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Section 3. Summaries of Infectious Diseases
Poliovirus Infections
Clinical ManifestationsEtiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
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CLINICAL MANIFESTATIONS
Approximately 95% of poliovirus infections are asymptomatic. Nonspecific illness with low-grade fever and sore throat (minor illness) occurs in 4% to 8% of people who become infected. Aseptic meningitis, sometimes with paresthesias, occurs in 1% to 5% of patients a few days after the minor illness has resolved. Rapid onset of asymmetric acute flaccid paralysis with areflexia of the involved limb occurs in 0.1% to 2% of infections, and residual paralytic disease involving the motor neurons (paralytic poliomyelitis) occurs in approximately two thirds of people with acute motor neuron disease. Cranial nerve involvement and paralysis of respiratory tract muscles can occur. Findings in cerebrospinal fluid (CSF) are characteristic of viral meningitis with mild pleocytosis and lymphocytic predominance.
Adults who contracted paralytic poliomyelitis during childhood may develop the noninfectious postpolio syndrome 30 to 40 years later. Postpolio syndrome is characterized by slow and often significant onset of muscle pain and exacerbation of weakness.
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ETIOLOGY
Polioviruses are enteroviruses and consist of serotypes 1, 2, and 3.
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EPIDEMIOLOGY
Poliovirus infections occur only in humans. Spread is by the fecal-oral and respiratory routes. Infection is more common in infants and young children and occurs at an earlier age among children living in poor hygienic conditions. The risk of paralytic disease after infection increases with age. In temperate climates, poliovirus infections are most common during summer and autumn; in the tropics, the seasonal pattern is less pronounced.
The last reported case of poliomyelitis attributable to indigenously acquired, wild-type poliovirus in the United States occurred in 1979 and was caused by a wild type 1 poliovirus. In that outbreak, 10 paralytic cases and 4 other poliovirus infections occurred among unimmunized people. The
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