Persistent poliovirus fragments/infection:
Some studies suggest low‑grade, persistent poliovirus (or viral RNA/proteins) may remain in long‑term survivors and could contribute to ongoing inflammation and motor neuron stress.
Immune system and antibody deficits:
A 2025 study found that many PPS patients have subtle humoral immune deficiencies (low IgG/IgA or subclasses) and sometimes lack neutralizing antibodies to specific poliovirus serotypes, even though overall protection from polio is usually adequate. This points to immune vulnerability as a contributor to PPS rather than simple “wear and tear.”
Vitamin D deficiency:
The same study highlighted frequent vitamin D deficiency in PPS patients, suggesting that correcting it may be a low‑risk, potentially helpful part of management, especially for muscle and immune function.