Polio (Poliomyelitis) in baby & child

Poliomyelitis (polio) is an acute viral infection accompanied by fever. Most of the time, the disease progresses without being noticed, or it resembles a flu-like infection. However, if the poliovirus infects the nerve cells in the spinal cord, permanent paralysis can occur or, in rare cases, even lead to death.

Only less than one percent of those infected suffer from the paralysis that gives the disease its name. However, thanks to widespread vaccination, there are hardly any cases of polio left in industrialized countries. According to the World Health Organization (WHO), poliomyelitis is expected to be completely eradicated worldwide.

The causative agent of polio is the poliovirus. In most cases, the infection is fecal-oral. This means that the infected child excretes the pathogens with the stool, the viruses enter the food cycle and enter the body again with the food. Therefore, there is also an increased risk of infection for the parents of the infected child. Infection can occur, for example, through diaper changing or food preparation.

Shortly after infection, person-to-person infection is also possible through droplet infection.

A person infected with polio is already infectious 36 hours after infection and can infect other people unnoticed for several weeks.

Polio has a phased course of disease. The first phase (six to nine days after infection) is characterised by the multiplication of the viruses. Nonspecific symptoms of the disease appear, which are similar to those of influenza. For the most part (over 95 percent), the disease heals after the initial symptoms subside.

Only in about one or two people out of 100 affected, the pathogen enters the central nervous system after a symptom-free period of about one week (second phase of the disease). If this occurs, the affected child suffers from meningitis, which can result in motor disorders or even paralysis.

Rarely, the basal brain areas can also be affected by the inflammation. As a result, paralysis of the nerves responsible for swallowing, as well as for respiratory and circulatory regulation occurs. This form of polio poses a particular danger.

The following symptoms can occur during the first phase of the disease:

• Fever
• Nausea and vomiting
• Sore throat and difficulty swallowing
• Headache and pain in the limbs

Symptoms of the second phase of the disease are:

• Fever - Headache
• Stiff neck
• Back pain
• Muscle pain
• Flaccid asymmetric paralysis resulting in increasing muscle atrophy, leg shortening and stiffness, especially in the legs.
• No sensory disturbances

If these characteristics occur, a doctor should be consulted immediately.

Often the doctor can already recognize polio by the characteristic symptoms and the typical course of fever. In addition, the doctor will also check for signs of meningitis by palpating the neck to see if it is painfully stiff. Laboratory tests can also provide information about a possible disease. The viruses can be detected in the stool, as well as in cells of the throat and in cerebrospinal fluid (CSF).

Polio can also be detected by certain proteins of the immune system (antibodies) in the blood.

If poliomyelitis of the nervous system is suspected, the doctor performs a lumbar puncture. If antibodies against the virus are detected in the blood, this does not necessarily mean that the viruses have also affected the nervous system.

A therapy against the causative agent of polio has not yet been discovered. For this reason, treatment is aimed solely at treating the existing symptoms. If poliomyelitis is accompanied by no signs of paralysis, hospitalisation can usually be dispensed with.

However, as soon as paralysis occurs, the course of the disease must be monitored in hospital, as swallowing or breathing paralysis may also occur.

After an acute poliomyelitis, a longer-term movement therapy with physiotherapeutic and orthopaedic methods is carried out, so that there are no late consequences of the paralysis of muscles and spine.

In most cases, the course of poliomyelitis is positive. Nevertheless, severe paralysis can remain if the nervous system is affected by the viruses. Very rarely, polio can also be fatal.

As a late consequence, the so-called post-polio syndrome (PPS) often occurs. In this case, symptoms recur years after the first signs of paralysis:

• Pain - Increasing weakness and paralysis in muscle groups that were not affected.
• Muscle degeneration (atrophy)
• Rapid fatigue

These symptoms are due to the constant overloading of the weakened musculature.

The only effective measure to prevent polio is vaccination. Since 1998, oral vaccination with inactivated but live polio viruses has been discouraged. Instead, vaccination with killed viruses is now administered.

Vaccination against polio is one of the recommended standard vaccinations given to children as part of a routine check-up with a paediatrician. To ensure basic immunization, children receive four doses of vaccine within the first two years of life. A booster is recommended between the ages of nine and 17.