Poliomyelitis Classification and external resources
ICD-10	A80., B91.
ICD-9	045, 138
DiseasesDB	10209
MedlinePlus	001402
eMedicine	ped/1843  pmr/6
MeSH	C02.182.600.700

Poliomyelitis, often called polio or infantile paralysis, is an acute viral infectious disease spread from person to person, primarily via the fecal-oral route. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings A00-A79 - Bacterial infections and other intestinal infectious diseases and STDs (A00-A09 Intestinal Infectious diseases ( A00-A79 - Bacterial infections and other intestinal infectious diseases and STDs (A00-A09 Intestinal Infectious diseases ( The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books A virus (from the Latin virus meaning Toxin or Poison) is a sub-microscopic infectious agent that is unable An infectious disease is a clinically evident Disease resulting from the presence of Pathogenic microbial agents including Pathogenic viruses Pathogenic The fecal-oral route (or alternatively the oral-fecal route or orofecal route) is a way Disease can be passed when fecal particles from one ^[1] The term derives from the Greek polio (πολίός), meaning "grey", myelon (µυελός), referring to the "spinal cord", and -itis, which denotes inflammation. Greek (el ελληνική γλώσσα or simply el ελληνικά — "Hellenic" is an Indo-European language, spoken today by 15-22 million people mainly The spinal cord is a long thin tubular bundle of Nerves that is an extension of the Central nervous system from the brain and is enclosed in and protected Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens ^[2] Although around 90% of polio infections have no symptoms at all, affected individuals can exhibit a range of symptoms if the virus enters the blood stream. Blood is a specialized Bodily fluid that delivers necessary substances to the body's cells ��such as nutrients and oxygen—and transports Waste products ^[3] In fewer than 1% of cases the virus enters the central nervous system, preferentially infecting and destroying motor neurons, leading to muscle weakness and acute flaccid paralysis. In Vertebrates the central nervous system ( CNS) is the part of the Nervous system which is enclosed in the Meninges. In Vertebrates the term motor neuron (or motoneuron) classically applies to Neurons located in the Central nervous system (or CNS that project Flaccid paralysis is a Clinical Manifestation characterized by Weakness or Paralysis and reduced Muscle tone without other obvious Different types of paralysis may occur, depending on the nerves involved. Spinal polio is the most common form, characterized by asymmetric paralysis that most often involves the legs. Bulbar polio leads to weakness of muscles innervated by cranial nerves. Cranial nerves are Nerves that emerge directly from the Brain stem in contrast to Spinal nerves which emerge from segments of the Spinal cord. Bulbospinal polio is a combination of bulbar and spinal paralysis. ^[4]

Poliomyelitis was first recognized as a distinct condition by Jakob Heine in 1840. Jakob (or Jacob) Heine ( April 16, 1800, Lauterbach ( Black Forest, Germany) – November 12, ^[5] Its causative agent, poliovirus, was identified in 1908 by Karl Landsteiner. Poliovirus, the causative agent of Poliomyelitis, is a human Enterovirus and member of the family of Picornaviridae. Karl Landsteiner ( June 14 1868 &ndash June 26 1943) was an Austrian Biologist and Physician. ^[5] Although major polio epidemics were unknown before the 20th century, polio was one of the most dreaded childhood diseases of the 20th century in the United States. In Epidemiology, an epidemic (from Greek epi- upon + demos people is a classification of a disease that appears as new cases in a Polio epidemics have crippled thousands of people, mostly young children; the disease has caused paralysis and death for much of human history. Polio had existed for thousands of years quietly as an endemic pathogen until the 1880s, when major epidemics began to occur in Europe; soon after, widespread epidemics appeared in the United States. In Epidemiology, an Infection is said to be endemic (from Greek en- in or within + demos people in a Population when ^[6] By 1910, much of the world experienced a dramatic increase in polio cases and frequent epidemics became regular events, primarily in cities during the summer months. These epidemics—which left thousands of children and adults paralyzed—provided the impetus for a "Great Race" towards the development of a vaccine. A vaccine is a biological preparation which is used to establish or improve immunity to a particular disease The polio vaccines developed by Jonas Salk in 1952 and Albert Sabin in 1962 are credited with reducing the annual number of polio cases from many hundreds of thousands to around a thousand. Two polio Vaccines are used throughout the world to combat Poliomyelitis (or polio Jonas Edward Salk ( October 28 1914 &ndash June 23, 1995) was an American Biologist and Physician best Albert Bruce Sabin (August 26 1906 – March 3 1993 was an American medical researcher best-known for having developed an oral Polio vaccine. ^[7] Enhanced vaccination efforts led by the World Health Organization, UNICEF and Rotary International could result in global eradication of the disease. Vaccination is the administration of Antigenic material (the Vaccine) to produce immunity to a disease The United Nations Children's Fund (or UNICEF) was created by the United Nations General Assembly on December 11, 1946 Rotary International is an organization of Service clubs known as Rotary Clubs located all over the world ^[8]

Contents 1 Cause 2 Transmission 3 Classification 4 Mechanism 4.1 Paralytic polio 4.1.1 Spinal polio 4.1.2 Bulbar polio 4.1.3 Bulbospinal polio 5 Diagnosis 6 Prognosis 6.1 Recovery 6.2 Complications 6.3 Post-polio syndrome 7 Treatment 8 Prevention 8.1 Passive immunization 8.2 Vaccine 9 Eradication 10 History 11 Further reading 12 Notes and references 13 External links

Cause

Main article: Poliovirus

Poliomyelitis is caused by infection with a member of the genus Enterovirus known as poliovirus (PV). A micrograph, microphotograph or photomicrograph is a Photograph or similar image taken through a Microscope or similar device to show Poliovirus, the causative agent of Poliomyelitis, is a human Enterovirus and member of the family of Picornaviridae. A genus (plural genera from Γένος Latin genus "descent family type gender" is a low-level Taxonomic The enteroviruses are a genus of (+ssRNA viruses associated with several human and mammalian diseases Poliovirus, the causative agent of Poliomyelitis, is a human Enterovirus and member of the family of Picornaviridae. This group of RNA viruses prefers to inhabit the gastrointestinal tract. An RNA virus is a Virus that has RNA (ribonucleic acid as its Genetic material. ^[1] PV infects and causes disease in humans alone. A pathogen (from Greek πάθος pathos "suffering passion" and γἰγνομαι (γεν- gignomai (gen- "I give birth to" infectious ^[3] Its structure is very simple, composed of a single (+) sense RNA genome enclosed in a protein shell called a capsid. A virus (from the Latin virus meaning Toxin or Poison) is a sub-microscopic infectious agent that is unable Sense, when applied in a Molecular biology context is a general concept used to compare the polarity of Nucleic acid molecules such as DNA or RNA Ribonucleic acid ( RNA) is a Nucleic acid that consists of a long chain of Nucleotide units In classical genetics the genome of a Diploid Organism including Eukarya refers to a full set of chromosomes or genes in a Gamete, thereby For the leaf bug see Miridae. A capsid is the protein shell of a virus. ^[3] In addition to protecting the virus’s genetic material, the capsid proteins enable poliovirus to infect certain types of cells. Three serotypes of poliovirus have been identified—poliovirus type 1 (PV1), type 2 (PV2), and type 3 (PV3)—each with a slightly different capsid protein. A serovar or serotype is a group of Microorganisms or Viruses based on their cell surface Antigens Serovars allow the epidemiologic classification ^[9] All three are extremely virulent and produce the same disease symptoms. Virulence (also called pestiferousness) refers to the degree of Pathogenicity of a Microbe, or in other words the relative ability of a Microbe ^[3] PV1 is the most commonly encountered form, and the one most closely associated with paralysis. ^[10]

