Zespół post-polio – Epidemiologia

Zespół post-polio
Epidemiologia

Zespół post-polio (PPS) to schorzenie neurologiczne manifestujące się nowymi lub postępującymi objawami osłabienia mięśniowego, zmęczenia i bólu u pacjentów po przebytym poliomyelitis, pojawiające się zwykle po 15-40 latach od pierwotnego zakażenia. Częstość występowania PPS jest zmienna i wynosi od 15% do 80% w populacji ozdrowieńców, z danymi epidemiologicznymi wskazującymi na około 28,5% w badaniu populacyjnym w USA (95% CI 24,4-32,6). Czynniki ryzyka rozwoju PPS obejmują ciężkość pierwotnego zakażenia, płeć żeńską, czas od zakażenia (szczyt po 30-34 latach), objawy oddechowe podczas ostrej fazy, wiek w momencie zakażenia oraz stopień powrotu do zdrowia. Diagnostyka opiera się na kryteriach EFNS, w tym potwierdzeniu odnerwienia neuronów ruchowych w EMG, stabilności funkcjonalnej przez co najmniej 15 lat, nowych objawach utrzymujących się minimum rok oraz wykluczeniu innych przyczyn klinicznych. PPS jest diagnozą wykluczającą, bez specyficznych testów laboratoryjnych czy obrazowych.

Epidemiologia zespołu post-polio

Częstotliwość występowania
Czynniki ryzyka
Czas występowania
Występowanie geograficzne

Nadzór nad zespołem post-polio

Systemy nadzoru
Kryteria diagnostyczne
Wpływ na jakość życia
Perspektywy i przyszłość
Kolejne rozdziały

Epidemiologia zespołu post-polio

Zespół post-polio (PPS, Post-Polio Syndrome) jest schorzeniem neurologicznym charakteryzującym się nowymi lub postępującymi objawami osłabienia mięśniowego, zmęczenia i bólu, które pojawiają się u osób, które przebyły poliomyelitis (chorobę Heinego-Medina) wiele lat po wstępnym zakażeniu. Objawy te występują zazwyczaj po długim okresie stabilności neurologicznej, trwającym od 15 do 40 lat po pierwotnym zachorowaniu.¹²³

Częstotliwość występowania

Dokładna częstość występowania PPS jest trudna do określenia i dane epidemiologiczne są zmienne. Według różnych źródeł, PPS dotyka od 15% do 80% osób, które przeżyły zakażenie polio.¹² Badania populacyjne przeprowadzone w hrabstwie Allegheny w Pensylwanii wykazały częstość występowania PPS na poziomie 28,5% wszystkich przypadków paralitycznych (95% przedział ufności 24,4-32,6).¹² Inne źródła podają wyższe wskaźniki – między 22% a 85%.¹² Nowsze dane z krajów, które skontaktowały się ze swoimi ozdrowieńcami po polio, pokazują, że nawet 85% z nich ma objawy PPS.¹²

Szacuje się, że na całym świecie około 15-20 milionów osób to ozdrowieńcy po polio, z czego 2 miliony mieszka w Ameryce Północnej, 700 000 w Europie i 60 000 we Francji.¹ W samych Stanach Zjednoczonych może być około 300 000 osób z objawami PPS.¹ W Wielkiej Brytanii szacuje się, że ponad 80% ze 120 000 ozdrowieńców po polio żyje z PPS.¹ W New Jersey może być nawet 30 000 ozdrowieńców zagrożonych rozwojem PPS.¹

Czynniki ryzyka

Kilka czynników zwiększa ryzyko rozwoju zespołu post-polio:

Ciężkość pierwotnego zakażenia – ryzyko PPS jest znacząco wyższe u pacjentów, którzy doznali znacznego trwałego uszkodzenia po polio.¹²³
Płeć żeńska – kobiety są bardziej narażone na rozwój PPS.¹²³⁴
Czas od pierwotnego zakażenia – najsilniejszym wyznacznikiem wystąpienia PPS jest długość odstępu od ostrej choroby, przy czym częstość występowania szczytuje po 30-34 latach.¹²
Objawy oddechowe podczas pierwotnego zakażenia.¹
Wiek w momencie zakażenia – jeśli polio rozwinęło się w wieku młodzieńczym lub dorosłym, a nie w dzieciństwie, zwiększa się ryzyko PPS.¹
Stopień powrotu do zdrowia po ostrym polio – im większe było odzyskanie funkcji, tym większe ryzyko PPS.¹

Czas występowania

PPS rozwija się średnio 30-35 lat po pierwotnym zakażeniu polio, jednak ten czas może wynosić od 8 do 71 lat.¹²³ U osób, które miały cięższy przebieg polio, PPS może wystąpić wcześniej – już po 10-20 latach, podczas gdy u osób z łagodnym przebiegiem polio opóźnienie może być dłuższe.¹ W badaniu obejmującym imigrantów nieeuropejskich w Norwegii stwierdzono, że objawy PPS pojawiły się 10-20 lat wcześniej (średnio w wieku 31 lat) w porównaniu z grupami imigrantów europejskich i rdzennych Norwegów.¹²

Występowanie geograficzne

Występowanie PPS ma charakter globalny, ale jego częstość różni się w zależności od regionu świata. Badania wykazały wyższe ryzyko PPS u imigrantów z regionów nieeuropejskich, szczególnie z Afryki i Azji, w porównaniu do osób urodzonych w krajach zachodnich.¹² Jest to szczególnie istotne dla systemów opieki zdrowotnej w krajach zachodnich, gdzie imigranci z regionów, w których polio nadal występuje, mogą wymagać specjalistycznej opieki.¹

PPS jest najbardziej rozpowszechnioną postępującą chorobą neuronu ruchowego w USA.¹ Dzięki powszechnemu stosowaniu szczepionki przeciwko polio, od 1965 roku wskaźnik zachorowalności na ostre polio w USA wynosi mniej niż 0,01 przypadków na 100 000 mieszkańców, a ostatni przypadek dzikiego polio w Stanach Zjednoczonych odnotowano w 1979 roku.¹ Jednak globalna eradykacja polio wciąż trwa, a w 2018 roku dziki wirus polio pozostawał endemiczny w Pakistanie i Afganistanie.¹

Nadzór nad zespołem post-polio

Systemy nadzoru

Nadzór nad polio i jego następstwami, w tym PPS, jest kluczowy dla globalnego programu eradykacji polio. Głównym elementem tego nadzoru jest system monitorowania ostrego wiotkiego porażenia (AFP – Acute Flaccid Paralysis).¹²³ System ten służy do wykrywania przypadków porażennego polio spowodowanego dzikim lub szczepionkowym wirusem polio.¹

