Çocuk Felci (Polio)

Enfeksiyonların %90–95'i asemptomatiktir (subklinik).

Abortif polio (%4–8): Ateş, halsizlik, baş ağrısı, boğaz ağrısı, bulantı — spesifik olmayan bulgular.

Non-paralitik (aseptik menenjit, %1–2): Ense sertliği, sırt ağrısı, kas spazmları.

Paralitik polio (<%1):

• Akut flask (gevşek) paralizi — asimetrik, alt ekstremitelerde daha sık

• Kas tonusu azalmış, derin tendon refleksleri kayıp

• Duyu korunmuş (motor nöron hastalığı)

• Bulber form: Kranial sinir felci, yutma güçlüğü, solunum yetmezliği — en ölümcül form

• Mesane disfonksiyonu

Post-polio sendromu: Hayatta kalanların %25–40'ında enfeksiyondan 15–40 yıl sonra ilerleyici kas güçsüzlüğü, yorgunluk ve ağrı gelişir.

Host factors increasing risk of paralytic disease:

• Age: Risk of paralysis increases with age at infection. Adults develop paralytic polio more frequently and with greater severity than children.

• Immunodeficiency: Primary immunodeficiency (especially B-cell defects such as agammaglobulinemia) dramatically increases risk of paralytic disease and chronic infection. These individuals can excrete vaccine-derived poliovirus for years (immunodeficiency-associated VDPV, iVDPV).

• Pregnancy: Pregnant women have a higher incidence of paralytic polio and higher case-fatality rates.

• Tonsillectomy: Prior tonsillectomy increases risk of bulbar polio.

• Intramuscular injections: Injections in the weeks before or during infection increase risk of paralysis in the injected limb ("provocation polio").

• Strenuous physical exercise: Physical exertion during the incubation period or early illness is associated with increased severity of paralysis.

Environmental and geographic risk factors:

• Lack of vaccination: Unvaccinated or under-vaccinated individuals in any country are at risk. Immunity gaps from missed routine immunization are the primary driver of cVDPV outbreaks.

• Poor sanitation: Fecal contamination of water supplies facilitates transmission.

• Conflict and displacement: Disruption of immunization programs in conflict zones (Afghanistan, Pakistan, parts of Africa) sustains transmission.

• Overcrowding: Close living conditions in camps or urban slums increase exposure risk.

Travel-related risk factors:

• Travel to endemic countries (Afghanistan, Pakistan) or countries with active cVDPV outbreaks

• Extended stays in rural areas with poor sanitation infrastructure

• Visiting friends and relatives (VFR) travelers may underestimate risk and delay vaccination

Komplikasyonlar:

• Kalıcı flask paralizi — rehabilitasyona rağmen tam iyileşme olmayabilir

• Solunum yetmezliği (bulber form): Mortalite %25–75

• Kemik ve eklem deformiteleri: Skolyoz, kontraktürler

• Post-polio sendromu: Yıllar sonra progresif güçsüzlük

Mortalite: Paralitik polioda %2–5 (çocuklar), %15–30 (yetişkinler). Bulber formda çok daha yüksek.