Sample Essay Paper on Disease Prevention: Polio

Disease Prevention: Polio

Medical research and innovation have led to the improvement of human life. Before breakthroughs in medical research and medicine, certain diseases were, especially a bane to humans among them being polio (Guo et al., 2015).Polio is a disease that results in paralysis and even death. Spread by a virus, the disease mostly affects children causing paralysis of the lower motor neurons. Indeed polio is a debilitating disease. Hence, it is essential to explore how it spreads, diagnosis, epidemiology, and primary and secondary methods of prevention.

  1. Polio Description

            Also known as poliomyelitis, polio is a contagious disease that mostly affects children. The disease is caused by the enterovirus found in the picornaviriade family. The virus attacks the central nervous system, destroying the lower motor neurons, thereby causing paralysis. Moreover, the disease spreads through different ways, and they include direct person-to-person contact, individual contact with feces, and contact with mucus or phlegm from the nose or mouth of an infected person (Zieve et al., 2012). Contaminated water or secretions from an infected individual can also pass the virus from one person to another (Guo et al., 2015). Zieve et al. (2012) inform that once the virus has entered the body through either the mouth or nose, it multiplies in both the throat and intestinal tracts, where the body absorbs it into the blood and the lymph system. Essentially, the disease’s incubation period ranges between 6 and 20 days, and while most people do not show symptoms of the disease, there are chances of paralysis from the disease (Zieve et al., 2012).

            Three different strains of polio are known currently. They include polio P1, P2, and P3 (Anand et al. 2015; Poy et al. 2016). Noteworthy is that the three vary in their risk of causing paralysis. Additionally, the World Health Organization warns that total paralysis from the disease can occur within hours of infection (WHO, 2017). While the three strains of the virus have distinct risks in their paralysis causation, P3 has the highest risk of causing paralysis, even as P1 accounts for a more substantial portion of paralysis from the disease (Anand et al. 2015; Poy et al. 2016). The risk and resultant effect of the virus call for regular surveillance of any case of the virus. Within the US, surveillance of communicable diseases has used passive reporting from physicians and other providers (Roush, 2014). Reports from physicians and health providers mostly fall within the realm of traditional surveillance, largely based on clinical and laboratory-based criteria of the disease in question (US Department of Health and Human Services, 2012). Worth mentioning, is the fact that lately, laboratory-based reporting has fast-replaced traditional physician reporting for specific diseases and conditions, especially those that require laboratory confirmation. A third surveillance method, the case-by-case method, is also used, which is appropriate for elimination programs as is the case with polio. In the US, both the CDC and PAHO (Pan American Health Organization) are responsible for polio surveillance, whereby they use both the case-by-case method and laboratory reported surveillance (Roush, 2014). In essence, the purpose of the two surveillance methods is to ascertain the cause of the infection, especially given the near eradication of polio in the United States. For this surveillance, CDC keeps the data on the disease’s data, along with data for other communicable and immunizable diseases, including Guillain-Barré Syndrome (GBS) and acute flaccid paralysis (AFP) all of which have a paralytic relation with polio (Roush, 2014).

  • Descriptive Epidemiology

            Polio is a unique infection that affects people regardless of their ethnicity or nationality. According to the CDC (2016), the disease occurred throughout the world. However, its transmission in the United Stated stopped 1979, and the elimination of the disease in the Western Hemisphere occurred in 1991 according to the Pan American Health Organization (see graph 1). Further, gender and race do not affect the prevalence and contracting the disease. While it affects people from all races and ethnicity equally, children are the most vulnerable regardless of their gender. According to the World Health Organization (WHO) (2017), children under five years are the most vulnerable to the disease. WHO (2017) posits that the infection of a single child puts other children in a country at risk of contracting the infection.

Poliomyelitis United States, 1950-2011 chart as described in the Secular Trends section

Figure 1: Polio in the United States, 1950-2011 (CDC, 2016)

