Background

Poliomyelitis is first known to have occurred nearly 6000 years ago, as evidenced by the withered and deformed limbs of certain Egyptian mummies. Polio was epidemic in the United States and the world in the 20th century, especially in the 1940s and 1950s. It was not until the 1950s that a vaccine became available.

Since May 1988, when the World Health Assembly resolved to eradicate poliomyelitis, the estimated global incidence of polio has decreased by more than 99%, and three World Health Organization (WHO) regions (the Americas, the Western Pacific, and Europe) have been certified as polio-free. Since 1994, when the countries of the WHO South-East Asia Region (SEAR) began accelerating polio-eradication activities, substantial progress toward that goal has been made.

Problems remain due to the difficulties involved in extending immunization coverage to some regions (especially Africa), integrating new vaccines into routine immunization schedules, and securing sufficient funding for programs. Injection safety is also a major problem that should be resolved by utilization and proper disposal of single-use autodisabling syringes. The forthcoming availability of new vaccines and the action of the Global Alliance for Vaccines and Immunization hold reasonable hope for the future. Other problems remain, such as new conditions resembling polio paralysis caused by viral infection other than by poliovirus 2 and postpolio syndrome (PPS).

In developed countries, on the other hand, residual poliomyelitis is still occasionally seen in the elderly and immigrants.^{[1, 2, 3, 4, 5, 6, 7, 8]}

Transmission of wild poliovirus (WPV) continues in only three countries: Afghanistran, Pakistan, and Nigeria. WPV type 1 (WPV1) is the only circulating serotype. Starting in 2015, injectable trivalent inactivated poliovirus vaccine (IPV) has been introduced as a part of routine immunization program in place of oral polio vaccine (OPV).^[9]

Pathophysiology

Poliovirus is spread by the fecal-oral route and by aerosol droplets. The poliovirus is shed in oral secretions for several weeks and in the feces for several months. The poliovirus destroys the anterior horn cells in the spinal cord.

Etiology

Acute poliomyelitis is caused by small RNA viruses of the Enterovirus genus of the Picornaviridae family. The single-stranded RNA core is surrounded by a protein capsid without a lipid envelope, which makes poliovirus resistant to lipid solvents and makes it stable at a low pH. Three antigenically distinct strains are known, with type 1 accounting for 85% of cases of paralytic illnesses. Infection with one type does not protect from the other types; however, immunity to each of the three strains is lifelong.

Clinical Presentation

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Media Gallery

Typical contractures of postpolio residual paralysis.
Manipulation of deformities of hip.
Genu recurvatum deformity of right knee.
Orthotic treatment for deformities around knee in poliomyelitis. (Click image to enlarge.)
Surgical correction of fixed flexion deformity of knee and hip due to iliotibial band contracture by Soutter and Yount release.
Manipulation of ankle and foot deformities.
Surgical correction of rigid foot deformities by osteotomies and fusion.

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Author

Ashish S Ranade, MBBS, MS, MRCS Consultant Orthopaedic Surgeon, Columbia Asia Hospital and Deenanath Mangeshkar Hospital, India

Ashish S Ranade, MBBS, MS, MRCS is a member of the following medical societies: Paediatric Orthopaedic Society of India

Disclosure: Nothing to disclose.

Coauthor(s)

Mohan V Belthur, MD, FRCSC, FRCS(Tr&Orth) Clinical Assistant Professor, Departments of Child Health, Orthopedics, and Pediatrics, University of Arizona College of Medicine; Staff Pediatric Orthopedic Surgeon, Center for Pediatric Orthopedics, Phoenix Children’s Hospital

Mohan V Belthur, MD, FRCSC, FRCS(Tr&Orth) is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Orthopaedic Surgeons, American College of Surgeons, AO Trauma, Limb Lengthening and Reconstruction Society, Paediatric Orthopaedic Society of India, Pediatric Orthopaedic Society of North America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Paul E Di Cesare, MD Clinical Operations Associate Medical Director, AIM Specialty Health

Paul E Di Cesare, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Jeffrey D Thomson, MD Professor of Orthopedic Surgery, University of Connecticut School of Medicine; Director of Orthopedic Surgery, Connecticut Children’s Medical Center; Vice President of Medical Staff, Connecticut Children's Medical Center

Jeffrey D Thomson, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Pediatric Orthopaedic Society of North America, Scoliosis Research Society

Disclosure: Nothing to disclose.

Additional Contributors

Mundkur Sudhakar Shetty, MBBS, MS, MCh Senior Professor and Head of Orthopedic Department, Yenapoya Medical College and Hospitals, Mangalore

Mundkur Sudhakar Shetty, MBBS, MS, MCh is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Sharath K Rao, MBBS, MS, D'Ortho Professor and Head of Unit V, Department of Orthopedics, Kasturba Medical College Hospital, India

Sharath K Rao, MBBS, MS, D'Ortho is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Indian Medical Association

Disclosure: Nothing to disclose.

Srinivasa Vidyadhara, MBBS, DNB, MS(Orth), DNB(Orth), FNB(SpineSurg), MNAMS Consultant, Department of Spine Surgery, Manipal Hospital, India

Srinivasa Vidyadhara, MBBS, DNB, MS(Orth), DNB(Orth), FNB(SpineSurg), MNAMS is a member of the following medical societies: AO Foundation, Scoliosis Research Society

Disclosure: Nothing to disclose.

James J Gnanadoss, MBBS, MS(Orth) Professor and Head of Unit, Director, Department of Orthopedics and Spine Surgery, Mahatma Gandhi Medical College Hospital, India

James J Gnanadoss, MBBS, MS(Orth) is a member of the following medical societies: AO Foundation

Disclosure: Nothing to disclose.

Poliomyelitis

Background

Pathophysiology

Etiology

References

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