Presented by:

Gayramara Arben John Z

DEFINITION
• Poliomyelitis, often called polio or infantile paralysis, is an
acute viral infectious disease spread from person to person,
primarily via the fecal-oral route
• Although around 90% of polio infections cause no symptoms at
all, affected individuals can exhibit a range of symptoms if the
virus enters the blood stream. In about 1% of cases the virus
enters the central nervous system, preferentially infecting and
destroying motor neurons, leading to muscle weakness and
acute flaccid paralysis. Different types of paralysis may occur,
depending on the nerves involved. Spinal polio is the most
common form, characterized by asymmetric paralysis that most
often involves the legs. Bulbar polio leads to weakness of muscles
innervated by cranial nerves. Bulbospinal polio is a combination
of bulbar and spinal paralysis.
Etiology and Epidemiology
Causative agent
Polio virus (Legio Debilitants)

TYPES OF POLIOMYELITIS
Abortive poliomyelitis
Non- Paralytic Poliomyelitis
Paralytic Poliomyelitis
Bulbar Poliomyelitis
Period of Communicability
Most contagious a few days before and after the onset of
symptoms when the virus is found in the orophrynx for
about a week and in large quantities in the small
bowels, and containing to be in the feces up to about 3
months

MODE OF TRANSMISSION
• Saliva
• Vomitus
• Feces
1. Direct contact- from person to another through
healthy carriers via intestinal or oral pathways. And
most common in household or family contact than
among non- contact
2. Indirect contact- fecal-oral through food ,water,
utensils and objects contaminated by human excreta
Incidence
 Children are most commonly affected and was
highest on infancy
 As sanitation and standards of living improve, the
peak age is noted to be among older children and
young adults
 In the Philippines sporadic are reported
 Localities were sanitation is poor
Incubation Period
Usually 7-14 days with range of 5-35 days, paralytic and
non paralytic forms; 3-5 days for minor illness.
 Pathology
Poliovirus enters the body through the mouth

 Pharynx and
intestinal mucosa

binding to an immunoglobulin-like receptor, known as the

poliovirus receptor

hijacks the host
cell's

Replication of the virus

 divides within gastrointestinal cells for about a
week

M cells of Peyer's
 tonsils lymphoid tissue patches

cervical and mesenteric
lymph nodes, where it
follicular dendrite
multiplies abundantly
cells

 germinal centers
 absorbed into the
bloodstream

 survive and multiply within the blood and lymphatics for long
periods of time, sometimes as long as 17 weeks

Replicates in  brown fat,

the reticuloendothelial tissues, and
muscle

Development of
 major viremia minor influenza-like
symptoms

 inflammation of
the meninges
Penetration of the CNS
 Clinical Manifestation
In apparent / Subclinical / Asymptomatic / silent type.
- Person who are expose to poliomyelitis ward like the nurses and
other member of health team. But not all polio victims has small
leg or both
Abortive type / minor illness of poliomyelitis.
-starts with a mild to moderate upper respiratory infection or
symptoms of mild influenza like slight fever ,malaise, headache,
sorethroat, inflamed pharynx and vomiting and follow by
remission This case is unnoticed
Preparalytic or meningitic type
- 5% are affected
- the second febrile stage is observe this time with higer
temperature, headache, vomiting, restlessness, anorexia, lethargy
and pain in the neck and back, arms, legs and abdomen
- it cause also muscle spasm
- it last about a weak with meningeal irritation persisting for
about 2 weeks.
Paralytic type
-(0.5-1%)
- there may be hyperesthesia and irritability
- loss of tendon reflex, positive Kernigs sign and Brudzinskis sign
- Positive Hoyne signs
Complications
Respiratory Paralysis which include the diaphragm and the
intercostals muscle
Pneumonia
Myocarditis
Atelectasis
 Pulmonary edema
Acute gastric dilatation, melena
HPN
Renal calculi
Late complication – skeletal and soft tissue deformity
Prognosis
 Prognosis is poorer in older children and adults
 Bulbar poliomyelitis is always serious particularly
when the medulla and respiratory muscles are
involved.
Treatment
(no specific treatment)
Abortive type
-Bed rest
-Analgesics to ease headache, back ache and muscle spasms
Preparalytic or meningitic type
-same as abortive type plus
-moist hot packs for 15 to 30 minutes every 2 to 4 hours over
the affected muscle
-firm bed or non sagging bed
-antibiotics are not indicated unless there are secondary
bacterial complications
-good nursing care is the most important
- anxiety and fear should be allayed
- The limb should be in a position of comfort (slightly flexed)
- Immobilization is not advised
- The presence of fever indicates viremia and possible spread
of paresis or paralysis so that the bed rest is imperative if the
patient is febrile
- Follow up until 2 months apparent recovery.
Paralytic type
- Suitable body alignment; feet at the right ankle , knees
slightly flexed, hips and spine straight with the use of
boards sand bags and occasionally light splint shells
- the orthopedist and physiatrist should be consulted early
to immunize deformities and possible crippling
- active and passive movements as soon as pain disappears
- avoid fecal impaction
Bladder paralysis:
A. Bethanecol 5-10 mg. orally or 2.5-5 mg
subcutaneously
B. Catheterize aseptically if necessary
Respiratory Distress
 Respirator
Tracheotomy
Oxygen
Rehabilitation
Muscle testing
Physical therapy
Prevention
Administration of polio vaccine
- Salk vaccine
- Sabin vaccine
Effective immunization- programs may be achieved if
carried out community wide to include all infants
over 2 months old , children and young adult with the
pre school age group as priority target.
Nursing Intervention
Enteric precaution
Apply moist hot packs to the affected muscle and to
relieve muscle shortening
Maintain good body alignment by using board and
sandbags
Make bed with cotton or woolen blanket both under
and over the patient
Change position frequently
Daily bath if necessary and change wet clothes
Isolation; secretions should be properly disposed
Avoid contact with person having known cases
Nasal and oral hygiene such as mouth and teeth must be
clean; nose should be cleansed for easy passage of air;
moisten the mucus membrane with some prescribed
lubricant.
Children activities should be reduced to avoid physical
exertion of fatigue and chilling should be avoided; hence
swimming pools should temporarily closed.
Unvaccinated children and susceptible may be immunized
Anyone who presents a minor febrile illness should be put
to bed.
Infectious Hepatitis A
Definition
Hepatitis A is caused by the hepatitis A virus. It is a
highly contagious disease that attacks the liver. It is
the most common type of viral hepatitis and one of
the most frequently reported vaccine preventable
diseases in the United States
Who gets hepatitis A?
Anyone can get hepatitis A, but you are at greater risk if
you:

