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Introduction
A case study on the case of poliomyelitis is carried out. The main key about this case study is to find out all the possible information regarding to this poliomyelitis. The reason why I choose this disease because it make me more curious to know more about polio after I watched a television film named Warm Springs that portrayed the U.S President Franklin D. Roosevelt was diagnosed with polio in 1921 and his fight to overcome the paralysis.
Background
Polio or poliomyelitis is an infectious disease that is caused by the poliovirus. This disease is also been considered as the disabling and life-threatening to human. It was been stated that 0.5 % of the cases people suffer muscle weakness and as a result caused them unable to move. This disease can exist over a few hours to a few days. The most fragile part is legs but the less common are muscles of the head, diaphragm and neck. The percentages polio that caused muscle weakness among all type of ages:
- 2 to 5 % are children,
- 15 to 30% are adults die
- 70% are infected with no symptoms
- 25% have minor symptoms
- 5% of people suffered headache, neck pain and pains in the legs and arms.
They normally back to normal in 1 or 2 weeks and also need years to recover. But, not for post-polio syndrome may existed but with slow evolution of muscle weakness that is almost similar to the person that had the initial infection.
To be exact, polio has existed for thousands of years. It was discovered by an Egyptian carving illustrate a young man with a leg abnormality similar to one caused by polio from 1400BCE. It has been circulated in human population at low levels and arise to be relatively uncommon disease in the 1800s. Polio outbreak spread in late 19th century in Europe and United States. In 1900s, polio outstretch epidemic proportions when at that time, other diseases such as tuberculosis, diphtheria and typhoid were decreasing. The infants were bare to polio through water supplies that have been polluted. The infants immune systems was supported by their maternal antibodies flowing in their blood that could conquer the poliovirus and build their lasting immunity. An English physician, Michael Underwood was the first person to recognize polio as a distinct condition. The Austrian immunologist, Karl Landsteiner was the one who discovered the virus in 1908. During the 20th century, this disease has been labelled as the most worrying disease among children. The first polio vaccine was developed in 1950s by Jonas Salk, then the oral vaccine was created by Albert Sabin that had been used until today. In 2013, World Health Organization (WHO) hope for vaccination struggle and early detection of cases until eradication of the disease by 2018.
So, how it can be spread? This virus can be spread from one person to another person through infected fecal matter that enters the mouth. Other than that, its also can be spread by food or water that contain human feces and less commonly from infected saliva. Those who infected are more likely to be concerned because they do not shown any symptoms of the disease even up to 6 weeks and probably spread the disease. To diagnose the disease by detecting the virus in blood by looking at the antibodies that fight up against the virus or finding the virus in the humans feces. If you have not been vaccinated, the chance of having poliomyelitis is high. You can be infected if you are:
- Travelling to places that had declared a recent polio outbreak,
- Pregnant women or people with weak immune systems,
- People with positive HIV and young children are at the mercy of getting poliovirus,
- Handling a laboratory specimen,
- Taking care of the infected person or live someone with polio.
Type of polio and symptoms
Up to 90 to 95% of people who affected by poliovirus are asymptomatic known as subclinical polio that does not have any symptoms, but still they are spreading the virus and cause infection to other people.
(i) Non-paralytic polio (abortive polio)
This type of polio symptoms can last from 1 to 10 days. The symptoms of this polio can be common one, flu-like or:
- Fever
- Sore throat
- Headache
- Vomiting
- Fatigue
- Meningitis
(ii) Paralytic polio
1% of the cases can be paralytic polio that can lead to paralysis in the spinal cord (spinal polio), brainstem (bulbar polio) or both (bulbospinal polio). The first symptoms are similar to non-paralytic polio. After 1 week, the symptoms will appear to be more serious:
- Loss of reflexes
- Severe spams and muscle pain
- Sloppy and loose limbs and sometimes just one side of the body
- Temporary, permanent or sudden paralysis
- Injured limbs especially the hips, ankles and feet.
It is very unusual cases for people who infected by polio to have a full paralysis. It is estimated that less than 1% will get permanent paralysis. 5-10% of the cases where the virus attacked the muscles that help you to live and can cause death.
(iii) Post-polio syndrome
There is a possibility for the recovered patient to be attack by polio that can happen in 15 to 40 years. It is also approximately that 20-25% of people who survived polio will get post-polio syndrome. The symptoms that may occur are:
- Continuation of muscle and joint weakness
- Muscle pain gets more worse
- Easy to get tired or drowsiness
- Muscle atrophy (muscle wasting)
- Struggle to breath and swallow
- Sleep-related problem or sleep apnea that have trouble to breath and others
Causes of polio
Polio is caused by the infection of Enterovirus known as poliovirus, PV. The RNA virus colonize the gastrointestinal tract oropharynx and intestine. The time ranges for the PV to incubate from three to thirty-five days or the common length of time can be from six to twenty days. After the time length, the PV infects and causes disease in humans. PV has a structure of a single RNA genome with enclosed protein shell, which is capsid. The function of capsid is to enable PV to damage certain cell. PV has 3 group of serotypes, Poliovirus type 1 (PV1), Poliovirus type 2 (PV2), and Poliovirus type 3 (PV3). The three serotypes have slightly non-identical capsid protein. All three of the PVs are extremely virulent and create the same disease symptoms.
PV1 has the most commonly to produce and most directly associated with paralysis. There are two possibility the virus can be transmitted. The first one is by fecal-oral route (intestinal source) and oral-oral route (oropharyngeal source). Fecal-oral route is caused by ingesting the contaminated food and water. In the endemic area, this wild PV can cause contaminate and entire human population. The PV occurs is seasonal in the temperate climates and the peak occur in summer and autumn. It is less seasonal in the tropical areas. The incubation time for the PV are from six to twenty days and a maximum length of three to thirty-five days of the first symptoms to show. The virus particle are excreted in the feces and takes about several weeks to get the initial infection. For the oral-oral route, it is frequently can be transmitted by the oral-oral route whereby it can visibly can be in an areas that have better disinfection and cleanliness. The spreading of the virus is possible as long as the virus stay around in the saliva or feces.
