Po­lio never far away in the jet age

Aus­tralia’s first case of po­lio in 21 years un­der­lines the im­por­tance of con­tin­ued vac­ci­na­tion. Neena Bhan­dari re­ports

The Weekend Australian - Travel - - Health -

ON a swel­ter­ing Fe­bru­ary day in 1951, one-year-old Maura Out­ter­side’s tiny body was gripped by high fever and mus­cle pain. As she be­came non-re­spon­sive, her par­ents wrapped her in cold tow­els and took her to St Ge­orge Hospi­tal in Syd­ney. A lum­bar punc­ture con­firmed ev­ery par­ent’s worst night­mare in those days — po­liomyeli­tis, the vi­ral dis­ease re­spon­si­ble for crip­pling hun­dreds of thou­sands of chil­dren dur­ing the 20th cen­tury.

Po­lio epi­demics from 1930 to 1970 af­flicted 40,000 Aus­tralians, in­clud­ing me­dia ty­coon Kerry Packer, talk­back ra­dio host John Laws and for­mer La­bor leader Kim Bea­z­ley.

The crip­pling dis­ease gripped en­tire com­mu­ni­ties with fear. ‘‘ Kids in Vic­to­ria went to school with pegs on their noses. They didn’t know how it was be­ing trans­mit­ted,’’ says a for­mer nurse turned his­to­rian, doc­tor Kristine Klug­man. ‘‘ They only knew peo­ple had to be iso­lated. Worse, po­lio car­ried a stigma and it still does. Peo­ple who had po­lio don’t want to talk about it.’’

A highly in­fec­tious dis­ease, po­lio is caused by a virus that mainly af­fects chil­dren un­der five years of age. While 90 per cent of cases do not cause symp­toms, in some cases it in­vades the ner­vous sys­tem and can lead to paral­y­sis. The virus en­ters the body through the mouth and mul­ti­plies in the in­tes­tine.

Ini­tial symp­toms are fever, fa­tigue, headache, vom­it­ing, and stiff­ness in the neck and pain in the limbs. Fewer than 1 per cent of peo­ple in­fected suf­fer paral­y­sis, but the other 99 per cent are still able to trans­mit the virus.

Ef­fec­tive vac­cines brought po­lio un­der con­trol. In 1955, Jonas Salk in the US dis­cov­ered the in­ac­ti­vated po­lio vac­cine (IPV), and six years later his ri­val Al­bert Sabin in­tro­duced the oral po­lio vac­cine (OPV).

Aus­tralia, the Amer­i­cas, West­ern Pa­cific and 51 Euro­pean-re­gion coun­tries have been de­clared po­lio-free by the World Health Or­gan­i­sa­tion (WHO).

But just when the world seemed a step closer to the erad­i­ca­tion of this deadly dis­ease, the virus has raised its ugly head in Aus­tralia.

Ear­lier this month, a 22-year-old Pak­istani stu­dent be­came the first con­firmed Aus­tralian case of po­lio in 21 years. Tests showed the man, who ar­rived on a Thai Air­ways flight from Bangkok car­ry­ing 249 pas­sen­gers, was car­ry­ing a strain of po­lio sim­i­lar to types cir­cu­lat­ing in Pak­istan’s North West Fron­tier Prov­ince, one of that coun­try’s last re­main­ing po­lio-in­fected ar­eas. The man re­mained in iso­la­tion in a Melbourne hospi­tal this week pend­ing the re­sult of tests. All but three pas­sen­gers con­tacted by Vic­to­rian health au­thor­i­ties ac­cepted a booster po­lio shot, but 29 pas­sen­gers could not be con­tacted.

Their de­tails were passed on to the fed­eral health de­part­ment, which traced some more of th­ese last pas­sen­gers. But the de­part­ment this week said it was ceas­ing at­tempts to con­tact the last 15 pas­sen­gers, whose de­tails on pas­sen­ger land­ing cards were in­ac­cu­rate or un­read­able, be­cause the risk of in­fec­tion was low.

‘‘ This case means po­lio is only a plane trip away from Aus­tralia,’’ says Mary West­brook, a con­joint as­so­ci­ate pro­fes­sor in the Fac­ulty of Medicine at the Univer­sity of NSW. ‘‘ It is a worry, be­cause there is a pool of un­vac­ci­nated peo­ple in (Aus­tralia). In fact, a large part of the non-vac­ci­nated chil­dren are in the more af­flu­ent ar­eas of the state.’’

In­ter­na­tional travel be­tween coun­tries with en­demic po­lio presents the great­est risk of spread of po­lio to non-im­mu­nised pop­u­la­tions in po­lio-free coun­tries. In 1988, po­lio paral­ysed more than 350,000 chil­dren in more than 125 en­demic coun­tries. That year, the World Health As­sem­bly adopted a res­o­lu­tion to erad­i­cate this an­cient scourge — it marked the launch of the Global Po­lio Erad­i­ca­tion Ini­tia­tive.

