| Disease/Syndrome |
Poliomyelitis |
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| Category |
Infection, Travel |
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| Acute/Chronic |
Acute-Severe |
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| Synonyms |
Polioviral fever; Infantile paralysis; Polio; Polio encephalitis; Epidemic acute poliomyelitis |
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| Biomedical References |
Search PubMed |
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| Comments |
FINDINGS: Initial symptoms are fever, headache, and sometimes mild GI symptoms followed in 3-10 days by fever, severe myalgia, stiff neck, and asymmetric flaccid paralysis. [ID, p. 2044] Flaccid paralysis of the lower extremities develops quickly. It is usually asymmetrical and is associated with fever, stiff neck, myalgias, and headache. Patients have diminished deep tendon reflexes, but no loss of sensation. [ID, p. 2044] Early signs of bulbar palsies include "dysphagia, nasal regurgitation, and nasal voice." In the differential diagnoses are other enteroviral infections, West Nile virus infection, and Guillain-Barre syndrome, the last of which differs in having symmetrical weakness, sensory loss in 70% of cases, CSF protein but normal cell count, and no fever. [Merck Manual, p. 1616] Over 90% of infections are inapparent or nonspecific. About 4-8% of patients have minor illness with flu-like symptoms including pharyngitis, headache, nausea, and abdominal pain. Major illness (stiff neck, back pain, and paralysis) develops in only about 1-2% of cases. [CCDM, p. 425-31; ID, p. 1352] The three main varieties of disease are spinal paralytic poliomyelitis, bulbar paralytic poliomyelitis (5% to 35% of cases), and polioencephalitis. Severe myalgias and sometimes paresthesias and fasciculations herald the onset of the major illness. The paralysis is usually asymmetrical. Reflexes are hyperactive initially, then absent. Bulbar disease may include dysphagia, pharyngeal paralysis, and dyspnea. Polioencephalitis is uncommon, found mainly in infants, and seizures may occur. [PPID, p. 2141-8] PREVENTION: "The last cases of indigenously acquired polio in the United States occurred in 1979. . . . OPV has not been recommended for routine immunization in the United States since January 1, 2000, and is no longer available in this country. . . . Adults who are traveling to areas where poliomyelitis cases are still occurring and who are unvaccinated, incompletely vaccinated, or whose vaccination status is unknown should receive IPV [inactivated poliovirus vaccine]." [CDC Travel, p. 270-1] EPIDEMIOLOGY: Spread by food or water may occur, but it is rare. The disease is transmitted mainly by the fecal-oral route. [CCDM] |
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| Latency/Incubation |
7-14 days with a range of 3 days to 5 weeks; |
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| Diagnostic |
Viral culture; Paired sera; CSF: increased WBCs, increased protein, and normal glucose; |
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| ICD-9 Code |
045 |
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| Available Vaccine |
Yes |
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| Scope |
Polio cases have been reduced by 99% since the mid-1980s, and global eradication is feasible. [CDC Travel, p. 270] Last reported case in the W. Hemisphere: Peru in 1991; [CCDM] |
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| Reference Link |
CDC - Poliomeyelitis PDF File |
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| Related Information in Haz-Map |
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| Symptoms/Findings |
Symptoms/Findings associated with this disease:
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| Job Tasks |
High risk job tasks associated with this disease:
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