This is a quick-reference section of “Frequently Asked Questions”. If you are looking for further information, please click the relevant link of interest.
Poliomyelitis (polio) is a highly infectious disease caused by a virus. There is no cure for polio, only prevention through vaccination. Polio is primarily spread through the oral-faecal route. Poliovirus enters through the mouth and multiplies in the intestine. People infected with the poliovirus can pass the virus on for 7–10 days before the onset of symptoms. In addition, they can continue to shed the virus in their stools for 3–6 weeks. Polio is still endemic in some countries.
The poliovirus invades the nervous system, infecting spinal motor neurons and/or brainstem nuclei. Initial symptoms are fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs. Although polio paralysis is the most visible sign of polio infection, fewer than 1% of polio infections ever result in paralysis. Amongst those paralysed, 5%-10% die when their breathing muscles become immobilised.
Yes, most people recover from the polio infection. The majority of polio survivors have lived relatively ‘normal’ lives. Immediately following paralytic polio, surviving motor nerve cells in the brain stem and spinal cord extend new branches (sprouts) to reconnect the nerve cell to the muscle. The new sprouts are capable of triggering contraction in the muscles and muscle function can be partially or fully regained.
The last recorded case of wild-poliovirus in Australia was in 1986, although there was a more recent case of polio in Melbourne in 2007, when an international student returned to Australia after contracting the disease in Pakistan. With the introduction of the Salk injectable vaccine in 1956 and Sabin oral vaccine in 1966, Australia's polio cases decreased dramatically following the final epidemic in 1961/62.
Without an ongoing vaccination program, it is possible for polio, and other eradicated communicable diseases, to return to Australia. Polio Australia supports the need for ‘herd immunity’ to protect the community. In Australia, the inactivated poliomyelitis vaccine (IPV) is used for all doses of polio vaccine. The advantage of using IPV is that it cannot cause vaccine-associated paralytic poliomyelitis.
Most polio survivors recovered from the poliovirus and went on to live productive lives. Some people have varying levels of residual disability, and others none at all. This integration of polio survivors into the community is why many people believe that polio is no longer an issue in Australia.
There is no way to accurately identify how many polio survivors are currently living in Australia. During the time of the epidemics, records were not routinely maintained, especially during the war years. There has also been considerable immigration and emigration, as well as natural attrition. Polio Australia estimates there are 400,000 polio survivors living in Australia. Most of these survivors are now aged over 60. However, there is a new cohort of younger polio survivors who contracted the virus in countries where polio eradication occurred more recently.
The Australian Polio Register was established by Polio Australia in 2010 to gather information on the number of polio survivors living in Australia today.
Today there are thousands of polio survivors who are now developing a range of new symptoms with potentially debilitating health effects, manifesting primarily as bio-mechanical and/or neurological decline. This overall condition is known as the Late Effects of Polio (LEoP).
These two terms are often used interchangeably but PPS is considered a sub-category of LEoP. Unlike the LEoP, PPS can be diagnosed. Polio Australia uses the terminology ‘LEoP’, which is inclusive of PPS and provides clarity and consistency.
LEoP refers to:
- Symptoms that are attributable to damage caused by the original acute poliomyelitis, including such aspects as residual weakness and musculoskeletal imbalance.
- Symptoms attributable to a failure to maintain the level of function achieved following the original acute infection, e.g. new weakness and fatigue (PPS).
- Secondary effects of chronic neuromuscular dysfunction, such as degenerative arthritis in overused joints and soft tissue diseases.
PPS refers to:
- The neurologic disorder characterised by a constellation of new symptoms including, but not limited to, increased weakness and/or abnormal muscle fatigability occurring many years after the initial polio infection. Read the March of Dimes criteria for diagnosis (contained in their report: Post-Polio Syndrome - Identifying Best Practices in Diagnosis & Care) for more information.
There are no definitive tests for LEoP. PPS is a ‘diagnosis of exclusion’. Blood tests can show if the person has polio antibodies, which may be due to either having had polio, or having been immunised against polio. Signs of denervation may be picked up through electromyography (EMG).
Below are some useful tools you can utilise to obtain the support you require.
- Check here what is and what is not LEoP.
- Contact your state polio network. Each network is knowledgeable about the services that are available in your area and can direct you to a local support group if desired.
- Register your details on the Australian Polio Register. This assists Polio Australia’s advocacy efforts to lobby for support and services for polio survivors like you.
- Search the Health Professionals Register to find a health professional and/or see whether a Post-Polio Clinic is available in your state.
- Join Polio Australia’s Buddy Call Register to connect with other polio survivors by phone.
- Browse our websites: Polio Australia and Polio Health. Each of these websites has a range of information on polio, LEoP and PPS.
- Contact Polio Australia if you have any further queries.
Unfortunately, Polio Australia does not have the capacity to keep these items. We recommend asking your local museum, library or similar institution if they would like to have them donated.
We recommend all health care professionals visit Polio Health to learn more about these conditions. We have also published clinical practice resources designed for health care professionals. Polio Australia also conducts clinical practice workshops on the late effects of polio for allied health professionals.
It is important to recognise that post-polio patients/clients have specific and varying needs. Polio Australia has a range of resources to assist, including:
- Research on LEoP and PPS, across more than 40 categories.
- A recent clinical resource publication by Polio Australia on managing LEoP: Managing Muscles and Mobility.
- In recognition of the limited information that exists within formal education on LEoP, Polio Australia conducts workshops on managing LEoP across the nation. Register for a workshop, or find out more information.
- A number of medical and health professionals have provided their details on the Health Professionals Register who you may wish to refer to or contact.
LEoP consists of a number of factors, which are separate, but often related to, or exacerbated by, the process of ageing. With any chronic health condition, understanding and managing health will differ between each patient based on their needs and available support. If there is something further you would like assistance with, you can contact Polio Australia.
LEoP differs regarding the symptoms and the difficulties a person may experience. The degree of impact can depend on a range of factors such as the extent of previous loss in function at the time of contracting the disease, the age at which a person was infected, their current loss in function after recovering or stabilising from the original infection, and what they may have done through their work and activity in subsequent decades.
If a person has LEoP, the condition will not go away or be controlled through medication. Appropriate management of symptoms and an understanding of the condition will assist people to maintain their function and independence. This is achieved through consultation with the person who is experiencing LEoP to understand their situation and overall health, and to determine the correct medical and health management.
A physical decline of 1-2% per year may be experienced by polio survivors, which could require lifestyle modifications, increased use of mobility aids, and other assistive technology. If the respiratory muscles are affected, and the condition not properly managed, this may impact on life expectancy. Otherwise, the life expectancy of polio survivors is similar to that of the general Australian population.
Key people to manage health may include specialists in neurology, rehabilitation and respiratory medicine; a General Practitioner; Physiotherapist, Occupational Therapist and Orthotist.