Poliomyelitis and post-polio syndrome: migrant health guide
Advice and guidance on the health needs of migrant patients for healthcare 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.
Consider the possibility of post-polio syndrome (PPS) in patients who may have been infected during childhood and are showing unexplained signs of fatigue and weakness. Patients may or may not be aware that they have had polio.
Poliomyelitis is an acute viral infection that can:
- affect the central nervous system
- lead to paralysis
Children under 5 years of age are at greatest risk of infection.
Since the launch of the Global Polio Eradication Initiative in 1988:
- more than 2.5 billion children have been immunised against polio
- reported cases have decreased by over 99%
In the UK, the last case of domestically acquired polio infection was in 1984. All cases since then have been acquired abroad.
In the UK, out of an estimated 120,000 people who have been previously affected by polio, up to 80% will develop post-polio syndrome (PPS), a neurological condition which can severely limit normal activities of daily living.
The polio virus is spread via:
- person-to-person contact with infected secretions from the nose or mouth
- 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.
On rare occasions, live polio vaccines can mutate to a virulent form that can cause paralytic disease in recipients or their contacts.
- stiffness in the neck
- pain in the limbs
One in 200 infections leads to irreversible paralysis (usually in the legs), and of these cases 5 to 10% die due to respiratory paralysis.
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
Testing and treatment
Urgently refer patients with suspected acute poliomyelitis to an infectious disease specialist for formal diagnosis and management.
Take appropriate samples for laboratory investigation according to the PHE enteric virus unit.
Local laboratories with queries about testing samples for polio virus should contact the Virus Reference Department at PHE Colindale.
Refer cases of suspected PPS to a neurologist for investigation and management.
PPS may respond to a range of therapies which might prevent further deterioration.
Prevention and control
In the UK, immunisation is used to prevent and control poliomyelitis, so ensure that children and adults are up to date with the UK immunisation schedule.
Ask opportunistically 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, see National Travel Health Network and Centre (NaTHNaC).
Acute poliomyelitis is a notifiable disease in the UK. If a case is diagnosed or suspected, you should immediately notify your local health protection team (HPT).
Patient.co.uk has produced a polio immunisation leaflet.
NaTHNaC’s Travel Health Pro has guidance on polio.
The Global Polio Eradication Initiative is a public health initiative working towards the eradication of polio with global partners, including: the World Health Organization, Rotary International, the US Centers for Disease Control and Prevention (US CDC) and the United Nations Children’s Fund (UNICEF).
The British Polio Fellowship is the national charity for people in the UK with polio and post-polio syndrome.