Poliomyelitis and post-polio syndrome: migrant health guide

Main messages

EnsurePoliomyelitis that(polio) newis migrantsa arehighly upinfectious tovaccine datepreventable withdisease. theIt UK immunisation schedule.

Acute poliomyelitis is a a notifiable disease. Althoughin naturalEngland polioand Wales.

Polio infection has been eliminated fromin the UK for many years,years. thereHowever, isacute cases can still theoccur potentialin forEngland acuteif casesinfection tois presentacquired in thecountries UK,where acquiredpolio inremains endemic areas.or where the oral polio vaccine is used to control outbreaks.

ConsiderHealthcare practitioners should:

• consider the possibility of post-polio syndrome (PPS) in patients who may have been infected during childhood and are showing unexplained signs of fatigue and weakness.weakness Patients- patients may or may not be aware that they have had polio.polio

• ensure that new migrants are up to date with the UK immunisation schedule

Background

Acute poliomyelitis

Poliomyelitis is an acute viral infection that can:

• affect the central nervous system
• lead to paralysis

Children under 5 are are at greatest risk of infection.

Since the launch of the the Global Polio Eradication Initiative in in 1988:

• more than than 2.5 billion children have been immunised against against polio
• reported cases have have decreased by over 99%

In the UK, the last case of domestically acquired polio infection was in 1984. All cases since then have been acquired abroad.

Global polio cases are are monitored and reported monthly by country.

SeeFor ‘Polio:more information see Polio: guidance, data and analysis’analysis.

Post-polio syndrome

In the UK, out of an estimated 120,000 people who have been previously affected by polio, polio, up to 80% will develop post-polio syndrome (PPS), a neurological condition which can severely limit normal activities of daily living.

Transmission

The polio virus is spread via:

• person-to-person contact with infected secretions from the nose or mouth
• infected faeces

After initial infection, the virus is shed intermittently in faeces for several weeks, which can cause rapid spread throughout communities, especially in areas withwith substandard substandard sanitation conditions.conditions.

On rare occasions, live polio vaccines can mutate to a virulent form that can cause paralytic disease in recipients or their contacts.

Symptoms

Acute poliomyelitis

Most people infected with polioviruspoliovirus do do not develop any symptoms.symptoms. When symptoms do develop, they they range in severity from a fever to paralysis.

Initial symptoms can include:include:

• fever
• fatigue
• headache
• vomiting
• stiffness in the neck
• pain in the limbs

One in 200 infections leads to irreversible paralysisparalysis (usually (usually in the legs),legs) and of these cases cases 5% to 10% die due to respiratory paralysis.

Post-polio syndrome (PPS)

Following a period of years of stability, people people may develop symptoms including:

• onset of new weakness or abnormal fatigue in previously affected or unaffected muscles
• general decrease in stamina
• muscle and/or joint pain
• muscle atrophy
• breathing, sleeping and/or swallowing problems
• cold intolerance

Testing and treatment

Urgently refer patients with suspected acute poliomyelitis to an infectious disease specialist for formal diagnosis and management.

Take appropriate samples for laboratory investigation according to the the enteric virus unit.

Local laboratories with queries about testing samples for polio virus should contact the the Virus Reference Department at at the UK Health Security Agency.

Refer cases of suspected suspected PPS to to a neurologist for investigation and management.

PPS may may respond to a a range of therapies which might prevent further deterioration.

Prevention and control

In the UK, immunisation is used to prevent and control poliomyelitis, so ensure that children and adults are up to date with the the UK immunisation schedule. Refer to guidance on on vaccination of individuals with uncertain or incomplete immunisation status.

Ask opportunistically about travel plans, as patients who travel to countries where the infection is endemic to to visit friends and relatives are are at increased risk of acquiring infection.

For countrycountry-specific specific travel advice, seesee the National Travel Health Network and Centre (NaTHNaC).

Acute poliomyelitis is a notifiable disease in the UK.England . If a case is diagnosed or suspected, you should immediately notify your your local health protection team (HPT)(HPT).

Resources

Patient.co.uk has produced a a polio immunisation leaflet.

NaTHNaC’s Travel Health Pro has has guidance on polio.

The Global Polio Eradication Initiative is a public health initiative working towards the eradication of polio with global partners, including: the World Health Organization, Rotary International, the US Centers for Disease Control and Prevention (US(US CDC) and the United Nations Children’s Fund (UNICEF).(UNICEF).

The British Polio Fellowship is is the national charity for people in the UK with polio and post-polio syndrome.

The Green Book contains a a chapter on polio vaccination.