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4 July 2006: No 36/06

POLIO OUTBREAK IN NAMIBIA

The office of the Surgeon General wishes to bring the following information regarding the reported outbreak of polio in our neighbouring country, Namibia, to the attention of all DOD members.

What is Poliomyelitis?

Poliomyelitis or polio as it is more commonly known, is a viral infection with a wide range of symptoms and signs. It is rapidly progressive infection for which there is no antibiotic treatment. A virus is a very small organism that can only live inside human cells. Polio is highly contagious in populations that are not immunised against it.

Poliomyelitis can occur in one of three forms:

Many people never realise that they have had a mild case of the disease, which has protected them from any further attacks. In such a case the disease may only cause an upset stomach, a little diarrhoea with loose movements of the bowel and/or a cold that lasts for a few days. This form of the disease occurs in 80-90% of cases. This is known as polio-that-stops (abortive poliomyelitis).
If temporary lameness of the limbs or the loss of power to move occurs for a short time only, this condition is known as polio-without-lameness (non-paralytic poliomyelitis).
The most severe form of polio causes lameness when the virus infects the central nervous system in the spine or brain. This form of the disease affects children (boys and girls), but may also occur in younger adults. It is only in a small number of cases that the viruses have the power to damage the nervous system permanently so that and lameness results (paralysis). Even during severe epidemics, when the disease spreads rapidly, infecting perhaps half of the people in the country, there may only be 5 cases of paralytic polio in every 10 000 people.
Attacks usually take place during the warm months, and children under one year of age are seldom affected. This may be because the mother passes the ability fight against the polio virus and other infectious diseases (antibodies in blood) on to her baby. This immunity or power to fight off the disease then only lasts for about a year.

How is polio spread?

Infected stools (faeces) are probably an important cause of infection. The virus usually passes quickly from one person to all the other family members.

The virus is spread through the intestinal tract (the canal or passage through which food passes from the stomach to where it leaves the body at the anus) by means of food and water.

Only food and water that is made impure by contact with patients who are recovering from the disease, healthy carriers of the disease that may not even know they have the virus, insects such as flies and secretions from the nose and throat of an infected person can cause the disease.

Signs and symptoms of the disease

The incubation period or the time taken from contact with the virus to the appearance of the first signs is between 7 and 28 days.

The disease usually starts suddenly with fever, headache, perhaps a stiff neck, sensation changes in muscles, sleepiness and irritation such as quick loss of temper.

In severe forms, the neck and spine (backbone) become stiff. Muscles can be quite painful when touched. By the third day, the fever may subside only to rise again on the fifth day as lameness of the muscles sets in. Although any muscle may be affected, it is usually those of the legs or back.

When the brain is affected the patient may be sleepy or even unconscious. In such cases the patient cannot swallow and talking as well as breathing are difficult. This form of the disease often results in death.

A patient with acute paralytic poliomyelitis typically has lameness that begins to appear in the legs or has difficulty in emptying the bladder. Usually the lameness spreads for two to three days, then stays the same for two weeks and hopefully slowly gets better.

Often patients who do not appear to be ill are difficult for the doctor to diagnose. The latter therefore need to take note of the outbreak in Namibia, and family members must know that they have to take a sick person with any lameness to a hospital for life-saving assistance.

Sometimes there are other side effects from the disease, especially pneumonia (which is an inflammation of the lungs) and kidney infections. Other problems arise in connection with the affected areas, and severity depends on how much nerve damage may have taken place.

Prevention

Luckily poliomyelitis can be prevented effectively today with the aid of a vaccine, which is given by mouth in the form of drops. This vaccine, if given at the right intervals, gives lifelong protection.

Every child should receive the vaccine at birth or for up to six weeks thereafter, next three months, four-and-a-half months and six months of age, with a booster (additional dose) at the age of 18 months. The health care practitioners of SAMHS will gladly answer your queries.

To prevent the disease from spreading, discharges from the patient's nose, mouth and throat as well as waste excretions from the body must be burnt or disinfected. Washing of hands with soap and water can also prevent the spread of the polio virus.

The National Department of Health strongly recommends that visitors to Namibia receive a polio vaccine booster 10 to 14 days before the visit. Only people who go to Namibia on official duties may get this booster through SAMHS.

DOD officials planning a private visit to Namibia should also receive this vaccination, but through a private travel clinic.

The Namibian Government, with assistance from South Africa, the World Health Organisation and other Non-Governmental Health Organisations (NGOs), has embarked on a massive campaign to vaccinate the entire population of Namibia, which numbers about two million people.

Any enquiries in this regard may be forwarded to Col H.S. Venter, Director Environmental Health or Col M. Opperman, SSO SG Office: Director Medicine, tel: (012) 671 5201.