Individuals who are exposed to the virus, either through infection or by immunization with polio vaccine, develop immunity. Immunization, or immunisation, is the process by which an individual's Immune system becomes fortified against an agent (known as the Immunity is a material term that describes a state of having sufficient biological defenses to avoid Infection, Disease, or other unwanted biological invasion In immune individuals, IgA antibodies against poliovirus are present in the tonsils and gastrointestinal tract and are able to block virus replication; IgG and IgM antibodies against PV can prevent the spread of the virus to motor neurons of the central nervous system. Immunoglobulin A ( IgA) is an Antibody playing a critical role in mucosal immunity Antibodies (also known as immunoglobulins, abbreviated Ig) are Gamma globulin Proteins that are found in Blood or other Bodily For the structure in the Cerebellum, see Cerebellar tonsil. The tonsils are areas Immunoglobulin G ( IgG) is a Monomeric Immunoglobulin, built of two heavy chains γ and two light chains. Immunoglobulin M, or IgM for short is a basic Antibody that is present on B cells It is the primary antibody against A and B In Vertebrates the central nervous system ( CNS) is the part of the Nervous system which is enclosed in the Meninges. ^[11] Infection or vaccination with one serotype of poliovirus does not provide immunity against the other serotypes, and full immunity requires exposure to each serotype. ^[11]

Transmission

Poliomyelitis is highly contagious and spreads easily from human-to-human contact. ^[11] In endemic areas, wild polioviruses can infect virtually the entire human population. ^[12] It is seasonal in temperate climates, with peak transmission occurring in summer and autumn. ^[11] These seasonal differences are far less pronounced in tropical areas. A tropical climate is a kind of Climate typical in the Tropics. ^[12] The time between first exposure and first symptoms, known as the incubation period, is usually 6 to 20 days, with a maximum range of 3 to 35 days. Incubation period is the Time elapsed between exposure to a Pathogenic Organism, or Chemical or radiation, and when Symptoms ^[13] Virus particles are excreted in the feces for several weeks following initial infection. Feces, faeces, or fæces (see spelling differences) is a waste product from an animal's digestive tract expelled through the Anus ^[13] The disease is transmitted primarily via the fecal-oral route, by ingesting contaminated food or water. In Medicine, transmission is the passing of a Disease from an infected individual or group to a previously uninfected individual or group The fecal-oral route (or alternatively the oral-fecal route or orofecal route) is a way Disease can be passed when fecal particles from one It is occasionally transmitted via the oral-oral route,^[10] a mode especially visible in areas with good sanitation and hygiene. ^[11] Polio is most infectious between 7–10 days before and 7–10 days after the appearance of symptoms, but transmission is possible as long as the virus remains in the saliva or feces. ^[10]

Factors that increase the risk of polio infection or affect the severity of the disease include immune deficiency,^[14] malnutrition,^[15] tonsillectomy,^[16] physical activity immediately following the onset of paralysis,^[17] skeletal muscle injury due to injection of vaccines or therapeutic agents,^[18] and pregnancy. In Medicine, immunodeficiency (or immune deficiency) is a state in which the Immune system 's ability to fight Infectious disease is compromised Malnutrition is a general term for a medical condition caused by an improper or insufficient diet. A tonsillectomy is a surgical procedure in which the Tonsils are removed Intramuscular injection is the injection of a substance directly into a Muscle. Pregnancy ( Latin graviditas) is the carrying of one or more offspring known as a Fetus or Embryo, inside the Uterus of a Female ^[19] Although the virus can cross the placenta during pregnancy, the fetus does not appear to be affected by either maternal infection or polio vaccination. The placenta is an Ephemeral organ present in placental Vertebrates, such as Eutherial Mammals and Sharks during Gestation ^[20] Maternal antibodies also cross the placenta, providing passive immunity that protects the infant from polio infection during the first few months of life. The placenta is an Ephemeral organ present in placental Vertebrates, such as Eutherial Mammals and Sharks during Gestation Passive immunity is the transfer of active Humoral immunity in the form of readymade antibodies from one individual to another ^[21]

Classification

Outcomes of poliovirus infection

Outcome	Proportion of cases[4]
Asymptomatic	90–95%
Minor illness	4–8%
Non-paralytic aseptic meningitis	1–2%
Paralytic poliomyelitis	0. 1–0. 5%
— Spinal polio	79% of paralytic cases
— Bulbospinal polio	19% of paralytic cases
— Bulbar polio	2% of paralytic cases

The term poliomyelitis is used to identify the disease caused by any of the three serotypes of poliovirus. A serovar or serotype is a group of Microorganisms or Viruses based on their cell surface Antigens Serovars allow the epidemiologic classification Two basic patterns of polio infection are described: a minor illness which does not involve the central nervous system (CNS), sometimes called abortive poliomyelitis, and a major illness involving the CNS, which may be paralytic or non-paralytic. In Vertebrates the central nervous system ( CNS) is the part of the Nervous system which is enclosed in the Meninges. ^[22] In most people with a normal immune system, a poliovirus infection is asymptomatic. Immunocompetence is the ability of the body to produce a normal Immune response (i Rarely the infection produces minor symptoms; these may include upper respiratory tract infection (sore throat and fever), gastrointestinal disturbances (nausea, vomiting, abdominal pain, constipation or, rarely, diarrhea), and influenza-like illnesses. In humans the respiratory tract is the part of the Anatomy that has to do with the process of respiration. ^[4]

The virus enters the central nervous system in about 3% of infections. Most patients with CNS involvement develop non-paralytic aseptic meningitis, with symptoms of headache, neck, back, abdominal and extremity pain, fever, vomiting, lethargy and irritability. Aseptic meningitis, or sterile meningitis is a condition in which the layers lining of the brain or Meninges, become inflamed and a Pyogenic Bacterial ^[2][23] Approximately 1 in 200 to 1 in 1000 cases progress to paralytic disease, in which the muscles become weak, floppy and poorly-controlled, and finally completely paralyzed; this condition is known as acute flaccid paralysis. Paralysed redirects here For other uses see xx Paralysed (disambiguation Paralysis is the complete loss of Muscle function Flaccid paralysis is a Clinical Manifestation characterized by Weakness or Paralysis and reduced Muscle tone without other obvious ^[24] Depending on the site of paralysis, paralytic poliomyelitis is classified as spinal, bulbar, or bulbospinal. Encephalitis, an infection of the brain tissue itself, can occur in rare cases and is usually restricted to infants. Encephalitis is an acute Inflammation of the Brain, commonly caused by a viral Infection. It is characterized by confusion, changes in mental status, headaches, fever, and less commonly seizures and spastic paralysis. An epileptic seizure is caused by excessive and/or hypersynchronous electrical Neuronal activity and is usually self-limiting Spasticity or muscular hypertonicity is a disorder of the body Motor system, and especially the central nervous system (CNS in which certain Muscles continually ^[25]

