Poliomyelitis and the postpolio syndrome

Introduction

In the first half of the 20th century, poliomyelitis was widely feared. It often struck without warning, was highly contagious, and affected large, young populations, causing prolonged or permanent flaccid paralysis or death. There are arresting and disturbing accounts of the explosive nature of polio epidemics and the response of communities to these outbreaks.1 The effective control of poliomyelitis throughout most of the world has been a remarkable story of scientific and social progress. However, “wild” poliomyelitis is still endemic in parts of sub-Saharan Africa and the Indian subcontinent, and it continues to occur sporadically elsewhere. In addition, there is a small incidence of vaccine induced polio in infants and adults. Global eradication remains a goal of the World Health Organization and of public health policies throughout the world, with the eventual discontinuation of routine immunisation.2^–4

Acute poliomyelitis is now rarely encountered in the United Kingdom, but “imported” poliomyelitis still occurs and it is necessary to distinguish acute poliomyelitis from other causes of acute flaccid paralysis. Despite the obvious success of preventive policies, many patients who had poliomyelitis experience late functional deterioration after periods of prolonged stability—the so called postpolio syndrome. The patterns of disability and their management present unique challenges to the multidisciplinary rehabilitation team.

Methods

This review is based on personal experience and the advice of numerous physicians and surgeons, in particular the combined expertise of my colleagues at the Lane Fox Unit at St Thomas' Hospital. In preparing the article, Iaccessed archive literature, departmental review papers,5 6 the library, Medline searches via Ovid, and websites of patient groups involved in the care of people with polio and postpolio functional deterioration.

The disease

Poliomyelitis is caused by an enterovirus of high infectivity whose mainroute of infection is via the human gastrointestinal tract. There are threesubtypes of …