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For a polio-free world

Abraham Eisenstein, M.D. |
Poliomyelitis or polio is the disease for which many thought it was eliminated. Indeed, polio cases have decreased by almost 99% since 1988. However, the virus is not eradicated and vaccination remains the vital part of protection.

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In 1988 wild poliovirus was endemic in more than 125 countries on five continents, paralyzing more than 1000 children every day. Thanks to efforts of all countries to eradicate the virus, there were no new cases in the Western Hemisphere since 1991.

The virus is now present in just few countries but it continues to spread, especially in war zones where doctors can't reach children to help them. Failure to stop polio in these last remaining areas could result in as many as 200,000 new cases every year within 10 years, all over the world.

Polio is an infectious disease caused by a virus that attacks and can lead to total paralysis in a few hours. The virus enters through the mouth and causes fatigue, fever, vomiting, headache, stiffness in the neck and pain in the limbs. One in 200 patients will end with irreversible paralysis usually in the legs, and 5% to 10% of those paralyzed will die when their breathing muscles become immobilized. The main risk group: children under five years.

Let's see it in more details. In most cases, polio virus is transmitted from the stool of an infected patient to the mouth of another person: dirty hands and kitchen utensils are ideal for polio to spread and that's the reason why the disease is coming back in some parts of the world with poor hygiene conditions. The virus can find its way from mouth to mouth, too.

The incubation period for polio is commonly anywhere from 3 to 35 days. Now, 95% of all infected patients have no apparent symptoms. Approximately 4%–8% patients have minor symptoms (sore throat and fever, nausea, vomiting - all common symptoms of any viral disease), and some 1%–2% of infected individuals develop nonparalytic aseptic meningitis, with temporary stiffness of the neck, back, or legs.

Less than 1% of all infections result in flaccid paralysis when the patient is left with permanent weakness or paralysis of legs, arms, or both. That one percent is the reason why polio is one of the most-feared diseases (and, of course, the fact nobody knows will their children fall into that group.)

If the patient has mild symptoms, that's not the reason for celebration: In as much as 40% of them will develop post-polio syndrome (PPS) after 30 to 40 years. The symptoms are muscle pain, weakness, or paralysis. Luckily, PPS is not infectious.

The diagnosis is simple: A sample of stool is tested for the poliomyelitis virus. If the person has the virus, that person was infecting other persons for a month and a half. So, the infected circle can become very wide.

The very bad news is that there's no cure for the disease. Infected patients need bed rest and fluids, and that's all we can do. The very good news is that we can prevent it with vaccine.

Given multiple times, it can protect for life. All infants should get the IPV vaccine unless they have some specific medical reason against it. A primary series consists of three doses given at two months, four months, and 6–18 months, and the booster dose is given at 4–6 years. Healthy adults have developed immune system so they don't need vaccine.

In the case of OPV (polio drops), paralysis happens in 1 of every 750,000 people after the first dose, while the polio shot (IPV) can't cause paralysis.

Although it is very well known how helpful vaccination is, doctors are constantly struggling with parents refusing vaccine. Parents in Nigeria, for example, refused vaccine and the virus started to spread fast from Nigeria to other countries.

Unfortunately, developed countries sometimes are facing the same problem. In the United States some groups were refusing vaccination but the doctors answered strongly: they asked those parents to leave.

There's no doctor that would risk the spreading of polio to another patient and sometimes there is no other way than to say "Please, leave my office."

In many cases that helped and children got the vaccine, but the constant education is a must because the benefits of the vaccine are so huge comparing to almost nonexistent dangers.

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