Poliomyelitis (nagminne porażenie dziecięce)
Rokowania, prognozy i postęp choroby
Prognoza zakażenia wirusem poliomyelitis zależy od formy klinicznej, wieku pacjenta, dostępności opieki medycznej oraz obecności powikłań. Około 75% zakażeń przebiega bezobjawowo lub jako łagodna choroba, natomiast 1 na 200 do 1 na 2000 zakażeń prowadzi do porażenia, które może być nieodwracalne. Śmiertelność wśród pacjentów z porażeniem wynosi 5-10%, a w przypadku niewydolności mięśni oddechowych sięga nawet 15-30% u dorosłych. Postać opuszkowa polio charakteryzuje się wysoką śmiertelnością (25-75%) bez wsparcia oddechowego, którą można zmniejszyć do 15% dzięki wentylacji mechanicznej. Okres rekonwalescencji trwa do 2 lat, z maksymalną poprawą w pierwszych 6 miesiącach; porażenie utrzymujące się po roku jest zwykle trwałe. Około 60% osób po przebytym polio ma trwałe deficyty, a u 2/3 przypadków występuje trwałe porażenie. Zespół post-polio (PPS) może pojawić się dekady po wyzdrowieniu, manifestując się nowym osłabieniem mięśni i zmęczeniem.
Poliomyelitis (nagminne porażenie dziecięce) – Prognoza
Prognoza w przypadku zakażenia wirusem polio zależy od kilku czynników, w tym od manifestacji klinicznej choroby, wieku pacjenta, dostępności odpowiedniej opieki medycznej oraz obecności powikłań. Poliomyelitis może przebiegać z różnym nasileniem – od infekcji bezobjawowych po ciężkie porażenie mięśni, które może prowadzić do trwałego kalectwa, a nawet śmierci.123
Prognoza w zależności od postaci klinicznej
Większość zakażeń wirusem polio (około 75%) przebiega bezobjawowo lub jako łagodna, krótkotrwała choroba. Pacjenci z abortywną postacią polio wracają do pełnego zdrowia bez powikłań długoterminowych.45 Jednak w zależności od serotypu wirusa polio, około 1 na 200 do 1 na 2000 zakażeń wiąże się z rozwojem porażenia. Jeden na 200 zakażeń prowadzi do nieodwracalnego porażenia.67
W przypadku porażennej postaci polio rokowanie jest znacznie poważniejsze. Porażenie może dotyczyć jednej lub więcej kończyn, a w ciężkich przypadkach może prowadzić do tetraplegii, niewydolności oddechowej, a rzadziej do śmierci. Dorośli, u których rozwija się porażenie, zazwyczaj doświadczają cięższego przebiegu choroby i mają gorsze rokowanie niż dzieci.8
Wskaźniki śmiertelności
Śmiertelność w poliomyelitis zależy od formy klinicznej i dostępności wsparcia oddechowego:
- Wśród osób z porażeniem, 5-10% umiera, gdy dochodzi do unieruchomienia mięśni oddechowych910
- Współczynnik śmiertelności różni się w zależności od wieku: 2-5% dzieci i do 15-30% dorosłych11
- Postać opuszkowa polio (bulbar polio) często prowadzi do śmierci, jeśli nie zapewni się wsparcia oddechowego; przy wsparciu współczynnik śmiertelności wynosi od 25% do 75%, w zależności od wieku pacjenta12
- Gdy dostępna jest wentylacja mechaniczna z przerywanym dodatnim ciśnieniem, śmiertelność można zmniejszyć do 15%13
W przypadku poliomyelitis rdzeniowego, który rzadko bywa śmiertelny, 10-15% pacjentów umiera z powodu zajęcia opuszki, co prowadzi do niewydolności oddechowej i sercowo-naczyniowej.14 Bez wsparcia oddechowego konsekwencje poliomyelitis z zajęciem układu oddechowego obejmują uduszenie lub zapalenie płuc z powodu aspiracji wydzieliny.15
Okres zdrowienia i powrót do sprawności
Po ostrej fazie choroby następuje okres zdrowienia i ewentualnego utrzymywania się porażenia. Okres rekonwalescencji rozpoczyna się, gdy ostra, grypopodobna choroba ustępuje i nie występuje dalsze porażenie. Zdrowienie może trwać do 2 lat, przy czym maksymalna poprawa następuje w pierwszych 6 miesiącach.16
W przypadku polio rdzeniowego, jeśli dotknięte komórki nerwowe zostają całkowicie zniszczone, porażenie będzie trwałe. Komórki, które nie zostały zniszczone, ale czasowo utraciły funkcję, mogą odzyskać sprawność w ciągu czterech do sześciu tygodni od wystąpienia objawów.17 Wiele przypadków poliomyelitis skutkuje jedynie tymczasowym porażeniem. Zazwyczaj w tych przypadkach impulsy nerwowe powracają do sparaliżowanych mięśni w ciągu miesiąca, a pełny powrót do zdrowia następuje w ciągu sześciu do ośmiu miesięcy.18
Procesy neurofizjologiczne zaangażowane w zdrowienie po ostrej postaci porażennej poliomyelitis są dość efektywne; mięśnie mogą zachować normalną siłę, nawet jeśli utracono połowę pierwotnych neuronów ruchowych.19 Porażenie utrzymujące się po roku prawdopodobnie będzie trwałe, choć pewna poprawa siły mięśniowej jest możliwa do 18 miesięcy po zakażeniu.20
Odległa prognoza i trwałe deficyty
Długoterminowe rokowanie dla pacjentów z poliomyelitis przedstawia się następująco:
- Około 60% osób, które przeżyły polio, ma trwałe deficyty21
- Połowa pacjentów z polio rdzeniowym powraca do pełnej sprawności22
- Jedna czwarta pacjentów wraca do zdrowia z łagodną niepełnosprawnością23
