Polio: Definition, Effects on The Body and Treatment

Have you ever heard of Poliomyelitis? Well, if you haven't you may have heard of it being referred to as polio. Polio was one of the most feared diseases in the early twentieth century. This disease was known for paralyzing hundreds of thousands of children each year. The polio epidemic was a terrible fear for all parents in 1916. However, you may ask why is polio so deadly? Well, let's first talk about the two different types of polio. There are two types of polio nonparalytic polio and there is paralytic polio. Nonparalytic polio is a form of polio that doesn't lead to patients having paralysis. This type of polio can many symptoms. These symptoms are very common in other viral illnesses as well. Some common symptoms are fever, sore throat, headache, vomiting, fatigue, back pain or stiffness, neck pain or stiffness, pain or stiffness in the arms or legs, and muscle weakness or tenderness. However, the most severe type of polio is known as Paralytic polio. This is the reason why polio was so feared because it was so deadly and the most serious form of the disease. However, the signs and symptoms of paralytic polio include symptoms like fever and headache, loss of reflexes, severe muscle aches or weakness, loose and floppy limbs, and also flaccid paralysis. A lot of these patients were seen with a great loss of muscle tone as well.

Now, this brings us to our next point what does polio do to the body? Well, polio involves damage to the motor neurons in the spinal cord. It is characterized by asymmetrical, flaccid paralysis in the muscles, mainly in the lower extremities. Bulbar polio or Paralytic polio involves damage to neurons in a reticular or square formation. This can do significant damage to the body because it can harm the nuclei of cranial nerves in the brain stem. Sadly, this disease affected more than just paralysis of the limbs. The polio virus also is known for reducing patients breathing capacity. Polio can even affect swallowing and speaking depending on the severity of the disease.

The Poliovirus can be transmitted in many ways. However, the most common is through direct contact with people who are infected with the virus. This is very similar to what we are experiencing with covid 19. Large gatherings of people who are close or near to each other make it easy for diseases like this to run rapid in spread rapidly from person to person. Even though polio is mainly spread from person to person it can also be spread in other ways as well. The polioviruses can also be transmitted through contaminated food and water. Some people who are carrying the poliovirus can spread this virus for weeks in their feces as well. However, the people who have this deadly virus and don't have symptoms can pass the virus to others just as easily.

Overall, the polio epidemic greatly impacted the world. In fact, The mortality rate for paralytic polio ranges from five to fifteen percent. During the polio epidemic an average of 16,316 paralytic polio cases and 1,879 deaths from polio were reported each year (Achievements in Public Health, 1900-1999 Impact of Vaccines Universally Recommended for Children -- the United States, 1990-1998. The polio virus mainly affects children five years of age or younger. About one in two 100 infections will cause irreversible paralysis in kids who get polio. Out of the percentage of kids with paralysis, five percent to ten percent die from their breathing muscles becoming immobilized. Even though polio is common in children it is also possible to get polio a second time as an adult. children who seem to fully recover can develop post-polio syndrome. Post-polio syndrome can cause new muscle pain, weakness, or paralysis as adults, up to 15 to 40 years later. Post-polio syndrome is a condition that can cause polio survivors years later to form an initial attack of the polio virus. Most of the time polio survivors start to experience a slight new weakening in muscles that were previously affected by the polio virus when they were a child. Most of the time post-polio syndrome is not life-threatening. However, the symptoms can greatly affect the patient and interfere with their ability to function independently. These patients may experience Respiratory muscle weakness, that can cause them to have trouble with proper breathing.

This brings us to our next point. How did doctors treat patients with polio? Well, patients with severe cases of polio that have affected their ability to breathe were introduced to a machine called the iron lung. The iron lung was designed in 1928 it consisted of a large metal cylinder that you enclosed the entire patient's body below the neck in. In the iron lung, the patient's head would be protruding through an airtight rubber neck seal. The iron lung is a ventilation system. There are two types of ventilation systems, there are positive ventilators which are the ventilators that we know the best today. The positive pressure ventilators are usually attached to the patient's endotracheal tube, trake tube, or the face with a face mask. However, the iron lung uses negative pressure to give its patients a breath this works very differently than the normal positive pressure ventilator. The use of negative pressure ventilators peaked in the 50s because of the polio epidemic. Negative pressure ventilators operate on the principle of increasing lung volumes by intermittently applying negative pressure to the entire body. These negative pressure devices transmit negative pressure across the chest wall into pleural spaces and into the alveoli (sacs in the lungs) to help the patient breathe. These devices allowed exhalation to be passive and simply depend on the elastic recoil of the lungs and chest wall. These machines were not very portable, and they were also difficult to provide routine care for patients in. Although the iron lung is mainly known for treating polio there was also another machine used that was simpler and less expensive than the tank devices like the iron lung. This machine was called the chest respirator and it became the ventilator that was predominantly used to treat paralyzed polio patients. The chest respirator used the same negative pressure concept as the iron lung it was just much smaller and the whole patient's body did not have to be in the device. In this device, only the patient's chest needed to be covered with the machine leaving the head neck, arms free, and legs free. this machine was much more comfortable for patients and well-tolerated compared to the iron lung.

