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Doris Obinna
Polio is a contagious viral illness that, in its most severe form, causes paralysis, difficulty in breathing and sometimes death.
In the United States, the last case of naturally occurring polio happened in 1979. Today, despite a concerted global eradication campaign, polio virus continues to affect children and adults in Afghanistan, Pakistan and some African countries.
The Center for Disease Control and Prevention (CDC) advises taking precautions to protect against polio if you are traveling anywhere there is a risk of polio.
If you are a previously vaccinated adult who plans to travel to an area where polio is occurring, you should receive a booster dose of inactivated poliovirus vaccine (IPV). Immunity after a booster dose lasts a lifetime.
Recently, it was reported that a parent used to chase health workers away from his home in northern Nigeria but now campaigns for vaccines after his son contracted polio.
It was gathered that his eight-year-old son went to bed one night healthy and strong. But by morning, he had lost his ability to walk.
Scared, the father took him to a traditional healer, who said an evil spirit had attacked his son, and applied some herbs.
It was not until a neighbour said he suspected the boy had polio that he was taken to the hospital where an immediate medical intervention saved him from the full effects of the virus.
“He cannot open his fingers fully like me,” said the father. He now campaigns for child vaccination, lending his voice and presence to local health workers who face stiff resistance from people against vaccines – or anti-vaxxers – in his community.
And it is not just a Nigerian problem. According to the World Health Organization (WHO), opposition to vaccines is currently a global problem.
There are instances of reluctance to accept the measles vaccine in parts of Europe, and the US, the human papillomavirus vaccine in Japan and India and the polio vaccine in parts of Pakistan.
However, Nigeria’s health ministry says that children should get at least six vaccines against killer diseases, including polio, in their first year. A child that misses any could be in danger.
According to experts, the polio virus usually affects children under 5-years of age who are not fully vaccinated. It can also affect adolescents and adults. The polio virus enters the body through the mouth when one eats food or drinks water that is contaminated with faecal matter from a person who carries the polio virus. The virus multiplies in the intestines and is passed through faeces. The symptoms of polio are fever, fatigue, headache, vomiting, stiffness in the neck, pain in the limbs, and weakness in the limbs. If a child under 15 years of age suddenly shows signs of a floppy or weak arm or leg, then health authorities should be informed immediately. However, there is no cure for polio.
There are two vaccines for polio: the Oral Polio Vaccine (OPV) and the Inactivated Polio Vaccine (IPV). OPV is taken orally as drops and can be easily administered. It does not require a trained health worker. OPV is still the main preventive measure against polio. Trivalent OPV (tOPV) and IPV protect against all three types of polio viruses (types 1, 2 and 3). Bivalent OPV (bOPV) targets type 1 and type 3, but not type 2. IPV is given through an injection by a trained health worker. In countries still using OPV, IPV does not replace the OPV vaccine, but is used with OPV to strengthen a child’s immune system and protect them from polio. Each country has its own immunisation schedules. Countries might have OPV or IPV alone or a combined schedule. By 2016, all countries will have introduced at least one dose of IPV.
WHO Recommendations in May 2012, the World Health Assembly of WHO declared poliovirus eradication to be a programmatic emergency for global public health. Under this plan to achieve and sustain a polio-free world, they recommend that the use of OPV must eventually be stopped worldwide, starting with OPV containing type 2 poliovirus (OPV type 2). At least one dose of IPV must be introduced, given in addition to OPV, to protect against type 2 poliovirus and to boost population immunity.
Immunisation and surveillance activities must continue to rapidly detect a potential re-introduction or re-emergence of the virus, the WHO said, explaining that only after three years have passed without a case of wild poliovirus on the African continent will an official ‘’certification’’ of polio eradication be conducted at the regional level in Africa.
Study shows that August 21, 2019 marks three years since Nigeria last reported a case of wild poliovirus. This is an important public health milestone for the country and the entire Africa Region, which is now a step now closer to polio-free certification.
Causes
The poliovirus resides only in humans and enters the environment in the feces of someone who’s infected. Poliovirus spreads primarily through the fecal-oral route, especially in areas where sanitation is inadequate.