- Pozostała jedna czwarta pozostaje z ciężką niepełnosprawnością24
- U około dwóch trzecich przypadków występuje trwałe porażenie25
Stopień zarówno ostrego porażenia, jak i porażenia resztkowego jest prawdopodobnie proporcjonalny do stopnia wiremii i odwrotnie proporcjonalny do stopnia odporności.26 Im cięższy ostry przebieg choroby, tym większe prawdopodobieństwo wystąpienia deficytów resztkowych i rozwoju zespołu post-polio w przyszłości.27
Zespół post-polio (PPS)
Zespół post-polio (PPS) lub następstwa polio mogą rozwinąć się jako dodatkowe objawy dekady po wyzdrowieniu z ostrej infekcji, w szczególności jako nowe osłabienie mięśni i skrajne zmęczenie.2829 U wielu osób z deficytami rezydualnymi, a nawet u niektórych, którzy w pełni wyzdrowieli, pogorszenie osłabienia lub porażenia może wystąpić 20-30 lat później.30
Brak leczenia przyczynowego
Należy podkreślić, że obecnie nie istnieje licencjonowane leczenie zakażenia wirusem polio, dostępna jest jedynie opieka wspomagająca objawów. Dwa leki przeciwwirusowe są w trakcie badań klinicznych do leczenia osób z niedoborami odporności, które są zakażone i wydalają VDPV związane z niedoborem odporności.31 Nie ma lekarstwa na polio – choroba może być jedynie zapobiegana poprzez szczepienia.32
Znaczenie dla zdrowia publicznego i prognoza globalna
Z punktu widzenia zdrowia publicznego, poliomyelitis pozostaje istotnym wyzwaniem, zwłaszcza w kontekście światowej inicjatywy eradykacji polio. Niepowodzenie w zatrzymaniu polio w ostatnich pozostałych obszarach występowania może skutkować globalnym nawrotem choroby.33
Międzynarodowe ryzyko rozprzestrzeniania
Końcowy etap eradykacji polio jest utrudniony przez międzynarodowe rozprzestrzenianie się wirusa polio przez podróżnych.34 Skala importu bezobjawowych i objawowych zakażeń polio jest znacząca. Dla krajów podatnych na epidemie polio z powodu niskiego poziomu krajowych szczepiień przeciwko polio, opracowane modele matematyczne mogą pomóc decydentom w określeniu, czy nałożenie wymogu wjazdowego w postaci dowodu szczepienia przeciwko polio byłoby uzasadnione.3536
Analiza wrażliwości pokazuje, że siła infekcji w kraju źródłowym epidemii jest głównym czynnikiem napędzającym ryzyko importu, w połączeniu z wielkością ruchu podróżnych.37
Predykcja zachorowań i skuteczność kampanii szczepień
Opracowane modele statystyczne mogą być wykorzystywane do przewidywania i zapobiegania wybuchom epidemii polio. Sześciomiesięczne prognozy liczby ognisk w danym kraju lub regionie zmieniały się w czasie i miały zdolność predykcyjną na poziomie 82%.3839
Czynniki ryzyka uwzględnione w modelach statystycznych wystarczają do opisania skali i geograficznego rozkładu ognisk polio w Afryce z sześciomiesięcznym wyprzedzeniem i wysoką zdolnością predykcyjną. Model wykorzystujący liczbę ognisk w poprzednich 3 latach jako predyktor ognisk w bieżących 6 miesiącach miał zdolność predykcyjną 0,76 (SE=0,04).40
Szacowana skuteczność kampanii szczepień poprawiła się w północnej Nigerii od 2004 roku, przy czym stan Kano doświadczył wzrostu skuteczności o 40% (95% CI, 26-54%) w latach 2013-2014. Odporność na poliowirus typu 1 stale wzrastała.41
Lokalne szacunki skuteczności kampanii mogą być następnie wykorzystane do oceny perspektywicznych planów kampanii. Szacunki odporności na poziomie dystryktu były znacząco związane z późniejszą obecnością lub nieobecnością WPV1 i cVDPV2.42
Prognozy globalne i znaczenie eradykacji
Epidemie poliomyelitis w krajach afrykańskich, które wcześniej były wolne od dzikiego wirusa polio, kosztowały Globalną Inicjatywę Eradykacji Polio 850 milionów dolarów w latach 2003-2009 i ograniczyły zdolność programu do skupienia się na krajach endemicznych.43 Ilościowe zrozumienie czynników, które przewidują rozkład i czas wystąpienia ognisk, umożliwi ich zapobieganie i ułatwi zakończenie globalnej eradykacji.44
Świat jest bliżej niż kiedykolwiek wcześniej Afryki wolnej od polio. Na tym końcowym etapie ważne jest zapewnienie wysokiego poziomu odporności populacji, aby zapobiec wybuchom polio.45
Najważniejsze jest to, że sukces będzie oznaczał, że żadne dziecko nigdy więcej nie będzie cierpiało z powodu strasznych skutków dożywotniego porażenia wywołanego przez polio.46
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Materiały źródłowe
- #1https://www.who.int/news-room/fact-sheets/detail/poliomyelitis
One in 200 infections leads to irreversible paralysis. Among those paralysed, 510% die when their breathing muscles become immobilized. […] There is no cure for polio, it can only be prevented. […] Failure to stop polio in these last remaining areas could result in global resurgence of the disease. […] Most importantly, success will mean that no child will ever again suffer the terrible effects of lifelong polio-paralysis.
