Polio has no cure, but is preventable — Ebirim
Dr. Obinna Ebirim, medical doctor and Fellow of the United States Mandela Washington Fellowship for young African leaders, gave these tips on polio to PAUL ADUNWOKE.
What is polio and what causes it?
Poliomyelitis, also known as Polio, is a viral, paralytic, faeco-oral and vaccine-preventable disease that destroys the anterior horn cells of the spinal cord. This means it is caused by a positive-sense single-stranded RNA virus of the enterovirus genus, causes paralysis, most commonly spread from one to another from faeces with the hand and through the mouth. Vaccines that are very effective and save lives prevent it.
It is very common and highly transmissible in children under the age of five years. Poliomyelitis is very infectious and can also be acquired from live oral polio vaccination (known as Vaccine-associated paralytic polio), through aerosol droplets from sneezing or coughing and by eating or drinking contaminated food or water. The virus is contained in the oral secretions of an infected patient for several weeks and in the faecal matter for months.
The viruses that cause poliomyelitis are of three types. The type one, which causes about 85 percent of the paralytic illness, was the one detected in Borno State a few months ago. Type two has been eradicated from the world since 1999. It is worth noting that only one out of 200 persons, who are infected by poliovirus acquire irreversible paralysis, with the rest having common or no symptoms because the virus has remained in the gastrointestinal tract and could not make its way into the central nervous system.
Poliomyelitis has been there for many centuries, but since 1988 that the World Health Organisation (WHO) resolved to eradicate polio from the world, the number of cases of this disease has significantly reduced by 99 per cent and is seen only in three countries, which include Nigeria, Afghanistan and Pakistan. Poliovirus transmission was interrupted in Nigeria in 2014, which made WHO to remove us from the list of polio endemic countries, but in the last six months, three cases have been detected in Borno State and the Nigerian government, with support from partners, is currently carrying out five rounds of coordinated vaccination to deal with this re-emergence.
What are the early symptoms?
The early symptoms of poliomyelitis that the mother will observe are those common to other diseases like fever, fatigue, feeling of vomiting and vomiting, abdominal pains, headache and pains. These occur one to three days before onset of paralysis and can last for weeks to months. Then it may die down or get into the central nervous system, where it causes paralysis and other symptoms of meningitis, such as, neck stiffness, muscle pain and weakness.
Therefore, it is difficult to say what a mother should look out for in early detection, but the symptoms I have highlighted are what she can see and suspect that the child has poliomyelitis. However, this suspicion should be high in areas that have little or no access to vaccination programmes.
What should a mother do as First Aid?
There is no First Aid for poliomyelitis, or I should rather say, that the First Aid in poliomyelitis would be to run to the hospital. Once suspected by the mother, she should take the child to the nearest health facility and once diagnosis is made at the health facility, it should be reported through the right channel to the government.
What is the next thing after going to the hospital?
Polio has no cure, but is prevented by two types of vaccines, namely, oral polio vaccine (OPV), and inactivated polio vaccine (IPV). Upon arrival at the hospital, the health practitioner would ask some questions, examine the patient, conduct some investigations or tests and when a diagnosis of poliomyelitis is made, the patient is given general supportive care for the acute symptoms of this viral disease and then orthopaedic and physiotherapeutic care to prevent deformity following paralysis.
General supportive care may include antipyretic for fever, prevention of secondary infection by broad-spectrum antibiotics and treatment of paralysis of the respiratory muscles like diaphragm, which kills five to 10 per cent of people who come down with paralytic poliomyelitis. Orthopaedic and physiotherapeutic care includes splinting, exercise therapy, electrical stimulation of muscles and surgeries to release contractures or musculoskeletal repair.
Following confirmation of poliomyelitis, public health interventions should be carried out and it includes disease reporting, contact investigation and prevention of further spread by isolation and community-wide vaccination.
For prevention, when and why should people administer vaccine?
The vaccines, oral polio vaccine (OPV) and inactivated polio vaccine (IPV) that effectively protect us from polio are given at birth. OPV0 is given at six weeks after birth, while OPV1 is given six weeks after birth and at 10 weeks OPV2 is administered, while at 14 weeks OPV3 and IPV are given. OPV is also given to all children below five years, six weeks apart, and IPV to children between ages 14 weeks and 59 months during mass vaccination campaign.
Administration of vaccines saves two to three million lives every year and has been shown to prevent diseases and paralysis that cause illness, poor growth, cognitive development, economic hardship upon families and even loss of job of caretaker or parents.
It is more important for even diseases like poliomyelitis that has no cure. Improved immunisation programme, following introduction of new vaccines such as, IPV, strengthening of the cold chain system, traditional and religious leaders support to stop vaccine rejection, support of partner organisations and adequate vaccine stock management that has prevented national vaccine stock-out in the last two years and increased coverage rates, led to Nigeria’s interruption of wild polio virus transmission in 2014.
However, sustainable funding for immunisation and equitable access to immunisation, especially to children in communities in crisis and hard-to-reach areas, remain a challenge for total eradication of polio in Nigeria
What is your advice for all?
Prevention with polio vaccines is better than its management, since there is no definite cure for its acute illness, paralysis and lifelong disability. Everyone has a role to play in the fight against polio in Nigeria. We must ensure that every child everywhere get the polio vaccines they need to remain alive, strong and healthy. We should encourage mothers around us to vaccinate their children. The media should help amplify the call for equitable access to immunisation, sustainable vaccine financing and accountability.
The Civil society organisations, partner organisations and donor agencies should continue to support the government to strengthen the immunisation programme. Now that some of these donor agencies are gradually withdrawing their financial support for purchase of some vaccines, government should increase its budgetary allocation for immunisation and continue to utilise strategies that ensure all Nigerian children get the polio vaccines they need, no matter where they live. We cannot afford to relent now that we are this close to ending polio in Nigeria. A polio-free Nigeria is possible.