RISK FACTORS: Living in areas where sanitation and hygiene are poor, Low socioeconomic status, Increasing age, if not immunized, Pregnancy, Recent tonsillectomy, Inoculation (e.g., DPT injection)
APPROPRIATE HEALTH CARE Inpatient for acute phase. Outpatient or rehabilitation facility for therapy.
GENERAL MEASURES
β’ Provide bed that has fi rm mattress, footboard, foam rubber pads or sandbags. Change positions frequently.
Give good skin care.
β’ Mechanical ventilation, if required
β’ Management of fecal impaction and urinary retention. Catheterization may be necessary.
β’ Nonnarcotic analgesics
β’ Hot, moist packs
β’ Physical therapy
β’ Public health - all suspected cases, report immediately to public health department
SURGICAL MEASURES Tracheostomy is frequently required in respiratory paralysis
ACTIVITY
β’ Bedrest during active phase. With paralysis, may require an extended period.
β’ Long-term rehabilitation plan - using physical therapy, braces, special shoes, possibly orthopedic surgery.
Team effort with doctors, physical and occupational therapists, and social worker or psychiatrist, if necessary.
DIET Be sure patient has adequate well-balanced diet. May require tube feedings.
DRUG(S) OF CHOICE
β’ Aspirin or other nonnarcotic analgesics
β’ Antibiotics, if other infection develops
β’ Parasympathomimetic (bethanechol) may help patient with urinary retention, 10-50 mg po bid-qid. Up to 100
mg qid may be required.
β’ New anti enteroviral agents may be useful
ALTERNATIVE DRUGS N/A
PATIENT MONITORING Individualized depending on severity and long-term physical therapy requirements
PREVENTION/AVOIDANCE
β’ Poliovirus vaccines; any inactivated vaccine recommended in USA. Disease may soon be eradicated.
Travelers may still need IPV. Recommendations are country/region specific.
POSSIBLE COMPLICATIONS
β’ Urinary tract infection
β’ Atelectasis
β’ Pneumonia
β’ Myocarditis
β’ Postpoliomyelitis progressive muscular atrophy (PPMA) - characterized by progressive weakness beginning
30 years or more after an attack of poliomyelitis. Many adult survivors of childhood polio now with late complications.
β’ Postpoliomyelitis motor neuron disease - occurs many years after acute poliomyelitis, less common than
PPMA
β’ Vaccine-associated paralytic poliomyelitis (VAPP) is a rare complication of OPV use
EXPECTED COURSE/PROGNOSIS
β’ Often irreversible paralysis; less than 5% mortality during acute disease
β’ Increased mortality over age 40
β’ Poor recovery for totally paralyzed muscle groups
β’ Good recovery for partially paralyzed muscle groups