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Poliovirus infection

Last reviewed: 9 Jun 2025
Last updated: 21 Mar 2025

Summary

Definition

History and exam

Key diagnostic factors

  • unimmunised status
  • residence or travel in endemic area
  • decreased tone and motor function of affected limb
  • decreased tendon reflexes of affected limb
  • muscle atrophy of affected limb
Full details

Other diagnostic factors

  • age <36 months
  • gastrointestinal prodrome
  • fever
  • malaise
  • respiratory muscle atrophy and respiratory distress
Full details

Risk factors

  • lack of vaccination
  • poor sanitation
  • poverty
  • area of endemic infection
  • immunosuppression
Full details

Diagnostic investigations

Investigations to consider

  • virus culture from stool, CSF, or pharynx
  • PCR plus sequencing
  • CSF analysis
  • serum antibodies to poliovirus
  • MRI of spinal cord
  • electromyelogram (EMG) of affected limb
Full details

Treatment algorithm

INITIAL

gastrointestinal illness: poliovirus suspected

ACUTE

paralytic poliomyelitis (acute flaccid paralysis)

ONGOING

post-poliomyelitis syndrome (PPS)

Contributors

Authors

Omar A. Khan, MD, MHS, FAAFP
Omar A. Khan

President and CEO

Delaware Health Sciences Alliance

Physician Leader, Partnerships & Academic Programs

Christiana Care Health System

Associate Professor

Department of Family & Community Medicine

Sidney Kimmel Medical College of Thomas Jefferson University

Newark

DE

Disclosures

OAK is an author of a number of references cited in this topic.

David L. Heymann, MD, DTM&H

Professor of Infectious Disease Epidemiology

London School of Hygiene and Tropical Medicine

University of London

Head

Centre on Global Health Security - Chatham House

London

UK

Disclosures

DLH is an author of a number of references cited in this topic.

Peer reviewers

Javed M. Gilani, MD, FRCP, FACP

Assistant Clinical Professor

Jefferson Medical College

Philadelphia

PA

Disclosures

JMG declares that he has no competing interests.

Gregory Pappas, MD, PhD

The Nordin M. Thobani Professor and Chairman

Department of Community Health Sciences

Aga Khan University

Karachi

Pakistan

Disclosures

GP declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Heymann DL, Aylward RB. Eradicating polio. N Engl J Med. 2004 Sep 23;351(13):1275-7. Abstract

Global Polio Eradication Initiative. GPEI Strategy 2022-2026. 2021 [internet publication].Full text

Farbu E, Gilhus NE, Barnes MP, et al. Post-polio syndrome: EFNS guidelines on post-polio syndrome. In: Gilhus NE, Barnes MP, Brainin M, eds. European Handbook of Neurological Management, Volume 1. 2nd ed. West Sussex, UK: Blackwell Publishing Ltd.; 2011:311-9.

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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