The First Step: Identification and Prevention | Part III

The first step in combating any disease is identification. Identifying a disease helps scientists to focus their efforts, saving time and money. Identification of polio may seem easy at first as the symptoms of the virus are easy to spot. A person infected with polio would show a sore throat, fever, and nausea. If you find an individual with these symptoms, then you may think that you have found a person infected with polio. But if you would take another glance at the listed symptoms, you will notice that they share a heavy resemblance with an innumerable number of diseases. Since other neurological diseases have similar symptoms as polio, laboratory confirmation is critical to establish the diagnosis of poliomyelitis.

The major tool epidemiologists use to identify polio virus in a community is genetic sequencing. Genetic sequencing allows for the identification of the geographic origin of the virus, which includes the approximate age of the virus and its relationship to other viruses. Genetic sequencing has enabled scientists to build a database of polioviruses worldwide. This database has provided critical insight into virus location and transmission pathways, consistent with population movement. This enables polio outbreak response teams to develop rapid approaches for responding to polio outbreaks and building immunity in populations.

After identifying communities where a polio virus outbreak has occurred it is the duty of epidemiologists to respond with immediate action. These actions include investigation of virus transmission and spread as well as risk assessment. Within 24 hours of a virus notification, an epidemiological and social investigation should be completed. Within 72 hours of identifying the virus, a detailed risk assessment should be prepared which should outline the virologic risk and the risk of international transmission. Depending on the level of risk, response activities are initiated which include but are not limited to:
  • Communicating the risk and informing the affected communities
  • Immunization campaigns to vaccinate children
  • Enhancing surveillance to help health workers  to recognize symptoms and identify new cases
  • Strengthening routine immunization to ensure that the people most likely to be infected are vaccinated

However these measures are an emergency response. With the goal of protecting unaffected communities from the virus and stopping further transmission. To eradicate the disease we must take one step further. Epidemiologists have devised four strategies to best combat and eradicate polio. The four core eradication strategies include:

  • Mass immunization campaigns, such as National Immunization Days or other supplementary immunization activities. These campaigns are implemented in areas where routine immunization is insufficient to either eradicate polio, or prevent its re-emergence. Such campaigns are conducted via a house-to-house strategy, whereby front-line health workers deliver the vaccine to children in their homes.
  • Ensuring an active surveillance system to rapidly detect any polio virus anywhere in the world. To eradicate polio, we need to know where the virus is so that we can rapidly respond and interrupt any transmission in the population.
  • Using the polio staff and infrastructure to help strengthen routine immunization activities. Routine immunization is critical to maintain immunity in the population and prevent the mutation of the polio virus.
  • Conducting mop-up immunization campaigns, rapidly boosting immunity in areas where the virus is known to be circulating or communities particularly at high risk of being reinfected. Following large-scale mass immunization campaigns, teams analyze campaign performance to identify any areas or populations that may have missed vaccination. Such gaps are then subsequently filled by implementing mop-up or focused immunization campaigns to help further boost coverage in those areas.
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