Polio

Abstract

Polio was declared an international public health emergency in May 2014. International travel and migration raises the threat for widespread outbreak. Promoting and protecting worker’s health requires increased vigilance over international public health concerns.

Four viral diseases, severe acute respiratory syndrome, swine influenza, Middle East respiratory syndrome, and Ebola, recently endangered global health. In 2014, polio, another highly infectious viral disease, was declared an international public health emergency (Centers for Disease Control and Prevention [CDC], 2014a). Polio, or poliomyelitis, affects the nervous system, and disabled thousands of individuals in the United States in the late 1940s and early 1950s. The United States remains polio free since initiation of massive immunization with the inactivated polio vaccine (IPV) developed in the 1950s. The live oral polio vaccine (OPV) was developed a decade later and is still used in some international countries; the only U.S.-approved vaccine is IPV (Wallace, Alexander, & Wassilak, 2014).

Polio is endemic in three countries, Afghanistan, Nigeria, and Pakistan, and seven additional countries, Cameroon, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia, and Syria, are considered polio-infected. No active cases have been reported, but wild polio virus (WPV) was detected in Israel, the West Bank, and Gaza in sewage and in healthy children fully vaccinated with IPV (CDC, 2014b). WPV outbreaks occurred in 2010 and 2011 after the virus was imported into 18 countries in Africa, Eastern Europe, and Asia (Wallace et al., 2014).

The WPV thrives in the throats and intestines of humans. Its primary exposure path is oral and usually spreads person-to-person via contact with contaminated feces. Polio infections are mostly asymptomatic, although roughly one fourth causes flu-like symptoms. Victims rarely develop severe polio symptoms such as paresthesia, meningitis, or paralysis (CDC, 2014c). Infected individuals are contagious immediately before and 1 to 2 weeks after symptoms appear, yet the virus lives in feces for many weeks and can infect without obvious symptoms. Under unsanitary conditions, the virus can contaminate food, water, and solid surfaces such as cooking utensils (CDC, 2014c).

Increasing globalization with travel and migration between countries and failure to fully vaccinate children increase risks for polio outbreaks. War and civil unrest disrupt public health systems; workers in health care settings, refugee camps, and other humanitarian aid settings in countries with active WPV and neighboring countries are at high risk for WPV exposure (CDC, 2014a).

Occupational and environmental health nurses can decrease the risk of polio by teaching workers to follow all routine vaccination guidelines for themselves and their family members and additional vaccinations prior to international travel. CDC routinely recommends complete polio vaccination for everyone; however, a one-time adult IPV booster is needed before travel to countries that have reported polio cases within the preceding 12 months or active WPV circulation (CDC, 2014b).

Promoting and protecting workers’ health requires increased vigilance over global public health concerns, and workers reporting sick should always be asked about recent international travel. Occupational and environmental health nurses must closely monitor vaccine recommendations and be aware that changing health conditions may revise documentation required on the International Certificate of Vaccination (CDC, 2014a). Health information in the “Yellow Book” and other resources on the CDC Travelers’ Health website (www.cdc.gov/travel) can update occupational and environmental health nurses about international health risks, travel restrictions, and vaccination requirements.