POLIO VIRUS: POLIO SYMPTOMS , POLIO ERADICATION , POLIO VACCINE , POLIO TREATMENT
Poliomyelitis (polio virus) is an acute infection of the Central Nervous System (CNS) which damages the anterior horn cells in the spinal cord and they lead to a low motor neuron type of paralysis (Infantile paralysis).
Polio virus is made up of 3 types
- Brunhilde type
- Lansing type
- Lean type
The associated paralysis results from failure of the voluntary impulses of the pyramidal tract to pass through the damage anterior horn cell to the lower motor nerves. Complete destruction of cells to permanent paralysis of the affected types. Atimes polio virus may involve parts of the brain including the brain stem, and the medulla oblongata giving rise to polioencephalities (inflammation of the brain as a result of polio) and also bulbar paralysis. Unvaccinated children are more commonly affected than adults.
MODE OF TRANSMISSION:
Man is the reservoir of the infection. The polio virus is excreted in the stool of infected persons convalescent and healthy carriers. The virus enters through the Naso-Pharynx to the blood stream, then to the spinal cord and finally to the brain.
It is transmitted by food, water or droplet infection. It enters the body by oropharynx. Virus is present in the throat, blood and feaces 3-4 days after exposure.
INCIDENCE AND PREVENTION
Infant paralysis has a worldwide distribution and occurs more during dry season than rainy season among children and young adults. It may occur sporadically or in epidemics. Positive polio eradication / preventive measures include isolation of infected persons during communicable stage and immunization with vaccine
Two types of polio vaccine are provided for infant paralysis
- The Salk Vaccine (This is a solution of killed virus) given intramuscularly
- Sabin Vaccine is given orally ( it is a preparation of attenuated living organism
Immunization commence at 1-22 years of age, 3 doses at 4 hourly interval for a young child with a booster dose at school age. Unimmunized young adults who is at risk should be given 2 doses at 8 weekly interval and a 3rd month dose in 6 months. They can receive booster doses in terms of epidemics
CLINICAL MANIFESTATION/POLIO SYMPTOMS
The severity and causes of poliomyelitis depends in whether or not the Central Nervous system is invaded and according to the level of involvement or degree of damage to motor neuron.
The onset or early polio symptoms are none specific and includes: headache, fever, malaise, sore throat and gastro intestinal disturbances. The disease may go unrecognized if it does not progress, this stage it is then described as "abortive poliomyelitis"
The progressive disease has 2 phases namely
- Non paralytic phase
- Paralytic phase
The Paralytic phase is made up of
- Spinal paralytic polio
- Bulbar polio
- Bulbo spinal polio
The Non paralytic phase: The signs and symptoms of the abortive polio becomes more intense. The inavation of the nervous system by viruses gives rise to restlessness. Limited spinal flexion, tenderness of muscles, painful back and limbs position. Kerning sign is characteristic of meningeal symptom (Kerning sign consists of the inability to extend the leg at the knee when the leg is flexed to the right angle of the abdomen due to tenseness of the hamstring (muscle). Examination of the Cerebrospinal fluid reveals an increase in the number of leucocytes and protein content. These symptoms may subside within a week or two.
Paralytic Phase: The patient who progresses to this stage develops paralysis of one or more parts of the body as a result of motor neurons in the cord.
Bulbar polio is when the motor neurons in the brain stem are attacked.
Bulbo-Spinal Polio refers to the involvement of neurons in both brain stem and spinal cord. When neurones at a higher level than brain stem are affected, it produces encaphalitic polio but this is rare.
SPINAL PARALYTIC POLIO
It is more commonly seen than other types. It is characterized by pain and tenderness of varying severity, loss of reflexes and the development of muscles. The site of paralysis varies with the level of cord affected.
Bulbar Polio: This may attack the neurons of various cranial nerves neuclei and regulatory centres of vital function situated in the brain stem. Patients may manifest Dysphagia, weakness or jaw or facial muscles. Inability to cough, respiratory insufficiency etc. The paralysis may be temporarily or permanent.
There is no specific treatment to polio. The care is principally symptomatic and directed towards minimizing pain, paralysis and deformities and the promotion of maximum rehabilitation if there is permanent disability. Analgesics may be necessary for inter current infection.
Nursing Care Outline (POLIO TREATMENT)
Isolation precautions 7-14 days or more should be taken if temperature remains elevated.
Rest especially during the pre-paralytic phase. This rest should be facilitated with analgesics and sedative
- Observation of vital signs and general condition with accurate recording
- Intensive supportive care with necessary equipment such as fracture board, foot board, bolsters and sand bags, bed cradles, pillows etc
- Maintain appropriate position to ensure (a) comfort (b) clear airway (c) pain relieve (d) minimization of complications
- Personal and general hygiene should be stressed with special attention to the skin
- Care of bladder and bowel: this requires special attention
Rehabilitation: To ensure polio eradication in the patient rehabilitative measures like Passive exercise, use of bracelets and calipers to facilitate ambulation. The physiotherapy should be involved as much as possible. Health education is useful part of the rehabilitation programme and should emphasis adequate personal and food hygiene. As well as environmental sanitation and the need for follow up.
For Bular polio: Constant nursing attention suctioning and positioning for impaired swallowing reflex. Pass nasogastric tube for nutrition and administration of fluid. Provide respirator and tracheotomy(an emergency operation in which a cut is made in the trachea so that a person can breathe) may be necessary to relieve airway obstruction either by secretion or laryngeal spasm
- Limb paralysis with muscle atrophy
- Bladder paralysis with incontinent
- Airway Obstruction
- Skeletal deformities
It depends on the type of polio and on the quality of its management, with adequate management (polio vaccine and polio treatment) the prognosis is usually good but permanent deformities may occur.