NHS plan to contain polio by contacting parents of unvaccinated children as source search continues

Parents of unvaccinated children in London are to be contacted by the NHS in a bid to try and contain a polio outbreak in the UK.

Health chiefs declared a national incident on Wednesday following the return of the disease for the first time in nearly 40 years.

The virus was detected at the Beckton sewage treatment works, which covers a population of four million in north and east London. Signs of it were first found in February.

The UK Health Security Agency believes a traveller, possibly from Pakistan, Afghanistan or Nigeria, shed the virus in their faeces after being given a live oral polio vaccine during an outbreak.

It is likely they then infected relatives by failing to wash their hands properly and contaminating food and drink. Officials are looking at the possibility that just one family – or an extended family – may be affected.

However, the NHS is now starting up a major drive to ensure routine vaccinations are being taken up after the Covid-19 pandemic caused a lull in appointments.

Jane Clegg, chief nurse for the NHS in London, said: ‘The NHS will begin reaching out to parents of children aged under five in London who are not up to date with their polio vaccinations to invite them to get protected.’

Health Secretary Sajid Javid said he was ‘not particularly worried’ about polio because of excellent vaccination rates. 

But he told BBC Radio 4’s PM programme: ‘As a precaution, sensibly what the NHS will be doing in London is contacting those families that have children age five or below and just making sure they’re up to date with their polio vaccination status.’ 

The virus was detected at the Beckton sewage treatment works, which covers a population of four million in north and east London

UK health workers routinely test samples from sewage works (pictured: the one in Beckton, east London, where polio was detected) 

The NHS are launching a campaign to contain polio by contacting the parents of unvaccinated children after health chiefs declared a national incident last night following the return of the disease for the first time in 40 years. File photo

Great Britain was pronounced clear of polio in 2003 with the last case coming in 1984, but this week, experts repeatedly found samples of it in the waste water site in London. 

Doctors, most of whom will have no direct experience of the disease, were yesterday given reminders of the symptoms and ordered to remain alert. In the worst cases polio can paralyse or even kill.  

Most people show no signs of infection at all but about one in 20 people have minor symptoms such as fever, muscle weakness, headache, nausea and vomiting. 

Around one in 50 patients develop severe muscle pain and stiffness in the neck and back. Less than one per cent of polio cases result in paralysis and one in 10 of those result in death.

Unvaccinated adults and parents of children who are behind with their polio jabs are urged to contact a GP, and youngsters should have had five doses between the ages of eight weeks and 14 years.

See also  Justin Bieber is seen for the first time since selling off his entire music catalog for $200million

Great Britain was pronounced clear of polio in 2003 with the last case coming in 1984, but this week, experts repeatedly found samples of it in a waste water site in London. A young girl is pictured getting her polio jab in May 1956

The live oral polio vaccine has not been used in the UK since 2004 but it is still deployed in some countries, particularly to respond to polio outbreaks. This vaccine generates gut immunity and for several weeks after vaccination people can shed the vaccine virus in their faeces.

These viruses can spread in under-protected communities and mutate into a ‘vaccine-derived poliovirus’ during this process. This behaves more like naturally occurring ‘wild’ polio and may lead to paralysis in unvaccinated individuals, as has happened abroad.

The UK uses an inactivated polio vaccine, which is given as part of a combined jab to babies, toddlers and teenagers as part of the NHS routine childhood vaccination schedule.

Vaccine-derived poliovirus type 2 (VDPV2), the one that has been detected in London, is the most common type. There were nearly 1,000 cases of VDPV2 globally in 2020.

Since 2019 every country in the world has been using vaccines that contain inactivated versions of the virus that cannot cause infection or illness.

But the UKHSA said countries where the virus is still endemic continue to use the live oral polio vaccine (OPV) in response to flare-ups.

That vaccine brought the wild poliovirus to the brink of eradication and has many benefits.

But in areas with low vaccination rates, the virus present in the jab can spread and acquire rapid mutations that make it as infectious and virulent as the wild type.

Parents are being urged to ensure their children’s polio vaccinations are up to date, particularly after the pandemic when school immunisation schemes were disrupted and uptake fell. Pictured, a girl gets her four-in-one pre-school jab offered by the NHS

An investigation is searching for the source of the outbreak, so the area can be targeted with a vaccination drive. Anyone found to be infected might be asked to isolate.

Despite clear signs of transmission, no human cases have yet been identified and officials say the risk to the public remains ‘extremely low’ because of high vaccination rates.

By the age of two, almost 95 per cent of UK children have had the correct number of doses. However, this drops to just under 90 per cent in London. When it comes to the pre-school booster, just 71 per cent of children in London have had it by the age of five.

When polio weakened muscles used in breathing, patients used to be treated using an ‘iron lung’. Pictured: A female patient in her iron lung at Fanzakerley hospital in Liverpool, now called Aintree University Hospital

It is normal for sampling to detect a few traces of poliovirus in sewage each year but these have previously been one-offs but officials say a sample identified in April was genetically linked to one first seen in February.

This has persisted and mutated into a ‘vaccine-derived’ poliovirus, which is more like the ‘wild’ type and can cause the same symptoms.

Dr Vanessa Saliba, consultant epidemiologist at the UKHSA, said: ‘Vaccine-derived poliovirus is rare and the risk to the public overall is extremely low. Vaccine-derived poliovirus has the potential to spread, particularly in communities where vaccine uptake is lower.

The polio vaccine is given at age eight, 12 and 16 weeks as part of the six-in-one vaccine and then again at three years as part of a pre-school booster. The final course is given at age 14. The World Health Organization has set the threshold of a successful school jabs programme at 95 per cent uptake, which England is failing to hit by all accounts

The polio virus was detected in samples taken from the sewage works in Beckton, east London (pictured)  

‘On rare occasions it can cause paralysis in people who are not fully vaccinated so if you or your child are not up to date with your polio vaccinations it’s important you contact your GP to catch up or, if unsure, check your red book.

‘Most of the UK population will be protected from vaccination in childhood, but in some communities with low vaccine coverage, individuals may remain at risk.

‘We are urgently investigating to better understand the extent of this transmission and the NHS has been asked to swiftly report any suspected cases to the UKHSA, though no cases have been reported or confirmed so far.’

During the early 1950s the UK was rocked by a series of polio epidemics, with thousands suffering paralysis each year. Mary Berry, the former Great British Bake Off judge, was hospitalised after contracting polio aged 13, leaving her with a twisted spine and damaged left hand. 

British children getting their oral vaccine for polio in 1965 — which used a live version of the virus — 12 years after the first vaccine was invented 

Polio used to paralyse millions of children around the world every year in the 1940s and 1950s but has been eliminated in virtually every country thanks to vaccines

The remaining, type 1, wild polio remains endemic in only two countries, Afghanistan and Pakistan but parts of Africa still suffer flare-ups

Symptoms of polio can include a high temperature, a sore throat, a headache, stomach pain, aching muscles, feeling and being sick. Doctors can test patients’ stool samples to aid diagnosis.

Nicholas Grassly, professor of vaccine epidemiology at Imperial College London, said: ‘Until polio is eradicated globally we will continue to face this infectious disease threat.’

It is estimated there are 120,000 polio survivors in the UK, with the last time someone contracted the disease was 38 years ago in 1984.