Poliovirus can be transmitted through contaminated water and food or through direct contact with someone infected with the virus. Polio is so contagious that anyone living with a recently infected person is likely to become infected, too. People carrying the poliovirus can spread the virus for weeks in their feces.
Symptoms
Although polio can cause paralysis and death, the vast majority of people who are infected with the poliovirus don’t become sick and are never aware they’ve been infected with polio.
Nonparalytic polio: Some people who develop symptoms from the poliovirus contract nonparalytic polio – a type of polio that doesn’t lead to paralysis (abortive polio). This usually causes the same mild, flu-like signs and symptoms typical of other viral illnesses.
Signs and symptoms, which generally last one to 10 days, include: fever, sore throat, headache, vomiting, fatigue, back pain or stiffness. Others are: neck pain or stiffness, pain or stiffness in the arms or legs, muscle weakness or tenderness and meningitis.
Paralytic polio: In rare cases, poliovirus infection leads to paralytic polio, the most serious form of the disease. Paralytic polio has several types, based on the part of your body that’s affected — your spinal cord (spinal polio), your brainstem (bulbar polio) or both (bulbospinal polio).
Initial signs and symptoms of paralytic polio, such as fever and headache, often mimic those of nonparalytic polio. Within a week, however, signs and symptoms specific to paralytic polio appear, including loss of reflexes, severe muscle aches or weakness and loose and floppy limbs (flaccid paralysis), often worse on one side of the body.
Post-polio syndrome: Post-polio syndrome is a cluster of disabling signs and symptoms that affect some people several years – an average of 35 years – after they had polio. Common signs and symptoms include:
• Progressive muscle or joint weakness and pain
• General fatigue and exhaustion after minimal activity
• Muscle atrophy
• Breathing or swallowing problems
• Sleep-related breathing disorders, such as sleep apnea
• Decreased tolerance of cold temperatures
• Cognitive problems, such as concentration and memory difficulties
• Depression or mood swings
Importance of vaccination
There has been confusion and misunderstandings about vaccines. But vaccinations are an important part of family and public health. Vaccines prevent the spread of contagious, dangerous, and deadly diseases. These include measles, polio, mumps, chicken pox, whooping cough, diphtheria, and HPV.
The first vaccine discovered was the smallpox vaccine. Smallpox was a deadly illness. It killed 300 million to 500 million people around the world in the last century. After the vaccine was given to people, the disease was eventually erased. It’s the only disease to be completely destroyed. There are now others close to that point, including polio.
A vaccine (or immunisation) is a way to build your body’s natural immunity to a disease before you get sick. This keeps you from getting and spreading the disease.
For most vaccines, a weakened form of the disease germ is injected into your body. This is usually done with a shot in the leg or arm. Your body detects the invading germs (antigens) and produces antibodies to fight them. Those antibodies then stay in your body for a long time. In many cases, they stay for the rest of your life. If you’re ever exposed to the disease again, your body will fight it off without you ever getting the disease.
Some illnesses, like strains of cold viruses, are fairly mild. But some, like smallpox or polio, can cause life-altering changes. They can even result in death. That’s why preventing your body from contracting these illnesses is very important.
Your body builds a defense system to fight foreign germs that could make you sick or hurt you. It’s called your immune system. To build up your immune system, your body must be exposed to different germs. When your body is exposed to a germ for the first time, it produces antibodies to fight it. But that takes time and you usually get sick before the antibodies have built up. But once you have antibodies, they stay in your body. So the next time you’re exposed to that germ, the antibodies will attack it, and you won’t get sick.
Tests and diagnosis
Doctors often recognize polio by symptoms, such as neck and back stiffness, abnormal reflexes, and difficulty swallowing and breathing. To confirm the diagnosis, a sample of throat secretions, stool or cerebrospinal fluid – a colorless fluid that surrounds your brain and spinal cord – is checked for the presence of poliovirus.
