Source: Health Canada" />

Source: Health Canada

 Know before you go!
Infectious diseases not necessarily common in Canada can occur and may even be widespread in other countries. Standards of hygiene and medical care may differ from those at home. Before departure, you should learn about the health conditions in the country or countries you plan to visit, your own risk of disease and the steps you can take to prevent illness.

The risk is yours
Your risk of acquiring a disease depends on several factors. They include: your age, gender, immunization status and current state of health; your itinerary, duration and style of travel (e.g., first class, adventure) and anticipated travel activities (e.g., animal contact, exposure to fresh water, sexual contact); as well as the local disease situation.

Risk assessment consultation
Health Canada strongly recommends that your travel plans include contacting a travel medicine clinic or physician 6 to 8 weeks before departure. Based on your individual risk assessment, a health care professional can determine your need for immunizations and/or preventive medication (prophylaxis) and advise you on precautions to avoid disease. We can help you locate a travel medicine clinic closest to your home.

Some facts from the experts
The information below has been developed and is updated in consultation with Health Canada's Committee to Advise on Tropical Medicine and Travel (CATMAT). The recommendations are intended as general advice about the prevention of poliomyelitis for Canadians travelling internationally.

Disease profile
Poliomyelitis, or polio, is an acute infectious disease caused by one of three gastrointestinal viruses, either poliovirus type 1, 2 or 3. The poliovirus can attack the nervous system and destroy the nerve cells that activate muscles. As a result, the affected muscles no longer function, and irreversible paralysis can occur. In severe cases, the disease may lead to death. Polio mainly affects children under three years of age, but can strike older children and adults as well.

Transmission
Poliovirus is spread from person to person either by mucus from the nose and throat or by the fecal-oral route. Through the fecal-oral route, polio can be contracted either indirectly through exposure to fecal-contaminated food or water or directly through contact with the fecal matter of an infected individual. After infection a person may become a 'carrier' and continue to excrete the virus in his/her feces for many weeks. Person-to-person transmission is especially common among children whose hands may be contaminated following toilet use.

Geographic distribution and incidence trends
Until 1988, polio occurred throughout the world. As a result of the World Health Organization's (WHO) Global Polio Eradication Initiative, the disease has been eradicated in many parts of the world. Of the six geopolitical regions of the WHO, polio has been eradicated from the Americas (1991), the Western Pacific (1997) and Europe (1998). At this time, polio remains a threat in more than 30 countries in the three remaining regions: Africa (with the highest concentration), Eastern Mediterranean and South East Asia. Although wild poliovirus is almost absent in southern and eastern Africa and has declined in western Africa, those countries with an ongoing and intense circulation of the virus (such as, Angola, Chad, Democratic Republic of the Congo and Nigeria) in effect 'export' polio throughout western and central Africa.

In Canada, the last major epidemic occurred in 1959. Following the introduction of the inactivated polio vaccine (IPV) in 1955 and the oral polio vaccine (OPV) in 1962, transmission of the wild poliovirus within Canada was rapidly controlled.

Note: In December 2000, the Pan American Health Organization (PAHO) reported an outbreak of polio in the Dominican Republic (DR) and Haiti. This raised concern because the Americas had been free of wild poliovirus since 1991. In both countries, the cases were not caused by wild poliovirus but by the vaccine-related virus (OPV). All of the new polio cases were either unvaccinated or had not received the complete schedule of polio vaccine doses. To control the circulation of both wild and OPV-derived polioviruses, countries must ensure their populations receive high vaccination coverage. As PAHO has stated, the outbreak is a powerful reminder that even polio-free areas need to maintain high polio immunization coverage.

Symptoms

The incubation period for poliomyelitis varies from 4 to 35 days. Polio infection often produces no symptoms or minor symptoms, such as fever, fatigue, headaches, vomiting, constipation (or less commonly diarrhea), stiff neck and pain in the limbs. Infected individuals can transmit the virus to others even though they exhibit no symptoms.

In severe cases, the muscles of the legs are affected with acute flaccid paralysis (AFP) that can spread to other muscle groups. In the most severe cases, the brain and respiratory system are affected, which may lead to death.

Treatment
There is no specific treatment for polio. Severe cases require supportive care that may help the patient recover.

Vaccines
Two types of polio vaccines are licensed in Canada: the Salk inactivated polio vaccine (IPV) and the Sabin oral polio vaccine (OPV). The IPV is delivered by injection of killed virus, and is highly protective and extremely safe but not necessarily lifelong. The OPV vaccine is given orally and is formulated from live viruses of each of the polio serotypes. While rare, vaccine-associated polio effects have been reported following OPV use. Health Canada's National Advisory Committee on Immunization recommends exclusive use of IPV for routine purposes in Canada.

Canada has a high standard of childhood immunization programs, and polio vaccination is included in our national childhood immunization schedule.

Children and adults who are not immunized should receive full immunization against polio (three doses of IPV) prior to travelling to areas where polio may be a risk. Children who have received their childhood polio series are protected against polio when travelling to an area where polio may be a risk. Adults who are immunized (i.e., have received their childhood series) require a single booster dose when travelling to an area where polio may be a risk.

Prevention and personal precautions
As there is no cure for polio, prevention is key.

Recommendations
Health Canada strongly recommends that Canadian international travellers contact a physician or travel medicine clinic prior to departure for an individual risk assessment. Based on travellers' current health status, previous immunization history and anticipated travel itinerary, their need for polio vaccination can be assessed.

For Canadians travelling to countries where poliomyelitis is epidemic or endemic, primary immunization of children and, if indicated, primary immunization of adults or a booster dose for adults, are recommended in accordance with the recommendations of the National Advisory Committee on Immunization.

Some things to think about...
International travel can expose Canadians to infectious diseases, like polio, that are not frequently seen in North America. Our high standard of sanitation and childhood immunization programs may lead many adult Canadians to become complacent about keeping their routine immunizations up to date. Travellers are reminded to ensure that their routine childhood immunizations are up to date prior to travelling. All travellers are advised to review their immunization history with a physician well in advance of departure to confirm whether they have been properly immunized against polio.

For more information...

• For a map of polio activity worldwide, visit the World Health Organization's Polio Eradication Web site page at: http://www.polioeradication.org/global_status.html

• To view "Immunizations recommended for travel outside of Canada",click here.

• For more Know before you go! information, click here.

SOURCE: http://www.phac-aspc.gc.ca/index-eng.php