Polio remains mostly absent in the United States since its eradication in 1991, although cases of the virus were reported in 2005, mainly in Minnesota among unvaccinated children (CDC, 2016). Globally, however, the disease is still present in countries such as Pakistan and Afghanistan. O’Reilly et al. (2015) argue that the persistence of polio in Pakistan is due to managerial and operational problems, ongoing conflict and inaccessibility, as well as difficulty in the identification and reach to at-risk but hard-to-reach populations. The population of these countries in conflict continues to be at risk of contracting the infection. Moreover, some cases occur due to the low vaccine coverage of the children in such war-torn areas.  Even with risks for children in such countries, there are regions in the world currently certified polio-free. According to WHO (2017), the Americas, Western Pacific Region, and South East Asia are polio-free certified regions. The certification is in addition to a tremendous reduction in worldwide reported cases of the disease, which have fallen from 3500,000 cases in 1988 to 37 in 2016 in endemic countries (WHO, 2017). Additionally, Maher (2013) informs that people in temperate and humid regions are the most at risk of contracting polio. September and August are especially vulnerable months for polio infection in New England. Conversely, the risk reduces during winter (CDC, 2017). Therefore, humidity and high temperatures seem to increase polio cases, perhaps the more reason the disease is still present in countries in Africa and Asia.

  • Prevention

Although there is no cure for polio, vaccination has been effective as a primary preventive measure. Poy et al. (2016) posit that there are two main forms of polio vaccine: oral and inactive polio vaccine (IPV). Mostly, children get the vaccines as injections or as oral drops scheduled at two months after birth, four months, 6-18 months and a last one between 4-6 years (see Figure 1). While the rest of the world used oral vaccines, IPV is the most common in the United States. However, internationally, WHO recommends the use of the oral vaccine for pre-exposure prophylaxis unless there is a global polio outbreak. Moreover, travelers to polio-infected countries should ensure they have completed the required polio vaccine dosage, with the requirement of all travelers from and to polio-free or polio-infected areas to carry written vaccination records.

Table 1: Immunization schedule (Children Hospital of Philadelphia, 2012)

While it has no cure, early detection of the virus can help prevent its spread and the paralytic effects of the disease. According to CDC (2017), virus isolation from stool specimen collected 24 hours apart from the suspected infected patient can help isolate the virus and confirm not only its genotype but likely geographic origin.  The process is a secondary preventive measure as an early diagnosis process. Through such processes, it is possible to prevent the spread of infection and mitigate the effects of the disease, before it attacks the patient’s lower neurons. Moreover, knowing the disease’s geographical origin can also help in carrying out preventive both primary and secondary preventive measures before the disease spreads to other place and to other people.

References

Anand, A., et al. (2015). Early priming with inactivated poliovirus vaccine (IPV) and intradermal fractional dose IPV administered by a microneedle device: A randomized controlled trial. Vaccine, 33(48), 6816-6822.

CDC (2016). Epidemiology and Prevention of Vaccine-Preventable Diseases: Poliomyelitis. Retrieved from https://www.cdc.gov/vaccines/pubs/pinkbook/polio.html#epi.

CDC (2017). Guidance for Assessment of Polio Vaccination Status and Vaccination of Children who have Received Poliovirus Vaccine outside the United States. Retrieved from https://www.cdc.gov/mmwr/volumes/66/wr/mm6601a6.htm

DHHS (2012). Principles of Epidemiology in Public Health Practice: An Introduction to Applied Epidemiology and Biostatistics, third edition. Atlanta: DHHS, CDC.

Guo, J., et al. (2015). Immunodeficiency-related vaccine-derived poliovirus (iVDPV) cases: A systematic review and implications for polio eradication. Vaccine, 33(10), 1235-1242.

Maher, D. (2013). The human qualities needed to complete the global eradication of polio. World Health Organization. Bulletin of the World Health Organization, 91(4), 283-9.

O’Reilly, K., M. et al. (2015). A new method for estimating the overage of mass vaccination campaigns against poliomyelitis from surveillance data. American Journal of Epidemiology, 182(11), 961-970.

Philadelphia Children Hospital (2012). Vaccine Schedule-Timetable. Retrieved from http://www.chop.edu/centers-programs/vaccine-education-center/vaccine-schedule/timetable.

Poy, A., et al. (2016). Polio eradication initiative contribution in strengthening immunization and integrated disease surveillance data management in WHO African region, 2014. Vaccine, 34(43), 5181-5186.

Roush, S. W. (2014). Role of surveillance in disease elimination Programs. Manual for the Surveillance of Vaccine-Preventable Diseases. CDC. Retrieved from https://www.cdc.gov/vaccines/pubs/surv-manual/chpt18-surv-indicators.html.

WHO. (2017). Poliomyelitis. Retrieved from http://www.who.int/mediacentre/factsheets/fs114/en/.

Zieve, D. et al. (2012). Poliomyelitis. The New York Times. Retrieved from http://www.nytimes.com/health/guides/disease/poliomyelitis/overview.html#Prevention.