Obecnie 179 z 194 państw członkowskich WHO prowadzi nadzór nad AFP i cotygodniowo składa raporty do regionalnych biur WHO i centrali WHO.¹² Liczba przypadków AFP zgłaszanych każdego roku jest wykorzystywana jako wskaźnik zdolności kraju do wykrywania polio, nawet w krajach, w których choroba już nie występuje. System nadzoru kraju musi być wystarczająco czuły, aby wykryć co najmniej jeden przypadek AFP na 100 000 dzieci poniżej 15 roku życia, nawet przy braku polio.¹²

Oprócz nadzoru klinicznego nad AFP, stosuje się również nadzór środowiskowy, który polega na badaniu ścieków lub innych próbek środowiskowych na obecność wirusa polio. Ten rodzaj nadzoru często potwierdza zakażenia dzikim wirusem polio przy braku przypadków porażenia.¹²

Kryteria diagnostyczne

Według kryteriów Europejskiej Federacji Towarzystw Neurologicznych (EFNS), uniwersalne kryteria diagnostyczne PPS obejmują:¹²³

Potwierdzoną historię odnerwiania neuronów ruchowych dolnego neuronu za pomocą elektromiografii (EMG) i badania neurologicznego
Potwierdzone częściowe lub prawie całkowite wyzdrowienie i stabilność funkcjonalną przez co najmniej 15 lat
Nowe lub zwiększone zmęczenie mięśni z lub bez uogólnionego zaniku mięśni lub bólu mięśni i stawów
Postępujący lub nagły początek osłabienia mięśni, które utrzymuje się przez co najmniej 1 rok
Wykluczenie innych stanów medycznych, które mogą powodować wyżej wymienione objawy

Diagnoza PPS jest diagnozą wykluczającą, bez specyficznych testów czy analiz, a rolą badania jest wykluczenie każdej innej możliwej przyczyny nowych objawów i pogorszenia klinicznego.¹²

Wpływ na jakość życia

PPS ma znaczący wpływ na jakość życia osób dotkniętych tym zespołem. Nowe objawy neuromięśniowe i zmiany funkcjonalne mogą prowadzić do znaczących ograniczeń.¹ PPS wpływa na wykonywanie codziennych czynności, co negatywnie oddziałuje na jakość życia pacjentów.¹

Badania wykazały, że osoby z PPS cierpią na niższe zdrowie psychiczne i fizyczne w porównaniu do innych osób.¹² Grupa imigrantów nieeuropejskich z polio w Norwegii zgłaszała więcej problemów zdrowotnych i społecznych, więcej zmęczenia, bólu i samotności, a także wysoki odsetek niewystarczającej pomocy ze strony publicznego systemu opieki zdrowotnej.¹²

Region	Szacowana liczba osób z PPS	Częstość występowania PPS wśród osób po polio
Ameryka Północna	2 miliony	25-40%
Europa	700 000	28,5% (badanie populacyjne)
Francja	60 000	Dane zgodne z europejskimi
Wielka Brytania	>80% ze 120 000 ozdrowieńców	>80%
USA	300 000	PPS jest najbardziej rozpowszechnioną postępującą chorobą neuronu ruchowego
New Jersey (USA)	30 000 osób zagrożonych	Brak dokładnych danych
Świat	15-20 milionów ozdrowieńców po polio, 20-80% z PPS	15-80% (w zależności od badania)

Perspektywy i przyszłość

Rokowanie w zespole post-polio jest zróżnicowane w zależności od tego, które mięśnie są dotknięte i nasilenia objawów.¹ W większości przypadków oczekiwana długość życia dla PPS jest dobra. PPS rzadko zagraża życiu, ale objawy mogą znacząco wpływać na codzienne funkcjonowanie.¹²

Objawy PPS postępują powoli u większości osób, z okresami nowych objawów, po których następują okresy stabilności.¹² Okresy stabilności mogą trwać od 3 do 10 lat.¹

PPS zniknie tylko dziesiątki lat po światowej eradykacji polio.¹ Dlatego ważne jest, aby utrzymać wysoki poziom szczepień przeciwko wirusowi polio, aby utrzymać eliminację poliomyelitis w Stanach Zjednoczonych do czasu osiągnięcia globalnej eradykacji.¹

Obecnie nie ma specyficznego leczenia PPS. Zamiast tego, opieka zdrowotna koncentruje się na zarządzaniu objawami i poprawie jakości życia.¹ Badania sugerują, że programy samopomocy dostosowane do PPS mogą znacząco poprawić przewlekłe objawy, samopoczucie, funkcje fizyczne i zrozumienie stanu.¹

Lekarze powinni być czujni na możliwe przypadki PPS wśród osób, które przeżyły polio. Ci pacjenci mogą wymagać skierowania do specjalistów rehabilitacji. Po właściwej diagnozie, pacjenci z PPS mogą również podjąć kroki w celu zarządzania swoim zdrowiem i zachowania zdolności do funkcjonowania.¹

