From the Guidelines
Contracting poliomyelitis in childhood can lead to severe long-term outcomes, including a 25-40% risk of developing post-polio syndrome, characterized by muscle pain, weakness, and paralysis, 30-40 years after the initial infection. The risk factors for post-polio syndrome include the passage of time since the acute infection, permanent residual impairment, and being female 1. Long-term outcomes may also include permanent muscle weakness, atrophy, skeletal deformities, and limb deformities that can affect mobility and independence.
Key Considerations
- The severity of long-term outcomes varies widely, with some individuals experiencing minimal lasting effects while others require lifelong assistive devices or respiratory support.
- Rehabilitation through physical therapy, orthotic devices, and sometimes surgery can significantly improve quality of life.
- Psychological support is also important as individuals may face social challenges and mental health issues related to their disability.
- The duration of immunity after receipt of the inactivated poliovirus vaccine (IPV) series is long-term, possibly lifelong, with a booster dose at 4-6 years of age providing substantial experience in sustaining polio elimination 1.
Recommendations
- The standard schedule for IPV should be 4 doses administered at 2 months, 4 months, 6-18 months, and 4-6 years of age to provide long-term immunity against polio.
- If there is a risk of imminent exposure to circulating polioviruses, the minimum interval between doses can be used to provide rapid protection 1.
- It is essential to ensure high poliovirus immunity levels in children to prevent outbreaks should poliovirus be imported into the country.
From the Research
Long-term Outcomes of Contracting Poliomyelitis in Childhood
- The long-term outcomes of contracting poliomyelitis in childhood can be severe and debilitating, with 30 to 65% of individuals who had been infected and recovered from polio beginning to experience new signs and symptoms after a few decades of stability 2.
- These new signs and symptoms can include muscular atrophy, muscle weakness and fatigue, muscle and/or joint pain, and significant changes in mobility, including falls and inability to carry on with daily life activities 2, 3.
- The normal aging process and weight gain are often blamed for these symptoms, but other factors such as respiratory disorders, sleep disorders, and orthopedic complications can also contribute to the development of post-polio syndrome (PPS) 2, 4.
- PPS can be characterized by a sudden or progressive loss of muscle strength, muscle atrophy, muscle pain, fatigue, and intolerance to cold, and can occur after a period of at least 15 years from the acute polio virus infection 3.
Management and Treatment of Post-Polio Syndrome
- There is no therapeutic benefit of drug agents such as pyridostigmine, steroids, and amantadine in the treatment of PPS, but rehabilitation programs through physical-kinetic therapy can help to limit functional deficit and improve quality of life 3, 4.
- Management of PPS should include the appropriate use of exercises, bracing and support, and speech therapy services and ventilatory support for bulbar and respiratory symptoms 4.
- Patient education, health promotion, and energy conservation strategies, such as gait training with assistive devices, can also be effective in reducing perceived fatigue and improving posture and function in individuals with PPS 5.
- A multi-disciplinary rehabilitation programme can provide long-term positive benefits for polio survivors, and strategies such as pacing and reflection can be helpful in enabling self-management of polio and PPS 6.