- Post-Polio Syndrome and Erectile Dysfunction
A report from Uk-Med.co.uk reports on how a disorder known as PPS (post-polio syndrome) is a complaint that can affect polio survivors in later life. It presents as muscle weakness in a previous site where the polio infection first occurred.
Markers are shown as gradual muscle weakening, unexplained overall tiredness and occasionally muscular degeneration. This can affect patients with different degrees of disability. With the pain from degenerating joints, that can cause bone deformities like scoliosis, also muscle atrophy.
The respiratory system can also be affected and there are reports of swallowing difficulties, all due to muscle weakness. As the majority of polio survivors were children when they were stricken with the virus, it makes them too young to recall the severity of the first attack of the disease.
This is showing that those with few original symptoms are a experiencing a minor relapse, whereas the more severe the original ailment the more likely they are to develop worse symptoms. The reoccurrence of problems from the original poliovirus is thought to originate from it damaging certain neurons (the motor unit in nerve cells). The anterior horn cells and the brainstem, seem to be the central areas where new nerve terminals have evolved, as a self-help to repair and recover some mobility. This internal support system happening over the years, is of great strain to the body and can’t be sustained as eventually this leads to permanent and irreversible damage.
This could possibly be the reason for a fairly stable period of remission from the initial infection, with a slow progression to a relapse. It has been reported from male and female PPS sufferers, a significant problem with sexual dysfunction. In the case of men, erectile dysfunction can be helped by taking Viagra and Cialis well-known treatments for impotency. It is not really known why sexual activity should be hindered by the reoccurrence of poliomyelitis. Even though muscle fatigue and pain induced by sudden movement, could be an obstacle, they are not aware of a cause for the erectile dysfunction.
- Europe at ‘polio risk’ from Syria
8 November 2013
Last updated at 02:21
Oral polio vaccine is given in two drops
Europe could be at risk from polio following a recent outbreak in Syria, according to infectious disease experts.
Two doctors in Germany have written to the Lancet journal warning that the cases in Syria – which had been free of wild poliovirus since 1999 – could endanger neighbouring regions.
Prof Martin Eichner, of the University of Tubingen and Stefan Brockmann, of Reutlingen Regional Public Health Office says that because only one in 200 people infected develop paralysis it might take nearly a year of “silent transmission” before an outbreak is detected. In that time hundreds of individuals could be carrying the infection.
The doctors explain that most European countries use inactivated polio vaccine (IPV) rather than the live oral polio vaccine (OPV), because the latter can, in rare cases, lead to cases of acute flaccid paralysis, the main symptom of polio.
Whilst IPV is highly effective at preventing polio disease, it does not give the same level of protection against the virus as the oral drops, so vaccination coverage needs to be very high. The doctors say that countries with low coverage such as Austria (83%) and Ukraine (74%) risk a sustained outbreak should the virus be introduced via refugees fleeing Syria. Polio vaccine coverage in the UK is at 95%.
The doctors said Israel could also pose a potential polio threat.
Prof Eichner told me: “Wild poliovirus has also been found in sewage in Israel and from samples taken from some symptom-free individuals since February 2013. Although there have been no cases of polio in Israel, tourists could risk bringing the infection to other countries.”
Dr Benjamin Neuman, a virologist at the University of Reading, said: “The Syrian outbreak puts Europe at risk because of the way we give vaccines. In parts of the world where it is still possible to catch a wild strain of poliovirus, children are usually vaccinated with a live but genetically weakened poliovirus which gives excellent protection but has a tiny risk of changing back to the more dangerous form.
“However, in parts of the world where polio has been eradicated, like the UK, children are usually given a killed vaccine. It doesn’t protect quite as well but it cannot mutate, so it protects reasonably well while preventing polio from being accidentally reintroduced to a country.
He added: “Vaccination is never perfect, so despite being vaccinated, a small percentage of children in the UK would be at risk of contracting polio if they were exposed to the virus. Until the virus is completely extinct, it is essential that we continue to vaccinate our children.”
Most of the 22 cases of polio-like paralysis in Syria (10 of which have been confirmed as wild poliovirus type) are among children below the age of two who were unimmunised or who had not received all three doses of vaccine.
The World Health Organization warned last month there was a high risk of polio spreading internationally because of the movement of refugees across the region and low immunisation rates in Syria.
Prof Eichner said: “The WHO wants to get rid of polio completely and had got pretty close until recent outbreaks. The fact that most of those infected do not display symptoms but can still spread the disease makes it a very hard virus to get rid of as it is like fighting an invisible enemy.”
So far this year 322 cases of wild poliovirus have been confirmed, more than half of them in Somalia.
- Syria: Polio epidemic fears grow
25 October 2013
Last updated at 13:13
Children under age five are at highest risk of contracting polio
At least 22 people – most of them babies and toddlers – are now believed to have contracted polio in Syria, the World Health Organization has reported.
If confirmed, it would be the first outbreak of the disease there in 14 years. Syria’s Health Ministry began an immunisation drive on Thursday.
Before Syria’s civil war began in 2011, some 95% of children were vaccinated against the disease.