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Materiały źródłowe

#1 Epidemiology of the post-polio syndrome – PubMed
https://pubmed.ncbi.nlm.nih.gov/1442743/
A late-onset syndrome, consisting of muscle weakness, muscle pain, and unaccustomed fatigue, has been reported with increasing frequency among former poliomyelitis patients. A population-based cohort of poliomyelitis patients from Allegheny County, Pennsylvania, was traced and surveyed to estimate the prevalence and incidence and to identify determinants of the post-polio syndrome. The prevalence of the post-polio syndrome was 28.5% of all paralytic cases (95% confidence interval 24.4-32.6). The risk of post-polio syndrome was significantly higher among patients who sustained substantial permanent impairment after polio and among females. The incidence did not vary with age at acute onset, acute severity, or level of physical activity after recovery. The strongest determinant of post-polio syndrome onset was the length of the interval following the acute illness, with incidence peaking at 30-34 years. Of all cases of post-polio syndrome, 79% reported no major change in impairment status since onset. This study demonstrates that poliomyelitis patients are not equally susceptible to post-polio syndrome within the interval of 30-40 years after the original illness. […] For syndrome cases, the onset was associated with new neuromuscular symptoms and functional changes but not with major new impairment.
#1
https://journals.lww.com/ijab/fulltext/2019/09030/postpolio_syndrome__a_review_of_lived_experiences.2.aspx
Postpolio syndrome (PPS) refers to a group of conditions that are present in patients, years after recovery from initial acute paralytic poliomyelitis. About 15%80% of 20 million polio survivors worldwide will experience exacerbation of symptoms which typically appear 1530 years after the resolution of initial poliomyelitis. […] PPS is the most prevalent progressive motor neuron disease in the USA. […] It is estimated that about 1520 million people are living with polio worldwide and about 20%80% of them will develop PPS, with 2 million in North America, 700,000 residing in Europe, and 60,000 in France. […] The severity and degree of recovery of the symptoms caused by the initial paralytic poliomyelitis determine the risk of developing PPS. […] The female gender and respiratory symptoms are the most important risk factors for developing PPS.
#1 Post-polio syndrome | MedLink Neurology
https://www.medlink.com/articles/post-polio-syndrome
Post-polio syndrome occurs in 22% to 85% of polio survivors. […] Onset of post-polio weakness ranges from 8 to 71 years from acute poliomyelitis. […] Data regarding the incidence and prevalence of post-polio syndrome are variable. […] The more severe the acute polio, the earlier new symptoms are likely to occur. […] In various series the average interval is about 35 years.
#1 POST POLIO SYNDROME – WILDROSE POLIO SUPPORT SOCIETY
https://polioalberta.ca/home/post-polio-syndrome/
Post-polio syndrome occurs in approximately 25 to 50 percent of people who survive a poliomyelitis infection. […] However newer data from countries that have contacted their polio survivors have shown 85% of their polio survivors to have symptoms of Post Polio Syndrome. […] On average, it occurs 30-35 years afterwards; however, delays of between 8-71 years have been recorded. […] The disease occurs sooner in persons with more severe initial infection. […] Other factors that increase the risk of post-polio syndrome include increasing length of time since acute poliovirus infection, presence of permanent residual impairment after recovery from the acute illness, and being female. […] Post-polio syndrome is documented to occur in cases of nonparalytic polio (NPP). One review states late-onset weakness and fatigue occurs in 14 to 42 percent of NPP patients.
#1 Post-Polio Syndrome | Living With Paralysis | Reeve Foundation
https://www.christopherreeve.org/todays-care/living-with-paralysis/health/causes-of-paralysis/post-polio-syndrome-poliomyelitis/
There is no vaccine or other medication that can prevent post-polio syndrome nor is there a way to predict who will develop it. […] The number of studies of post-polio syndrome are vast. […] Post-polio syndrome is not contagious. It is not caused by a virus. It is the result of previously damaged nerves from the initial polio event. […] There is no central system for reporting post-polio syndrome, but it is estimated that 300,000 individuals are survivors of polio in the United States and have mild to severe symptoms.
#1 The value of a post-polio syndrome self-management programme – Curtis – Journal of Thoracic Disease
https://jtd.amegroups.org/article/view/44758/html
Post-polio syndrome is characterised by symptoms of fatigue, pain and new-onset neuromuscular weakness, and emerges decades after the initial poliovirus infection. […] It is estimated that more than 80% of 120,000 polio survivors are living with PPS in the UK. […] A tailored self-management programme for PPS can significantly improve chronic symptoms, wellbeing, physical function and the understanding of the condition. […] A self-management programme for PPS can improve fatigue, the severity to which pain, atrophy and bulbar function issues are experienced and the overall knowledge of PPS, as well as physical function over a 6-month period.
#1 Department of Health | Communicable Disease Service | Post-Polio Syndrome
https://www.nj.gov/health/cd/topics/postpolio.shtml
Polio — once one of the most feared diseases in America — has nearly been eliminated in the U.S. through widespread immunization with polio vaccine. However, the health impact of past polio epidemics is still being felt. […] Many polio survivors are now experiencing new and disabling symptoms of Post-Polio Syndrome, a neurological disorder related to their earlier illness. In New Jersey alone, there may be as many as 30,000 survivors at-risk of having PPS. […] Physicians should be alert for possible cases of PPS among polio survivors. These patients may need to be referred to rehabilitation specialists. Once properly diagnosed, PPS patients can also take steps to manage their health and preserve their ability to function.
#1 Post-polio syndrome – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/post-polio-syndrome/symptoms-causes/syc-20355669
The more severe the initial infection, the more likely that you’ll have signs and symptoms of post-polio syndrome. […] If you developed polio as an adolescent or adult rather than as a child, your chances of developing post-polio syndrome increase. […] The greater your recovery after acute polio, the more likely it seems that post-polio syndrome will develop. […] If you often exercise to the point of exhaustion or fatigue, you might overwork already stressed-out motor neurons and increase your risk of post-polio syndrome. […] Post-polio syndrome is rarely life-threatening, but severe muscle weakness can lead to complications.
#1 Post-polio Syndrome: An Overview | O&P Virtual Library
http://www.oandplibrary.org/cpo/1987_02_074.asp
Poliomyelitis was a dreaded disease of developed countries, affecting tens of thousands of children and adults during each of the epidemic years up to the mid-1950s. […] Recently, it has become clear that some patients who had paralytic poliomyelitis may develop new complaints after decades of stable function. These new symptoms have been designated the „post-polio syndrome” (PPS) or „late sequella of poliomyelitis.” […] If this estimate is correct, over 50,000 persons in the U.S. are at risk of developing PPS. […] The risk of developing PPS appears to correlate with severity of the original poliomyelitis. […] The severity of the original onset of polio also seems to predict the latency of developing the syndrome; severely affected patients may develop new symptoms after only 10-20 years, whereas mildly affected patients are more likely to exhibit extended delays in time of onset of PPS.