Mechanism

Poliovirus enters the body through the mouth, infecting the first cells it comes in contact with—the pharynx (throat) and intestinal mucosa. In Anatomy, lumbar is an Adjective that means of or pertaining to the Abdominal segment of the Torso, between the diaphragm and Arteries are Blood vessels that carry blood away from the Heart. The pharynx (plural pharynges) is the part of the Neck and Throat situated immediately Posterior to (behind the Mouth and Nasal It gains entry by binding to a immunoglobulin-like receptor, known as the poliovirus receptor or CD155, on the cell surface. Antibodies (also known as immunoglobulins, abbreviated Ig) are Gamma globulin Proteins that are found in Blood or other Bodily CD155 is a Type I Transmembrane Glycoprotein in the Immunoglobulin superfamily ^[26] The virus then hijacks the host cell's own machinery, and begins to replicate. In Biology, a host is an organism that harbors a Virus or Parasite, or a mutual or Commensal Symbiont, typically providing nourishment Chronic since 1992 ( talk) 2200 12 December 2007 (UTC --> Viral replication Poliovirus divides within gastrointestinal cells for about a week, from where it spreads to the tonsils (specifically the follicular dendritic cells residing within the tonsilar germinal centers), the intestinal lymph nodes including the M cells of Peyer's patches, and the deep cervical and mesenteric lymph nodes, where it multiplies abundantly. For the structure in the Cerebellum, see Cerebellar tonsil. The tonsils are areas Follicular dendritic cells (FDC are cells of the Immune system found in Lymph follicles They are probably not of Hematopoietic origin but simply look Germinal centres (GC are areas within Lymph nodes where B lymphocytes rapidly divide and are an important part of the humoral immune response. A Lymph node ( lɪmf noʊd is an organ consisting of many types of cells and is a part of the Lymphatic system. M cells (or microfold cells) are cells found in the follicle-associated epithelium of the Peyer's patch that have the unique ability to sample Antigen from Peyer's patches are secondary lymphoid tissue named after the 17th-century Swiss anatomist Johann Conrad Peyer. Cervical lymph nodes are Lymph nodes found in the neck Classification There are approximately 300 lymph nodes in the neck and they can be classified in many The inferior mesenteric glands consist of (a small glands on the branches of the Left colic and Sigmoid arteries (b a group in the The virus is subsequently absorbed into the bloodstream. ^[27]

Known as viremia, the presence of virus in the bloodstream enables it to be widely distributed throughout the body. Viremia (UK viraemia) is a medical condition where Viruses enter the Bloodstream and hence have access to the rest of the body Poliovirus can survive and multiply within the blood and lymphatics for long periods of time, sometimes as long as 17 weeks. ^[28] In a small percentage of cases, it can spread and replicate in other sites such as brown fat, the reticuloendothelial tissues, and muscle. Brown adipose tissue ( BAT) or brown fat is one of the two types of Adipose tissue (the other being White adipose tissue) that is present in many The reticuloendothelial system ( RES) part of the Immune system, consists of the phagocytic cells located in Reticular connective tissue, primarily ^[29] This sustained replication causes a major viremia, and leads to the development of minor influenza-like symptoms. Rarely, this may progress and the virus may invade the central nervous system, provoking a local inflammatory response. Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens In most cases this causes a self-limiting inflammation of the meninges, the layers of tissue surrounding the brain, which is known as non-paralytic aseptic meningitis. The meninges (singular meninx) is the system of membranes which envelops the Central nervous system. The brain is the center of the Nervous system in animals All Vertebrates and the majority of Invertebrates have a brain ^[2] Penetration of the CNS provides no known benefit to the virus, and is quite possibly an incidental deviation of a normal gastrointestinal infection. ^[30] The mechanisms by which poliovirus spreads to the CNS are poorly understood, but it appears to be primarily a chance event—largely independent of the age, gender, or socioeconomic position of the individual. Socioeconomics or socio-economics is the study of the relationship between economic activity and Social life. ^[30]

Paralytic polio

In around 1% of infections, poliovirus spreads along certain nerve fiber pathways, preferentially replicating in and destroying motor neurons within the spinal cord, brain stem, or motor cortex. In Vertebrates the term motor neuron (or motoneuron) classically applies to Neurons located in the Central nervous system (or CNS that project The spinal cord is a long thin tubular bundle of Nerves that is an extension of the Central nervous system from the brain and is enclosed in and protected The brain stem (or brainstem) is the lower part of the Brain, adjoining and structurally continuous with the Spinal cord. Motor cortex is a term that describes regions of the Cerebral cortex involved in the planning control and execution of voluntary motor functions This leads to the development of paralytic poliomyelitis, the various forms of which (spinal, bulbar, and bulbospinal) vary only with the amount of neuronal damage and inflammation that occurs, and the region of the CNS that is affected.

The destruction of neuronal cells produces lesions within the spinal ganglia; these may also occur in the reticular formation, vestibular nuclei, cerebellar vermis, and deep cerebellar nuclei. A lesion is any abnormal tissue found on or in an organism usually damaged by disease or trauma In Anatomy and Neurology, the dorsal root Ganglion (or spinal ganglion) is a nodule on a Dorsal root that contains cell bodies of The reticular formation is a part of the Brain that is involved in actions such as awaking/ sleeping cycle, and lying down The vestibular nuclei are the Cranial nuclei for the Vestibular nerve. Part of the structure of animal Brains the cerebellar vermis is a narrow wormlike structure between the hemispheres of the Cerebellum. The cerebellum ( Latin: "little brain" is a region of the Brain that plays an important role in the integration of sensory perception ^[30] Inflammation associated with nerve cell destruction often alters the color and appearance of the gray matter in the spinal column, causing it to appear reddish and swollen. A vertebra (plural vertebrae) is an individual Irregular bone in the spinal or Vertebral column ( aka ischis a flexuous and flexible column ^[2] Other destructive changes associated with paralytic disease occur in the forebrain region, specifically the hypothalamus and thalamus. In the Anatomy of the Brain of Vertebrates, the prosencephalon (or forebrain) is the Rostral -most (forward-most portion of the The hypothalamus links the Nervous system to the Endocrine system via the Pituitary gland (hypophysis The thalamus (from Greek θάλαμος = room chamber, IPA= /ˈθæləməs/ is a pair and symmetric part of the brain ^[30] The molecular mechanisms by which poliovirus causes paralytic disease are poorly understood.