- #2 Poliomyelitis – StatPearls – NCBI Bookshelfhttps://www.ncbi.nlm.nih.gov/books/NBK558944/
Most poliovirus infections are asymptomatic or self-limiting. […] For those with poliomyelitis (ie, symptomatic poliovirus infection), 10% to 15% will die due to bulbar involvement, with respiratory and cardiovascular collapse. […] For those who survive, recovery and residual paralysis stages follow. […] Convalescence or recovery begins when the acute, flu-like illness resolves and no further paralysis occurs. […] Recovery can last up to 2 years, with maximal improvement occurring in the first 6 months. […] Approximately 60% of polio survivors have permanent deficits. […] The more severe the acute phase of the disease, the greater the likelihood of residual deficits and the development of postpolio syndrome in the future.
- #3 Poliomyelitis | Yellow Book | CDChttps://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/poliomyelitis
Most poliovirus infections are asymptomatic; approximately 25% cause minor short-term illness. Depending on poliovirus serotype, approximately 1 in 200 to 1 in 2,000 infections are associated with paralysis. Paralysis affects 1 limbs, and in severe cases can result in quadriplegia, respiratory failure, and rarely, death. Adults who develop paralysis usually have more severe disease and a worse prognosis than children. Residual paralysis occurs in about two-thirds of cases. For many people with residual deficits, and even for some who recover fully, worsening of weakness or paralysis can occur 20-30 years later, known as post-polio syndrome. […] No licensed treatment exists for poliovirus infection, and only supportive care for symptoms is available. Two antiviral agents are undergoing clinical testing for the treatment of people with immunodeficiencies who are infected with and excreting immunodeficiency-associated VDPV.
- #4 Polio – Wikipediahttps://en.wikipedia.org/wiki/Polio
Patients with abortive polio infections recover completely. […] In cases of spinal polio, if the affected nerve cells are completely destroyed, paralysis will be permanent; cells that are not destroyed, but lose function temporarily, may recover within four to six weeks after onset. […] Half the patients with spinal polio recover fully; one-quarter recover with mild disability, and the remaining quarter are left with severe disability. […] The degree of both acute paralysis and residual paralysis is likely to be proportional to the degree of viremia, and inversely proportional to the degree of immunity. […] Spinal polio is rarely fatal. […] Without respiratory support, consequences of poliomyelitis with respiratory involvement include suffocation or pneumonia from aspiration of secretions.
- #5 Poliomyelitis | Yellow Book | CDChttps://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/poliomyelitis
Most poliovirus infections are asymptomatic; approximately 25% cause minor short-term illness. Depending on poliovirus serotype, approximately 1 in 200 to 1 in 2,000 infections are associated with paralysis. Paralysis affects 1 limbs, and in severe cases can result in quadriplegia, respiratory failure, and rarely, death. Adults who develop paralysis usually have more severe disease and a worse prognosis than children. Residual paralysis occurs in about two-thirds of cases. For many people with residual deficits, and even for some who recover fully, worsening of weakness or paralysis can occur 20-30 years later, known as post-polio syndrome. […] No licensed treatment exists for poliovirus infection, and only supportive care for symptoms is available. Two antiviral agents are undergoing clinical testing for the treatment of people with immunodeficiencies who are infected with and excreting immunodeficiency-associated VDPV.
- #6https://www.who.int/news-room/fact-sheets/detail/poliomyelitis
One in 200 infections leads to irreversible paralysis. Among those paralysed, 510% die when their breathing muscles become immobilized. […] There is no cure for polio, it can only be prevented. […] Failure to stop polio in these last remaining areas could result in global resurgence of the disease. […] Most importantly, success will mean that no child will ever again suffer the terrible effects of lifelong polio-paralysis.
- #7 Poliomyelitis | Yellow Book | CDChttps://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/poliomyelitis
Most poliovirus infections are asymptomatic; approximately 25% cause minor short-term illness. Depending on poliovirus serotype, approximately 1 in 200 to 1 in 2,000 infections are associated with paralysis. Paralysis affects 1 limbs, and in severe cases can result in quadriplegia, respiratory failure, and rarely, death. Adults who develop paralysis usually have more severe disease and a worse prognosis than children. Residual paralysis occurs in about two-thirds of cases. For many people with residual deficits, and even for some who recover fully, worsening of weakness or paralysis can occur 20-30 years later, known as post-polio syndrome. […] No licensed treatment exists for poliovirus infection, and only supportive care for symptoms is available. Two antiviral agents are undergoing clinical testing for the treatment of people with immunodeficiencies who are infected with and excreting immunodeficiency-associated VDPV.
- #8 Poliomyelitis | Yellow Book | CDChttps://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/poliomyelitis
Most poliovirus infections are asymptomatic; approximately 25% cause minor short-term illness. Depending on poliovirus serotype, approximately 1 in 200 to 1 in 2,000 infections are associated with paralysis. Paralysis affects 1 limbs, and in severe cases can result in quadriplegia, respiratory failure, and rarely, death. Adults who develop paralysis usually have more severe disease and a worse prognosis than children. Residual paralysis occurs in about two-thirds of cases. For many people with residual deficits, and even for some who recover fully, worsening of weakness or paralysis can occur 20-30 years later, known as post-polio syndrome. […] No licensed treatment exists for poliovirus infection, and only supportive care for symptoms is available. Two antiviral agents are undergoing clinical testing for the treatment of people with immunodeficiencies who are infected with and excreting immunodeficiency-associated VDPV.
- #9https://www.who.int/news-room/fact-sheets/detail/poliomyelitis
One in 200 infections leads to irreversible paralysis. Among those paralysed, 510% die when their breathing muscles become immobilized. […] There is no cure for polio, it can only be prevented. […] Failure to stop polio in these last remaining areas could result in global resurgence of the disease. […] Most importantly, success will mean that no child will ever again suffer the terrible effects of lifelong polio-paralysis.