#1 Journal of Rehabilitation Medicine – Polio and post-polio syndrome in non-Western immigrants: A new challenge for the healthcare system in Norway – HTML
https://www.medicaljournals.se/jrm/content/html/10.2340/16501977-2624
The non-Western immigrant polio group had a mean age of 46 years, were highly educated, reported high frequency of mental health problems and only one-third was working. […] Post-polio symptoms had started at a mean age of 31 years. […] The group of non-Western immigrants with polio in Norway reported more health and social problems than the group of Western immigrants with polio or the native Norwegian group with polio, even though they were younger and more highly educated. […] The non-Western immigrant group reported more fatigue, pain and loneliness, and a high proportion reported insufficient assistance from the public health system. […] The non-Western polio group reported new muscular weakness, loss of muscle size and volume and post-polio syndrome 10-20 years earlier after the acute onset compared with the Western immigrant and the Norwegian polio groups, and at a mean age of 31 years.
#1 The risk of post-polio syndrome among immigrant groups in Sweden | Scientific Reports
https://www.nature.com/articles/s41598-023-33240-w
To examine the risk of post-polio syndrome (PPS) in immigrant groups using native Swedish-born individuals as referents. This is a retrospective study. The study population included all individuals aged 18 years and older registered in Sweden. PPS was defined as having at least one registered diagnosis in the Swedish National Patient Register. The incidence of post-polio in different immigrant groups, using Swedish-born individuals as referents, was assessed by Cox regression, with hazard ratios (HRs) and 99% confidence intervals (CI). […] It is of importance to be aware of risks of PPS in immigrants settled in Western countries, and that it is more common in immigrants from regions of the world where polio is still prevalent. Patients with PPS need treatment and proper follow-up until polio has been eradicated through global vaccination programs.
#1 Acute Poliomyelitis: Practice Essentials, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/306440-overview
Epidemiology […] Because of widespread use of the poliovirus vaccine, the incidence rate has been less than 0.01 cases per 100,000 population since 1965. The last case of wild-type polio in the United States was in 1979. Rare cases have been reported of poliomyelitis resulting from live attenuated poliovirus vaccine, with the disease having been brought into the United States via people who have traveled to countries where polio is endemic or where an outbreak is occurring. These vaccine-derived poliovirus infections were last reported in the United States in 2005. They have been seen primarily in low-vaccination communities and isolated religious sects, with the latter often choosing not to participate in government-sponsored public health services, such as immunizations for infectious diseases.
#1 Acute Poliomyelitis: Practice Essentials, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/306440-overview
As of 2018, wild-type polio remained endemic in Pakistan and Afghanistan; by late April, cases for 2018 numbered one in Pakistan and seven in Afghanistan. In 2016, it was discovered that wild poliovirus transmission was also endemic in Nigeria, although the virus was not detected there in 2017 or, as of a May report by the Centers for Disease Control and Prevention (CDC), in 2018. (However, the CDC report stated that because of access limitations for poliovirus surveillance in insurgent-held areas of Nigeria, the virus could have continued to be transmitted in that country undetected.) […] Of acute poliovirus infections, 4-8% show only nonspecific illness, and 1-2% of infections finally result in neurologic symptoms. The incidence of paralytic diseases increases with young age, advanced age, recent hard exercise, tonsillectomy, pregnancy, and impairment of B-lymphocyte defenses. The mortality from acute paralytic poliomyelitis is 5-10%, but it can reach 20-60% in cases of bulbar involvement. […] Acute poliomyelitis has no racial predilection. […] The male-to-female ratio for acute poliomyelitis is 1:1. […] Most cases of acute poliomyelitis occur in the pediatric population. Infection or immunization against poliovirus provides lifelong protection.
#1 Chapter 12: Poliomyelitis | Manual for the Surveillance of Vaccine-Preventable Diseases | CDC
https://www.cdc.gov/surv-manual/php/table-of-contents/chapter-12-poliomyelitis.html
This chapter provides general guidance for vaccine-preventable disease surveillance, describing the disease background/epidemiology, case investigation and reporting/notification, disease case definitions, and activities for enhancing surveillance, case investigation, and outbreak control for poliomyelitis. […] Starting about 1540 years after the initial infection, about 2540% of paralytic polio survivors will develop post-polio syndrome (PPS). […] The poliomyelitis surveillance system serves to detect cases of paralytic polio caused by wild or vaccine-derived polioviruses into the United States. […] High coverage with poliovirus vaccine is required to maintain elimination of poliomyelitis in the United States until global eradication is achieved. […] The occurrence of this case, combined with the identification in wastewater in multiple counties, underscores the importance of maintaining high vaccination coverage to prevent paralytic polio in persons of all ages.
#1
https://chiro.org/cases/ABSTRACTS/Post-Poliomyelitis_Syndrome.shtml
Most developed countries eliminated paralytic poliomyelitis (polio) in the 1970s to 1980s. […] Hundreds of thousands of polio survivors worldwide are still at risk of developing the late effects of the disease. […] It is essential that health professionals be aware of these conditions and have an understanding of the underlying pathophysiology of the symptoms. […] During the post-polio eradication era, the rate of isolation of nonpolio enteroviruses remains a clinical yardstick for the surveillance of acute flaccid paralysis (AFP) cases in the field. […] Comprehensive AFP surveillance, which is essential for global certification of polio eradication, includes certification, containment, integration and eradication. […] Today, 179 of 194 the World Health Organization (WHO) member states conduct AFP surveillance and submit weekly AFP reports to WHO regional offices and WHO headquarters.
#1 Surveillance – GPEI
https://polioeradication.org/what-we-do/
Polio surveillance underpins the entire polio eradication initiative. Without surveillance, it would be impossible to pinpoint where and how poliovirus is still circulating. Polio surveillance identifies new cases and detects any circulation of poliovirus. […] Nationwide AFP (acute flaccid paralysis) surveillance is the gold standard for detecting cases of poliomyelitis. […] Environmental surveillance involves testing sewage or other environmental samples for the presence of poliovirus. Environmental surveillance often confirms wild poliovirus infections in the absence of cases of paralysis. […] The number of AFP cases reported each year is used as an indicator of a countrys ability to detect polio even in countries where the disease no longer occurs. A countrys surveillance system needs to be sensitive enough to detect at least one case of AFP for every 100 000 children under 15 even in the absence of polio.
#1
https://journals.lww.com/ijab/fulltext/2019/09030/postpolio_syndrome__a_review_of_lived_experiences.2.aspx