In the 1950s the polio vaccine was developed. The polio vaccine saved millions of people all around the world. This vaccine was created by a man named Dr. Jonas Salk and it was first used in the US in 1955. The inactivated polio vaccine is the only vaccine that has been given in the United States since 2000. Now Because of widespread vaccination polio has been illuminated in the United States. This means that there are no year-round transmissions of polio in the US anymore. In fact, since the year of 1979, the United States has had no cases of polio. The vaccine is given by a shot in the leg or the arm. The CDC has recommended giving children a four-dose series. The first dose is given at two months old the second dose is given at 4 months the third dose is given at six through eighteen months old and the last shot is given at 4through six years of age. According to the CDC, about 99 out of 100 children who get the recommended dosages of the polio vaccine are protected from polio. Even though polio was extinguished in us do to wide spared vaccination doesn't mean that this disease was eradicated worldwide. There are three strands of polio the third strand is said to be eradicated worldwide. Also, the second strand of polio was eradicated back in 2015. However, the 1st strand of polio is not eradicated worldwide yet. Now only type 1 polio is large in Afghanistan and Pakistan. If this strand is eradicated, polio will be able to join smallpox as the only two human diseases wiped off the face of the earth do to vaccinations. In order for a disease to be considered eradicated it has to have no cases or appearances worldwide for at least three years. If we all stick together worldwide it will become more of a possibility ultimately for all strands of polio to be completely extinguished forever. This could save many lives and help and prevent many polio cases.

Resources

1. Achievements in Public Health, 1900-1999 Impact of Vaccines Universally Recommended for Children -- United States, 1990-1998. (n.d.). Retrieved November 28, 2020, from https://www.cdc.gov/mmwr/preview/mmwrhtml/00056803.htm
2. Belluz, J. (2019, October 24). WHO just declared another polio virus strain eradicated. There's one more to go. Retrieved November 28, 2020, from https://www.vox.com/2019/10/24/20930553/polio-outbreak-2019-eradication-who
3. Cairo, J. M. (2020). Pilbeam's mechanical ventilation: Physiological and clinical applications. St. Louis, MO: Elsevier.
4. Disease factsheet about poliomyelitis. (2018, July 11). Retrieved November 28, 2020, from https://www.ecdc.europa.eu/en/poliomyelitis/facts
5. History of Polio. (n.d.). Retrieved November 28, 2020, from https://polioeradication.org/polio-today/history-of-polio/
6. NMAH: Polio: The Iron Lung and Other Equipment. (2005, February 01). Retrieved November 28, 2020, from https://amhistory.si.edu/polio/howpolio/ironlung.htm
7. Pinkbook. (2020, November 16). Retrieved November 28, 2020, from https://www.cdc.gov/vaccines/pubs/pinkbook/polio.html
8. Polio. (2017, December 09). Retrieved November 28, 2020, from https://www.mayoclinic.org/diseases-conditions/polio/symptoms-causes/syc-20376512
9. Poliomyelitis. (n.d.). Retrieved November 28, 2020, from https://www.who.int/news-room/fact-sheets/detail/poliomyelitis
10. Post-Polio Syndrome Fact Sheet. (n.d.). Retrieved November 28, 2020, from https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/post-polio-syndrome-fact-sheet
11. Principles and Practice of Mechanical Ventilation, 3e. (n.d.). Retrieved November 28, 2020, from https://accessmedicine.mhmedical.com/content.aspx?bookid=520
12. Production and control of polio vaccines. (2011, October 12). Retrieved November 28, 2020, from https://www.who.int/biologicals/areas/vaccines/polio/production/en/
13. Spinal Poliomyelitis. (n.d.). Retrieved November 28, 2020, from https://www.sciencedirect.com/topics/medicine-and-dentistry/spinal-poliomyelitis
14. What is Polio? (2019, October 24). Retrieved November 28, 2020, from https://www.cdc.gov/polio/what-is-polio/index.htm