured "pacing" techniques are recommended:
• Setting priorities
• Taking scheduled breaks
• Engaging in gentle exercise regularly

Physical and Occupational Therapy

• Therapy focuses on improving mobility and reducing pain. Early intervention can lead to better long-term results.

Mobility Aids

• Devices like braces, walking aids, and wheelchairs help individuals move around more comfortably. Shoe inserts may assist with gait abnormalities caused by polio-related deformities.

Hot and Cold Compresses

• Alternating hot and cold treatments can ease muscle tightness and discomfort.

Psychological Support

• Dealing with the long-term effects of polio, especially post-polio syndrome, can take a toll on mental health. Support for stress, anxiety, and depression is crucial.

Diet and Weight Management

• Maintaining a balanced diet and a healthy weight is important, as extra body weight can burden weakened muscles.

The major complications associated with polio include:

• Paralysis: Can interfere with essential functions like breathing, swallowing, and bladder control.
• Respiratory Failure: In severe cases, paralysis of respiratory muscles may cause death.
• Post-Polio Syndrome (PPS): Occurs decades after the initial infection in up to 30–40% of survivors. Symptoms include progressive muscle weakness, joint pain, respiratory issues, and overwhelming fatigue.

Massage Therapy

• Targeted massage therapy under medical supervision can ease muscle stiffness and pain. Herbal oils may enhance the effect and provide relaxation.

Hydrotherapy

• Exercises performed in water reduce the impact on joints and muscles. The buoyancy can help polio survivors regain some mobility and alleviate pain.

The lifestyle impact of polio depends on the severity of symptoms and the support available. Many patients rely on physical aids such as orthotics, canes, braces, or wheelchairs to maintain independence.

Physical and occupational therapy helps manage pain and improve functional ability. Equally important is emotional support from family and caregivers, especially for those with long-term impairments.