Early symptoms of paralytic polio include high fever, headache, stiffness in the back and neck, asymmetrical weakness of various muscles, sensitivity to touch, difficulty swallowing, muscle pain, loss of superficial and deep reflexes, paresthesia (pins and needles), irritability, constipation, or difficulty urinating. A reflex action, also known as a reflex, is an involuntary and almost instant movement in response to stimulus. Paresthesia (pron /ˌpɛɹɪsˈθiʒə/ paraesthesia in British English, pron Paralysis generally develops one to ten days after early symptoms begin, progresses for two to three days, and is usually complete by the time the fever breaks. ^[31]

The likelihood of developing paralytic polio increases with age, as does the extent of paralysis. In children, non-paralytic meningitis is the most likely consequence of CNS involvement, and paralysis occurs in only 1 in 1000 cases. In adults, paralysis occurs in 1 in 75 cases. ^[32] In children under five years of age, paralysis of one leg is most common; in adults, extensive paralysis of the chest and abdomen also affecting all four limbs—quadriplegia—is more likely. The chest is a part of the Anatomy of humans and various other animals sometimes referred to as the Thorax. In Vertebrates such as Mammals the abdomen (belly constitutes the part of the body between the Thorax (chest and Pelvis. Quadriplegia, also known as tetraplegia, is a Symptom in which a human experiences Paralysis affecting all four limbs although not necessarily total paralysis ^[33] Paralysis rates also vary depending on the serotype of the infecting poliovirus; the highest rates of paralysis (1 in 200) are associated with poliovirus type 1, the lowest rates (1 in 2,000) are associated with type 2. ^[34]

Spinal polio

Spinal polio is the most common form of paralytic poliomyelitis; it results from viral invasion of the motor neurons of the anterior horn cells, or the ventral (front) gray matter section in the spinal column, which are responsible for movement of the muscles, including those of the trunk, limbs and the intercostal muscles. In Vertebrates the term motor neuron (or motoneuron) classically applies to Neurons located in the Central nervous system (or CNS that project The anterior horn of the Spinal cord (or anterior cornu, or anterior column, or ventral horn) is the ventral (front Grey matter A vertebra (plural vertebrae) is an individual Irregular bone in the spinal or Vertebral column ( aka ischis a flexuous and flexible column The anterior horn of the Spinal cord (or anterior cornu, or anterior column, or ventral horn) is the ventral (front Grey matter In fields of Anatomy, anatomical terms of location are descriptive terms to help identify relative positions or directions within a species A vertebra (plural vertebrae) is an individual Irregular bone in the spinal or Vertebral column ( aka ischis a flexuous and flexible column Torso is an anatomical term for the central part of the many animal bodies (including that of the human from which extend the neck and limbs A limb (from the Old English lim) is a jointed or Prehensile (as Octopus tentacles or new world Monkey tails Appendage of the Intercostal muscles are several groups of Muscles that run between the Ribs, and help form and move the Chest wall. ^[24] Virus invasion causes inflammation of the nerve cells, leading to damage or destruction of motor neuron ganglia. In Anatomy, a ganglion (pl ganglia) is a tissue mass. Neurology In neurological contexts ganglia are composed mainly of When spinal neurons die, Wallerian degeneration takes place, leading to weakness of those muscles formerly innervated by the now dead neurons. Wallerian degeneration is a process that results when a Nerve fiber is cut or crushed in which the part of the Axon separated from the Neuron 's Cell A nerve is an enclosed cable-like bundle of peripheral Axons (the long slender projections of Neurons. ^[35] With the destruction of nerve cells, the muscles no longer receive signals from the brain or spinal cord; without nerve stimulation, the muscles atrophy, becoming weak, floppy and poorly controlled, and finally completely paralyzed. Atrophy is the partial or complete Wasting away of a part of the Body. ^[24] Progression to maximum paralysis is rapid (two to four days), and is usually associated with fever and muscle pain. ^[35] Deep tendon reflexes are also affected, and are usually absent or diminished; sensation (the ability to feel) in the paralyzed limbs, however, is not affected. Tendon reflex (or T-reflex) is a feedback mechanism that controls increasing muscle tension by causing muscle relaxation before tension force becomes so great it may damage the A reflex action, also known as a reflex, is an involuntary and almost instant movement in response to stimulus. In Psychology, sensation is the first stage in the biochemical and neurologic events that begins with the impinging of a stimulus upon the receptor cells of a ^[35]

The extent of spinal paralysis depends on the region of the cord affected, which may be cervical, thoracic, or lumbar. In Anatomy, ' cervical' is an Adjective that has two meanings of or pertaining to any Neck. The thorax is a division of an Animal 's body that lies between the head and the Abdomen. In Anatomy, lumbar is an Adjective that means of or pertaining to the Abdominal segment of the Torso, between the diaphragm and ^[36] The virus may affect muscles on both sides of the body, but more often the paralysis is asymmetrical. Asymmetry is the absence of or a violation of a Symmetry. In organisms Due to how cells divide in Organisms asymmetry in organisms is ^[27] Any limb or combination of limbs may be affected—one leg, one arm, or both legs and both arms. A limb (from the Old English lim) is a jointed or Prehensile (as Octopus tentacles or new world Monkey tails Appendage of the Paralysis is often more severe proximally (where the limb joins the body) than distally (the fingertips and toes). In fields of Anatomy, anatomical terms of location are descriptive terms to help identify relative positions or directions within a species In fields of Anatomy, anatomical terms of location are descriptive terms to help identify relative positions or directions within a species A finger is a type of digit, an organ of manipulation and sensation found in the Hands of Humans and other Primates Normally humans have five digits Toes are the digits of the Foot of an animal Many animal species such as Cats walk on their toes and are described as being Digitigrade ^[27]

Bulbar polio

Comprising about 2% of cases of paralytic polio, bulbar polio occurs when poliovirus invades and destroys nerves within the bulbar region of the brain stem. The corticobulbar (or corticonuclear) tract is a White matter pathway connecting the Cerebral cortex to the Brainstem (the term "bulbar" The brain stem (or brainstem) is the lower part of the Brain, adjoining and structurally continuous with the Spinal cord. ^[4] The bulbar region is a white matter pathway that connects the cerebral cortex to the brain stem. White matter is one of the three main solid components of the Central nervous system. The cerebral cortex is a structure within the Brain that plays a key role in Memory, Attention, perceptual Awareness, Thought, The destruction of these nerves weakens the muscles supplied by the cranial nerves, producing symptoms of encephalitis, and causes difficulty breathing, speaking and swallowing. Cranial nerves are Nerves that emerge directly from the Brain stem in contrast to Spinal nerves which emerge from segments of the Spinal cord. Encephalitis is an acute Inflammation of the Brain, commonly caused by a viral Infection. ^[23] Critical nerves affected are the glossopharyngeal nerve, which partially controls swallowing and functions in the throat, tongue movement and taste; the vagus nerve, which sends signals to the heart, intestines, and lungs; and the accessory nerve, which controls upper neck movement. The glossopharyngeal nerve is the ninth of twelve pairs of Cranial nerves. The vagus nerve (ˈveɪˌgəs (VĀ-gəs (also called pneumogastric nerve or cranial nerve X) is the tenth of twelve paired Cranial nerves, and is the In Anatomy, the accessory nerve is a Nerve that controls specific Muscles of the neck Due to the effect on swallowing, secretions of mucus may build up in the airway causing suffocation. In vertebrates mucus is a slippery secretion produced by and covering Mucous membranes It is a viscous Colloid containing Antiseptic enzymes (such as ^[31] Other signs and symptoms include facial weakness, caused by destruction of the trigeminal nerve and facial nerve, which innervate the cheeks, tear ducts, gums, and muscles of the face, among other structures; double vision; difficulty in chewing; and abnormal respiratory rate, depth, and rhythm, which may lead to respiratory arrest. The trigeminal nerve (the fifth Cranial nerve, also called the fifth nerve or simply V) is responsible for sensation in the face The facial nerve is the seventh (VII of twelve paired Cranial nerves. The nasolacrimal duct (sometimes called tear ducts) carries Tears from the Lacrimal sac into the Nasal cavity. Diplopia, commonly known as double vision, is the simultaneous Perception of two images of a single object Respiratory arrest is the cessation of Breathing. It is a Medical emergency and it usually is related to or coincides with a Cardiac arrest. Pulmonary edema and shock are also possible, and may be fatal. Pulmonary Edema (American English or oedema (British English is swelling and/or fluid accumulation in the Lungs It leads to impaired gas exchange and may cause ^[36]

