Polio's Comeback in Indonesia: Disease factsheet about Polio

On November 2022, three cases of polio diseases have been detected in Pidie, Aceh. There are several reasons why this could happen, but the most important thing is immunization which is still not comprehensive in this region. Poliomyelitis or Polio is an infection caused by a virus. Poliovirus enters the body through the mouth and is acquired most commonly through contact with stool of an infected individual or through contaminated food or water. Poliovirus can also be spread through saliva and respiratory droplets. Polio typically affects children aged 5 years or younger.  It can result in muscle weakness, permanent disability, and even death. 

The incubation period of polio virus is 3--6 days, with paralysis onset in 7--21 days.  Most poliovirus infections (75%) are asymptomatic. Nonspecific symptoms occur in 24% of people. In up to 95% of cases, infections are non-paralytic, presenting as a flu-like illness. In approximately 5% of cases, pure motor paralysis can occur. Clinically, the prodrome may consist of headaches, muscle aches and pain,  feeling tiredness or weakness, nausea, neck stiffness, or sore throat. In infections that progress into the spinal cord, severe muscle spasms with myalgias typically present before an asymmetrical flaccid paralysis. The paralysis tends to have a lower limb predominance.

Doctors recognize polio by symptoms, medical history and perform physical examination. To confirm the diagnosis, we can detected polio virus from blood specimen, cerebrospinal fluid, respiratory and stool by isolating the virus in cell culture or by detecting the virus by polymerase chain reaction (PCR). We can also perform Electromyography (EMG) test and brain/spinal cord Magnetic resonance imaging (MRI) to rule out other pathologies.

In the acute stage, treatment involves general supportive measures for fever and irritation, preventing respiratory tract infections, and managing any respiratory paralysis. The paralyzed legs are supported by splints to relieve pain and spasm. In the convalescent stage, the goal should be to achieve an acceptable physical status for the patients to be integrated into their communities.

The greatest complications of polio infection include paralysis with bulbar involvement, fatal respiratory, cardiovascular collapse, and Post-polio syndrome (PPS). PPS is characterized by new-onset or progressive muscle weakness in a patient previously diagnosed with poliomyelitis.

Patients must be educated on how to avoid transmission with proper hygiene and prevention through vaccination efforts.  There are two types of polion vaccines, inactivated polio vaccine (IPV) and live-attenuated oral polio vaccine (OPV). Inactivated vaccines provide immunity by supplying the body's immune system with a dose of inactivated antigen. The oral poliovirus vaccine used in other regions of the world is a live attenuated virus. This formulation allows the body's immune system to encounter the virus in a less threatening manner and to mount a humoral immune response to protect the recipient from harm with potential future exposures.

IDAI reccomends that all infants and children receive 4 doses of polio vaccine, first dose given immediately after birth up to 1 month, next vaccine dose at ages 2 months, 3 months, and 4 months as part of the national immunization schedule. 

Polio is a notifiable disease in Indonesia and globally. Notify immediately if there is clinical suspicion, even without laboratory confirmation. Any person with symptoms suggestive of polio should seek medical care.