- #10 Polio – Wikipediahttps://en.wikipedia.org/wiki/Polio
Overall, 5 to 10 percent of patients with paralytic polio die due to the paralysis of muscles used for breathing. […] The case fatality rate (CFR) varies by age: 2 to 5 percent of children and up to 15 to 30 percent of adults die. […] Bulbar polio often causes death if respiratory support is not provided; with support, its CFR ranges from 25 to 75 percent, depending on the age of the patient. […] When intermittent positive pressure ventilation is available, the fatalities can be reduced to 15 percent. […] Many cases of poliomyelitis result in only temporary paralysis. […] Generally in these cases, nerve impulses return to the paralyzed muscle within a month, and recovery is complete in six to eight months. […] The neurophysiological processes involved in recovery following acute paralytic poliomyelitis are quite effective; muscles are able to retain normal strength even if half the original motor neurons have been lost.
- #11 Polio – Wikipediahttps://en.wikipedia.org/wiki/Polio
Overall, 5 to 10 percent of patients with paralytic polio die due to the paralysis of muscles used for breathing. […] The case fatality rate (CFR) varies by age: 2 to 5 percent of children and up to 15 to 30 percent of adults die. […] Bulbar polio often causes death if respiratory support is not provided; with support, its CFR ranges from 25 to 75 percent, depending on the age of the patient. […] When intermittent positive pressure ventilation is available, the fatalities can be reduced to 15 percent. […] Many cases of poliomyelitis result in only temporary paralysis. […] Generally in these cases, nerve impulses return to the paralyzed muscle within a month, and recovery is complete in six to eight months. […] The neurophysiological processes involved in recovery following acute paralytic poliomyelitis are quite effective; muscles are able to retain normal strength even if half the original motor neurons have been lost.
- #12 Polio – Wikipediahttps://en.wikipedia.org/wiki/Polio
Overall, 5 to 10 percent of patients with paralytic polio die due to the paralysis of muscles used for breathing. […] The case fatality rate (CFR) varies by age: 2 to 5 percent of children and up to 15 to 30 percent of adults die. […] Bulbar polio often causes death if respiratory support is not provided; with support, its CFR ranges from 25 to 75 percent, depending on the age of the patient. […] When intermittent positive pressure ventilation is available, the fatalities can be reduced to 15 percent. […] Many cases of poliomyelitis result in only temporary paralysis. […] Generally in these cases, nerve impulses return to the paralyzed muscle within a month, and recovery is complete in six to eight months. […] The neurophysiological processes involved in recovery following acute paralytic poliomyelitis are quite effective; muscles are able to retain normal strength even if half the original motor neurons have been lost.
- #13 Polio – Wikipediahttps://en.wikipedia.org/wiki/Polio
Overall, 5 to 10 percent of patients with paralytic polio die due to the paralysis of muscles used for breathing. […] The case fatality rate (CFR) varies by age: 2 to 5 percent of children and up to 15 to 30 percent of adults die. […] Bulbar polio often causes death if respiratory support is not provided; with support, its CFR ranges from 25 to 75 percent, depending on the age of the patient. […] When intermittent positive pressure ventilation is available, the fatalities can be reduced to 15 percent. […] Many cases of poliomyelitis result in only temporary paralysis. […] Generally in these cases, nerve impulses return to the paralyzed muscle within a month, and recovery is complete in six to eight months. […] The neurophysiological processes involved in recovery following acute paralytic poliomyelitis are quite effective; muscles are able to retain normal strength even if half the original motor neurons have been lost.
- #14 Poliomyelitis – StatPearls – NCBI Bookshelfhttps://www.ncbi.nlm.nih.gov/books/NBK558944/
Most poliovirus infections are asymptomatic or self-limiting. […] For those with poliomyelitis (ie, symptomatic poliovirus infection), 10% to 15% will die due to bulbar involvement, with respiratory and cardiovascular collapse. […] For those who survive, recovery and residual paralysis stages follow. […] Convalescence or recovery begins when the acute, flu-like illness resolves and no further paralysis occurs. […] Recovery can last up to 2 years, with maximal improvement occurring in the first 6 months. […] Approximately 60% of polio survivors have permanent deficits. […] The more severe the acute phase of the disease, the greater the likelihood of residual deficits and the development of postpolio syndrome in the future.
- #15 Polio – Wikipediahttps://en.wikipedia.org/wiki/Polio
Patients with abortive polio infections recover completely. […] In cases of spinal polio, if the affected nerve cells are completely destroyed, paralysis will be permanent; cells that are not destroyed, but lose function temporarily, may recover within four to six weeks after onset. […] Half the patients with spinal polio recover fully; one-quarter recover with mild disability, and the remaining quarter are left with severe disability. […] The degree of both acute paralysis and residual paralysis is likely to be proportional to the degree of viremia, and inversely proportional to the degree of immunity. […] Spinal polio is rarely fatal. […] Without respiratory support, consequences of poliomyelitis with respiratory involvement include suffocation or pneumonia from aspiration of secretions.
- #16 Poliomyelitis – StatPearls – NCBI Bookshelfhttps://www.ncbi.nlm.nih.gov/books/NBK558944/
Most poliovirus infections are asymptomatic or self-limiting. […] For those with poliomyelitis (ie, symptomatic poliovirus infection), 10% to 15% will die due to bulbar involvement, with respiratory and cardiovascular collapse. […] For those who survive, recovery and residual paralysis stages follow. […] Convalescence or recovery begins when the acute, flu-like illness resolves and no further paralysis occurs. […] Recovery can last up to 2 years, with maximal improvement occurring in the first 6 months. […] Approximately 60% of polio survivors have permanent deficits. […] The more severe the acute phase of the disease, the greater the likelihood of residual deficits and the development of postpolio syndrome in the future.
