1. What is Poliomyelitis

3. What is Polio? Introduction Poliomyelitis (polio) is a highly infectious disease caused by a virus. It invade the nervous system, and can cause total paralysis in a matter of hours. Amongst those paralyzed, 5%-10% die when their breathing muscles become immobilized. Visible sign of polio infection: fewer than 1% of polio infections ever result in paralysis. Poliovirus can spread widely before cases of paralysis are seen. As most people infected with poliovirus have no signs of illness, they are never aware they have been infected. After initial infection with poliovirus, the virus is shed intermittently in faeces (excrement) for several weeks. During that time, polio can spread rapidly through the community It can strike at any age, but affects mainly children under three (over 50% of all cases).

4. Etiology Etiology: poliovirus Family: picorna viridae Polio Virus is sensitive to heat, formaldehyde ultraviolet light, chlorine

5. Types of Polio Three related enteroviruses Type 1: most typically causes outbreaks most likely to cause paralysis Type 2: easiest to eradicate Type 3: often last to be eradicated

7. Pathogenesis Entry into mouth Replication in pharynx, GI tract, local lymphatic Hematologic spread to lymphatic's and central nervous system Viral spread along nerve fibers Destruction of motor neurons

8. POLIO PARALYSIS Once established in the intestines, poliovirus can enter the blood stream and invade the central nervous system - spreading along nerve fibers. As it multiplies, the virus destroys nerve cells (motor neurons) which activate muscles. These nerve cells cannot be regenerated and the affected muscles no longer function. The muscles of the legs are affected more often than the arm muscles.

9. POLIO PARALYSIS Cont… The limb becomes floppy and lifeless a condition known as acute flaccid paralysis (AFP). More extensive paralysis, involving the trunk and muscles of the thorax and abdomen, can result in quadriplegia. In the most severe cases (bulbar polio), poliovirus attacks the motor neurons of the brain stem - reducing breathing capacity and causing difficulty in swallowing and speaking. Without respiratory support, bulbar polio can result in death.

10. Risk Factors These include: immune deficiency pregnancy removal of the tonsils (tonsillectomy) intramuscular injections injury

11. HOW IS POLIO SPREAD? Poliovirus is spread through person-to-person, fecal-oral contact. Where hygiene and sanitation are poor, young children are especially at risk. Young children who are not yet toilet-trained are a ready source of transmission Polio can be spread when food or drink is contaminated by fasces. There is also evidence that flies can passively transfer poliovirus from faeces to food.

12. How is polio spread? Cont… Asymptomatic individuals will not develop polio, but can carry the virus in their intestines and can pass it to others in conditions of sub- standard hygiene. The disease may infect thousands of people, depending on the level of sanitation, before the first case of polio paralysis emerge. Individuals can carry the virus in their intestines just long enough to transmit to others.

13. Who is most at risk of polio? Polio mainly affects children under five years of age. However, immune and/or partially immune adults and children can still be infected with poliovirus These infected individuals can carry the virus for long enough to take the virus from one country to another, infecting close contacts and contaminating sanitation systems. This could facilitate transmission especially in countries where sanitation systems are sub-standard.

14. Clinical Features of Poliomyelitis Acute onset, flaccid paralysis Fever present at onset No progression after 2-3 days Asymmetric Legs affected most often Mortality rate 5-10% Paralysis is permanent Aseptic meningitis & non-paralytic illness

15. Index symptoms (Clues) - Paralysis, paresis (weakness), - Flaccid (floppy) paralysis (in combination with any other words) - Weakness (of limb, of unclear origin, etc.) - “Gait disturbance", -- “Cannot walk", etc.

16. Clinical Outcome of Poliovirus Infections asymptomatic infection(90-95%) clinical illness, no paralysis(4-8%) paralytic poliomyelitis(< 1%)

17. Diagnosis Clinical: Acute onset of Flaccid paralysis Asymmetric Paralysis Associated fever Affecting leg than arms Decreased tendon reflexes Intact sensation Laboratory Stool culture: Viral Culture for primary isolates (National Labs) Serological test: Antibody testing CSF: Lymhocytosis and elevated proteins and rarely detection of Polio virus PCR amplification, to determine whether it is " wild type or "vaccine type" ( Regional Labs )- Intratypic differentiationPCR wild type Genetic tree : to determine the source of the virus (specialized labs)

18. Supportive Care to Parlayed persons by polio There is no cure for polio.cure Treatment is entirely symptomatic. The focus of modern treatment has been on providing relief of symptoms, speeding recovery and preventing complications. Supportive measures include antibiotics to prevent infections in weakened muscles, antibiotics analgesics for pain,analgesics moderate exercise and a nutritious diet.

19. Treatment of polio often requires long-term rehabilitation, including physical therapy,physical therapy braces, corrective shoes and, orthopedic surgery in some cases,. orthopedic surgery Portable ventilators to support breathing.ventilators Today many polio survivors with permanent respiratory paralysis use modern jacket-type negative-pressure ventilators that are worn over the chest and abdomen.jacket-type Treatment Cont….

20. Prognosis 5–10% of patients with paralytic polio die due to the paralysis of muscles used for breathing. 2–5% of children and up to 15–30% of adults die Bulbar polio often causes death if respiratory support is not provided; with support, its mortality rate ranges from 25 to 75%, depending on the age of the patient. When positive pressure ventilators are available, the mortality can be reduced to 15%.

21. Complications Skeletal deformities,Skeletal Tightening of the joints and Movement disability Equines foot deformities of the spine (such as scoliosis)scoliosis one leg is shorter than the other and the person limps and leans to one side Osteoporosis and increased likelihood of bone fractures may occurOsteoporosisbone fractures Extended use of braces or wheelchairs may cause compression neuropathyneuropathy Complications from prolonged immobility involving the lungs, kidneys and heart:lungskidneys heart pulmonary edema, aspiration pneumonia, urinary tract infections, kidney stones, paralytic ileus, myocarditis and pulmonary edemaaspiration pneumoniaurinary tract infections kidney stonesparalytic ileusmyocarditis cor pulmonale.cor pulmonale

22. How can polio be prevented? There is no cure for polio, It can only be prevented through immunization. Polio vaccine, given multiple times, almost always protects a child for life. Full immunization will markedly reduce an individual's risk of developing paralytic polio. Full immunization will protect most people,

23. Confirm Polio Cases of 2011 Total 36 Polio Confirm Cases all of the are P.1 31Polio Cases from Southern Region (Kandahar & Helmand) 4 Polio Cases from Western Region (Farah & Badghis) 1 Polio Case from Central Region (Parwan Province)

24. Polio Eradication Strategies 1- Strong EPI Routine Program OPV 3 Coverage equal or more that 80% 2 -National Immunization days the objective is to vaccinate all the target under five children (100%) 3-AFP Surveillance to reach and on time notify all paralysis or weaknesses under fifteen years old children 4- Mopping Up Immunization 100% reach and vaccinated all under five years old children in the selected area or district with strong monitoring.

25. Afghan Public Health Minister During NIDs Campaign in Nangarhar Province

26. Polio Plus Promotional Activities

27. Grants For Coming NIDs Polio Plus International has donated Grants for coming NIDs 31 Dec 2012 US $ 802,756.00 Operational Support to UNICEF US $ 257,143.00 Operational Support to WHO

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