Bulbospinal polio

Approximately 19% of all paralytic polio cases have both bulbar and spinal symptoms; this subtype is called respiratory polio or bulbospinal polio. ^[4] Here the virus affects the upper part of the cervical spinal cord (C3 through C5), and paralysis of the diaphragm occurs. In Vertebrates cervical vertebrae (singular vertebra) are those vertebrae immediately behind (posterior to the Skull. For other types of diaphragm see Diaphragm. In the Anatomy of Mammals the thoracic diaphragm is a sheet of Muscle The critical nerves affected are the phrenic nerve, which drives the diaphragm to inflate the lungs, and those that drive the muscles needed for swallowing. The phrenic nerve arises from the third fourth and fifth cervical Spinal nerves (C3-C5 in Humans. lung is the essential Respiration organ in air-breathing Animals including most Tetrapods a few Fish and a few Snails The most primitive By destroying these nerves this form of polio affects breathing, making it difficult or impossible for the patient to breathe without the support of a ventilator. It can lead to paralysis of the arms and legs and may also affect swallowing and heart functions. ^[37]

Diagnosis

Paralytic poliomyelitis may be clinically suspected in individuals experiencing acute onset of flaccid paralysis in one or more limbs with decreased or absent tendon reflexes in the affected limbs, that cannot be attributed to another apparent cause, and without sensory or cognitive loss. Cognition is a concept used in different ways by different disciplines but is generally accepted to mean the process of awareness or thought ^[38]

A laboratory diagnosis is usually made based on recovery of poliovirus from a stool sample or a swab of the pharynx. The pharynx (plural pharynges) is the part of the Neck and Throat situated immediately Posterior to (behind the Mouth and Nasal Antibodies to poliovirus can be diagnostic, and are generally detected in the blood of infected patients early in the course of infection. Antibodies (also known as immunoglobulins, abbreviated Ig) are Gamma globulin Proteins that are found in Blood or other Bodily ^[4] Analysis of the patient's cerebrospinal fluid (CSF), which is collected by a lumbar puncture ("spinal tap"), reveals an increased number of white blood cells (primarily lymphocytes) and a mildly elevated protein level. Cerebrospinal fluid ( CSF) Liquor cerebrospinalis, is a clear Bodily fluid that occupies the Subarachnoid space and the Ventricular system In Medicine, a lumbar puncture (colloquially known as a spinal tap) is a Diagnostic and at times therapeutic procedure that is performed in order A lymphocyte is a type of White blood cell in the Vertebrate Immune system. Detection of virus in the CSF is diagnostic of paralytic polio, but rarely occurs. ^[4]

If poliovirus is isolated from a patient experiencing acute flaccid paralysis, it is further tested through oligonucleotide mapping (genetic fingerprinting), or more recently by PCR amplification, to determine whether it is "wild type" (that is, the virus encountered in nature) or "vaccine type" (derived from a strain of poliovirus used to produce polio vaccine). An oligonucleotide (or oligo) is a short segment of RNA or DNA, typically with twenty or fewer bases. Wild type, sometimes written wildtype or wild-type, is the typical form of an organism strain gene or characteristic as it occurs in nature ^[39] It is important to determine the source of the virus because for each reported case of paralytic polio caused by wild poliovirus, it is estimated that another 200 to 3,000 contagious asymptomatic carriers exist. An asymptomatic carrier ( healthy carrier or just carrier) is a person or other organism that has contracted an Infectious disease, but who displays no symptoms ^[40]

Prognosis

Patients with abortive polio infections recover completely. In those that develop only aseptic meningitis, the symptoms can be expected to persist for two to ten days, followed by complete recovery. ^[41] In cases of spinal polio, if the affected nerve cells are completely destroyed, paralysis will be permanent; cells that are not destroyed but lose function temporarily may recover within four to six weeks after onset. ^[41] Half the patients with spinal polio recover fully, one quarter recover with mild disability and the remaining quarter are left with severe disability. ^[42] The degree of both acute paralysis and residual paralysis is likely to be proportional to the degree of viremia, and inversely proportional to the degree of immunity. Viremia (UK viraemia) is a medical condition where Viruses enter the Bloodstream and hence have access to the rest of the body This article is about proportionality the mathematical relation Immunity is a material term that describes a state of having sufficient biological defenses to avoid Infection, Disease, or other unwanted biological invasion ^[30] Spinal polio is rarely fatal. ^[31]

Without respiratory support, consequences of poliomyelitis with respiratory involvement include suffocation or pneumonia from aspiration of secretions. In Animal physiology, respiration is the transport of Oxygen from the outside air to the cells within tissues and the transport of Carbon dioxide Aspiration pneumonia is Bronchopneumonia that develops due to the entrance of foreign materials that enter the bronchial tree usually oral or gastric contents (including food ^[43] Overall, 5–10% of patients with paralytic polio die due to the paralysis of muscles used for breathing. The mortality rate varies by age: 2–5% of children and up to 15–30% of adults die. ^[4] Bulbar polio often causes death if respiratory support is not provided;^[37] with support, its mortality rate ranges from 25 to 75%, depending on the age of the patient. ^[4][44] When positive pressure ventilators are available, the mortality can be reduced to 15%. ^[45]

Recovery

Many cases of poliomyelitis result in only temporary paralysis. ^[24] Nerve impulses return to the formerly paralyzed muscle within a month, and recovery is usually complete in six to eight months. ^[41] The neurophysiological processes involved in recovery following acute paralytic poliomyelitis are quite effective; muscles are able to retain normal strength even if half the original motor neurons have been lost. Neurophysiology (from Greek grc νεῦρον neuron, "nerve" grc φύσις physis, "nature origin" and grc -λογία ^[46] Paralysis remaining after one year is likely to be permanent, although modest recoveries of muscle strength are possible 12 to 18 months after infection. ^[41]

