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Polio and infectious diseases of the anterior horn

Author
Burk Jubelt, MD
Section Editor
Jeremy M Shefner, MD, PhD
Deputy Editor
John F Dashe, MD, PhD

INTRODUCTION

Although polio no longer poses the worldwide public health threat that it once did, small areas of endemic wild-type poliovirus still exist in Asia and Africa. An understanding of this virus and other enteroviruses is important in the evaluation of the patient with acute flaccid paralysis.

ENTEROVIRUS CLASSIFICATION

Human enteroviruses contain a single-stranded RNA genome, and are divided into four species: human enteroviruses A, B, C, and D. Polioviruses are part of the human enterovirus C group [1].

There are 64 human serotypes of enteroviruses. The three poliovirus serotypes are conveniently named types 1, 2, and 3. All produce motor neuron disease, although most paralytic disease was caused by poliovirus type 1 in the prevaccination era. The non-polio enteroviruses include coxsackieviruses A and B and various echoviruses and enteroviruses. (See "Epidemiology, pathogenesis, treatment, and prevention of enterovirus and parechovirus infections".)

POLIOVIRUS AND POLIOMYELITIS

Epidemiology — The polio epidemics that occurred in the first half of the 20th century in the United States were, ironically, a result of improved sanitation. Prior to 1900 in the United States, polio was endemic. Most infants were infected with poliovirus before age six months. While some developed infantile paralysis, many were protected by maternal antibodies and had inapparent infections, resulting in widespread immunity in American children. Improved sanitation led to many less infants being exposed to poliovirus, creating a large pool of susceptible individuals. When exposure occurred later and the individuals were not protected by maternal antibodies, there were polio epidemics.

Similarly, polio was endemic in less industrialized areas of the world well into the 20th century. As sanitation and hygiene improved in these countries, they too began to experience epidemics of poliomyelitis [2,3].

                  

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