The risk of polio infection can increased by the immune deficiency, malnutrition, physical activity that have an immediate of the onset to paralysis, injuries involve skeletal muscles that caused by the injection of vaccines or therapeutic agents and pregnancy. For the pregnancy part, the fetus does not get to be infected by the virus as the maternal antibodies give the passive immunity that can save the infants from the infection of polio during the first few months of survivorship.
[image: C:UsersHPDesktopSEM 4 NOTESCSC134endemicpolio19882018_final02.png]STATISTIC / DATA Sources from: https://www.cdc.gov/polio/images/maps/endemicpolio19882018_final02.png
The data above shown the polio cases over the past 26-years.It is estimated the number of worldwide polio cases has fallen from 350,000 in 1988 to 407 in 2013, declining of more than 99% in the polio cases that have been reported. There are four regions that have been announced as polio-free, for example, the Western Pacific, the Americas, South East Asia and Europe. Afghanistan, Nigeria and Pakistan are considered to be the only three countries that still have polio endemic, whereas these three countries have never disturbed the spreading of the wild PV. 17 million or more than that, people are currently healthy would have been petrified by the virus. This could not be done by the efforts of people in fighting against the polio eradication.
As for the polio case in Malaysia, it is reported that in 2020, it is involved one case only, and in 2019, a total number of 3 cases were reported and still remain the same until now. The polio made its first comeback on 8 December 2019 after 27 years in Malaysia. The first case was involving a three-month old boy from Tuaran, Sabah was admitted to the intensive care unit.
Solution
There are two type of solution was created to fight back over the disease which are:
- Passive immunization
- Polio vaccine
1. Polio immunization
Polio immunization was created by William Hammon in 1950 at the University of Pittsburgh. He discovered that by purifying the gamma globulin component of polio survivors blood plasma. He also come up with the gamma globulin that carried the antibodies to poliovirus by helping to stop the spreading of the poliovirus, and contract the strength of the polio in other patients that had eased polio. Thus, during the large clinical trial, Henrys polio immunization, the gamma globulin shown 80% of successfulness in reducing the evolution of paralytic poliomyelitis and preventing the less severe of the disease towards the patients that already have the polio. This solution cannot be used until now because the limitation of blood plasma gamma globulin supplies. This method was really unrealistic to use for worldwide. As a result, this solution is not used anymore and a group of medical helped each other to concentrate to find the suitable invention of polio vaccine.
2. Polio vaccine
A virologist named Hilary Koprowski was the first person to invent the 1st polio vaccine. It is based on a live weakened virus that can be identified as one of the serotype. In 27 February 1950, the very first polio vaccine was inspected to an 8 year old boy. The vaccine itself was fully function in Belgian Congo in the 1950s. Between 1958 and 1960, 7 million children that had PV1 and PV3 were given vaccination.
In 1952, Jonas Salk from University of Pittsburgh invented the second vaccine and use to the widespread in 12 April 1955. Salk vaccine was known as inactivated poliovirus vaccine that was based on the growth of the poliovirus in a type of monkey kidney tissue- tissue culture. Injection method was used to vaccine people. Hence, 90% and above of the individuals shown the development in their protective antibody to the three types of the serotypes poliovirus for 2 doses. Three doses can be used were as 99% are immune to the PV.
Another polio vaccine was developed, it was oral polio vaccine. This vaccine was created by Albert Sabin. It was created with the replicated passage of the virus that went into the non-human cell at sub-physiological temperature. The duplication was very lucid in the gut, where the primary site of wild PV infection and replication, but not able to photocopy structured with the nervous system tissue. About 50% of the receiver was given a single dose of Sabins oral polio vaccine made immunity to PV1, PV2 and PV3. 95% of the receiver were given three doses of oral vaccine generate productive antibody to the three type of serotypes: PV1, PV2 and PV3. In 1957, the Sabins vaccine was tested to human and in 1958, the vaccine was chosen, as the vaccine itself was also in competition with other researchers live vaccine including Koprowski vaccine by the US National Institutes of Health. Sabins vaccine was licensed in 1962 and been considered the only oral polio vaccine used by the widespread.
The oral polio vaccine was chosen because it is inexpensive, easy to administrator and generate a superb immunity in the intestine by reducing the infection with wild virus in endemic areas. Sabins vaccine has been declared as vaccine of the choice as it authorise poliomyelitis in many countries.
Ways to improve
There is no cure for polio but can be prevented by vaccination. Moreover, some of the prevention step can be applied in order to fight against polio. A few common supportive treatments can be used:
- Bed rest,
- Painkillers,
- Antispasmodic drugs to relax muscle,
- Portable ventilators to help with breathing,
- Physical therapy to treat pain in the affected muscles, to address breathing and pulmonary problems or corrective braces to help with walking,
- Pulmonary rehabilitation to increase lung endurance,
- Advanced cases of leg weakness wheelchair or other mobility devices.
A lot of polio survivors with permanent respiratory paralysis used modern jacket-type negative ventilators that they wore over the chest and abdomen. Other historical treatment of polio also included surgical treatments such as tendon lengthening and nerve grafting, massage and passive motion exercises and so on.
Conclusion
In a nutshell, from this case study, we can conclude that polio is known as poliomyelitis is a life-threatening disease that can spread from a person to another person. Other than that, there is no cure for this disease, yet, we can prevent ourselves from getting this disease because prevention is better than cure.
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