Approach
There is no cure for poliovirus infection or post-poliomyelitis syndrome. Treatment for the minor illness, the major (paralytic) illness, and the respiratory and post-poliomyelitis syndromes is supportive, with the aim of preventing or limiting disability and disease progression. When poliovirus infection is suspected, the local health authority should be immediately notified. In many disease-endemic countries, this is the local office of the WHO.[1]
Gastrointestinal illness: poliovirus suspected
Oral rehydration and/or intravenous fluids should be given to prevent volume depletion. The treatment is similar to that for any paediatric GI illness. Monitor for acute flaccid paralysis (AFP), which indicates progression to paralytic poliomyelitis.
Paralytic poliomyelitis (acute flaccid paralysis)
There is no treatment for paralytic poliomyelitis. The main goals of therapy are to mobilise the affected limb(s) early and continue physiotherapy, to minimise subsequent handicaps.[1][28][42][47] Supportive treatment, early physiotherapy, and mobilisation are required. [Figure caption and citation for the preceding image starts]: A young boy with polio walking with bilateral leg braces: Peshawar, PakistanFrom the collection of Dr Omar Khan; used with permission [Citation ends].
Vaccine-associated paralytic poliomyelitis (VAPP) and circulating vaccine-derived poliovirus (cVDPV) are rare occurrences following the use of oral attenuated poliovirus vaccine (OPV) (Sabin). OPV should not be administered to children who are immunocompromised, or who have family members who are immunocompromised.
Bulbar poliomyelitis (respiratory paralysis)
Patients should be monitored for progression of limb paralysis to respiratory paralysis (a life-threatening condition requiring expert medical assistance). No experimental or alternative treatments have been demonstrated as effective to date. Immediate transport to a specialised centre is required for treatment. Respiratory support measures include intubation and ventilation as needed.[1][48]
Post-poliomyelitis syndrome (PPS)
This syndrome may develop many years or even decades following paralytic poliomyelitis, and consists of fatigue, weakness, and wasting of affected muscles. Ongoing physiotherapy and mobilisation are required.[43][49][50]
A systematic review on pharmacologic and non-pharmacologic therapies found insufficient good-quality evidence to make definite recommendations concerning the various treatments used for PPS.[51]
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