Medical Care
Poliomyelitis [37]
No specific antiviral agents for the treatment of poliomyelitis are available; therefore, management is supportive and symptomatic.
Patients in the acute phase of paralytic poliomyelitis may require hospitalization.
Paralysis of the respiratory muscles necessitates mechanical ventilation before severe hypoventilation develops.
Severe bulbar paralysis necessitates tracheal intubation.
Weakness or paralysis of the bladder necessitates catheterization.
Applying moist hot packs to muscles can help relieve pain and muscle spasm.
Bed rest prevents the augmentation or extension of paralysis. Animal model data suggest that exercise early during infection can heighten the paresis.
Other systemic enteroviral infections [33, 48]
Because of the lack of specific antiviral therapy, clinicians manage most enteroviral illnesses symptomatically.
Patients with agammaglobulinemia and echoviral meningoencephalitis have benefited from immunoglobulin therapy.
Hepatitis A [30]
At present, no specific therapy is available for HAV infection, and management is supportive in nature.
Explain dietary recommendations to the patient, including the avoidance of other potentially hepatotoxic substances (eg, medications, ethanol).
Hospitalize and offer supportive treatment to any patient with fulminant hepatitis. Consider liver transplantation in patients who have a poor prognosis with medical management alone.
Rhinovirus [18]
Symptomatic care for fever and rhinitis.
Rest, hydration, nasal decongestants, and cough suppressants may be appropriate.
Start treatment as early as symptoms are recognized, and continue for 4-5 days.
Consider petrolatum-based ointment to nares to prevent painful maceration.
Surgical Care
Tracheotomy or tracheostomy may be required for acute paralysis that involves the respiratory muscles in patients with poliomyelitis.
Consultations
Polio survivors may require consultations with a physical, occupational, or speech therapist.
Gastric or other feeding tubes may be needed if ventilation or cranial nerve disability is prolonged.
Prevention
The importance of proper hand hygiene, cough etiquette, and safe food/beverage choices (particularly during travel) cannot be emphasized enough and are the keys to interrupting picornavirus disease transmission.
The Advisory Committee on Immunization Practices, under the Department of Health and Human Services and the Centers for Disease Control and Prevention, regularly updates immunization recommendations for children, adolescents, and adults in the United States.
Poliomyelitis vaccine recommendations are as follows:
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The current recommendation for IPV is 4 doses, at ages 2 months, 4 months, 6-18 months, and 4-6 years. The efficacy of IPV after only 1-2 doses is lower than the equivalent number of OPV doses.
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Outside the United States, OPV is given in 4 doses, at ages 2 months, 4 months, 6-18 months, and 4-6 years. The main disadvantage of OPV is the very rare occurrence of vaccine virus-associated poliomyelitis (ie, 8 cases annually in the United States). The mechanism by which vaccine virus strains cause paralytic disease is not fully understood.
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OPV is not recommended for use in the Unites States except for certain circumstances, as follows: (1) rapid control of an outbreak, (2) IPV is unavailable, (3) children of parents who do not accept the recommended number of vaccine injections, and (4) unvaccinated children traveling within 4 weeks to endemic areas.
HAV vaccine is recommended for the following:
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All children aged 12 months and older
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Populations at increased risk of infection
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Persons traveling to endemic countries
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Men who have sex with men
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Users of illegal drugs
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Patients with chronic liver disease or clotting factor deficiencies
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People who may have occupational risk for exposure, including sewage workers, plumbers, primate handlers, medical and nursing staff, and daycare staff
Populations recommended to receive HAV immunoglobulin after exposure or as an alternative for HAV immunization include the following:
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Patients exposed to HAV in the past 14 days who may be susceptible to the disease
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Household and sexual contacts of known cases
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Staff and attendees of daycare centers or homes after 1 or more cases occur in children and employees or 2 or more cases occur in the household of attendees
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Fellow food handlers
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Those at risk who work in schools and hospitals or other work settings
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Patients in outbreak situations with suspected exposure
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Children younger than 2 years