For­mer WHO di­rec­tor-gen­eral Gro Har­lem Brundt­land said un­til the world stopped trans­mis­sion of po­lio in re­main­ing in­fected coun­tries, ‘‘ chil­dren ev­ery­where will re­main at risk of con­tract­ing this dis­ease’’.

The ini­tia­tive — the world’s largest pub­lic health cam­paign — has achieved mas­sive progress, al­though some of the gains have slipped. Po­lio re­mains en­demic in four coun­tries — Afghanistan, Pak­istan, In­dia and Nige­ria — with fewer than 300 wild po­lio virus cases re­ported from them in 2007.

But some coun­tries where po­lio was pre­vi­ously erad­i­cated have recorded re­newed out­breaks. Be­sides cases re­ported from en­demic coun­tries, the re-in­fected coun­tries — An­gola, Myan­mar, Chad, the Congo, Niger and So­ma­lia — have also re­ported po­lio cases this year, show­ing the re-in­fec­tion threat is very real.

As Dr Ken­neth Collins, co-or­di­na­tor of Ro­tary’s po­lio pro­gram, says, the re­in­fec­tion risk is very real. ‘‘ We are ad­vo­cat­ing all chil­dren in Aus­tralia need to be im­mu­nised be­cause we face the threat of po­lio be­ing brought into the coun­try by in­ter­na­tional trav­ellers,’’ he says.

Aus­tralia moved to the in­jectable Salk vac­cine in 2005 be­cause of the po­ten­tial dan­ger of vac­cine-as­so­ci­ated par­a­lytic po­lio, which af­fects ap­prox­i­mately one in 2.4 mil­lion re­cip­i­ents of the al­ter­na­tive oral vac­cine.

Po­lio vac­cine is funded for chil­dren un­der the na­tional im­mu­ni­sa­tion Pro­gram, and is ad­min­is­tered at two, four and six months with a booster at four years. Data from the Aus­tralian Child­hood Im­mu­ni­sa­tion Reg­is­ter on June 30 shows that 91.8 per cent of chil­dren aged from 12 to 15 months, and 95.1 per cent of chil­dren aged 24-27 months have re­ceived their po­lio vac­ci­na­tions. In 2007-08, the Gov­ern­ment is pro­vid­ing $45 mil­lion for po­lio vac­cines.

Booster vac­cine doses are rec­om­mended for adults and health care work­ers, if at risk, and for trav­ellers visit­ing po­lio en­demic coun­tries.

‘‘ There are three types of po­lio and hav­ing one type does not, un­for­tu­nately, make us im­mune from the other two types,’’ says Mary-Ann Li­ethof of ParaQuad Vic­to­ria. ‘‘ For­tu­nately, the vac­cine im­mu­nises against all three types, so it is the only way we can en­sure we are fully pro­tected.’’

Many of the 40,000 ill Aus­tralians who sur­vived the po­lio epi­demics of the 20th cen­tury are fac­ing of new dis­abil­i­ties. While they ini­tially re­cov­ered and made the most of life with dis­abil­ity, to­day they are bat­tling with pro­found fa­tigue, in­creas­ing mus­cle weak­ness, joint and mus­cle pain, in­creased sen­si­tiv­ity to cold tem­per­a­tures and sleep­ing, breath­ing or swal­low­ing dif­fi­cul­ties and fre­quent falls — all linked to late ef­fects of po­lio.

Most doc­tors are not trained to recog­nise late ef­fects of po­lio or the post-po­lio syn­drome (PPS), or are re­luc­tant to treat it as a new con­di­tion.

The main ad­vo­cates for in­creased med­i­cal and gov­ern­ment at­ten­tion to PPS have been the sup­port groups for po­lio sur­vivors.

Merle Thompson, who had po­lio at 15 months of age on the first Anzac Day af­ter World War II (April 25, 1946), is the vi­cepres­i­dent of the NSW Post-Po­lio Net­work. She has pro­duced a re­search re­port that shows that the in­ter­val be­tween the ini­tial po­lio ill­ness and the on­set of the late ef­fects of po­lio is be­tween 30 and 40 years.

Ac­cord­ing to the re­port find­ings, more than 80 per cent of par­tic­i­pants in the po­lio group rely on at least one ap­pli­ance, and 12 per cent use at least six ap­pli­ances. Many have found their need to use aids has in­creased, par­tic­u­larly for mo­bil­ity. A cure for po­lio is still a cher­ished dream.

With strin­gent pre­ven­tive mea­sures and vac­ci­na­tion drives, gov­ern­ments across the world also need to in­vest in med­i­cal and health care for age­ing po­lio pa­tients.

Hol­i­day af­ter­math: Fred Gath holds son Michael, 7, as they re­ceive post-flight po­lio vac­ci­na­tions

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