- #17 Polio – Wikipediahttps://en.wikipedia.org/wiki/Polio
Patients with abortive polio infections recover completely. […] In cases of spinal polio, if the affected nerve cells are completely destroyed, paralysis will be permanent; cells that are not destroyed, but lose function temporarily, may recover within four to six weeks after onset. […] Half the patients with spinal polio recover fully; one-quarter recover with mild disability, and the remaining quarter are left with severe disability. […] The degree of both acute paralysis and residual paralysis is likely to be proportional to the degree of viremia, and inversely proportional to the degree of immunity. […] Spinal polio is rarely fatal. […] Without respiratory support, consequences of poliomyelitis with respiratory involvement include suffocation or pneumonia from aspiration of secretions.
- #18 Polio – Wikipediahttps://en.wikipedia.org/wiki/Polio
Overall, 5 to 10 percent of patients with paralytic polio die due to the paralysis of muscles used for breathing. […] The case fatality rate (CFR) varies by age: 2 to 5 percent of children and up to 15 to 30 percent of adults die. […] Bulbar polio often causes death if respiratory support is not provided; with support, its CFR ranges from 25 to 75 percent, depending on the age of the patient. […] When intermittent positive pressure ventilation is available, the fatalities can be reduced to 15 percent. […] Many cases of poliomyelitis result in only temporary paralysis. […] Generally in these cases, nerve impulses return to the paralyzed muscle within a month, and recovery is complete in six to eight months. […] The neurophysiological processes involved in recovery following acute paralytic poliomyelitis are quite effective; muscles are able to retain normal strength even if half the original motor neurons have been lost.
- #19 Polio – Wikipediahttps://en.wikipedia.org/wiki/Polio
Overall, 5 to 10 percent of patients with paralytic polio die due to the paralysis of muscles used for breathing. […] The case fatality rate (CFR) varies by age: 2 to 5 percent of children and up to 15 to 30 percent of adults die. […] Bulbar polio often causes death if respiratory support is not provided; with support, its CFR ranges from 25 to 75 percent, depending on the age of the patient. […] When intermittent positive pressure ventilation is available, the fatalities can be reduced to 15 percent. […] Many cases of poliomyelitis result in only temporary paralysis. […] Generally in these cases, nerve impulses return to the paralyzed muscle within a month, and recovery is complete in six to eight months. […] The neurophysiological processes involved in recovery following acute paralytic poliomyelitis are quite effective; muscles are able to retain normal strength even if half the original motor neurons have been lost.
- #20 Polio – Wikipediahttps://en.wikipedia.org/wiki/Polio
Paralysis remaining after one year is likely to be permanent, although some recovery of muscle strength is possible up to 18 months after infection. […] Post-polio syndrome (PPS) or post-polio sequelae can develop additional symptoms decades after recovering from the acute infection, notably new muscle weakness and extreme fatigue.
- #21 Poliomyelitis – StatPearls – NCBI Bookshelfhttps://www.ncbi.nlm.nih.gov/books/NBK558944/
Most poliovirus infections are asymptomatic or self-limiting. […] For those with poliomyelitis (ie, symptomatic poliovirus infection), 10% to 15% will die due to bulbar involvement, with respiratory and cardiovascular collapse. […] For those who survive, recovery and residual paralysis stages follow. […] Convalescence or recovery begins when the acute, flu-like illness resolves and no further paralysis occurs. […] Recovery can last up to 2 years, with maximal improvement occurring in the first 6 months. […] Approximately 60% of polio survivors have permanent deficits. […] The more severe the acute phase of the disease, the greater the likelihood of residual deficits and the development of postpolio syndrome in the future.
- #22 Polio – Wikipediahttps://en.wikipedia.org/wiki/Polio
Patients with abortive polio infections recover completely. […] In cases of spinal polio, if the affected nerve cells are completely destroyed, paralysis will be permanent; cells that are not destroyed, but lose function temporarily, may recover within four to six weeks after onset. […] Half the patients with spinal polio recover fully; one-quarter recover with mild disability, and the remaining quarter are left with severe disability. […] The degree of both acute paralysis and residual paralysis is likely to be proportional to the degree of viremia, and inversely proportional to the degree of immunity. […] Spinal polio is rarely fatal. […] Without respiratory support, consequences of poliomyelitis with respiratory involvement include suffocation or pneumonia from aspiration of secretions.
- #23 Polio – Wikipediahttps://en.wikipedia.org/wiki/Polio
Patients with abortive polio infections recover completely. […] In cases of spinal polio, if the affected nerve cells are completely destroyed, paralysis will be permanent; cells that are not destroyed, but lose function temporarily, may recover within four to six weeks after onset. […] Half the patients with spinal polio recover fully; one-quarter recover with mild disability, and the remaining quarter are left with severe disability. […] The degree of both acute paralysis and residual paralysis is likely to be proportional to the degree of viremia, and inversely proportional to the degree of immunity. […] Spinal polio is rarely fatal. […] Without respiratory support, consequences of poliomyelitis with respiratory involvement include suffocation or pneumonia from aspiration of secretions.
- #24 Polio – Wikipediahttps://en.wikipedia.org/wiki/Polio
Patients with abortive polio infections recover completely. […] In cases of spinal polio, if the affected nerve cells are completely destroyed, paralysis will be permanent; cells that are not destroyed, but lose function temporarily, may recover within four to six weeks after onset. […] Half the patients with spinal polio recover fully; one-quarter recover with mild disability, and the remaining quarter are left with severe disability. […] The degree of both acute paralysis and residual paralysis is likely to be proportional to the degree of viremia, and inversely proportional to the degree of immunity. […] Spinal polio is rarely fatal. […] Without respiratory support, consequences of poliomyelitis with respiratory involvement include suffocation or pneumonia from aspiration of secretions.
