Although the polio virus was eliminated from the Americas in 1994, the disease still circulates in Asia and Africa, paralyzing the world’s most vulnerable children. In a continually shrinking world polio, like many other vaccine-preventable diseases, remains only a plane ride away. The Global Polio Eradication Initiative started in 1988. That year, an estimated 350,000 children were paralyzed with polio worldwide. In 2017, polio cases had fallen to just over 22 cases globally.
Polio is transmitted through the fecal-oral route, although there is some evidence that oral-to-oral transmission is possible. The virus is killed by regular household disinfectants and standard hygiene protocols can prevent transmission. The virus affects the nervous system of a patient, and can lead to a flaccid paralysis of the legs while sensation remains intact.
Recent cases in Indonesia
There were several confirmed cases of “wild” polio in Indonesia in the Sukabumi area of West Java in the early 2000s. All patients were children from poor social backgrounds who did not start or complete a vaccination series as recommended by the WHO.
The vaccination against polio started in 1955 with the oral vaccine developed by Jonas Salk and his team of scientists at the University of Pittsburgh. From there, the next development was a trivalent vaccine effective against all known strains of polio, and in 1987 an injectable vaccine was introduced. Although rare, vaccination-associated paralytic polio (VAPP) was a side effect occurring in 5-10 cases annually during the period of exclusive oral vaccination. This includes adults over the age of 18, who were at a higher risk of VAPP than small children.
Independent of any cases of polio in the country, every child and adult in Indonesia should receive a full series of four vaccinations against polio. A person who did not complete the regimen is advised to do so at their earliest convenience, as it is not necessary to repeat the whole series if only one injection had been missed. An incomplete oral vaccination schedule (OPV) can be completed by injection (IPV).
Booster vaccination of adults or children who have already completed a full series of injections in the past is not recommended. It is recommended to use the injectable vaccine for any new full vaccination of adults and children. The minimum time between injections must be four weeks, though a rapid two month schedule is recommended for the first three injections. Adults should follow the 0/1/2 month schedule with a further booster sometime after one year.
Additional info on Polio from the US Center for Disease Control
If you have any further questions about medical concerns in Indonesia, see the Ask the Experts.
We trust this information will assist you in making correct choices regarding your health and welfare. However, it is not intended to be a substitute for personalized advice from your medical adviser.
Our appreciation to Hill and Associates for passing along this update from Dr. Uwe Stocker of International SOS, an AEA Company, who has contributed this article in response to a growing health concern in Indonesia.