JAKARTA – The Resurgence of Polio in East Java: A Public Health Emergency

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In early 2024, Indonesia faced a significant public health challenge with the reemergence of polio in East Java. This alarming situation captured the nation’s attention and prompted the Ministry of Health to declare an Extraordinary Event (KLB) status, a critical step in controlling the spread of this debilitating disease.

The Emergence of New Cases

The initial cases were identified in three children from East Java and Central Java, suffering from acute flaccid paralysis (AFP), a severe condition caused by polio virus type 2. In a concerning development, subsequent laboratory tests in nearby areas revealed nine additional children who tested positive for the virus, albeit asymptomatic. This discovery underscored the insidious nature of polio, capable of spreading silently.

Government Response and Immunization Efforts

In response to this outbreak, the Ministry of Health swiftly declared a polio epidemic. Concurrently, they organized a National Polio Immunization Week (NIP) in Central Java, East Java, and Slemen Regency, Yogyakarta. This campaign was conducted in two phases: first on January 15, 2024, and then on February 19, 2024. The immunization drive targeted children aged 0 to 7 years, irrespective of their prior vaccination status, highlighting the urgency of protecting all children from this virus.

Transmission and Risks

According to AI Care, polio, or poliomyelitis, is a highly infectious disease caused by the polio virus, predominantly affecting the nervous system. It is primarily transmitted through contaminated water or food and can lead to paralysis or even death. An alarming aspect of polio is its ability to be spread by infected individuals who show no symptoms, particularly endangering children under five years, especially those unvaccinated.

Indonesia’s Journey with Polio

Indonesia achieved a significant milestone in its public health history by being declared polio-free on March 27, 2014, along with other WHO member countries in the Southeast Asia region. However, this triumph was short-lived as polio resurfaced in Aceh in October 2022 in a 7-year-old boy, marking the first case since the nation’s polio-free declaration. Following this, more cases surfaced in January 2023 in northern Aceh and Purwakarta, highlighting the persistent threat of this virus.

The Challenge of Rapid Transmission

The ease and speed of polio transmission are alarming. The virus can spread through saliva droplets from coughing or sneezing and through direct contact with feces from an infected person. Dr. Sean Edbert Lim from VOI highlighted the rapid progression of the disease, where infected children can experience paralysis within 7 to 21 days of infection.

Factors Contributing to the Resurgence

Dr. Sean identified several factors contributing to these recurring polio cases. Key among them is the low or incomplete polio vaccination coverage for children under five years of age. Hygiene practices, like washing hands and proper waste disposal, also play a crucial role in preventing the spread of polio.

Vaccination Coverage: A Crucial Metric

The Ministry of Health’s data from 2020 revealed that the average coverage for the four-dose oral polio vaccine (OPV4) was 86.8%, falling short of the national target of 95%. Notably, Aceh recorded the lowest coverage at 51.7%, followed by West Sumatra at 57.9%. The COVID-19 pandemic further exacerbated this situation, as many parents postponed or skipped vaccinations due to fears of COVID-19 infection.

Conclusion

The resurgence of polio in Indonesia serves as a stark reminder of the importance of maintaining high vaccination coverage and robust public health measures. As the country rallies to combat this outbreak, the lessons learned will be crucial in safeguarding the health and well-being of its youngest citizens against this reemerging threat.


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Polio: A Detailed Look at a Crippling Disease

What is Polio?

Polio, short for poliomyelitis, is a highly infectious disease caused by the poliovirus. This virus invades the nervous system, and in some cases, can lead to paralysis (loss of muscle function). While most people who contract polio experience no symptoms or mild illness, about 1 in 200 infections result in irreversible paralysis, often affecting the legs. Polio mainly affects children under 5 years of age.

Types of Poliovirus:

There are three types of poliovirus:

  • Poliovirus type 1 (WPV1): Eradicated in 2020.
  • Poliovirus type 2 (WPV2): Eradicated in 2013.
  • Poliovirus type 3 (WPV3): On the brink of eradication, with only two endemic countries remaining (Afghanistan and Pakistan) as of October 2023.

How Does Polio Spread?

The poliovirus spreads from person to person mainly through the fecal-oral route. This means the virus is present in the feces of an infected person and can enter the body of another person through the mouth, usually via:

  • Contaminated water or food
  • Poor hand hygiene after using the toilet
  • Direct contact with an infected person’s feces or contaminated objects

Less commonly, the virus can also spread through the oral-oral route, such as through coughing or sneezing.

Symptoms of Polio:

  • Mild symptoms (in about 75% of cases): These may include fever, sore throat, fatigue, nausea, headache, and stomach ache. These symptoms usually go away within a few days and most people make a full recovery.
  • Severe symptoms (in about 1 in 200 cases): These can develop a few days to a few weeks after the initial mild symptoms. They may include muscle weakness, meningitis (inflammation of the membranes surrounding the brain and spinal cord), and paralysis. Paralysis can affect any part of the body, but most commonly affects the legs.

Diagnosis of Polio:

Polio is diagnosed by testing stool or cerebrospinal fluid (CSF) for the presence of the poliovirus.

Treatment of Polio:

There is no cure for polio. Treatment focuses on relieving symptoms and supporting recovery, such as:

  • Bed rest and pain management
  • Physical therapy to help regain muscle strength and function
  • Respiratory support if needed

Prevention of Polio:

The most effective way to prevent polio is vaccination. The polio vaccine is safe and effective, and can protect a child for life. There are two types of polio vaccines:

  • Inactivated polio vaccine (IPV): This is injected into the arm or leg and is the only vaccine used in the United States since 2000.
  • Oral polio vaccine (OPV): This is given by mouth and is still used in some countries.

The Global Polio Eradication Initiative (GPEI) is a worldwide effort to eradicate polio. Since its launch in 1988, the number of polio cases has decreased by over 99%. However, as long as even a single case of polio exists anywhere in the world, all children remain at risk.

The Impact of Polio:

Polio can have a devastating impact on individuals, families, and communities. It can lead to permanent disability, reduced quality of life, and increased healthcare costs. The eradication of polio would be a major public health achievement and would save millions of lives.

Here are some additional resources you may find helpful:

I hope this detailed document has provided you with a comprehensive understanding of polio. Please let me know if you have any other questions.

Additional Notes:

  • It is important to note that while polio has been nearly eradicated, the risk of outbreaks remains in areas with low vaccination rates. It is important to ensure that all children are vaccinated according to the recommended schedule.
  • There are also several strains of circulating vaccine-derived poliovirus (cVDPV) that have emerged in recent years. These viruses are derived from the weakened poliovirus used in the OPV and can cause paralysis in unvaccinated individuals. However, the risk of cVDPV is much lower than the risk of wild poliovirus, and can be mitigated through high vaccination coverage.

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