One mechanism involved in recovery is nerve terminal sprouting, in which remaining brainstem and spinal cord motor neurons develop new branches, or axonal sprouts. ^[47] These sprouts can reinnervate orphaned muscle fibers that have been denervated by acute polio infection,^[48] restoring the fibers' capacity to contract and improving strength. When a Motor nerve dies a nearby nerve can grow a new Axon to the affected muscle in order to take over the functionality of the dead nerve ^[49] Terminal sprouting may generate a few significantly enlarged motor neurons doing work previously performed by as many as four or five units:^[32] a single motor neuron that once controlled 200 muscle cells might control 800 to 1000 cells. Other mechanisms that occur during the rehabilitation phase, and contribute to muscle strength restoration, include myofiber hypertrophy—enlargement of muscle fibers through exercise and activity—and transformation of type II muscle fibers to type I muscle fibers. Muscle hypertrophy is a scientific term for the growth and increase of the size of muscle cells Skeletal muscle is a type of Striated muscle, which usually attaches to tendons Skeletal muscle is a type of Striated muscle, which usually attaches to tendons ^[48][50]

In addition to these physiological processes, the body possesses a number of compensatory mechanisms to maintain function in the presence of residual paralysis. These include the use of weaker muscles at a higher than usual intensity relative to the muscle's maximal capacity, enhancing athletic development of previously little-used muscles, and using ligaments for stability, which enables greater mobility. A muscles contraction (also known as a muscle twitch or simply twitch) occurs when a Muscle fibre generates tension through the action of Actin In Anatomy, the term ligament is used to denote three different types of structures Fibrous tissue that connects Bones to other bones ^[50]

Complications

Residual complications of paralytic polio often occur following the initial recovery process. ^[23] Muscle paresis and paralysis can sometimes result in skeletal deformities, tightening of the joints and movement disability. Paresis is a condition typified by partial loss of movement or impaired movement In Biology, the skeleton is a strong and often a rigid framework that supports the body of an animal holding it upright and giving it shape and strength (Also skeletal Once the muscles in the limb become flaccid, they may interfere with the function of other muscles. A typical manifestation of this problem is equinus foot (similar to club foot). A clubfoot, or talipes equinovarus (TEV is a Birth defect.TEV is classified into 2 groups Postural TEV or Structural TEV This deformity develops when the muscles that pull the toes downward are working, but those that pull it upward are not, and the foot naturally tends to drop toward the ground. If the problem is left untreated, the Achilles tendons at the back of the foot retract and the foot cannot take on a normal position. The Achilles tendon (or occasionally Achilles’ tendon) also known as the calcaneal tendon or the tendocalcaneous, is a Tendon of the posterior Polio victims that develop equinus foot cannot walk properly because they cannot put their heel on the ground. A similar situation can develop if the arms become paralyzed. ^[51] In some cases the growth of an affected leg is slowed by polio, while the other leg continues to grow normally. The result is that one leg is shorter than the other and the person limps and leans to one side, in turn leading to deformities of the spine (such as scoliosis). Scoliosis is a medical condition in which a person's spine is curved from side to side and may also be rotated ^[51] Osteoporosis and increased likelihood of bone fractures may occur. Osteoporosis is a Disease of Bone that leads to an increased risk of fracture. A bone fracture (sometimes abbreviated # or Fx or Fx) is a medical condition in which a Bone is cracked or broken Extended use of braces or wheelchairs may cause compression neuropathy, as well as a loss of proper function of the veins in the legs, due to pooling of blood in paralyzed lower limbs. Neuropathy is a medical term usually short for Peripheral neuropathy. In the Circulatory system, a vein is a Blood vessel that carries Blood back toward the Heart (as opposed to Artery, a blood vessel ^[52][37] Complications from prolonged immobility involving the lungs, kidneys and heart include pulmonary edema, aspiration pneumonia, urinary tract infections, kidney stones, paralytic ileus, myocarditis and cor pulmonale. lung is the essential Respiration organ in air-breathing Animals including most Tetrapods a few Fish and a few Snails The most primitive The kidneys are complicated organs that have numerous biological roles The heart is a muscular organ in all Vertebrates responsible for pumping Blood through the Blood vessels by repeated rhythmic Pulmonary Edema (American English or oedema (British English is swelling and/or fluid accumulation in the Lungs It leads to impaired gas exchange and may cause Aspiration pneumonia is Bronchopneumonia that develops due to the entrance of foreign materials that enter the bronchial tree usually oral or gastric contents (including food A urinary tract infection ( UTI) is a bacterial Infection that affects any part of the Urinary tract. Kidney stones, also called renal calculi, are solid concretions (crystal aggregations of dissolved minerals in Urine; calculi typically form Ileus is a disruption of the normal propulsive gastrointestinal motor activity from non-mechanical mechanisms In Medicine ( Cardiology) myocarditis is Inflammation of the Myocardium, the muscular part of the Heart. Cor pulmonale is a change in structure and function of the Right ventricle of the heart as a result of a respiratory disorder ^[52][37]

Post-polio syndrome

Main article: Post-polio syndrome

Around a quarter of individuals who survive paralytic polio in childhood develop additional symptoms decades after recovering from the acute infection, notably muscle weakness, extreme fatigue, or paralysis. Post-polio syndrome ( PPS) sometimes termed Middle age onset Post-polio syndrome is a condition that affects survivors of Poliomyelitis, a viral This condition is known as post-polio syndrome (PPS). Post-polio syndrome ( PPS) sometimes termed Middle age onset Post-polio syndrome is a condition that affects survivors of Poliomyelitis, a viral ^[53] The symptoms of PPS are thought to involve a failure of the over-sized motor units created during recovery from paralytic disease. ^[54][55] Factors that increase the risk of PPS include the length of time since acute poliovirus infection, the presence of permanent residual impairment after recovery from the acute illness, and both overuse and disuse of neurons. ^[53] Post-polio syndrome is not an infectious process, and persons experiencing the syndrome do not shed poliovirus. ^[4]

Treatment

There is no cure for polio. A cure is a substance or procedure that makes a sick or diseased person well The focus of modern treatment has been on providing relief of symptoms, speeding recovery and preventing complications. Supportive measures include antibiotics to prevent infections in weakened muscles, analgesics for pain, moderate exercise and a nutritious diet. In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa ^[56] Treatment of polio often requires long-term rehabilitation, including physical therapy, braces, corrective shoes and, in some cases, orthopedic surgery. Orthopedic surgery or orthopedics (also spelled orthopaedics) is the branch of Surgery concerned with injuries to or conditions involving the ^[36]

Portable ventilators may be required to support breathing. Historically, a noninvasive negative-pressure ventilator, more commonly called an iron lung, was used to artificially maintain respiration during an acute polio infection until a person could breathe independently (generally about one to two weeks). An iron lung is a large machine that enables a person to breathe when normal Muscle control has been lost or the work of breathing exceeds the person's ability Today many polio survivors with permanent respiratory paralysis use modern jacket-type negative-pressure ventilators that are worn over the chest and abdomen. Biphasic Cuirass Ventilation ( BCV) is a method of Ventilation which requires the patient to wear an upper body shell or Cuirass, so named after the body-armour ^[43]