According to the European Federation of Neurological Societies taskforce on PPS, the universal criteria for diagnosing PPS include (a) confirmed history of LMN denervation using electromyography (EMG) and neurological examination; (b) confirmed partial- or near-complete recovery and functional stability for at least 15 years; (c) new or increased muscle fatigability with or without generalized muscle atrophy or muscle and joint pain; (d) progressive or sudden onset of muscle weakness which persists for at least 1 year; and (e) rule out of any other medical conditions that can cause the aforementioned symptoms. […] The management of PPS involves identifying the signs and symptoms to determine the best treatment available.
#1 Post-poliomyelitis syndrome | IMCRJ
https://www.dovepress.com/post-poliomyelitis-syndrome-peer-reviewed-fulltext-article-IMCRJ
Post-polio syndrome (PPS), a sub-category of the late effects of polio, is a neurologic disorder characterized by new weakness, muscle fatigability, general fatigue and muscle and joint pain in polio survivors. […] During the post-polio eradication era, the rate of isolation of nonpolio enteroviruses remains a clinical yardstick for the surveillance of acute flaccid paralysis (AFP) cases in the field. […] Comprehensive AFP surveillance, which is essential for global certification of polio eradication, includes certification, containment, integration and eradication. […] Today, 179 of 194 the World Health Organization (WHO) member states conduct AFP surveillance and submit weekly AFP reports to WHO regional offices and WHO headquarters. […] The diagnosis of PPS is an exclusion diagnosis with no specific test or analysis, and the role of the investigation is to rule out every other possible cause for the new symptoms and clinical deterioration. […] Interdisciplinary care is the best strategy for patients with PPS.
#1 The legacy of polio: 2 cases of post-polio syndrome and review
http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-50442022000300097
Post-polio syndrome (PPS) is a rare neurological disorder that affects 20-40% of paralytic and non-paralytic polio survivors. It is estimated that about 15 million people worldwide are survivors of the polio infection that occurred during the 1940s and 1950s, until the vaccine was first introduced. Its main characteristic is the appearance of de novo muscle weakness or its increase and atrophy, accompanied by other symptoms such as fatigue, joint, bone or muscle pain, intolerance to cold, and bulbar symptoms (involvement of swallowing, speech and breathing). PPS usually affects performance in daily activities with a negative effect on patients’ quality of life. […] The exact incidence and prevalence of PPS are unknown, for 2004 were estimated 250,000 patients with PPS in Europe and 20 million worldwide. Ragonese showed a prevalence of PPS of 31% in 2005 with predominance in women.
#1 Comparing Symptoms of Post-Polio Syndrome in Athlete and Non-Athlete Poliomyelitis Survivors – Physical Treatments – Specific Physical Therapy Journal
https://ptj.uswr.ac.ir/browse.php?a_id=235&sid=1&slc_lang=en&html=1
About 50 million people around the world have been affected by poliomyelitis. Of the patients who had polio, a significant number develop new symptoms known as Post-Polio Syndrome (PPS) many years after recovery from the initial attack. The people with a history of poliomyelitis do not equally suffer from PPS. On average, PPS emerges 30-35 years after poliomyelitis, however, this time may vary from 8 to 71 years. Muscular weakness, muscular atrophy and pain in the muscles and joints with fatigue are the main symptoms of PPS. Dysphasia, dysphonia and respiratory disorders are the other symptoms of PPS. About 18% to 29% of poliomyelitis survivors face these problems in their daily life. The exact reason for emerging PPS symptoms has not been found yet. The prevalence of PPS in the people with a history of polio still needs more studies. The research results indicate a high prevalence of PPS syndrome with regard to pain and fatigue, especially in non-athlete people. In a study on the prevalence of PPS syndrome and its risk factors, it was reported that on average 61.6% of the people with a history of polio show the symptoms of PPS and most of them are middle-aged. The current study results are consistent with the findings of researchers who concluded that the people with PPS suffer from a lower mental and physical health compared to the other people. Future research is suggested on the relationship between fatigue, pain, physical and mental health in PPS.
#1 Post-Polio Syndrome: What It Is, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/24584-post-polio-syndrome
The only way to prevent PPS is to prevent getting polio. The only way to do this is to get the polio vaccine. […] The prognosis (outlook) for post-polio syndrome (PPS) varies depending on which muscles are affected and the severity of symptoms. […] In most cases, the life expectancy for post-polio syndrome is good. PPS is rarely life-threatening.
#1 Post-polio Syndrome: Symptoms and Treatment | Doctor
https://patient.info/doctor/post-polio-syndrome
PPS affects 15-20 million people worldwide. It is estimated that PPS may occur in 28-75% of patients with previous polio. The time interval is usually around 35 years but may be 8-70 years after the acute polio episode. […] There is insufficient evidence to draw definite conclusions about the effectiveness of interventions for PPS. There is evidence that intravenous immunoglobulin, lamotrigine, muscle strengthening exercises and static magnetic fields may be beneficial but further investigation is needed to clarify whether any real and meaningful effect exists. […] The symptoms of post-polio syndrome are slowly progressive, with periods of stability lasting 3-10 years.
#1 The risk of post-polio syndrome among immigrant groups in Sweden | Scientific Reports
https://www.nature.com/articles/s41598-023-33240-w
The aim of this study was to examine the relative risk of PPS in foreign-born men and women compared to Swedish-born men and women. […] The main results of the study were that the risk of being diagnosed with incident PPS was higher in both men and women from Africa and Asia, and in men from Latin America. […] In conclusion, we found a higher risk of PPSs in individuals from non-Western regions, especially from Africa and Asia. It is of importance to be aware of PPS in the whole healthcare system in Western countries, and that it is more common in immigrants from regions of the world where polio is still prevalent. PPS patients need treatment and follow-up for their lifetime. PPS will only disappear decades after the worldwide eradication of polio.
#1 Post-Polio Syndrome: What It Is, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/24584-post-polio-syndrome
Post-polio syndrome (PPS) is a condition that can affect people several years after an initial polio infection. It causes gradual muscle weakness and atrophy. Theres no cure, so treatment focuses on managing symptoms. […] Post-polio syndrome affects people whove had polio. PPS develops 10 years or more after the original illness and can occur as late as 40 years afterward. […] Approximately 30% to 40% of people whove had polio will develop PPS. A person who was more severely affected by polio may develop a more severe case of PPS. […] Post-polio syndrome is rare because polio is rare. The polio vaccine has gotten rid of polio from the U.S. However, polio still exists in some countries, and cases of PPS still occur. […] Theres currently no specific treatment for post-polio syndrome (PPS). Instead, healthcare providers focus on managing symptoms and improving quality of life.
#2
https://journals.lww.com/ijab/fulltext/2019/09030/postpolio_syndrome__a_review_of_lived_experiences.2.aspx
