In November 2013, the CDC issued multiple Alerts on various polio outbreaks in Asia and Africa. Countries currently with the heaviest burden are Syria, Pakistan, Somalia, Kenya, and Cameroon. Nigeria and Afghanistan have also had persistent epidemics.
General Information:
95% of Polio cases are asymptomatic. (Not important clinically, but important for transmission)
4-8% present with non-specific flu-like symptoms +/- nuchal rigidity
Only 1% have the classic syndrome of flaccid limb paralysis with decreased limb reflexes
Paralysis may affect respiratory muscles leading to respiratory failure and death
Treatment is supportive, but immunization of contacts is important
Relevance to the EM Physician:
The diagnosis can be made by detecting:
Virus in stool sample or a nasopharyngeal swap is sensitive and specific in all patients.
Polio antibodies in the patient’s serum is sensitive and specific in symptomatic patients.
The CSF analysis results will resemble that of aseptic meningitis.
Bottom Line:
Have a high suspicion for travellers to affected regions and recognize the high prevalence of asymptomatic infection (and thus importable epidemic potential). Pre-travel vaccination is essential.
University of Maryland Section of Global Emergency Health