Other historical treatments for polio include hydrotherapy, electrotherapy, massage and passive motion exercises, and surgical treatments such as tendon lengthening and nerve grafting. The history of poliomyelitis (polio infections extends into Prehistory. Hydrotherapy, formerly called hydropathy involves the use of Water for soothing pains and treating diseases Electrotherapy is the use of Electrical energy in the treatment of impairments of health and a conditions of abnormal functioning. ^[24] Devices such as rigid braces and body casts—which tended to cause muscle atrophy due to the limited movement of the user—were also touted as effective treatments. An orthopaedic brace (also orthosis or orthotic is a device used to immobilize a Joint or body segment restrict movement in a given direction Muscle atrophy is defined as a decrease in the mass of the muscle it can be a partial or complete wasting away of muscle ^[57]

Prevention

Passive immunization

In 1950, William Hammon at the University of Pittsburgh purified the gamma globulin component of the blood plasma of polio survivors. William McDowall Hammon (1904 &ndash 1989-09-19) was an American physician and researcher best known for his work on Poliomyelitis. The University of Pittsburgh, commonly referred to as Pitt, is a non-sectarian coeducational independent state-related, "public" research University Gamma globulins, or Ig's are a class of Proteins in the blood identified by their position after Serum protein electrophoresis. Blood plasma is the Liquid component of Blood, in which the Blood cells are suspended ^[58] Hammon proposed that the gamma globulin, which contained antibodies to poliovirus, could be used to halt poliovirus infection, prevent disease, and reduce the severity of disease in other patients who had contracted polio. The results of a large clinical trial were promising; the gamma globulin was shown to be about 80% effective in preventing the development of paralytic poliomyelitis. In health care clinical trials are conducted to allow safety and Efficacy data to be collected for new drugs or devices ^[59] It was also shown to reduce the severity of the disease in patients that developed polio. ^[58] The gamma globulin approach was later deemed impractical for widespread use, however, due in large part to the limited supply of blood plasma, and the medical community turned its focus to the development of a polio vaccine. ^[60]

Vaccine

Main article: Polio vaccine

Two vaccines are used throughout the world to combat polio. Two polio Vaccines are used throughout the world to combat Poliomyelitis (or polio Poliomyelitis, often called polio or infantile paralysis, is an acute viral Infectious disease spread from person to person primarily via Both vaccines induce immunity to polio, efficiently blocking person-to-person transmission of wild poliovirus, thereby protecting both individual vaccine recipients and the wider community (so-called herd immunity). Herd immunity (or community immunity) describes a type of immunity that occurs when the Vaccination of a portion of the Population (or herd ^[61]

The first polio vaccine was developed in 1952 by Jonas Salk, also at the University of Pittsburgh, and announced to the world on April 12, 1955. Jonas Edward Salk ( October 28 1914 &ndash June 23, 1995) was an American Biologist and Physician best Events 467 - Anthemius is elevated to Emperor of the Western Roman Empire. Year 1955 ( MCMLV) was a Common year starting on Saturday (link displays the 1955 Gregorian calendar) ^[62] The Salk vaccine, or inactivated poliovirus vaccine (IPV), is based on poliovirus grown in a type of monkey kidney tissue culture (Vero cell line), which is chemically inactivated with formalin. Vero cells are lineages of cells used in Cell cultures. The Vero lineage was isolated from Kidney Epithelial cells extracted Cell culture is the process by which prokaryotic, or eukaryotic cells are grown under controlled conditions Formaldehyde is a Chemical compound with the formula H2CO It is the simplest Aldehyde —an organic compound containing a terminal Carbonyl ^[11] After two doses of IPV (given by injection), 90% or more of individuals develop protective antibody to all three serotypes of poliovirus, and at least 99% are immune to poliovirus following three doses. An injection is an infusion method of putting Liquid into the Body, usually with a hollow needle and a Syringe which is pierced through For the term's use in bacteriology see Serovar. Transplants between genetically non-identical humans induce the creation of antibodies in the recipient ^[4]

Subsequently, Albert Sabin developed an oral polio vaccine (OPV) using live but weakened (attenuated) virus, produced by the repeated passage of the virus through non-human cells at sub-physiological temperatures. Albert Bruce Sabin (August 26 1906 – March 3 1993 was an American medical researcher best-known for having developed an oral Polio vaccine. "Attenuated" redirects here For the bacterial use of the term see Attenuator (genetics Attenuation in Virology is reducing Physiology (from Greek grc φύσις physis, "nature origin" and grc -λογία -logia) is the study of the mechanical physical ^[63] Human trials of Sabin's vaccine began in 1957 and it was licensed in 1962. In health care clinical trials are conducted to allow safety and Efficacy data to be collected for new drugs or devices ^[64] The attenuated poliovirus in the Sabin vaccine replicates very efficiently in the gut, the primary site of wild poliovirus infection and replication, but the vaccine strain is unable to replicate efficiently within nervous system tissue. The nervous system is a Network of specialized cells that communicate information about an animal's surroundings and itself ^[65] A single dose of oral polio vaccine produces immunity to all three poliovirus serotypes in approximately 50% of recipients. Three doses of live-attenuated OPV produce protective antibody to all three poliovirus types in more than 95% of recipients. ^[4]

Because OPV is inexpensive, easy to administer, and produces excellent immunity in the intestine, (which helps prevent infection with wild virus in areas where it is endemic) it has been the vaccine of choice for controlling poliomyelitis in many countries. In Epidemiology, an Infection is said to be endemic (from Greek en- in or within + demos people in a Population when ^[66] On very rare occasions (about 1 case per 750,000 vaccine recipients) the attenuated virus in OPV reverts into a form that can paralyze. ^[13] Most industrialized countries have switched to IPV, which cannot revert, either as the sole vaccine against poliomyelitis or in combination with oral polio vaccine. The term developed country, or advanced country, is used to categorize countries with developed Economies in which the tertiary and quaternary sectors ^[67]

Eradication

Main article: Poliomyelitis eradication

Following the widespread use of poliovirus vaccine in the mid-1950s, the incidence of poliomyelitis declined dramatically in many industrialized countries. The global eradication of poliomyelitis is a Public health effort to eliminate all cases of Poliomyelitis (polio infection A global effort to eradicate polio began in 1988, led by the World Health Organization, UNICEF, and The Rotary Foundation. The United Nations Children's Fund (or UNICEF) was created by the United Nations General Assembly on December 11, 1946 The Rotary Foundation is a Not-for-profit Corporation that supports the efforts of Rotary International to achieve world understanding and peace through ^[68] These efforts have reduced the number of annual diagnosed cases by 99%; from an estimated 350,000 cases in 1988 to fewer than 2,000 cases in 2006. ^[69] Should eradication be successful it will represent only the second time mankind has ever completely eliminated a disease. The first such disease was smallpox, which was officially eradicated in 1979. Smallpox is an Infectious disease unique to humans caused by either of two virus variants named Variola major and Variola minor. ^[70] A number of eradication milestones have already been reached, and several regions of the world have been certified polio-free. The Americas were declared polio-free in 1994. The Americas are the lands of the Western hemisphere or New World, consisting of the Continents of North America and South America ^[71] In 2000 polio was officially eradicated in 36 Western Pacific countries, including China and Australia. ^[72][73] Europe was declared polio-free in 2002. ^[74] As of 2006, polio remains endemic in only four countries: Nigeria, India, Pakistan, and Afghanistan. In Epidemiology, an Infection is said to be endemic (from Greek en- in or within + demos people in a Population when Nigeria, officially named the Federal Republic of Nigeria, is a federal Constitutional republic comprising thirty-six states and one Federal India, officially the Republic of India (भारत गणराज्य inc-Latn Bhārat Gaṇarājya; see also other Indian languages) is a country Pakistan () officially the Islamic Republic of Pakistan, is a country located in South Asia, Southwest Asia, Middle East and Afghanistan /æfˈgænɪstæn/ officially the Islamic Republic of Afghanistan ( Pashto: د افغانستان اسلامي جمهوریت, ^[69]