Postpolio syndrome (PPS) refers to a group of conditions that are present in patients, years after recovery from initial acute paralytic poliomyelitis. About 15%80% of 20 million polio survivors worldwide will experience exacerbation of symptoms which typically appear 1530 years after the resolution of initial poliomyelitis. […] PPS is the most prevalent progressive motor neuron disease in the USA. […] It is estimated that about 1520 million people are living with polio worldwide and about 20%80% of them will develop PPS, with 2 million in North America, 700,000 residing in Europe, and 60,000 in France. […] The severity and degree of recovery of the symptoms caused by the initial paralytic poliomyelitis determine the risk of developing PPS. […] The female gender and respiratory symptoms are the most important risk factors for developing PPS.
#2 The legacy of polio: 2 cases of post-polio syndrome and review
http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-50442022000300097
Post-polio syndrome (PPS) is a rare neurological disorder that affects 20-40% of paralytic and non-paralytic polio survivors. It is estimated that about 15 million people worldwide are survivors of the polio infection that occurred during the 1940s and 1950s, until the vaccine was first introduced. Its main characteristic is the appearance of de novo muscle weakness or its increase and atrophy, accompanied by other symptoms such as fatigue, joint, bone or muscle pain, intolerance to cold, and bulbar symptoms (involvement of swallowing, speech and breathing). PPS usually affects performance in daily activities with a negative effect on patients’ quality of life. […] The exact incidence and prevalence of PPS are unknown, for 2004 were estimated 250,000 patients with PPS in Europe and 20 million worldwide. Ragonese showed a prevalence of PPS of 31% in 2005 with predominance in women.
#2 Epidemiology – Post Polio
https://post-polio.org/late_effect_polio/epidemiology/
Epidemiology is the study of disease in populations or groups rather than in individuals. Epidemiological studies provide important information about frequency, distribution, and the risks of developing a certain type of problem. […] Many studies of polio survivors have been done on small, select populations such as individuals who seek treatment at a post-polio clinic, members of a support group, or subscribers to a newsletter. Due to this self-selection, the results often are questioned. Another criticism is the lack of data from longitudinal studies. Below are short summaries and references of the best epidemiologic studies concerning post-polio syndrome (PPS) among polio survivors. […] A population-based study from Allegheny County, Pennsylvania, using a survey validated by clinical examination, found a prevalence of 28.5% of post-polio syndrome in all paralytic cases. The risk was higher in individuals who experienced substantial permanent impairment after polio and in females. The strongest indicator was the polio/post-polio interval â not age at acute onset, acute severity, or level of physical activity after recovery. Incidence peaked at 30-34 years post-onset (Ramlow et al., 1992). It should be noted that exceeding that interval does not exempt one from future post-polio problems. […] Analysis of the self-reported symptoms among NHIS survey participants suggests that at least 25% are likely to have PPS.
#2 Pharyngolaryngeal manifestations of post-polio syndrome
https://arquivosdeorl.org.br/conteudo/acervo_eng.asp?Id=820
The post-polio syndrome (PPS) is characterized by a new episode of atrophy or muscle weakness in individuals previously affected by poliomyelitis. […] The percentage of individuals that develop the PPS is not precisely known. In an epidemiological study performed at Mayo Clinic, it was observed that 25% of the patients that survive poliomyelitis presented late effects of the disease. […] The PPS pathogenesis remains unknown although several mechanisms have already been proposed: natural loss of motoneurons because of age in individuals with reduced numbers of neurons because of the previous poliomyelitis, accelerated loss of motoneurons because of the overload of the surviving cells, incapacity of surviving motoneurons to keep in constant operation, large motor territories after extensive reinnervation, changes in the brainstem producing central fatigue, autoimmunity and chronic infection by the virus.
#2 Post-polio syndrome – Wikipedia
https://en.wikipedia.org/wiki/Post-polio_syndrome
Old data show PPS occurs in roughly 25 to 50% of people who survive a polio infection. […] Newer data from countries that asked their polio survivors show 85% of respondents have symptoms of post-polio syndrome. […] Typically, it occurs 30-35 years afterward, but delays between 8 and 71 years have been recorded. […] The disease occurs sooner in those with more severe initial infections. […] Other factors that increase the risk of PPS include increasing length of time since acute poliovirus infection, presence of permanent residual impairment after recovery from the acute illness, and being female. […] PPS is documented to occur in cases of nonparalytic polio (NPP). One review states late-onset weakness and fatigue occur in 14-42% of NPP patients.
#2 POST POLIO SYNDROME – WILDROSE POLIO SUPPORT SOCIETY
https://polioalberta.ca/home/post-polio-syndrome/
Post-polio syndrome occurs in approximately 25 to 50 percent of people who survive a poliomyelitis infection. […] However newer data from countries that have contacted their polio survivors have shown 85% of their polio survivors to have symptoms of Post Polio Syndrome. […] On average, it occurs 30-35 years afterwards; however, delays of between 8-71 years have been recorded. […] The disease occurs sooner in persons with more severe initial infection. […] Other factors that increase the risk of post-polio syndrome include increasing length of time since acute poliovirus infection, presence of permanent residual impairment after recovery from the acute illness, and being female. […] Post-polio syndrome is documented to occur in cases of nonparalytic polio (NPP). One review states late-onset weakness and fatigue occurs in 14 to 42 percent of NPP patients.
#2 Journal of Rehabilitation Medicine – Polio and post-polio syndrome in non-Western immigrants: A new challenge for the healthcare system in Norway – HTML
https://www.medicaljournals.se/jrm/content/html/10.2340/16501977-2624
In the non-Western immigrant group, 79% reported that they thought they had post-polio syndrome. […] The non-Western immigrant group reported severe fatigue, with a mean FSS score of 5.5. […] Psychological problems and loneliness were reported more frequently in the 2 immigrant polio groups. […] The non-Western immigrant polio group had a higher level of education than the Western immigrant and the native Norwegian polio groups, with nearly half being educated at bachelor or higher university level. […] The non-Western immigrant polio group reported that the public health system did not cover their needs.
#2 The risk of post-polio syndrome among immigrant groups in Sweden | Scientific Reports
https://www.nature.com/articles/s41598-023-33240-w
The aim of this study was to examine the relative risk of PPS in foreign-born men and women compared to Swedish-born men and women. […] The main results of the study were that the risk of being diagnosed with incident PPS was higher in both men and women from Africa and Asia, and in men from Latin America. […] In conclusion, we found a higher risk of PPSs in individuals from non-Western regions, especially from Africa and Asia. It is of importance to be aware of PPS in the whole healthcare system in Western countries, and that it is more common in immigrants from regions of the world where polio is still prevalent. PPS patients need treatment and follow-up for their lifetime. PPS will only disappear decades after the worldwide eradication of polio.
#2 Surveillance – GPEI
