Snapshot A 2-month-old girl is brought to the pediatrician for a routine well-baby visit. She is due for multiple vaccines, including the polio vaccine. Her mother is concerned about potential post-vaccine poliomyelitis, something she has heard about from her friends abroad. The pediatrician reassures her that the vaccine responsible for that is a live-attenuated vaccine. The vaccine they will administer to the baby today is inactivated and safe. Introduction Classification poliovirus a single-stranded (+) RNA virus a picornavirus and enterovirus transmission fecal-oral Associated conditions poliomyelitis meningitis Prevention vaccines live-attenuated oral polio vaccine (OPV) developed by Sabin may be associated with vaccine-associated paralytic poliomyelitis and thus, no longer offered in the United States and most high-income countries inactivated polio vaccine (IPV) developed by Jonas Salk 4 doses for infants from 2 months of age to 4-6 years of age Epidemiology Incidence endemic in areas of Asia and Africa Demographics affects children ETIOLOGY Pathogenesis replicates in oropharynx and small intestines and spreads to the central nervous system via bloodstream destroys the anterior horn of the spinal cord, causing lower motor neuron cell death Presentation Symptoms poliomyelitis meningitis headache vomiting stiff neck myalgias Physical exam systemic signs of infection fever and malaise lower motor neuron lesion asymmetric weakness asymmetric hypotonia flaccid paralysis legs > arms fasciculations decreased or absent reflexes muscle atrophy normal sensory exam Studies Labs cerebral spinal fluid ↑ white blood cells ↑ protein normal glucose presence of viral RNA viral isolation stool throat Making the diagnosis based on clinical presentation and laboratory studies Differential Werdnig-Hoffmann disease distinguishing factor both affect the anterior horns of the spinal cord but Werdnig-Hoffmann presents with symmetric weakness Guillain-Barré syndrome distinguishing factor symmetric weakness Treatment Management approach mainstay of treatment is supportive care management is focused on vaccine and prevention Conservative physical therapy and occupational therapy indication all patients respiratory support indication disease progression to respiratory system Complications Progression to respiratory failure Permanent deformity Prognosis Disease starts with preceding aseptic meningitis and progresses to flaccid paralysis Two-thirds of patients do not recover their strength