Poliomielitis: climatic changes and impossibility in border control

(Copyright: World Health Organization)

This article was exclusively written for The European Sting by Ms. Ana Flávia Cury Ivantes and Rariane Bernardino Marani, two third-year medical students from a private university in south region of Brasil. They are affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

Climatic and global changes affect the life of the world population directly and indirectly, and these changes can contribute to the spread of diseases¹, as is the case of Poliomyelitis, a fecal-oral disease that since 1988 with the World Polio Eradication Campaign², the World Health Organization (WHO) has distributed certificates to regions where, in other criteria, the absence of wild poliovirus transmission is at least 3 consecutive years. According to WHO, the region of the Americas received the certificate in 1994, the Western Pacific region in 2000, the European region in 2002, and South-East Asia in 2014, with only the African and Eastern Mediterranean regions being required³.

In Brazil, the last case of wild poliovirus was in 1989; however, countries such Afghanistan, Nigeria, and Pakistan are considered as endemic areas, another 6 countries are in an outbreak situation, and approximately 15 countries are at risk. Efforts are being made both by WHO and by groups such as the Global Polio Eradication Initiative (GPEI) to strengthen immunization, once the substantial migration across borders and climatic diferences between regions, which makes the spread of poliovirus na international concern and a public health emergency^4,5.

Poliomyelitis is an acute viral infectious contagious disease that occurs primarily through nasopharyngeal secretions, food, water, objects, and contaminated feces, caused by three types of poliovirus. Most of its occurrences have a form of asymptomatic presentation or non-specific febrile condition, but in more severe cases, Aseptic Meningitis, which is characterized by flaccid paralysis, may be present⁶.

Post-polio syndrome, in turn, is a derangement of the nervous system characterized by motor neuropathies, being an acute muscular atrophy and a motor neuron disease that has as main signs and symptoms myalgia, arthralgia, loss of strength and muscular fatigue, respiratory and swallowing dificulties. Such syndrome is manifested in individuals who had Poliomyelitis after approximately 15 years, and are diagnosed by excluding mainly neurological, orthopedic and psychiatric diseases⁶.

Immunization of polio occurs through natural infection, which generates lasting immunity to the particular type that caused the stimulus, or through vaccination that, for Brazil, occurs in the first year of life². However, currently, both Brazil, Europe and United States have seen a general drop in the rate of people seeking to vaccinate themselves, leading to a fragility in the health-disease process. This situation, coupled with the climate change, bad conditions of tratment of water and food, lack of knowledge about the risks of the disease, fears of symptoms due to vaccination and problems with the vaccine registration system, is related to the fact that many people find it necessary to vaccinate themselves only at an imminent risk of a particular disease, and when there is no such risk or when the disease is already eradicated, immunization for a particular pathology is not treated as a priority and vaccination does not occur. Therefore, there is the inverse effect, which is the greater spread of the disease favoring the sickness of the population, and the vaccination becomes the victim of its own success.

References

1) (LIS/ICICT/FIOCRUZ), Christovam Barcellos. Estudo sobre o impacto das mudanças climáticas na ocorrência de doenças vetoriais como dengue e malária nos biomas brasileiros. Available from: <https://www.icict.fiocruz.br/content/estudo-sobre-o-impacto-das-mudancas-climaticas-na-ocorrencia-de-doencas-vetoriais-como>. Access from: 17 jan. 2019.

2) BARRO, Pedro; RIBEIRO, Particia; GASPAR, Margarida. A Poliomielite. 2004. 20 f. TCC (Graduação) – Curso de Biologia, Universidade de Évora, Évora, 2004. Available from: <http://home.uevora.pt/~sinogas/TRABALHOS/2003/Polio.pdf>. Access from: 17 jan. 2019.

3) INITIATIVE, Global Polio Eradication. Certification. Available from: <http://polioeradication.org/polio-today/preparing-for-a-polio-free-world/certification/>. Acesso from: 17 jan. 2019.  . Certification. Disponível em: <http://polioeradication.org/polio-today/preparing-for-a-polio-free-world/certification/>. Acess from: 17 jan. 2019.

4) INITIATIVE, Global Polio Eradication. Where we work. Available from: <http://polioeradication.org/where-we-work/>. Access from: 17 jan. 2019.

5) ORGANIZATION, World Health. Statement of the Nineteenth IHR Emergency Committee Regarding the International Spread of Poliovirus. Available from: <https://www.who.int/news-room/detail/30-11-2018-statement-of-the-nineteenth-ihr-emergency-committee-regarding-the-international-spread-of-poliovirus>. Access from: 17 jan. 2019.

6) VRANJAC, Alexandre. Poliomielite e Síndrome Pós-Poliomielite. Rev. Saúde Pública, São Paulo, v. 40, n. 6, p.941-945, 2006.

About the authors

Ana Flávia Cury Ivantes and Rariane Bernardino Marani are third-year medical students from a private university in south region of Brasil. Ana is a member of the academic league of Gastroenterology and the Humanization Project in health care (Humanizart), while Rariane is a part of the academic league of Maternal and Child Health and the Oncology and Hematology league. Both academics participate in extracurricular activities, and believe that the primordial principle for the formation of a good doctor and the realization of a quality medicine is the development of scientific research since graduation, which promotes new discoveries for health and minimizes the challenges of the health-disease process.