https://polioeradication.org/what-we-do/
Polio surveillance underpins the entire polio eradication initiative. Without surveillance, it would be impossible to pinpoint where and how poliovirus is still circulating. Polio surveillance identifies new cases and detects any circulation of poliovirus. […] Nationwide AFP (acute flaccid paralysis) surveillance is the gold standard for detecting cases of poliomyelitis. […] Environmental surveillance involves testing sewage or other environmental samples for the presence of poliovirus. Environmental surveillance often confirms wild poliovirus infections in the absence of cases of paralysis. […] The number of AFP cases reported each year is used as an indicator of a countrys ability to detect polio even in countries where the disease no longer occurs. A countrys surveillance system needs to be sensitive enough to detect at least one case of AFP for every 100 000 children under 15 even in the absence of polio.
#2 Post-poliomyelitis syndrome | IMCRJ
https://www.dovepress.com/post-poliomyelitis-syndrome-peer-reviewed-fulltext-article-IMCRJ
Post-polio syndrome (PPS), a sub-category of the late effects of polio, is a neurologic disorder characterized by new weakness, muscle fatigability, general fatigue and muscle and joint pain in polio survivors. […] During the post-polio eradication era, the rate of isolation of nonpolio enteroviruses remains a clinical yardstick for the surveillance of acute flaccid paralysis (AFP) cases in the field. […] Comprehensive AFP surveillance, which is essential for global certification of polio eradication, includes certification, containment, integration and eradication. […] Today, 179 of 194 the World Health Organization (WHO) member states conduct AFP surveillance and submit weekly AFP reports to WHO regional offices and WHO headquarters. […] The diagnosis of PPS is an exclusion diagnosis with no specific test or analysis, and the role of the investigation is to rule out every other possible cause for the new symptoms and clinical deterioration. […] Interdisciplinary care is the best strategy for patients with PPS.
#2 Surveillance – GPEI
https://polioeradication.org/who-we-are/surveillance/
Polio surveillance underpins the entire polio eradication initiative. Without surveillance, it would be impossible to pinpoint where and how poliovirus is still circulating. Polio surveillance identifies new cases and detects any circulation of poliovirus. […] The number of AFP cases reported each year is used as an indicator of a country’s ability to detect polio even in countries where the disease no longer occurs. A country’s surveillance system needs to be sensitive enough to detect at least one case of AFP for every 100,000 children under 15 even in the absence of polio. […] Environmental surveillance involves testing sewage or other environmental samples for the presence of poliovirus. Environmental surveillance often confirms wild poliovirus infections in the absence of cases of paralysis. Systematic environmental sampling (e.g. in Egypt and Mumbai, India) provides important supplementary surveillance data. Adhoc environmental surveillance elsewhere (especially in polio-free regions) provides insights into the international spread of poliovirus.
#2 Post-Polio Syndrome – Post Polio
https://post-polio.org/late_effect_polio/pps/
Post-polio syndrome (PPS) is now recognized as a new neurological disorder that can develop in people with a past history of poliomyelitis. It has been given a unique code number in the 10th edition of the International Classification of Medial Disorders (ICD-10) in the Neurological Disorders section on Diseases of the Motor Unit. This allows it to be differentiated from simply a âlate effect of the viral infection of poliomyelitis,â which has a code in the Infectious Diseases Section. […] From a scientific research perspective the diagnosis of PPS is accurately given only to people who meet the following five criteria: a history of acute paralytic poliomyelitis with evidence of motor neuron loss; a period of partial or complete recovery followed by a period of stability of neurological functions; gradual or sudden onset of progressive new muscle weakness or abnormal muscle fatigability, with or without generalized fatigue, pain, muscle atrophy, breathing, or swallowing problems; symptoms persist for at least one year; exclusion of other neurological, medical, or orthopedic problems that account for the symptoms.
#2
https://chiro.org/cases/ABSTRACTS/Post-Poliomyelitis_Syndrome.shtml
Post-polio syndrome (PPS), a sub-category of the late effects of polio, is a neurologic disorder characterized by new weakness, muscle fatigability, general fatigue and muscle and joint pain in polio survivors. […] The diagnosis of PPS is an exclusion diagnosis with no specific test or analysis, and the role of the investigation is to rule out every other possible cause for the new symptoms and clinical deterioration. […] Interdisciplinary care is the best strategy for patients with PPS. […] Conservative treatment is a cornerstone of management of PPS. […] The goals of surgery include pain relief, deformity correction, muscle transfers to counter muscle force imbalance, stabilizing unstable joints, and allowing for more effective use of orthoses and braces.
#2 Comparing Symptoms of Post-Polio Syndrome in Athlete and Non-Athlete Poliomyelitis Survivors – Physical Treatments – Specific Physical Therapy Journal
https://ptj.uswr.ac.ir/browse.php?a_id=235&slc_lang=en&sid=1&ftxt=1&html=1
About 50 million people around the world have been affected by poliomyelitis. Of the patients who had polio, a significant number develop new symptoms known as Post-Polio Syndrome (PPS) many years after recovery from the initial attack. The people with a history of poliomyelitis do not equally suffer from PPS. On average, PPS emerges 30-35 years after poliomyelitis, however, this time may vary from 8 to 71 years. Muscular weakness, muscular atrophy and pain in the muscles and joints with fatigue are the main symptoms of PPS. About 18% to 29% of poliomyelitis survivors face these problems in their daily life. The exact reason for emerging PPS symptoms has not been found yet. The prevalence of PPS in the people with a history of polio still needs more studies. The research results indicate a 75% prevalence rate for the moderate and severe pains among the polio survivors, while Talebian et al. reported an 86% prevalence rate of fatigue in these people. The current study results are consistent with the findings of researchers such as Ostlund et al. who concluded that the people with PPS suffer from a lower mental and physical health compared to the other people. According to the literature, people with a history of polio who regularly do physical exercises enjoy more public health and complain less from arthritis, muscular pain, fatigue and functional disorders as compared to the inactive survivors of polio. The results of various studies in this field indicate that the quality of life of people with a history of polio, especially in terms of physical aspects, may significantly be decreased with increasing age in males and females. Future research is suggested on the relationship between fatigue, pain, physical and mental health in PPS.
#2 Polio | Post-Polio Syndrome | PPS | MedlinePlus
https://medlineplus.gov/polioandpostpoliosyndrome.html
Post-polio syndrome (PPS) is a condition that affects polio survivors many years after they recovered from polio. It usually happens 15-40 years later. It is not contagious. […] PPS is rarely life-threatening, but the symptoms can interfere with your daily life. […] ClinicalTrials.gov: Postpoliomyelitis Syndrome From the National Institutes of Health.
#2 Post-polio syndrome – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/post-polio-syndrome/symptoms-causes/syc-20355669