- #25 Poliomyelitis | Yellow Book | CDChttps://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/poliomyelitis
Most poliovirus infections are asymptomatic; approximately 25% cause minor short-term illness. Depending on poliovirus serotype, approximately 1 in 200 to 1 in 2,000 infections are associated with paralysis. Paralysis affects 1 limbs, and in severe cases can result in quadriplegia, respiratory failure, and rarely, death. Adults who develop paralysis usually have more severe disease and a worse prognosis than children. Residual paralysis occurs in about two-thirds of cases. For many people with residual deficits, and even for some who recover fully, worsening of weakness or paralysis can occur 20-30 years later, known as post-polio syndrome. […] No licensed treatment exists for poliovirus infection, and only supportive care for symptoms is available. Two antiviral agents are undergoing clinical testing for the treatment of people with immunodeficiencies who are infected with and excreting immunodeficiency-associated VDPV.
- #26 Polio – Wikipediahttps://en.wikipedia.org/wiki/Polio
Patients with abortive polio infections recover completely. […] In cases of spinal polio, if the affected nerve cells are completely destroyed, paralysis will be permanent; cells that are not destroyed, but lose function temporarily, may recover within four to six weeks after onset. […] Half the patients with spinal polio recover fully; one-quarter recover with mild disability, and the remaining quarter are left with severe disability. […] The degree of both acute paralysis and residual paralysis is likely to be proportional to the degree of viremia, and inversely proportional to the degree of immunity. […] Spinal polio is rarely fatal. […] Without respiratory support, consequences of poliomyelitis with respiratory involvement include suffocation or pneumonia from aspiration of secretions.
- #27 Poliomyelitis – StatPearls – NCBI Bookshelfhttps://www.ncbi.nlm.nih.gov/books/NBK558944/
Most poliovirus infections are asymptomatic or self-limiting. […] For those with poliomyelitis (ie, symptomatic poliovirus infection), 10% to 15% will die due to bulbar involvement, with respiratory and cardiovascular collapse. […] For those who survive, recovery and residual paralysis stages follow. […] Convalescence or recovery begins when the acute, flu-like illness resolves and no further paralysis occurs. […] Recovery can last up to 2 years, with maximal improvement occurring in the first 6 months. […] Approximately 60% of polio survivors have permanent deficits. […] The more severe the acute phase of the disease, the greater the likelihood of residual deficits and the development of postpolio syndrome in the future.
- #28 Polio – Wikipediahttps://en.wikipedia.org/wiki/Polio
Paralysis remaining after one year is likely to be permanent, although some recovery of muscle strength is possible up to 18 months after infection. […] Post-polio syndrome (PPS) or post-polio sequelae can develop additional symptoms decades after recovering from the acute infection, notably new muscle weakness and extreme fatigue.
- #29 Poliomyelitis | Yellow Book | CDChttps://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/poliomyelitis
Most poliovirus infections are asymptomatic; approximately 25% cause minor short-term illness. Depending on poliovirus serotype, approximately 1 in 200 to 1 in 2,000 infections are associated with paralysis. Paralysis affects 1 limbs, and in severe cases can result in quadriplegia, respiratory failure, and rarely, death. Adults who develop paralysis usually have more severe disease and a worse prognosis than children. Residual paralysis occurs in about two-thirds of cases. For many people with residual deficits, and even for some who recover fully, worsening of weakness or paralysis can occur 20-30 years later, known as post-polio syndrome. […] No licensed treatment exists for poliovirus infection, and only supportive care for symptoms is available. Two antiviral agents are undergoing clinical testing for the treatment of people with immunodeficiencies who are infected with and excreting immunodeficiency-associated VDPV.
- #30 Poliomyelitis | Yellow Book | CDChttps://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/poliomyelitis
Most poliovirus infections are asymptomatic; approximately 25% cause minor short-term illness. Depending on poliovirus serotype, approximately 1 in 200 to 1 in 2,000 infections are associated with paralysis. Paralysis affects 1 limbs, and in severe cases can result in quadriplegia, respiratory failure, and rarely, death. Adults who develop paralysis usually have more severe disease and a worse prognosis than children. Residual paralysis occurs in about two-thirds of cases. For many people with residual deficits, and even for some who recover fully, worsening of weakness or paralysis can occur 20-30 years later, known as post-polio syndrome. […] No licensed treatment exists for poliovirus infection, and only supportive care for symptoms is available. Two antiviral agents are undergoing clinical testing for the treatment of people with immunodeficiencies who are infected with and excreting immunodeficiency-associated VDPV.
- #31 Poliomyelitis | Yellow Book | CDChttps://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/poliomyelitis
Most poliovirus infections are asymptomatic; approximately 25% cause minor short-term illness. Depending on poliovirus serotype, approximately 1 in 200 to 1 in 2,000 infections are associated with paralysis. Paralysis affects 1 limbs, and in severe cases can result in quadriplegia, respiratory failure, and rarely, death. Adults who develop paralysis usually have more severe disease and a worse prognosis than children. Residual paralysis occurs in about two-thirds of cases. For many people with residual deficits, and even for some who recover fully, worsening of weakness or paralysis can occur 20-30 years later, known as post-polio syndrome. […] No licensed treatment exists for poliovirus infection, and only supportive care for symptoms is available. Two antiviral agents are undergoing clinical testing for the treatment of people with immunodeficiencies who are infected with and excreting immunodeficiency-associated VDPV.
- #32https://www.who.int/news-room/fact-sheets/detail/poliomyelitis
One in 200 infections leads to irreversible paralysis. Among those paralysed, 510% die when their breathing muscles become immobilized. […] There is no cure for polio, it can only be prevented. […] Failure to stop polio in these last remaining areas could result in global resurgence of the disease. […] Most importantly, success will mean that no child will ever again suffer the terrible effects of lifelong polio-paralysis.
