Poliomyelitis and Post-Polio Syndrome

Key messages for primary care practitioners

  • Ensure that new migrants are up to date with the UK immunisation schedule.
  • Although natural polio infection has been eliminated from the UK for many years, there is still the potential for acute cases to present in the UK that have been acquired in endemic areas.
  • Acute poliomyelitis is a notifiable disease.
  • It is also important to consider post-polio syndrome in patients who may have been infected during childhood (patients may or may not be aware that they have had polio), and are showing unexplained signs of fatigue and weakness.

Background information

Testing and treatment

Prevention and control

Patient information (English only)

Other useful resources

References

Background information

Acute poliomyelitis

  • Since the launch of the Global Polio Eradication Initiative in 1988, more than two billion children around the world have been immunised against polio and reported cases have decreased by over 99% [1,2].
  • In the UK, the last case of domestically acquired polio infection in the UK was in 1982.  All cases since then have been acquired abroad. 
  • Poliomyelitis is an acute viral infection that can affect the central nervous system and can lead to paralysis. Children under five years of age are at greatest risk of infection [1,2].
  • Most people infected with poliovirus do not develop any symptoms.  When symptoms do develop, they range in severity from a fever to paralysis [1,2].
  • Initial symptoms can include:
    • Fever
    • Fatigue
    • Headache
    • Vomiting
    • Stiffness in the neck and pain in the limbs [1,2].
  • One in 200 infections leads to irreversible paralysis (usually in the legs) and of these cases, 5% to 10% die due to respiratory paralysis [2].
  • The virus is spread through person to person contact with infected secretions from the nose or mouth, or via 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 with substandard sanitation conditions [1].
  • Rarely, live polio vaccines may mutate to a virulent form that can cause paralytic disease in recipients or their contacts.
  • For further background information please see the PHE polio pages.

Post-polio syndrome

  • Currently, there are an estimated 120,000 people previously affected by polio living in the UK. Up to 80% of these will develop post-polio syndrome (PPS) a neurological condition which can severely limit normal activities of daily living [3,4].
  • Following a period of years of stability, 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 [3]
  • PPS may respond to a range of therapies which might prevent further deterioration [3].

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Testing and treatment

Patients with suspected acute poliomyelitis should be urgently referred to an infectious disease specialist for formal diagnosis and management. Appropriate samples should be taken for laboratory investigation (see UK Standards for Microbiology Investigations - P1 - Surveillance of Polio in the UK). Local laboratories with queries about testing samples for polio virus should contact the Virus Reference Department at PHE Colindale. Cases of suspected post-polio syndrome should be referred to a neurologist for investigation and management.

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Prevention and control

Immunisation is used to prevent and control poliomyelitis in the UK. Ensure that children and adults are up to date with the UK immunisation schedule. Opportunistically ask about travel plans as patients who travel to countries where the infection is endemic to visit friends and relatives are at increased risk of acquiring infection. For country specific travel advice please consult the National Travel Health Network and Centre [external link] (NaTHNaC).

Acute poliomyelitis is a notifiable disease in the UK. If a case is diagnosed or suspected it should be notified immediately to your local Health Protection Team (see QSOP 31 guidelines: surveillance of polio in the UK).

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Patient information (English only)

Patient UK polio immunisation leaflet [external link]

NaTHNaC polio information for travellers [external link]

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Other useful resources

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

The British Polio Fellowship [external link] the national charity for people in the UK with polio and Post Polio Syndrome. 

National Travel Health Network and Centre [external link] (NaTHNaC) - for country specific travel advice.

NaTHNaC polio information for health professionals [external link]

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References

  1. World Health Organization. Poliomyelitis [external link]
  2. Global polio eradication initiative [external link]
  3. British Polio Fellowship. Post polio syndrome [external link] 
  4. British Polio Fellowship. GP Survey Results [external link] 

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