Much of this work was documented by Brazilian photographer Sebastião Salgado, as a UNICEF Goodwill Ambassador, in the book The End of Polio: Global Effort to End a Disease. Sebastião Salgado (born February 8 1944 in Aimorés, Minas Gerais, Brazil) is a Brazilian documentary photographer This is a list of UNICEF Goodwill Ambassadors, who work on behalf of the United Nations Children's Fund. ^[75]

History

Main article: History of poliomyelitis

The effects of polio have been known since prehistory; Egyptian paintings and carvings depict otherwise healthy people with withered limbs, and children walking with canes at a young age. The history of poliomyelitis (polio infections extends into Prehistory. This article is about the country of Egypt For a topic outline on this subject see List of basic Egypt topics. A stele (from Greek:, stēlē, ˈstiːli plural stelae,, stēlai, ˈstiːlaɪ also found Latinised singular stela "Amarna period" redirects here For information on Amarna see Amarna The Eighteenth Dynasty (1550-1292 BC is perhaps the best known of Stone Age Paleolithic See also Paleolithic, Recent African Origin, Early Homo sapiens, Early human migrations "Paleolithic" Ancient Egypt was an Ancient Civilization in eastern North Africa, concentrated along the lower reaches of the Nile River in what is now ^[5] The first clinical description was provided by the British physician Michael Underwood in 1789, where he refers to polio as "a debility of the lower extremities". ^[76] The work of physicians Jakob Heine in 1840 and Karl Oskar Medin in 1890 led to it being known as Heine-Medin disease. Jakob (or Jacob) Heine ( April 16, 1800, Lauterbach ( Black Forest, Germany) – November 12, Karl Oskar Medin ( August 14 1847 – December 24 1927) was a Swedish pediatrician. ^[77] The disease was later called infantile paralysis, based on its propensity to affect children.

Before the 20th century, polio infections were rarely seen in infants before six months of age, most cases occurring in children six months to four years of age. ^[78] Poorer sanitation of the time resulted in a constant exposure to the virus, which enhanced a natural immunity within the population. Sanitation is the hygienic means of preventing human contact from the hazards of wastes to promote health Immunity is a material term that describes a state of having sufficient biological defenses to avoid Infection, Disease, or other unwanted biological invasion In developed countries during the late 19th and early 20th centuries, improvements were made in community sanitation, including better sewage disposal and clean water supplies. Sewage is the mainly liquid Waste containing some solids produced by humans which typically consists of washing water Feces, Urine, laundry waste and other These changes drastically increased the proportion of children and adults at risk of paralytic polio infection, by reducing childhood exposure and immunity to the disease.

Small localized paralytic polio epidemics began to appear in Europe and the United States around 1900. In Epidemiology, an epidemic (from Greek epi- upon + demos people is a classification of a disease that appears as new cases in a ^[6] Outbreaks reached pandemic proportions in Europe, North America, Australia, and New Zealand during the first half of the 20th century. A pandemic (from Greek παν pan all + δήμος demos people is an Epidemic of Infectious disease that spreads through By 1950 the peak age incidence of paralytic poliomyelitis in the United States had shifted from infants to children aged five to nine years, when the risk of paralysis is greater; about one-third of the cases were reported in persons over 15 years of age. ^[79] Accordingly, the rate of paralysis and death due to polio infection also increased during this time. ^[6] In the United States, the 1952 polio epidemic became the worst outbreak in the nation's history. Of nearly 58,000 cases reported that year 3,145 died and 21,269 were left with mild to disabling paralysis. ^[80]

The polio epidemics changed not only the lives of those who survived them, but also affected profound cultural changes; spurring grassroots fund-raising campaigns that would revolutionize medical philanthropy, and giving rise to the modern field of rehabilitation therapy. For other meanings see Grass roots (disambiguation. A grassroots movement (often referenced in the context of a Political movement Philanthropy is the act of donating money goods services time and/or effort to support a socially beneficial cause with a defined objective and with no financial or material As one of the largest disabled groups in the world polio survivors also helped to advance the modern disability rights movement through campaigns for the social and civil rights of the disabled. The disability rights movement aims to improve the Quality of life of people with disabilities. The World Health Organization estimates that there are 10 to 20 million polio survivors worldwide. ^[81] In 1977 there were 254,000 persons living in the United States who had been paralyzed by polio. ^[82] According to doctors and local polio support groups, some 40,000 polio survivors with varying degrees of paralysis live in Germany, 30,000 in Japan, 24,000 in France, 16,000 in Australia, 12,000 in Canada and 12,000 in the United Kingdom. ^[81] Many notable individuals have survived polio and often credit the prolonged immobility and residual paralysis associated with polio as a driving force in their lives and careers. This is a list of notable people who have survived the infectious disease poliomyelitis. ^[83]

The disease was very well publicized during the polio epidemics of the 1950s, with extensive media coverage of any scientific advancements that might lead to a cure. Thus, the scientists working on polio became some of the most famous of the century. Fifteen scientists and two laymen who made important contributions to the knowledge and treatment of poliomyelitis are honored by the Polio Hall of Fame at the Roosevelt Warm Springs Institute for Rehabilitation in Warm Springs, Georgia, USA. The' Polio Hall of Fame' (or the Polio Wall of Fame) consists of a linear grouping of sculptured busts of fifteen scientists and two laymen who made important contributions to The Roosevelt Warm Springs Institute for Rehabilitation was founded in 1927 in Warm Springs, Georgia, by United States President Franklin Warm Springs is a City in Meriwether County, Georgia, United States.

Further reading

Notes and references

External links

• Poliomyelitis at the Open Directory Project
• Polio: A Virus' Struggle – an amusing yet educational graphic novella from the Science Creative Quarterly (co-published by the University of British Columbia, in PDF format). The Open Directory Project ( ODP) also known as dmoz (from directory A The University of British Columbia ( UBC) is a Canadian public research University with campuses near Vancouver and in Kelowna
• Fermín: Making Polio History An article about Luis Fermín Tenorio Cortez, the last case of polio reported in the Americas.
• A UK Polio survivor – An account of John Prestwich, who lived 50 years in an iron lung.

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