Nowadays we hear little about poliomyelitis, the viral infectious disease that caused the greatest epidemics of the 1900s, despite its low paralytic frequency of 0.5%. Or in other words, about the Heine-Medin disease in reference to its discoverers. The peculiarity of the disease stems from the fact that it was a relatively new disease, present worldwide, mainly affecting children, and causing disability. Due to these attributes, it gained attention from scientists to bureaucrats, as the characteristics of the disease merged with the characteristics of the post-war era. While treating the polio challenged demographic was the goal, the process also improved the manufacturing technology, the theory and practice of medicine, and renewed the obsession with child propaganda and humanitarian work (Vargha 2018).
Because of efforts to curb and eradicate it, the viral infectious disease has now disappeared in more developed countries. However, a smaller number of African and Asian areas remain affected (Oberste and Lipton 2014). Based on the World Health Organization (WHO) data, the number of survivors in the world is 20 million (Koopman et al. 2011).
Epidemiological data from Hungary have been available since 1927, with three major waves of polio being highlighted: 1954, 1957, and 1959. Based on these records, 16,515 cases were detected between 1931 and 1976 (Hungarian Polio Foundation 2017).
Primarily, the polio infection caused permanent disability in children under 5 years of age through the destruction of motile neurons located in the spinal cord (Oberste and Lipton 2014).
The residual symptoms (asymmetrical flaccid paralysis, limb shortening, deformities, joint instability, contractures, loss of function, physical disability, etc.) affect the current 56–65 year-old generation, and the number of polio survivors is estimated at approximately 3000 in Hungary (based on the data officially collected from the National Health Insurance Data Management Fund between January 1, 2012 and December 31, 2016, 2990 patients participated in health care based on the B91H0 BNO, of whom 2760 patients were still alive on 2017−01−01). This is approximately 0.2% of the age group concerned (based on the 2016 Population Data of the Central Statistical Office) (Central Statistics Office 2018).
Owing to the “polio immunity” of the European region and the small number of new infection, little is heard about this polio epidemic today. For the younger generation, the name of it is unknown, in the curriculum of healthcare students it is only tangential and the practitioners also have minimal knowledge of the symptoms and treatment of the poliomyelitis. Mostly, contemporaries remember the fear caused by the terrifying illness and the severe, lasting physical symptoms. However, we must not forget the fact that children–who became infected and survived at the time–are now adults with residual symptoms, presumably living in a deteriorating physical and functional state.
The global collaboration in research, prevention, and treatment of polio has been exemplary, in addition to the fact that the international exchanges of knowledge have existed from the very beginning. Of course, the actual time period itself must not be forgotten, which also significantly influenced the attitudes and financial opportunities. Regardless, the polio epidemic raised many global issues. Contemporary scientific articles and discussions highlighted the presence of polio across the continent and the serious problems raised in terms of medical care, the economy, and social stability. Furthermore, some articles highlighted the economic repercussions of the epidemic; the feasibility of the quarantine and the costs incurred in terms of their impact on trade. In addition to these, the subjugation of political independence in the fight against the epidemic was an important topic as well (Vargha 2018).
Numerous essays, in particular foreign literature describe the status and quality of life of the infected with poliomyelitis, and the assessment of the threat related to the syndromes that can appear up to decades after infection or in other words the so-called post-polio syndrome (PPS) (Werhagen and Borg 2013; Adegoke et al. 2012; Garip et al. 2017; Atwal et al. 2014; Yang et al. 2015). A retrospective study conducted in France in 2013 foresees a serious public health problem due to the deteriorating state of the survivors (Yelnik et al. 2013). PPS is an uncommonly occurring neurodegenerative, chronic, progressive disease that does not correspond to normal aging, which results from the destruction of remaining brain and spinal cord neurons due to prolonged overload (Koopman et al. 2011).
Most of the studies on quality of life report extremely poor physical but satisfactory mental functions (Garip et al. 2017; Yang et al. 2015; Jung et al. 2014). The quality of life was assessed in 2015 within the survivors of the Turkish polio population, in a study where a group of 40 healthy persons and a group of 40 people infected with polio virus were compared to each other. The participants of this latter group were distinguished by the fact of whether they were affected by post-polio syndrome (21 persons) or not (19 persons) according to the Healstead criteria. In comparison to the other polio counterparts and to the healthy group, based on the fatigue assessment, the Turkish post-polio infected generated higher, while from among the elements of the quality of life, such as physical activity, pain and energy, they generated lower results. In the examined groups, there was no significant difference in the social, emotional functions, in sleep quality, and depression (Garip et al. 2017).
On the other hand, based on a self-assessment, a group of Nigerian polio survivors even had lower mental functions. In Nigeria, the virus was still active even a few years ago; thus, in 2012 the quality of life of adolescent patients was measured in comparison to a healthy population of similar gender and age (Adegoke et al. 2012). The fifth edition of the Comprehensive Quality of Life Scale-Adolescent Questionnaire was filled out by 73 persons infected with polio viruses (mean age 14.16 ± 2.01 years) and by 73 healthy young persons (mean age 14.18 ± 2.02 years). The self-evaluation of polio survivors has presented significantly lower values for health, fertility, community, emotional and psychological factors, and overall quality of life in comparison with the healthy group. Polio reached significantly higher (p < 0.001) results in 5 out of the 7 subjective range of the Comprehensive Quality of Life Scaled Adolescent compared to the objective values.
Domestic research is limited, and most of the studies are also directed to the treatment of the residual symptoms and physical disability and the search for suitable tools for rehabilitation (Pettyán and Béresné Lutter 2010, Pettyán 2012). However, to date, there is no study on the state of health and quality of life of the polio survivors in Hungary. Therefore, the aim of this study is to fill the gap in this area.