Manual for the surveillance of vaccine-preventable diseases. Chapter 12: Poliomyelitis
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Manual for the surveillance of vaccine-preventable diseases. Chapter 12: Poliomyelitis

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      Manual for the surveillance of vaccine-preventable diseases
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      Chapter 12 of: Manual for the surveillance of vaccine-preventable diseases. 5th edition, 2012.

      Poliomyelitis is a highly contagious disease caused by three serotypes of poliovirus. Infection with poliovirus results in a spectrum of clinical manifestations from inapparent infection to nonspecific febrile illness, aseptic meningitis, paralytic disease, and death. Two phases of acute poliomyelitis can be distinguished: a nonspecific febrile illness (minor illness) followed, in a small proportion of patients, by aseptic meningitis and/or paralytic disease (major illness). The ratio of cases of inapparent infection to paralytic disease among susceptible individuals ranges from 100:1 to 1000:1 or more.

      Following poliovirus exposure, viral replication occurs in the oropharynx and the intestinal tract. Viremia follows, which may result in infection of central nervous system cells. The virus attaches and enters cells via a specific poliovirus receptor. Replication of poliovirus in motor neurons of the anterior horn and brain stem results in cell destruction and causes the typical clinical manifestations of poliomyelitis. Depending on the site of infection and paralysis, poliomyelitis can be classified as spinal, bulbar, or spino-bulbar disease. Progression to maximum paralysis is rapid (2– 4 days), usually associated with fever and muscle pain, and rarely progresses after the temperature has returned to normal. Spinal paralysis is typically asymmetric, more severe proximally than distally, and deep tendon reflexes are absent or diminished. Bulbar paralysis may compromise respiration and swallowing. Between 2%–10% of cases of paralytic poliomyelitis are fatal. Infection with poliovirus results in lifelong, typespecific immunity.

      Following the acute episode, many patients recover muscle functions at least partially, and prognosis for recovery can usually be established within six months after onset of paralytic manifestations.


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