Now, Unicef estimates 500,000 children have not been immunised.
WHO said the suspected outbreak centres on the eastern province of Deir Ezzor.
“There is a cluster of 22 acute flaccid paralysis cases that is being investigated in that area,” WHO spokesman Oliver Rosenbauer told Reuters news agency. “Everybody is treating this as an outbreak and is in outbreak response mode.”
Two cases have already been confirmed by laboratory tests while the WHO expects final laboratory confirmation on the remaining 20 cases next week.
There are more than 100,000 children, all under age five, now at risk of polio in Deir Ezzor province alone, which has been caught in fierce battles between Syrian government forces and opposition fighters.
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People are flooding across borders in an uncontrolled manner and this increase the possibilities and means by which the virus can spread.”
The city of Deir Ezzor remains partially controlled by forces loyal to President Bashar al-Assad, while the countryside is in the hands of the opposition.
The WHO is now working with the UN, Syria’s Health Ministry and other agencies on a mass immunisation programme.
But it is expected to be a difficult undertaking, says the BBC’s Imogen Foulkes in Geneva, given the widespread insecurity and estimates that over half of Syria’s medical professionals have left the country.
More than four million Syrians have been displaced internally by the conflict and generally live in overcrowded, unsanitary conditions. The WHO has already reported increases in cases of measles, typhoid and hepatitis A.
Aid agencies are also developing emergency immunisation plans for Syrian refugee camps in Jordan, Lebanon, Turkey and Egypt.
Syrian refugees are also at risk of disease due to poor living conditions
“Obviously, we’re extremely worried about the situation,” Simon Ingram, a spokesman for Unicef’s operations in the Middle East, told the BBC.
“People are flooding across borders in an uncontrolled manner and this increases the possibilities and means by which the virus can spread.”
No known cure
The highly contagious disease is most often spread by consuming food or liquid contaminated with faeces.
Polio has been largely eradicated in developed countries but remains endemic in Nigeria, Pakistan and Afghanistan.
Worldwide, polio cases have fallen from an estimated 350,000 at the start of a WHO-led immunisation campaign in 1988 to just 223 reported cases last year.
There is no known cure, though a series of vaccinations can confer immunity. Young children are particularly susceptible to paralytic polio, the most serious form of the disease.
- Syria: Polio outbreak fears
21 October 2013
Last updated at 09:35
Polio can be prevented but not cured
Experts are concerned that polio may have made a return to war-torn Syria.
The World Health Organization says it has received reports of the first suspected outbreak in the country in 14 years.
Syrian’s Ministry of Public Health is launching an urgent response, but experts fear the disease will be hard to control amid civil unrest.
Immunisation is almost impossible to carry out in regions under intense shellfire.
As a result, vaccination rates have been waning – from 95% in 2010 to an estimated 45% in 2013.
At least a third of the country’s public hospitals are out of service, and in some areas, up to 70% of the health workforce has fled.
Outbreak risks have also increased due to overcrowding, poor sanitation and deterioration in water supply.
More than four million Syrians who have relocated to less volatile areas of the country are mostly living in overcrowded, unsanitary conditions.
The WHO says it is already seeing increased cases of measles, typhoid and hepatitis A in Syria.
Dr Jaouad Mahjour, director of the department for communicable diseases at WHO’s regional office for the Eastern Mediterranean, said: “Given the scale of population movement both inside Syria and across borders, together with deteriorating environmental health conditions, outbreaks are inevitable.”
The cluster of suspected polio cases was detected in early October 2013 in Deir al-Zour province.
Initial results from a laboratory in Damascus indicate that at least two of the cases could indeed be polio.
A surveillance alert has been issued for the region to actively search for additional potential cases. Supplementary immunisation activities in neighbouring countries are currently being planned.
WHO’s International Travel and Health recommends that all travellers to and from polio-infected areas be fully vaccinated against polio.
Most people infected with the poliovirus have no signs of illness and are never aware they have been infected. These symptomless people carry the virus in their intestines and can “silently” spread the infection to thousands of others before the first case of polio paralysis emerges.
Polio is spread by eating food or drink contaminated with faeces or, more rarely, directly from person-to-person via saliva.
- Polio vaccinators killed in Nigeria
8 February 2013
Last updated at 11:47
Nigeria is one of only three countries where polio is still endemic
Nine female polio vaccinators have been killed in two shootings at health centres in northern Nigeria, police have told the BBC.
In the first attack in Kano the polio vaccinators were shot dead by gunmen who drove up on a motor tricycle.
Thirty minutes later gunmen targeted a clinic outside Kano city as the vaccinators prepared to start work.
Some Nigerian Muslim leaders have previously opposed polio vaccinations, claiming they could cause infertility.
On Thursday, a controversial Islamic cleric spoke out against the polio vaccination campaign, telling people that new cases of polio were caused by contaminated medicine.
Such opposition is a major reason why Nigeria is one of just three countries where polio is still endemic.
But this is believed to be the first time polio vaccinators have been attacked in the country.
Some Kano residents told the BBC’s Yusuf Yakasai in the city that other people injured in the first attack had been taken to hospital.
