Medical and Surgical Care
Medical care
No antivirals are effective against polioviruses. The treatment of poliomyelitis is mainly supportive.
Analgesia is indicated in cases of myalgias or headache.
Mechanical ventilation is often needed in patients with bulbar paralysis.
Tracheostomy care is often needed in patients who require long-term ventilatory support.
Physical therapy is indicated in cases of paralytic disease. In paralytic disease, provide frequent mobilization to avoid development of chronic decubitus ulcerations. Active and passive motion exercises are indicated during the convalescent stage.
Fecal impaction is frequent in cases of paralytic disease and can be treated with laxatives as soon as it develops.
Because patients with poliomyelitis are prone to develop constipation, a diet rich in fiber is usually indicated.
Surgical care
Total hip arthroplasty is a surgical therapeutic options for patients with paralytic sequelae of poliomyelitis who develop of hip dysplasia and degenerative disease. [21]
Further care
Patients who suffer from long-term complications of poliomyelitis should be included in rehabilitation programs that focus on individual needs. [22]
Patients with poliomyelitis may develop bladder dysfunction for which catheterization is frequently required.
Consultations
Consultations include the following:
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Physical therapist and rehabilitation therapist
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Pulmonologist
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Neurologist
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Immunologist
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Infectious diseases specialist
Prevention
Two types of vaccines used in the prevention of poliomyelitis are inactivated poliovirus vaccine (IPV) administered parenterally and oral attenuated poliovirus vaccine (OPV).
Inactivated poliovirus vaccine
IPV was the first polio vaccine available on the market, and its widespread administration began in the 1950s. An enhanced inactivated poliovirus vaccine (eIPV) formulation is now available. Nonenhanced early formulations had the disadvantages of not being as immunogenic as OPV, not being able to induce mucosal immunity, and having to be administered parenterally, which increased costs and decreased compliance. [23]
One of the major advantages of IPV is that it contains an inactivated virus; for that reason, IPV is not associated with the development of vaccine-associated poliomyelitis. Although they do not induce mucosal immunity, new eIPV formulations have been proven to be as immunogenic as OPV. For that reason, countries in which no cases of wild-type disease have been reported during the last several years (eg, the United States) have now adopted eIPV immunization schedules. This new prophylactic approach has the advantage of eliminating vaccine-associated cases.
This vaccine is administered when individuals are aged 2 months, 4 months, and 6-12 months and before school entry, which is usually at age 4 years. [24, 25]
IPV is now included in different combination vaccine products available in the United States. [26]
Oral attenuated poliovirus vaccine
Trivalent OPV has been used since the early 1960s. Immunization with this formulation was responsible for the significant decrease in the prevalence of disease throughout the world. This formulation has the advantages of inducing mucosal immunity, providing appropriate herd immunity, and increasing vaccine uptake because of oral administration. Additionally, it is cost-effective, especially in countries in the developing world.
The major disadvantage of trivalent OPV is its association with vaccine-associated paralytic poliomyelitis (VAPP). Although the virus contained in this formulation is attenuated, it may occasionally become neurotropic and be able to produce disease similar to wild-type virus.
Trivalent OPV was administered in developing countries when individuals at ages 2 months, 4 months, and 6 months and with a booster at age 4 years. VAPP occurs most frequently after the first dose of OPV but may also occur after administration of the second or third doses. Since the global eradication of WPV2 in 2015, bivalent OPV containing types 1 and 3 is being utilized. [12]
A high-potency monovalent oral poliovirus type 1 vaccine (mOPV1) was introduced in India in April 2005. This vaccine is targeted to eliminate some of the last poliovirus reservoirs. This product constitutes part of an international effort to eradicate wild poliovirus. Studies have revealed that mOPV1 is 3 times more effective against type 1 poliomyelitis than trivalent OPV. In addition, it has been demonstrated to be particularly efficacious in areas in which the efficacy of trivalent OPV may be compromised by the high prevalence of diarrhea and other infectious processes. mOPV1 may be the preferred option to control a poliovirus outbreak in areas that have already been declared free of wild poliovirus transmission. [27, 28]
According to a study by Sutter et al, a combination of four dose bivalent oral polio vaccine and single inactivated polio vaccine has a superior immunogenicity to the conventional trivalent OPV, especially against poliovirus type 3. [29]
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The typical contractures of postpolio residual paralysis.
