HEALTH ISSUES

documentation from: POLISI (2022) – CIMSA UGM

Extraordinary Event! Polio Emerge Back After Eradicated

Fathiyah Zahra Muhammad from CIMSA FK UIN SH

Polio, a highly infectious disease caused bythepoliovirus,hasbeenconfirmedto have resurfaced unexpectedly in Pidie, Aceh. This amazing case was reported by Indonesia's Ministry of Health and declaredanextraordinaryeventbecause polio was declared completely eradicated seven years ago. At the Meeting of the South-East Asia Regional Certification Commission for Polio Eradication (SEA-RCCPE) in New Delhi, India, in 2014, Indonesia became one of eleven countries in South-East Asia to eradicate polio and achieve polio-free certification. It is not at all a piece of cake to receive the polio-free predicate, it is complicated since it is a vicious cycle. If someone is infected with the poliovirus, the virus will spread through contaminated water, foods, or even something as simple as droplets. The droplet then infects people of all ages (mainly children) and develops many symptoms, such as flu-like syndrome, paralysis,andevendeath.

We are probably wondering how this virus can be so durable and last so long. Among other viruses, poliovirus hasmoreconcisegeneticmaterial,positive single-stranded RNA, which eases the replication and translation processes after it invades a single human cell. Single-stranded RNA can be directly translated into protein, and its genome replicates using its own RNA-dependent RNA polymerase. New particles are assembled. They kill the infected cells and release many viral particles. This is also why poliovirus tends to mutate easily. Due to its unembellished, simple RNA, each nitrogen base is vulnerable and unstable. This strain is prone to changing and becoming a different variety of virus. Other than that, strong free viruses scattered in the air adapt swiftly to survive. They mutate and become a new strain of poliovirus that hasn'tbeenrecognizedbyourbodyyet. Thiswillbetroublesomelater.

People have been protected by their immune-induced vaccine for an estimated7years.Itwasbecauseofherd immunity and personal immunity. Most mothers follow the government's advice and take their child to get vaccinated.Until two years ago, COVID-19 attacked the world. Everybodywasworkingfromhome, minimizing mobilization by staying in their own homes; hospitals were full. Adherence to vaccines also loosened. Newborn babies didn’t receive adequate vaccines and immunity. This can make babies more susceptible to a varietyofillnesses.

Until now, there have been three serotypes of wild poliovirus. It is poliovirus 1, 2, and 3. Type 1 poliovirus was the main cause of most cases of paralyticpoliointheworlduntilvaccines became widespread. Type 2 and 3 were considered eradicated in 2015. When a baby or a person is infected with a new or existing strain of poliovirus, he becomes an "agent" of the virus. The virus lives in the throat or nasopharynx, then travels down into the stomach and intestine and infects several epithelial cells, developing and producing uncountable offspring there. Together with the food that is absorbed simultaneously, the virus can enter and circulate in the nearest lymphatic system, then end up in the blood circulation. Here is one of the points where immunity determines the body’s response.Iftheimmunesystemisnotas strong as the virus, the virus can cause viremia.Viremiaisaconditionwherethe virus spreads all over the blood. Then, inflammation occurred, which was detected by the hypothalamus, and it raised the body’s temperature. The infected host has developed a fever. After viremia, viruses can find a way into some axons of motor neurons and do the replication, which damages the neuron.Thisprocessiscalledretrograde axonal transport. Every axon will eventually stop in the spinal cord and causemoredamage.

Poliovirus causes several symptoms, but most of the patients have asymptomatic poliovirus. Some experience flu-likesyndrome,nausea,headache,vomiting, that condition, so the importance of vaccines, especially the polio vaccine, should have been known by everyone. The polio vaccine is available in two forms.Oralpoliovirusvaccine(OPV)and inactivated poliovirus vaccine (IPV) OPV contains an attenuated virus that is givenbymouthanddirectlytravelsinto the digestive tract. Then, the vaccine will stimulate the immune system, and the body will form antibodies to fight polio. An attenuated virus will be directly bound and shut down by the child's immunity formed after vaccination.OPV,ontheotherhand,has more side effects than IPV. For the first dose,shortlyafterbirth,OPVisgivento the baby. At the ages of 2 months, 3 months, and 4 months, IPV is injected into the muscle or under the skin. Booster vaccines are given when the child is 18 months old. IPV contains a deadvirusthatisformedinthebloodto stimulate direct immunity. In this condition, the virus will still be able to multiplyinsidetheintestinebutwillnot cause symptoms because polio immunity has been formed. Patients with bleeding disorders, such as thrombocytopenia, require special care because hematomas can occur during intramuscular IPV injection. Normal babies without immunodeficiency should be vaccinated well to prevent anotherextraordinarycase.

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References

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