- #33https://www.who.int/news-room/fact-sheets/detail/poliomyelitis
One in 200 infections leads to irreversible paralysis. Among those paralysed, 510% die when their breathing muscles become immobilized. […] There is no cure for polio, it can only be prevented. […] Failure to stop polio in these last remaining areas could result in global resurgence of the disease. […] Most importantly, success will mean that no child will ever again suffer the terrible effects of lifelong polio-paralysis.
- #34 Potential for international spread of wild poliovirus via travelers | BMC Medicine | Full Texthttps://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0363-y
The endgame of polio eradication is hampered by the international spread of poliovirus via travelers. […] Our objective was to develop a mathematical model to estimate the international spread of polio infections. […] The extent of importations of asymptomatic and symptomatic polio infections is substantial. For countries that are vulnerable to polio outbreaks due to poor national polio immunization coverage rates, our newly developed model may help guide policy-makers to decide whether imposing an entry requirement in terms of proof of vaccination against polio would be justified. […] Given WHO’s recent focus on the contribution of the international spread of poliovirus via travelers, it is important and timely to assess the potential for further spread. […] Our objective was to develop a mathematical model to estimate the international spread of symptomatic and asymptomatic polio infections.
- #35 Potential for international spread of wild poliovirus via travelers | BMC Medicine | Full Texthttps://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0363-y
The endgame of polio eradication is hampered by the international spread of poliovirus via travelers. […] Our objective was to develop a mathematical model to estimate the international spread of polio infections. […] The extent of importations of asymptomatic and symptomatic polio infections is substantial. For countries that are vulnerable to polio outbreaks due to poor national polio immunization coverage rates, our newly developed model may help guide policy-makers to decide whether imposing an entry requirement in terms of proof of vaccination against polio would be justified. […] Given WHO’s recent focus on the contribution of the international spread of poliovirus via travelers, it is important and timely to assess the potential for further spread. […] Our objective was to develop a mathematical model to estimate the international spread of symptomatic and asymptomatic polio infections.
- #36 Potential for international spread of wild poliovirus via travelers | BMC Medicine | Full Texthttps://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0363-y
Our model not only takes into account polio endemicity (force of infection), population size, polio vaccination coverage, and infectious period, but also the probability of a traveler being infectious at the time of travel. […] Our sensitivity analysis shows that the force of infection in the epidemic source country is the main driving factor for the importation risk, combined with the travel volume. […] Our model can be applied to all countries and provides an additional tool to estimate the risk of importation based on the main contributing factors such as travel volume and polio endemicity. In particular, for countries that are vulnerable to polio outbreaks due to poor national polio immunization coverage rates, our model may help guide policy-makers to decide whether imposing an entry requirement in terms of proof of vaccination against polio would be justified.
- #37 Potential for international spread of wild poliovirus via travelers | BMC Medicine | Full Texthttps://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0363-y
Our model not only takes into account polio endemicity (force of infection), population size, polio vaccination coverage, and infectious period, but also the probability of a traveler being infectious at the time of travel. […] Our sensitivity analysis shows that the force of infection in the epidemic source country is the main driving factor for the importation risk, combined with the travel volume. […] Our model can be applied to all countries and provides an additional tool to estimate the risk of importation based on the main contributing factors such as travel volume and polio endemicity. In particular, for countries that are vulnerable to polio outbreaks due to poor national polio immunization coverage rates, our model may help guide policy-makers to decide whether imposing an entry requirement in terms of proof of vaccination against polio would be justified.
- #38 A Statistical Model of the International Spread of Wild Poliovirus in Africa Used to Predict and Prevent Outbreaks | PLOS Medicinehttps://journals.plos.org/plosmedicine/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001109
Outbreaks of poliomyelitis in African countries that were previously free of wild-type poliovirus cost the Global Polio Eradication Initiative US$850 million during 20032009, and have limited the ability of the program to focus on endemic countries. […] A quantitative understanding of the factors that predict the distribution and timing of outbreaks will enable their prevention and facilitate the completion of global eradication. […] The predictive ability of 6-mo-ahead forecasts of poliomyelitis outbreaks in each country based on the regression model was assessed. […] Six-month-ahead forecasts of the number of outbreaks in a country or region changed over time and had a predictive ability of 82%. […] Outbreaks of poliomyelitis resulted primarily from continued transmission in Nigeria and the poor immunisation status of populations in neighbouring countries.
- #39 A Statistical Model of the International Spread of Wild Poliovirus in Africa Used to Predict and Prevent Outbreaks | PLOS Medicinehttps://journals.plos.org/plosmedicine/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001109
Importantly, the risk factors included by the researchers in their statistical model are sufficient to describe the scale and geographical distribution of polio outbreaks in Africa six months in advance with a high predictive ability. […] The AUC of the Poisson regression model was 0.82 (SE=0.03), indicating a good predictive ability for the number of future outbreaks. […] The model that used the number of outbreaks in the previous 3 y as a predictor for outbreaks in the current 6 mo had a predictive ability of 0.76 (SE=0.04). […] Our analysis highlights how the geographical risk of poliomyelitis outbreaks has changed over time, particularly in 2010 and 2011, moving from countries surrounding Nigeria to countries bordering those with re-established transmission. […] This predicted change in risk has been followed by outbreaks in the Congo and Uganda during the period 1 July31 December 2010. […] Planning SIA campaigns based on evolving risk may reduce the number of outbreaks by responding to increased risk prior to an outbreak occurring.
