Poliomyelitis and post-polio syndrome: migrant health guide
Source: gov.uk (2025-03-31)

Advice and guidance on the health needs of migrant patients for healthcare practitioners.

Main messages

Ensure that new migrants are up to date with the UK immunisation schedule (https://www.gov.uk/government/collections/immunisation).

Acute poliomyelitis is a notifiable disease (https://www.gov.uk/notifiable-diseases-and-causative-organisms-how-to-report). Although natural polio infection has been eliminated from the UK for many years, there is still the potential for acute cases to present in the UK, acquired in endemic areas.

Consider the possibility of post-polio syndrome (PPS) in patients who may have been infected during childhood and are showing unexplained signs of fatigue and weakness. Patients may or may not be aware that they have had polio.

Background

Acute poliomyelitis

Poliomyelitis is an acute viral infection that can:
- affect the central nervous system
- lead to paralysis
Children under 5 (http://www.who.int/en/news-room/fact-sheets/detail/poliomyelitis) are at greatest risk of infection.

Since the launch of the Global Polio Eradication Initiative (http://polioeradication.org/) in 1988:
- more than 2.5 billion children have been immunised (http://polioeradication.org/who-we-are/) against polio
- reported cases have decreased by over 99% (http://www.who.int/en/news-room/fact-sheets/detail/poliomyelitis)
In the UK, the last case of domestically acquired polio infection was in 1984. All cases since then have been acquired abroad.

Global polio cases are monitored and reported monthly by country (https://polioeradication.org/polio-today/polio-now/wild-poliovirus-list/).

See ‘Polio: guidance, data and analysis’ (https://www.gov.uk/government/collections/polio-guidance-data-and-analysis).

Post-polio syndrome

In the UK, out of an estimated 120,000 people who have been previously affected by polio, up to 80% will develop post-polio syndrome (PPS) (https://www.nhs.uk/conditions/post-polio-syndrome/), a neurological condition which can severely limit normal activities of daily living.

Transmission

The polio virus is spread via:
- person-to-person contact with infected secretions from the nose or mouth
- infected faeces
After initial infection, the virus is shed intermittently in faeces for several weeks, which can cause rapid spread throughout communities, especially in areas with substandard sanitation conditions (http://polioeradication.org/polio-today/polio-prevention/).

On rare occasions, live polio vaccines can mutate to a virulent form that can cause paralytic disease in recipients or their contacts.

Symptoms

Acute poliomyelitis

Most people infected with poliovirus do not develop any symptoms (http://polioeradication.org/polio-today/polio-prevention/). When symptoms do develop, they range in severity from a fever to paralysis (http://www.who.int/en/news-room/fact-sheets/detail/poliomyelitis).

Initial symptoms can include (http://www.who.int/en/news-room/fact-sheets/detail/poliomyelitis):
- fever
- fatigue
- headache
- vomiting
- stiffness in the neck
- pain in the limbs
One in 200 infections leads to irreversible paralysis (https://www.who.int/news-room/fact-sheets/detail/poliomyelitis) (usually in the legs), and of these cases 5% to 10% die due to respiratory paralysis (https://www.who.int/news-room/fact-sheets/detail/poliomyelitis).

Post-polio syndrome

Following a period of years of stability, people may develop symptoms including (https://www.britishpolio.org.uk/about-pps1):
- onset of new weakness or abnormal fatigue in previously affected or unaffected muscles
- general decrease in stamina
- muscle and/or joint pain
- muscle atrophy
- breathing, sleeping and/or swallowing problems
- cold intolerance
Testing and treatment

Urgently refer patients with suspected acute poliomyelitis to an infectious disease specialist for formal diagnosis and management.

Take appropriate samples for laboratory investigation according to the enteric virus unit (https://www.gov.uk/guidance/enteric-virus-unit-evu-diagnostic-and-reference-services).

Local laboratories with queries about testing samples for polio virus should contact the Virus Reference Department (https://www.gov.uk/government/collections/virus-reference-department-vrd) at the UK Health Security Agency.

Refer cases of suspected PPS to a neurologist for investigation and management.

PPS may respond to a range of therapies which might prevent further deterioration (https://www.britishpolio.org.uk/guides-hc-professionals).

Prevention and control

In the UK, immunisation is used to prevent and control poliomyelitis, so ensure that children and adults are up to date with the UK immunisation schedule (https://www.gov.uk/government/collections/immunisation). Refer to guidance on vaccination of individuals with uncertain or incomplete immunisation status (https://www.gov.uk/government/publications/vaccination-of-individuals-with-uncertain-or-incomplete-immunisation-status).

Ask opportunistically about travel plans, as patients who travel to countries where the infection is endemic to visit friends and relatives (https://www.gov.uk/guidance/travel-to-visit-friends-and-relatives-migrant-health-guide) are at increased risk of acquiring infection.

For country specific travel advice, see National Travel Health Network and Centre (NaTHNaC) (https://travelhealthpro.org.uk/countries).

Acute poliomyelitis is a notifiable disease in the UK. If a case is diagnosed or suspected, you should immediately notify your local health protection team (HPT) (https://www.gov.uk/health-protection-team).

Resources

Patient.co.uk has produced a polio immunisation leaflet (https://patient.info/health/immunisation/polio-immunisation).

NaTHNaC’s Travel Health Pro has guidance on polio (https://travelhealthpro.org.uk/disease/144/polio).

The Global Polio Eradication Initiative (http://polioeradication.org/polio-today/polio-prevention/) is a public health initiative working towards the eradication of polio with global partners, including: the World Health Organization, Rotary International, the US Centers for Disease Control and Prevention (US CDC) and the United Nations Children’s Fund (UNICEF).

The British Polio Fellowship (https://britishpolio.org.uk/) is the national charity for people in the UK with polio and post-polio syndrome.

The Green Book contains a chapter on polio vaccination (https://www.gov.uk/government/publications/polio-the-green-book-chapter-26).