Resurgence of Polio in UK – The Risks….

 

The Polio virus is back – at least in our sewage system. 

Does this mean we’re in for yet another another viral epidemic ?

It could do, if we take no action – how then can we prevent it happening ?

The reasons why polio virus has suddenly started to appear in our sewage system are not completely clear, given that no cases of active disease have been reported in UK so far.

The most prevalent view amongst epidemiologists at present is that it has been imported by vaccinated individuals from areas of the world where vaccination is via the old-style oral attenuated live virus vaccine. This vaccine continues to be used in 3rd world countries because it is a) cheap and easy to administer and b) gives very good immune responses over a short period.

It is the ideal rapid immunisation strategy in the few remaining areas of the world where the live virus is still endemic due to religious antipathy to vaccination (Afghanistan and Pakistan). It is also used as a rapid response tool to tackle local outbreaks in other areas where the virus isn't endemic, but appears as a result of transmission by travelers from the endemic regions.

The problem from our point of view in UK is that the attenuated virus used in the oral vaccine is still ‘live’ and capable of replicating. It can therefore overcome the attenuation process by mutating to new variants which may be able to cause the disease and its associated paralysis. This is the main concern in first world countries where the virus has re-appeared. Only one case of paralysis has been seen (in USA) so far, but the risk is there, particularly if the virus is allowed to proliferate unchecked.

The best way of dealing with this threat, of course, would be to complete the eradication process, as we did for Smallpox in 1980. The chances of this succeeding, however, are slim. Afghanistan is fast becoming a 'rogue' state again under Taliban rule, with even the basics of life in short supply. Pakistan, although perhaps less ungovernable, would also be a difficult 'nut to crack', given its ingrained religious anti-vax traditions. The only defences we have in the rest of the world is elimination of transmission - and vaccination.

Children in UK have been routinely vaccinated against Polio for many years since its eradication here. We use more modern vaccines which don’t involve live virus.

The problem lies with the non-vaccinated, of which there are growing numbers amongst immigrant communities, particularly in some London boroughs. There are a variety of reasons why some parents in these areas don't get their children vaccinated, poverty and religious taboos being the main ones. The DOH has become concerned enough about the risks of an epidemic to offer free vaccinations to all children between 1 and 9 years old, whether or not they have already been vaccinated. This is in order to ‘catch’ as many of the non-vaccinated as possible, and provide immune ‘top-ups’ for the rest.

It is to be hoped this will prevent an epidemic….if not, we may start to see the disease rearing its ugly head again, particularly if immigration from endemic regions is allowed to continue without adequate screening for the virus on entry to UK. 

In the event of a new epidemic, and to protect public health, pressure would need to be applied to those already resident in UK who continued to act irresponsibly by refusing the vaccine for themselves and their children.

Viv

Version Date 12.8.22

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