- #40 A Statistical Model of the International Spread of Wild Poliovirus in Africa Used to Predict and Prevent Outbreaks | PLOS Medicinehttps://journals.plos.org/plosmedicine/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001109
Importantly, the risk factors included by the researchers in their statistical model are sufficient to describe the scale and geographical distribution of polio outbreaks in Africa six months in advance with a high predictive ability. […] The AUC of the Poisson regression model was 0.82 (SE=0.03), indicating a good predictive ability for the number of future outbreaks. […] The model that used the number of outbreaks in the previous 3 y as a predictor for outbreaks in the current 6 mo had a predictive ability of 0.76 (SE=0.04). […] Our analysis highlights how the geographical risk of poliomyelitis outbreaks has changed over time, particularly in 2010 and 2011, moving from countries surrounding Nigeria to countries bordering those with re-established transmission. […] This predicted change in risk has been followed by outbreaks in the Congo and Uganda during the period 1 July31 December 2010. […] Planning SIA campaigns based on evolving risk may reduce the number of outbreaks by responding to increased risk prior to an outbreak occurring.
- #41 Analysis of vaccination campaign effectiveness and population immunity to support and sustain polio elimination in Nigeriahttps://pmc.ncbi.nlm.nih.gov/articles/PMC4812602/
The world is closer than ever to a polio-free Africa. […] In this end-stage, it is important to ensure high levels of population immunity to prevent polio outbreaks. […] We demonstrate how this approach can be used to plan the vaccination campaigns prospectively to better manage population immunity in Northern Nigeria. […] Estimated campaign effectiveness has improved across northern Nigeria since 2004, with Kano state experiencing an increase of 40 % (95 % CI, 2654 %) in effectiveness from 2013 to 2014. […] Immunity to type 1 poliovirus has increased steadily. […] We find that immunity estimates are related to the occurrence of both wild and vaccine-derived poliovirus cases and that campaign effectiveness correlates with direct measurements using lot-quality assurance sampling. […] The model in this study provides a novel method for assessing vaccination campaign performance and epidemiologically-relevant estimates of population immunity.
- #42 Analysis of vaccination campaign effectiveness and population immunity to support and sustain polio elimination in Nigeriahttps://pmc.ncbi.nlm.nih.gov/articles/PMC4812602/
Small-area estimates of campaign effectiveness can then be used to evaluate prospective campaign plans. […] District immunity estimates were significantly associated with the subsequent presence or absence of WPV1 and cVDPV2. […] Our calculations of campaign effectiveness showed steadily increasing quality from 20042014, in line with increased focus and resources devoted to the country’s polio program. […] Our estimates of campaign effectiveness and population immunity rely on the accuracy of AFP data. […] The campaign effectiveness and immunity model presented here advance the use of these data and can help polio eradication efforts.
- #43 A Statistical Model of the International Spread of Wild Poliovirus in Africa Used to Predict and Prevent Outbreaks | PLOS Medicinehttps://journals.plos.org/plosmedicine/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001109
Outbreaks of poliomyelitis in African countries that were previously free of wild-type poliovirus cost the Global Polio Eradication Initiative US$850 million during 20032009, and have limited the ability of the program to focus on endemic countries. […] A quantitative understanding of the factors that predict the distribution and timing of outbreaks will enable their prevention and facilitate the completion of global eradication. […] The predictive ability of 6-mo-ahead forecasts of poliomyelitis outbreaks in each country based on the regression model was assessed. […] Six-month-ahead forecasts of the number of outbreaks in a country or region changed over time and had a predictive ability of 82%. […] Outbreaks of poliomyelitis resulted primarily from continued transmission in Nigeria and the poor immunisation status of populations in neighbouring countries.
- #44 A Statistical Model of the International Spread of Wild Poliovirus in Africa Used to Predict and Prevent Outbreaks | PLOS Medicinehttps://journals.plos.org/plosmedicine/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001109
Outbreaks of poliomyelitis in African countries that were previously free of wild-type poliovirus cost the Global Polio Eradication Initiative US$850 million during 20032009, and have limited the ability of the program to focus on endemic countries. […] A quantitative understanding of the factors that predict the distribution and timing of outbreaks will enable their prevention and facilitate the completion of global eradication. […] The predictive ability of 6-mo-ahead forecasts of poliomyelitis outbreaks in each country based on the regression model was assessed. […] Six-month-ahead forecasts of the number of outbreaks in a country or region changed over time and had a predictive ability of 82%. […] Outbreaks of poliomyelitis resulted primarily from continued transmission in Nigeria and the poor immunisation status of populations in neighbouring countries.
- #45 Analysis of vaccination campaign effectiveness and population immunity to support and sustain polio elimination in Nigeriahttps://pmc.ncbi.nlm.nih.gov/articles/PMC4812602/
The world is closer than ever to a polio-free Africa. […] In this end-stage, it is important to ensure high levels of population immunity to prevent polio outbreaks. […] We demonstrate how this approach can be used to plan the vaccination campaigns prospectively to better manage population immunity in Northern Nigeria. […] Estimated campaign effectiveness has improved across northern Nigeria since 2004, with Kano state experiencing an increase of 40 % (95 % CI, 2654 %) in effectiveness from 2013 to 2014. […] Immunity to type 1 poliovirus has increased steadily. […] We find that immunity estimates are related to the occurrence of both wild and vaccine-derived poliovirus cases and that campaign effectiveness correlates with direct measurements using lot-quality assurance sampling. […] The model in this study provides a novel method for assessing vaccination campaign performance and epidemiologically-relevant estimates of population immunity.
- #46https://www.who.int/news-room/fact-sheets/detail/poliomyelitis
One in 200 infections leads to irreversible paralysis. Among those paralysed, 510% die when their breathing muscles become immobilized. […] There is no cure for polio, it can only be prevented. […] Failure to stop polio in these last remaining areas could result in global resurgence of the disease. […] Most importantly, success will mean that no child will ever again suffer the terrible effects of lifelong polio-paralysis.
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