live in an area with increased rates of hepatitis A (i.e.,

certain Western states in the United States)
travel to regions where hepatitis A is common (i.e., Central
and South America, Africa, the Middle East, Asia, and the
Western Pacific)
are a man and have sex with men
are an injection or non-injection drug user
have sex with someone infected with hepatitis A
live in the same house with someone who has hepatitis A
How thus the virus spread

Hepatitis A virus is usually spread from person to person by putting

something in the mouth that has been contaminated with the stool of a
person with hepatitis A. This type of transmission is called the "fecal-oral"
route. For this reason, the virus is more easily spread in areas where there are
poor sanitary conditions or where good personal hygiene is not observed.
Most infections in the United States result from contact with a household
member or sex partner who has hepatitis A. Hepatitis A virus may also be
spread by consuming food or drink that has been handled by an infected
person. Waterborne outbreaks are infrequent and are usually associated with
sewage-contaminated or inadequately treated water. Casual contact, as in the
usual office, factory, or school setting, does not spread the virus
Symptoms of HAV
abrupt onset of fever
 fatigue
poor appetite
Nausea
stomach pain
dark-colored urine 
jaundice (a yellowing of the skin and whites of the
eyes)
The disease is rarely fatal and most people recover in a
few weeks without any complications. Adults are more
likely than children to develop symptoms. Infants and
young children tend to have very mild symptoms and
are less likely to develop jaundice than are older
children and adults. Not everyone who is infected will
have all of the symptoms.

The symptoms commonly appear within 28 days of

exposure, with a range of 15-50 days.
The contagious period begins about two weeks before
symptoms appear and lasts about one week after
symptoms appear
Once an individual recovers from hepatitis A, he or she cannot be
re-infected. He or she is immune for life and does not continue to
carry the virus.

Prevention for Infectious Hepatitis A

 In the event of exposure to hepatitis A, consult a doctor or the local health
department.
 To prevent person-to-person spread, careful hand washing after using the
bathroom, changing diapers and before preparing or eating food, is the single
most important means of prevention.
 Close contacts who do not have immunity to hepatitis A virus should be
administered immune globulin (IG) or hepatitis A vaccine within 2 weeks of
exposure to a person who is contagious with hepatitis A infection. Close
contacts include:
Household contacts
Sexual contacts
Playmates
Attendees at childcare centers
Persons sharing illegal drugs
Persons sharing food or beverages
Persons in common-source exposure situations (i.e.,
coworkers and/or restaurant patrons where an infected
food worker has been identified)
Travelers to areas with increased rates of hepatitis A
Men who have sex with men
Injection and non-injection drug users
Persons with blood clotting disorders (i.e.,
hemophilia)
Persons with chronic liver disease (including persons
with chronic hepatitis B or chronic hepatitis C virus
infection)
tnx