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Poliovirus infection for health professionals

Poliomyelitis or polio is an infection caused by the polio virus. It is a serious disease affecting the central nervous system. Infection with the poliovirus can lead to a life-threatening muscular paralysis of the body.

In the last 20 years the number of polio cases around the world has reduced. This is largely due to global vaccination programs that aim to immunise people against the poliovirus.

Countries such as North and South America, the western Pacific region (including Australia) and Europe are now all polio-free; however cases are still being reported in some parts of Asia and Africa, including cases of vaccine derived polio in Papua New Guinea in 2018. For up to date information see:

Poliovirus infection is a notifiable condition1

How polio is spread

People can become infected with polio primarily via faecal – oral transmission. Ingestion can occur in the following ways:

  • eating food prepared by someone who has polio
  • drinking untreated water that has been contaminated with the poliovirus via sewage
  • contact with the nose and throat discharge of a person infected with the poliovirus for example contact with soiled handkerchiefs or discarded tissues
  • contact with objects or surfaces touched by an infected person whose hands contain traces of faeces or alternatively having direct contact with the infected persons hands
  • inhaling or ingesting airborne droplets from the coughs and sneezes of someone infected with poliovirus.

Polio can be easily transmitted when someone infected with the poliovirus has close contact with many other people, such as in day care centres and family homes.

Signs and symptoms

Most people infected with the poliovirus will have no symptoms. Ten per cent of infected people may experience flu-like symptoms such as:

  • fever
  • fatigue
  • nausea
  • vomiting
  • headache
  • occasionally neck and back stiffness – referred to as non-paralytic aseptic meningitis.

Less than 1% of people infected with poliovirus develop severe muscle weakness (acute flaccid paralysis) affecting the limbs, diaphragm muscle (essential for breathing), and the head and neck muscles.

The risk of permanent limb paralysis is less than 1%. Death occurs in 2 to 5% of children and 15 to 30% of adults with paralytic polio.

Diagnosis

Cases are diagnosed on signs and symptoms; and also by a laboratory test for the poliovirus on a person’s throat secretions, faeces or CSF.

Incubation period

Typically 7 to 14 days with a range of 3 to 35 days.

Infectious period

Transmission is possible as long as the poliovirus is shed.

The poliovirus can stay in the throat for about 7 days and in the faeces for 3 to 6 weeks.

Treatment

There is no cure for poliovirus infection.

Treatment focuses on managing the consequences of severe muscle weakness. This may include admission to intensive care for mechanical ventilation, and physiotherapy or antispasmodic medications to reduce muscle spasm.

Prevention

  • Exclude people with polio from childcare, preschool, school and work until a public health doctor has given a clearance to return.
  • Vaccination provides protection from poliovirus infection.
  • There are two types of polio vaccines:
    • oral poliomyelitis vaccine (OPV) 
    • inactivated poliomyelitis vaccine (IPV). All the polio vaccines recommended for use in Australia are IPV
  • The first dose of polio vaccine, in combination with other vaccines, is now recommended to be given at 6 weeks of age. Adults should have received a minimum of 3 doses of vaccine previously.
  • Booster vaccinations are recommended for travellers to countries where polio occurs, health care workers and laboratory workers handling specimens containing live poliovirus.

Notification

The Communicable Disease Control Branch, South Australia, should be notified on suspicion or confirmed cases on 1300 232 272 (24 hours, 7 days).

Resources for health professionals

Poliovirus (You’ve Got What?)

Poliovirus (You’ve Got What?) is a fact sheet for patients about the causes, signs, symptoms, treatment and prevention of poliovirus.


1 – In South Australia the law requires doctors and laboratories to report some infections or diseases to SA Health. These infections or diseases are commonly referred to as 'notifiable conditions'.


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