Treatment and drugs
Because no cure for polio exists, the focus is on increasing comfort, speeding recovery and preventing complications. Supportive treatments include:
• Bed rest
• Pain relievers
• Portable ventilators to assist breathing
• Moderate exercise (physical therapy) to prevent deformity and loss of muscle function
• A nutritious diet
Lifestyle and home remedies
Although improved public sanitation and careful personal hygiene may help reduce the spread of polio, the most effective way to prevent the disease is with polio vaccine.
Polio vaccine: Currently, most children in the United States receive four doses of inactivated poliovirus vaccine (IPV) at the following ages: two months, four months, between six and 18 months, between ages four and six when children are just entering school.
IPV is 90 per cent effective after two shots and 99 per cent effective after three. It can’t cause polio and is safe for people with weakened immune systems, although it’s not certain just how protective the vaccine may be in cases of severe immune deficiency. Common side effects are pain and redness at the injection site.
Allergic reaction to the vaccine: IPV can cause an allergic reaction in some people. Because the vaccine contains trace amounts of the antibiotics streptomycin, polymyxin B and neomycin, it shouldn’t be given to anyone who’s had a reaction to these medications.
Signs and symptoms of an allergic reaction usually occur within minutes to a few hours after the shot and may include: difficulty breathing, weakness, hoarseness or wheezing, rapid heart rate, hives, dizziness, unusual paleness and swelling of the throat.
If you or your child experiences an allergic reaction after any shot, get medical help immediately.
Fewer shots for your child: Polio vaccine is normally given in conjunction with vaccinations against other diseases, including diphtheria, tetanus and acellular pertussis (DTaP), pneumococcal infections, and hepatitis B. But your child may not need to receive all these injections separately.
A combination vaccine called Pediarix is available that reduces the number of injections given during the first two years of life. Pediarix combines DTaP, hepatitis B and polio vaccine into a single vaccine. Side effects of Pediarix are similar to those of the individual vaccines administered separately, though fever is more likely to occur in children who receive Pediarix than in children who receive vaccines separately.
Adult vaccination: In the U.S., adults aren’t routinely vaccinated against polio because most are already immune and the chances of contracting polio are minimal. However, certain adults at high risk of polio who have had a primary vaccination series with either IPV or the oral polio vaccine (OPV) should receive a single booster shot of IPV. A single booster dose of IPV lasts a lifetime. Adults at risk include those who are traveling to parts of the world where polio still occurs or those who care for people who may be excreting wild poliovirus.
If you’re unvaccinated or your vaccination status is undocumented, get a series of primary polio vaccination shots – two doses of IPV at four -to eight-week intervals and a third dose six to 12 months after the second dose.
Risk factors
You are at greatest risk of polio if you have not been immunised against the disease. In areas with poor sanitation and sporadic or nonexistent immunisation programs, the most vulnerable members of the population – pregnant women, the very young and those with weakened immune systems – are especially susceptible to experience paralysis if they are infected with poliovirus.
These factors also increase your risk if you haven’t been vaccinated:
• Travel to an area where polio is common or that has recently experienced an outbreak
• Living with or caring for someone who may be shedding poliovirus
• A compromised immune system, such as occurs with HIV infection
• Having had your tonsils removed (tonsillectomy)
• Extreme stress or strenuous physical activity after being exposed to poliovirus, both of which can depress your immune system
When to see a doctor
Be sure to check with your doctor for polio vaccination recommendations before travelling to a part of the world where polio may still occur naturally, or where oral polio vaccine (OPV) is still used, such as Central and South America, Africa and Asia. “In countries that use the OPV – vaccine made with live, but weakened (attenuated) polio virus – the risk of paralytic polio to travellers is extremely low, but not zero,” said an expert.
Additionally, call your doctor if:
• Your child hasn’t completed the series of polio vaccinations
• Your child experiences an allergic reaction after receiving polio vaccine
• Your child has problems other than a mild redness or soreness at the vaccine injection site
• You have questions about adult vaccination or other concerns about polio immunisation
• You had polio years ago and are now experiencing unexplained weakness and fatigue.
