Polio (also called poliomyelitis) is a contagious, historically devastating

disease that was virtually eliminated from the Western hemisphere in the
second half of the 20th century. Although polio has plagued humans since
ancient times, its most extensive outbreak occurred in the first half of the
1900s before the vaccination, created by Jonas Salk, became widely
available in 1955.
At the height of the polio epidemic in 1952, nearly 60,000 cases with more
than 3,000 deaths were reported in the United States alone. However, with
widespread vaccination, wild-type polio, or polio occurring through natural
infection, was eliminated from the United States by 1979 and the Western
hemisphere by 1991.

Signs and Symptoms

Polio is a viral illness that, in about 95% of cases, actually produces no
symptoms at all (called asymptomatic polio). In the 4% to 8% of cases in
which there are symptoms (called symptomatic polio), the illness appears in
three forms:
a mild form called abortive polio (most people with this form of polio
may not even suspect they have it because their sickness is limited to
mild flu-like symptoms such as mild upper respiratory infection,
diarrhea, fever, sore throat, and a general feeling of being ill)
a more serious form associated with aseptic meningitis called
nonparalytic polio (1% to 5% show neurological symptoms such as
sensitivity to light and neck stiffness)
a severe, debilitating form called paralytic polio (this occurs in 0.1%
to 2% of cases)
People who have abortive polio or nonparalytic polio usually make a full
recovery. However, paralytic polio, as its name implies, causes muscle
paralysis - and can even result in death. In paralytic polio, the virus leaves
the intestinal tract and enters the bloodstream, attacking the nerves (in
abortive or asymptomatic polio, the virus usually just stays in the intestinal
tract). The virus may affect the nerves governing the muscles in the limbs
and the muscles necessary for breathing, causing respiratory difficulty and
paralysis of the arms and legs.

Contagiousness
Polio is transmitted primarily through the ingestion of material contaminated
with the virus found in stool (poop). Not washing hands after using the
bathroom and drinking contaminated water were common culprits in the
transmission of the disease.

Prevention
In the United States, it's currently recommended that children have four
doses of inactivated polio vaccination (IPV) between the ages of 2 months
and 6 years.
By 1964, the oral polio vaccine (OPV), developed by Albert Sabin, had
become the recommended vaccine. OPV allowed large populations to be
immunized because it was easy to administer, and it provided "contact"
immunization, which means that an unimmunized person who came in
contact with a recently immunized child might become immune, too. The
problem with OPV was that, in very rare cases, paralytic polio could develop
either in immunized children or in those who came in contact with them.
Since 1979 (when wild polio was eliminated in the United States), the
approximately 10 cases per year of polio seen in this country were traced to
OPV.
IPV is a vaccine that stimulates the immune system of the body (through
production of antibodies) to fight the virus if it comes in contact with it. IPV
cannot cause polio.
In an effort to eradicate all polio, including those cases associated with the
vaccine, the Centers for Disease Control and Prevention (CDC) decided to
make IPV the only vaccine given in the United States. Currently, the CDC
and American Academy of Pediatrics (AAP) recommend three spaced doses
of IPV given before the age of 18 months, and an IPV booster given between
the ages of 4 to 6, when children are entering school.
If you're planning to travel outside the United States, particularly to Africa
and Asia (where polio still exists), be sure that you and your child receive a
complete set of polio vaccinations.

Duration
Although the acute illness usually lasts less than 2 weeks, damage to the
nerves could last a lifetime. In the past, some patients with polio never
regained full use of their limbs, which would appear withered. Those who
did fully recover might go on to develop post-polio syndrome (PPS) as many
as 30 to 40 years after contracting polio. In PPS, the damage done to the
nerves during the disease causes an acceleration of the normal, gradual
weakness due to aging.

Treatment
In the height of the polio epidemic, the standard treatment involved placing a
patient with paralysis of the breathing muscles in an "iron lung" - a large
machine that actually pushed and pulled the chest muscles to make them
work. The damaged limbs were often kept immobilized because of the
confinement of the iron lung. In countries where polio is still a concern,
ventilators and some iron lungs are still used.
Historically, home treatment for paralytic polio and abortive polio with
neurological symptoms wasn't sufficient. However, asymptomatic and mild
cases of abortive polio with no neurological symptoms might have been
treated like the flu, with plenty of fluids and bed rest.

The Future of Polio

The World Health Organization (WHO) is working toward eradicating polio
throughout the world. Significant strides have already been made. In 1988,
355,000 cases of polio in 125 countries were reported. By the end of 2004,
there were just 1,255 cases.
Six countries (Afghanistan, Egypt, India, Niger, Nigeria, and Pakistan) still
have polio circulating, and the virus could be introduced to other countries.
If the polio virus is imported into a country where not enough people have
been immunized, there's the risk that it could spread from person to person.
That's what has happened in some countries in Africa and Asia. So until it
has been eliminated worldwide, it's important to continue vaccinating kids
against polio.

Reviewed by: Barbara P. Homeier, MD

Date reviewed: December 2004
Originally reviewed by: Joel Klein, MD