As a very young girl in Europe I recall a particularly grumpy uncle, coincidentally his name was the same as mine. “Uncle Kim” probably had every right to be grumpy, as since a young man he had been confined to a wheelchair, paralyzed from the waist down. “It was the war,” I heard them say. But it was not bullets or bravery that brought him down. “It was a shame” they said, that such a fit young man should be crippled by polio. I never really thought much about polio, as they had also said that it was no longer a problem where we lived, and that Uncle Kim had contracted it in a far-away land during the Second World War. Even through nursing academy, I don’t think the disease was ever mentioned. In Australia, poliomyelitis was history, no longer an issue, and yet here, now, it festers on our doorstep.
The recent outbreak of polio in West Java has brought the reality of this disease back into the picture. The threat of an epidemic is a very real issue, and we should be aware of how this disease could threaten us and our families, and how best avoid it.
What is polio?
Poliomyelitis (polio) is a highly infectious disease caused by a viral infection in the bowel. It mainly affects children under 5 years of age. Most people who get the infection either do not get sick, or they have only a short illness with fever, headache, and sometimes nausea (feeling sick) and vomiting. Approximately 1 in 1000 children and 1 in 75 adults who have the infection get paralysis due to the infection.
Effects of polio infection
- Most people who get a polio infection do not get any illness.
- A few will get a brief illness with fever, headaches, some muscle aches, sometimes nausea (feeling sick) and vomiting, and then recover fully.
- In a very small number of people the virus enters the blood stream and infects cells in the nervous system.
- 1 in 1000 children and 1 in 75 adults who get a polio infection will get a more intense headache, nausea and vomiting, soreness and stiffness of the back and neck. Children may have a short period of feeling well again then a return of the symptoms, while adults usually do not have a symptom-free phase.
- In this group, paralysis follows (damage to muscles and nerves such that the muscles cannot be moved) and it can affect many different muscles including those of the bladder, bowel, heart, diaphragm and limbs. It is not possible to tell which person will get the paralysis.
- There may be some recovery of movement in the first few weeks, but after a year the remaining paralysis is permanent.
- There is no specific treatment for polio, but supportive care can make a lot of difference to the effects of the paralysis.
How is polio caught?
- The polio virus is one of a group of viruses called
enteroviruses.
- Enteroviruses are highly infectious, and any person who is not immune to the polio virus (from having had the
infection before or having been immunized) is very likely to get the infection if they are exposed to the virus.
- The infection is passed from one person in his or her bowel motion to the mouth of the next person (faecal-oral spread).
- An enterovirus infection will spread quickly among young children who are not toilet-trained, and their carers, if they are not very careful with hand washing and other hygiene practices.
Preventing the spread of polio
- Because polio is so highly infectious, preventing the spread has only been possible since the introduction of vaccines.
- Oral Polio Vaccine - These contain living viruses very similar to the ones causing polio. These viruses, called ‘attenuated’ polioviruses, do not cause polio illness, but they cause the immune system to be able to recognize and destroy the illness-causing viruses.
- Oral polio vaccines (OPV) are being used world-wide to eradicate the infection, and immunization days are being held in many countries to make sure that all children are protected.
The schedule
- It is recommended that oral polio vaccines be given at 2, 4 and 6 months with an additional dose before school
entry (when the child is 4 years old).
- The vaccine can be given at the same time as other
vaccines (DTPa, hepatitis B, Hib and MMR).
- Any person who has not been immunized can and should have the full course of oral (or injected) vaccine at any age. A booster dose is recommended at 10 year intervals.
Reactions
- A small number of children given OPV have mild symptoms such as loose bowel actions, headache and sore muscles.
- OPV can cause the very rare vaccine associated paralytic poliomyelitis (VAPP). Two cases of VAPP have occurred in Australia (in 1986 and 1995) during the time that many millions of doses of oral vaccine were given.
- The vaccine virus from OPV can be passed in the bowel motions of immunized babies for up to 6 weeks, and can lead to infection in un-immunized people in contact with the baby. The carers for a recently immunized baby need to be very careful about hand washing after changing nappies, and how they handle the nappies. Adults who have not had OPV can be immunized at the same time as the babies.
Reasons for not giving the vaccine
- When children are obviously unwell (such as vomiting, diarrhea or having a high temperature) they will usually not be given either vaccine until they are well again a few days later.
- Children who have had a severe allergic reaction to a previous dose of the vaccine or to any part of the vaccine, should be seen by a specialist in allergy medicine to work out whether another dose can be recommended.
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Kim Patra is a qualified Registered Nurse and Midwife that has been living and working in Bali for almost twenty years. She now runs her own private practice and medical referral service from her Kuta office. Kim is happy to discuss any health concerns with you and she may be contacted via e-mail at info@chcbali.com”.
