Dear Editor,
We read with great interest the paper by Laurenti et al.11 . Laurenti R, Nubila HB, Quadros AA, Conde MT, Oliveira AS. The
International Classification of Diseases, the family of international classifications, the
ICD-11, and post-polio syndrome. Arq Neuropsiquiatr 2013;71:3-10. that performed a paper about International Classification of Diseases
and post-poliomyelitis syndrome. Poliomyelitis is an acute infectious disease which is caused
by the poliovirus. The poliovirus is directly transmitted from person to person, whenever they
are in contact with infected mucus and/or phlegm from the nose or mouth, or in direct contact
with infected feces. Approximately 90% of the individuals infected do not present any
symptoms. However, the affected ones can show a variety of symptoms, after the virus enters
the bloodstream11 . Laurenti R, Nubila HB, Quadros AA, Conde MT, Oliveira AS. The
International Classification of Diseases, the family of international classifications, the
ICD-11, and post-polio syndrome. Arq Neuropsiquiatr 2013;71:3-10.. In approximately 2% of the
cases, the virus reaches the central nervous system, where it preferably infects and destroys
motor neurons. This normally results in muscular weakness and acute flaccid paralysis11 . Laurenti R, Nubila HB, Quadros AA, Conde MT, Oliveira AS. The
International Classification of Diseases, the family of international classifications, the
ICD-11, and post-polio syndrome. Arq Neuropsiquiatr 2013;71:3-10.. After the introduction of an effective
vaccination program more than 50 years ago – the number of new cases dramatically dropped. The
wild-type poliovirus was eliminated from the western hemisphere, and the number of cases
continually decreases in other parts of the world. Nevertheless, new cases of poliomyelitis
have been reported in certain African, Asian, and Middle East countries22 . World Health Organization. Poliomyelitis. Fact sheet 114. Available from:
http://www.who.int/mediacentre/factsheets/fs114/en/. (accessed Nov 22,
2013).
http://www.who.int/mediacentre/factsheet...
. For instance new cases of poliomyelitis were registered in
Syria, that had not registered any case of poliomyelitis since 199522 . World Health Organization. Poliomyelitis. Fact sheet 114. Available from:
http://www.who.int/mediacentre/factsheets/fs114/en/. (accessed Nov 22,
2013).
http://www.who.int/mediacentre/factsheet...
; this new register was primarily attributed to the civil war
that prevented children to be vaccinated33 . WHO. Third dose of polio vaccine. Reported estimates of Pol3 coverage.
http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tscoveragepol3.html.
(accessed Dec 04, 2013).
http://apps.who.int/immunization_monitor...
.
Since polio is still a threat in those aforementioned regions, healthcare professionals should
be aware of the clinical characteristics of the disease.
In addition, a significant number of patients with history of poliomyelitis report a late-onset of neuromuscular symptoms, followed by decline in their functional capacity. These symptoms are normally referred to as post-poliomyelitis syndrome (PPS)44 . Trojan DA, Cashman NR. Post-poliomyelitis syndrome. Muscle Nerve 2005;31:6-19.. PPS is characterized by a new increased muscle weakness, fatigue, muscle and joint pain, muscle cramps, cold intolerance, and severe lung problems44 . Trojan DA, Cashman NR. Post-poliomyelitis syndrome. Muscle Nerve 2005;31:6-19..
Recently, we conducted a study that evaluated the knowledge about poliomyelitis and PPS among Brazilian physical education professionals55 . de Lira CAB, Alves TMA, Peixinho-Pena LF, et al. Knowledge among physical education professionals about poliomyelitis and post-poliomyelitis syndrome: a cross-sectional study in Brazil. Degenerative Neurological and Neuromuscular Disease 2013;3:41-46.. The knowledge about poliomyelitis and PPS were found to be low among these professionals, especially among those who had not access to previous information about PPS55 . de Lira CAB, Alves TMA, Peixinho-Pena LF, et al. Knowledge among physical education professionals about poliomyelitis and post-poliomyelitis syndrome: a cross-sectional study in Brazil. Degenerative Neurological and Neuromuscular Disease 2013;3:41-46.. This situation could compromise the service provided, the services provided by these professionals. Moreover, it is possible that similar levels of knowledge about poliomyelitis and PPS may be present among other health professionals, including nurses, physiotherapists, physicians, and nutritionists. Hence, studies should be conducted to better understand the knowledge of health on poliomyelitis and PPS, as well as public training policies should be implemented to increase knowledge about poliomyelitis and PPS in order to improve the services provided to the patients. Overall, we would like to express our congratulations to Laurenti et al.11 . Laurenti R, Nubila HB, Quadros AA, Conde MT, Oliveira AS. The International Classification of Diseases, the family of international classifications, the ICD-11, and post-polio syndrome. Arq Neuropsiquiatr 2013;71:3-10. on their interesting paper.
Acknowledgment
We would like to thank Fundação de Amparo à Pesquisa do Estado de Goiás (FAPEG, Brazil; grant no. 2009/10267000347) that supported our studies about poliomyelitis and post-poliomyelitis syndrome.
References
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1Laurenti R, Nubila HB, Quadros AA, Conde MT, Oliveira AS. The International Classification of Diseases, the family of international classifications, the ICD-11, and post-polio syndrome. Arq Neuropsiquiatr 2013;71:3-10.
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2World Health Organization. Poliomyelitis. Fact sheet 114. Available from: http://www.who.int/mediacentre/factsheets/fs114/en/. (accessed Nov 22, 2013).
» http://www.who.int/mediacentre/factsheets/fs114/en/ -
3WHO. Third dose of polio vaccine. Reported estimates of Pol3 coverage. http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tscoveragepol3.html. (accessed Dec 04, 2013).
» http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tscoveragepol3.html -
4Trojan DA, Cashman NR. Post-poliomyelitis syndrome. Muscle Nerve 2005;31:6-19.
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5de Lira CAB, Alves TMA, Peixinho-Pena LF, et al. Knowledge among physical education professionals about poliomyelitis and post-poliomyelitis syndrome: a cross-sectional study in Brazil. Degenerative Neurological and Neuromuscular Disease 2013;3:41-46.
Publication Dates
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Publication in this collection
July 2014
History
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Received
19 Dec 2013 -
Reviewed
28 Apr 2014 -
Accepted
16 May 2014