Many thanks to Mary-ann Liethof, National Program Manager of Polio Australia for contributing this valuable information for health professionals.
Australia experienced waves of polio epidemics throughout the 20th century. However, with the introduction of the Salk and Sabin vaccines, polio was an uncommon infection in Australia by the early 1960s.
According to the Australian Department of Health website, Poliomyelitis (polio) is an acute illness following gastrointestinal (stomach and gut) infection by one of the 3 types of polioviruses. The virus spreads between people through contact with infected faeces and throat secretions. Polio can cause meningitis (brain infection) and paralysis. About 5% of people hospitalised with polio die from it, and about half of those who survive suffer permanent paralysis.
In 90 per cent of cases, the illness has no symptoms. If symptoms do occur they can take between 3 and 21 days after infection to show. Where symptoms do occur they can include:
- nausea and vomiting;
- neck and back stiffness;
- severe muscle pain; and
Thankfully, Australia is now free of new cases of polio, although years after contracting the infection, increasing numbers of Australia’s 400,000 polio survivors are developing a range of new symptoms.
The post-polio sequelae cause a range of debilitating health effects, and manifest primarily as biomechanical and neurological symptoms. The condition is referred to broadly as the late effects of polio (LEoP) or, in circumstance where specific clinical diagnostic criteria are satisfied, as post-polio syndrome (PPS).
The symptoms experienced by those with LEoP, which are primarily biomechanical, vary considerably both in range and severity. The added neurological symptoms of PPS provide further health concerns. The symptoms experienced by those suffering LEoP/PPS commonly include:
- general fatigue;
- pain in muscles and/or joints;
- weakness and muscle atrophy;
- muscle spasms/twitching;
- respiratory and sleep problems; and
- difficulties with swallowing and speaking; and
- cold intolerance.
The criteria for diagnosing PPS are:
- Prior paralytic poliomyelitis with evidence of motor neuron loss, as confirmed by history of the acute paralytic illness, signs of residual weakness and atrophy of muscles on neuromuscular examination, and signs of nerve damage on electromyography (EMG). Rarely, persons have subclinical paralytic polio, described as a loss of motor neurons during acute polio but with no obvious deficit. That prior polio now needs to be confirmed with an EMG. Also, a reported history of nonparalytic polio may be inaccurate.
- A period of partial or complete functional recovery after acute paralytic poliomyelitis, followed by an interval (usually 15 years or more) of stable neuromuscular function.
- Gradual onset of progressive and persistent new muscle weakness or abnormal muscle fatigability (decreased endurance), with or without generalised fatigue, muscle atrophy, or muscle and joint pain. Onset may at times follow trauma, surgery, or a period of inactivity, and can appear to be sudden. Less commonly, symptoms attributed to PPS include new problems with breathing or swallowing.
- Symptoms that persist for at least a year.
- Exclusion of other neuromuscular, medical, and orthopaedic problems as causes of symptoms.
The Challenges of Living with LEoP/PPS
Most Australian polio survivors affected by LEoP/PPS are now over 60 years of age, limiting this potentially debilitating disease to an ageing population. It should be noted that the National Disability Insurance Scheme does not cover people over the age of 65 years, which will subsequently impact on the majority of Australia’s polio survivors by the time the NDIS is fully rolled out in the coming years. However, there is also an unknown number of younger polio survivors who migrated from countries where polio was eradicated more recently, or is still endemic. Both these populations need specific post-polio health care.
Although not a new condition, knowledge of the LEoP/PPS across the health sector is limited, resulting in widespread issues including, but not limited to:
- clinical misdiagnosis, or even a dismissal of the symptoms;
- polio survivors lacking awareness of their own condition;
- the exacerbation of motor neuron damage due to poor management;
- a significant increase in falls leading to the need for expensive acute care; and
- extraordinary costs relating to health and disability.
Polio Australia’s Mission
In the late 1980s, Polio Networks were formed in every state of Australia, predominantly governed and managed by volunteer polio survivors, to provide information about the LEoP/PPS for their brethren. Most were funded through membership; others attracted small amounts of state government funding.
In 2007, these Networks came together to discuss the need for a national body, as the volunteer polio survivors became increasingly more debilitated by the LEoP/PPS. The result is that Polio Australia was incorporated in 2008 as the sole national peak body to represent polio survivors throughout Australia.
Polio Australia is a self-funded not-for-profit with limited resources. However, it is committed to standardising quality polio information and service provision across Australia for polio survivors. To help achieve its goals, Polio Australia recently launched a new website for health professionals at www.poliohealth.org.au.
The Polio Health website is the only Australian website where health professionals can find specific post-polio information including the 2016 Australasia-Pacific Post-Polio Conference, PD Workshops, Videos and other Resources, Clinical Practice and other Publications, Research, and the Australian Polio Register.
Working with Health Professionals
Polio Australia works with general practitioners and allied health professionals to promote activities which will raise awareness of the late effects of polio/post-polio syndrome. We believe there is an urgent need for:
- specialised health practices;
- empowerment for polio survivors to self-manage their condition;
- focus on an interdisciplinary approach;
- awareness raising of the LEoP/PPS in Australia;
- a focus on undergraduate training;
- ongoing training for health professionals;
- education in the health sector; and
- specialised operational procedures and protocols for polio survivors requiring acute care.
Health professionals interested is contributing to the care of polio survivors are encouraged to contact Polio Australia to discuss further opportunities: email@example.com.
National Program Manager
PO Box 500
Kew East Vic 3102
Ph: 03 9016 7678
Mob: 0466 718 222
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Image: 3-D schematic of a poliomyelitis virus particle – the logo of Polio Australia.