Poliomyelitis (polio)

Poliomyelitis, also known as polio or polio, is a viral disease that causes paralysis in severe cases. They rarely had any vaccinations in Germany

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Children stare at the ceiling, wedged up to their necks in a narrow metal box, motionless. It is oppressive to look at pictures like this from the 1950s. But the so-called iron lung saved the lives of many children and also some adults. Patients whose respiratory muscles were paralyzed by polio were artificially ventilated in an airtight box: Differences in pressure ensured that their lungs were soaked with oxygen.

Today this device has disappeared from hospitals. Polio, which spread epidemically again and again in the first half of the 20th century, has now almost died out thanks to consistent vaccination. But only almost. In some two nations, in which many people live without vaccination protection, the disease breaks out again and again and can also be introduced into other regions: Afghanistan and Pakistan. In contrast, Africa, where outbreaks had also occurred for decades, was declared wild polio-free by the independent Africa Regional Certification Commission in August 2020.

The German Standing Vaccination Commission (STIKO) therefore continues to recommend polio vaccination in this country. In Germany, it is estimated that between 50,000 and 60,000 people still suffer from the long-term effects of a polio infection that they went through decades ago.

How do you get infected?

The polio virus enters the body through the mouth or nose. You can get infected through the smallest droplets of saliva that get into the air when you speak or breathe, or when you come into direct contact with people, for example when you shake someone's hand. The pathogen can also be picked up through contaminated objects or food. From the mouth, the pathogen first reaches the gastrointestinal tract, then the lymph and blood vessels. The pathogen spreads through the body through the veins.

How does paralysis arise?

The virus does not stop at nerve cells either. There it can trigger inflammatory reactions. If such an inflammation is too severe, the nerve cell can fail temporarily or permanently. Those nerves that lead to the skeletal muscles are particularly affected. Due to nerve damage, muscles can lose their connection to the brain, they can no longer be moved at will and remain limp.

What symptoms can poliomyelitis cause?

Most people who contract the virus (more than 90 percent) are lucky: They do not even notice the infection because they do not develop any symptoms. Once infected, they are immune to the polio pathogen that infected them. However, they are not completely protected from polio because there are at least three different types of polio virus worldwide; their immune system only recognizes one of them with certainty. Only a vaccination can offer comprehensive protection.

Other patients experience various symptoms about a week after being infected, for example fever, gastrointestinal inflammation, nausea, headache or muscle pain. They usually go away after a few days. In a few people, the polio virus also affects nerve cells in the spinal cord and brain. Then the dreaded muscle paralysis can occur.

The paralysis can come suddenly or gradually. One of the legs fails particularly often, but muscles in the arms or trunk can also be affected. In rare cases, the diaphragm or the swallowing muscles can also fail.

Once poliomyelitis is suspected, patients should be isolated in the hospital to prevent the disease from spreading. If necessary, they can also be artificially ventilated or fed there if paralysis of the breathing or swallowing muscles occurs.

A severe polio infection often leaves disabilities, some paralysis does not resolve completely, muscles atrophy, and limbs can be deformed by the disease.

Post-Polio Syndrome (PPS): People who have been through a polio infection with symptoms of paralysis can develop Post-Polio Syndrome (PPS) decades later. Muscle wasting, muscle pain and recurring paralysis are typical. Chronic muscle weakness worsens over time. Doctors suspect that the symptoms are due to the fact that healthy nerve cells partially take over the work of dead neighboring cells. In the long run, they are not able to cope with the constant overload and age prematurely. It is estimated that between 50,000 and 60,000 people in Germany live with PPS.

How is polio diagnosed?

The polio virus can be detected in a stool sample or a swab from the throat in the laboratory. If a doctor wants to test whether the virus is already in the central nervous system (spinal cord and brain), he can take "nerve water" in the lumbar spine area (lumbar puncture). There are also indications of whether someone has been infected with polio, antibodies in the blood, i.e. defensive substances that the body forms against the pathogen.

How is polio treated?

There is currently no specific drug against the polio virus. The doctor can only treat the individual symptoms. Heat and pain medication can relieve muscle pain. If vital muscles fail, patients are cared for in the intensive care unit, where they are ventilated or fed. After acute poliomyelitis, patients often have to rest for several years. Physiotherapy can help them cope with paralysis. Specially made shoes can make walking easier. In some cases, orthopedic surgery, for example by moving muscle tissue, can help.

How can you prevent it?

"Oral vaccination is sweet, polio is cruel" was the slogan that was used to advertise polio vaccination in the 1960s. Today a new vaccine is used in this country that is no longer swallowed, but injected. Vaccination is still important, because the viruses can return to Germany from other parts of the world at any time. The Robert Koch Institute recommends immunizing babies as early as possible. This requires several doses of vaccine in the first and second year of life. Ten years later, the vaccination should be refreshed. A further refresher is only recommended for risk groups, for example for tourists traveling to an area where the disease is common, for health workers and for people who have had contact with infected people.

Swell:
http://www.rki.de/DE/Content/Infekt/EpidBull/Merkblaetter/Ratgeber_Poliomyelitis.html?nn=2386228
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002375/

Important NOTE:
This article contains general information only and should not be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor. Unfortunately, our experts cannot answer individual questions.

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