A health official confirmed to the BBC that those killed in the second attack in Hotoro were female health workers – there were earlier reports that people waiting at the clinic may have been among those shot.
Witnesses in Hotoro told the BBC gunmen also approached the health centre using a motor tricycle.
Kano banned motorbikes from carrying passengers after a recent attack on the prominent Muslim leader, the emir of Kano.
Analysts believe the attacks may have been the work of the militant Islamist group Boko Haram but it has not yet commented and no group has said it carried out the attack.
The group – whose name translates as “Western education is forbidden” – says it is fighting to overthrow the government and impose Sharia.
It has been blamed for the deaths of some 1,400 people in central and northern Nigeria since 2010.
According to the Global Polio Eradication Initiative, there were 121 cases of polio in Nigeria last year, compared to 58 in Pakistan and 37 in Afghanistan.
In the past month, polio workers have also been targeted and killed in Pakistan, where the Taliban have threatened anti-polio efforts – accusing health workers of working as US spies and alleging that the vaccine makes children sterile.
- Bill Gates: The world can defeat polio
28 January 2013
Last updated at 01:14
Vaccination is key to controlling the disease
Glance at the latest figures for polio incidence and it would appear that the world is within touching distance of eradicating the disease.
Last year there were just 205 cases of naturally occurring poliovirus compared with 650 cases in 2011 and a staggering 350,000 a quarter of a century ago.
There are now three countries – Pakistan, Afghanistan and Nigeria – where transmission of the disease has never been halted compared to 125 countries in the late 1980s.
India has been polio-free for two years – a remarkable achievement.
This week the billionaire philanthropist Bill Gates will deliver the annual BBC Richard Dimbleby Lecture in which he will spell out his commitment to ridding the world of this dread infectious disease which can cause paralysis and even death within hours.
Bill Gates is the single most influential voice in global health, so when he turns his attention to an issue, it is worth listening.
Through the Gates Foundation, Bill and his wife Melinda have already given away nearly $30 billion of their fortune and there are tens of billions more in the pipeline.
He has spoken to me previously of his passionate belief in the power of vaccines and his determination to defeat polio.
In his lecture Mr Gates will liken the pace of innovation in computers with the fight against polio: .
He will say: “In the late 1970s we had a dream of giving everybody access to computer technology – a vision of a computer on every desktop. Now there is a computer in every pocket.
“The pace of innovation keeps getting faster. The same is true of polio.
“It was first recognised at least 4,000 years ago, but it was just 200 years ago we figured out it’s contagious – just 100 years ago we learned it’s a virus. Just 50 years ago we developed the vaccine to prevent it.
“Just 25 years ago we resolved to eradicate it. And so on.“
But Mr Gates will also acknowledge that the final push against polio is proving extremely difficult: “I can say without reservation that the last mile is not only the hardest mile; it’s also much harder than I expected,” he said.
The killing of nine health workers in Pakistan last month was a shocking reminder of the challenges facing those trying to chase down the virus and protect every last child. I have written before of the hurdles facing immunisation teams.
Part of polio’s danger is its utter portability – it can be spread across borders by one infected traveller, who can continue to shed virus for weeks on end.
Only last week an emergency vaccination programme was ordered in Cairo after samples of the polio virus were found in sewage – the strain matches that in southern Pakistan.
The oral polio vaccine can – in very rare cases – trigger polio. The WHO says this happens in one in 2.5 million first doses of vaccine.
Over the past decade 15 billion doses of polio vaccine drops have been given and there have been 200 confirmed cases of circulating vaccine-derived polio virus.
But with naturally occurring polio cases now so low there is a minority which claims the oral live vaccine is causing significant harm.
Dr Jacob Puliyel, a paediatrician in Delhi, wrote in the Indian Journal of Medical Ethics last year that “the polio eradication programme epitomises nearly everything that is wrong with donor-funded ‘disease specific’ vertical projects, at the cost of investments in community-oriented primary care”.
Dr Puliyel said the money spent on fighting polio in India would have been put to better use on water, sanitation and routine immunisation.
Now or never
Dr Puliyel blames the polio vaccine for a sharp rise in India of cases of Acute Flaccid Paralysis – weakness or inability to move limbs.
But polio is just one of many causes, with other viruses and bacteria also responsible. Public health officials also point out that monitoring of cases is now far better than in previous decades.
In pure economic terms it is hard to justify the $1bn (£630,000) spent annually on driving down polio cases by a few hundred each year.
It makes sense only if global eradication is achieved. Then the repeated – sometimes monthly – polio immunisation rounds in at-risk communities can stop and the vaccine be part of the standard childhood schedule.
This is a now or never moment – kick polio off the planet over the next few years or face a humiliating retreat which could see the virus re-emerge in scores of countries.
Bill Gates recognises what is at stake for global health: “Polio eradication is a proving ground, a test. It will reveal what human beings are capable of, and suggest how ambitious we can be about our future.”
The 2013 Richard Dimbleby Lecture will be shown on Tuesday 29 January on BBC One at 22:35 GMT