Post-polio syndrome is a group of potentially disabling signs and symptoms that appear decades after the initial polio illness. These signs and symptoms usually appear between 30 to 40 years after having polio. […] Today, very few people in developed countries are paralyzed from the polio virus, usually related to a reaction from one form of the vaccine. However, there remain many people who had polio at a young age who now later in life might develop the post-polio syndrome. […] Post-polio syndrome only affects people who had polio. […] Post-polio syndrome progresses slowly in most people. They may experience new signs and symptoms followed by periods of stability. […] There are several theories as to what causes post-polio syndrome, but no one knows for sure. […] Factors that can increase your risk of developing post-polio syndrome include:
#3 Improving Strength and Fatigue Resistance in Post-Polio Syndrome Individuals with REAC Neurobiological Treatments
https://www.mdpi.com/2075-4426/13/11/1536
Post-Polio Syndrome (PPS) is a chronic condition characterized by the emergence of new symptoms and functional decline in individuals who previously had polio. […] The percentage of polio patients affected by PPS varies widely, ranging from 20% to 85%, depending on the diagnostic criteria utilized. […] The disease manifests at least 15 years after the initial polio infection, presenting symptoms such as muscle weakness, fatigue, muscle pain and or joint pain, cold intolerance, cramps, sleep disorder, reduced functional capacity, thus negatively affecting the quality of life of these individuals. […] Emerging muscle weakness and fatigue are among the most frequent and debilitating late symptoms of poliomyelitis, causing significant functional impairment in the functional capacity of people with PPS.
#3 Post-polio syndrome – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/post-polio-syndrome/symptoms-causes/syc-20355669
The more severe the initial infection, the more likely that you’ll have signs and symptoms of post-polio syndrome. […] If you developed polio as an adolescent or adult rather than as a child, your chances of developing post-polio syndrome increase. […] The greater your recovery after acute polio, the more likely it seems that post-polio syndrome will develop. […] If you often exercise to the point of exhaustion or fatigue, you might overwork already stressed-out motor neurons and increase your risk of post-polio syndrome. […] Post-polio syndrome is rarely life-threatening, but severe muscle weakness can lead to complications.
#3 Post-polio syndrome – Wikipedia
https://en.wikipedia.org/wiki/Post-polio_syndrome
Old data show PPS occurs in roughly 25 to 50% of people who survive a polio infection. […] Newer data from countries that asked their polio survivors show 85% of respondents have symptoms of post-polio syndrome. […] Typically, it occurs 30-35 years afterward, but delays between 8 and 71 years have been recorded. […] The disease occurs sooner in those with more severe initial infections. […] Other factors that increase the risk of PPS include increasing length of time since acute poliovirus infection, presence of permanent residual impairment after recovery from the acute illness, and being female. […] PPS is documented to occur in cases of nonparalytic polio (NPP). One review states late-onset weakness and fatigue occur in 14-42% of NPP patients.
#3 Post-Polio Syndrome: What It Is, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/24584-post-polio-syndrome
Post-polio syndrome (PPS) is a condition that can affect people several years after an initial polio infection. It causes gradual muscle weakness and atrophy. Theres no cure, so treatment focuses on managing symptoms. […] Post-polio syndrome affects people whove had polio. PPS develops 10 years or more after the original illness and can occur as late as 40 years afterward. […] Approximately 30% to 40% of people whove had polio will develop PPS. A person who was more severely affected by polio may develop a more severe case of PPS. […] Post-polio syndrome is rare because polio is rare. The polio vaccine has gotten rid of polio from the U.S. However, polio still exists in some countries, and cases of PPS still occur. […] Theres currently no specific treatment for post-polio syndrome (PPS). Instead, healthcare providers focus on managing symptoms and improving quality of life.
#3 Post-poliomyelitis syndrome | IMCRJ
https://www.dovepress.com/post-poliomyelitis-syndrome-peer-reviewed-fulltext-article-IMCRJ
Post-polio syndrome (PPS), a sub-category of the late effects of polio, is a neurologic disorder characterized by new weakness, muscle fatigability, general fatigue and muscle and joint pain in polio survivors. […] During the post-polio eradication era, the rate of isolation of nonpolio enteroviruses remains a clinical yardstick for the surveillance of acute flaccid paralysis (AFP) cases in the field. […] Comprehensive AFP surveillance, which is essential for global certification of polio eradication, includes certification, containment, integration and eradication. […] Today, 179 of 194 the World Health Organization (WHO) member states conduct AFP surveillance and submit weekly AFP reports to WHO regional offices and WHO headquarters. […] The diagnosis of PPS is an exclusion diagnosis with no specific test or analysis, and the role of the investigation is to rule out every other possible cause for the new symptoms and clinical deterioration. […] Interdisciplinary care is the best strategy for patients with PPS.
#3 Post-polio syndrome presenting as isolated neck extensor myopathy: a case report – Chu – AME Case Reports
https://acr.amegroups.org/article/view/7667/html
Post-polio syndrome (PPS) is characterized by new or worsening muscular weakness, atrophy, muscle and joint pain, and muscle fatiguability decades after paralytic poliomyelitis infection. […] Survivors frequently recover only partially from their paralysis. It has been proposed that a certain amount of recovery is due to the ability of unaffected neighboring nerve cells to sprout and reconnect to the paralyzed muscles. The gradual and latent deterioration of muscle weakness is related to years of overuse of the compensatory motor units that can no longer respond properly, unveiling the neurological impairment caused by the initial illness. […] The European Federation of Neurological Societies (EFNS) criteria for the diagnosis of PPS are as follows: (I) previous episode of paralytic polio; (II) rehabilitation followed by over 15 years of steady neuromuscular function; (III) new or worsening muscle weakness; (IV) symptoms last at least a year; (V) exclusion of other possible causes of symptoms. Common symptoms include muscle weakness, fatigability, and muscle and joint pain, which are hypothesized to be caused by muscle overuse, leg length discrepancy, asymmetric biomechanics, asymmetric loading on the axial spine, and age-related changes.
#4 What Is Post-polio Syndrome?
https://www.icliniq.com/articles/infectious-diseases/post-polio-syndrome
Post-polio syndrome is a condition affecting the nerves and muscles in individuals who have recovered from a polio infection after many years. […] The incidence of post-polio syndrome ranges from 22 to 68 %. The prevalence of post-polio syndrome is 28.5 % in paralytic polio cases. Studies have suggested that all the individuals affected with polio have a 100 % chance of developing at least one sign of post-polio syndrome. The risk of post-polio syndrome is higher among individuals who sustained a permanent impairment. […] The post-polio syndrome has a female predilection. Studies based on surveys have shown that fatigue and pain are common among women. […] People between the ages of 30 and 34 with a history of polio infection have a higher incidence of presenting with post-polio syndrome.