For the past few weeks, media across the world have been full of reports about a new outbreak of polio in Syria, which has dramatically limited the vaccination of children due to the civil war that started in 2011. Ten children under the age of 2 have been diagnosed with polio so far, and the World Health Organization has warned of increased spreading of polio outbreak risk in Syria as well as the neighbouring countries.
We've checked with the National Institute of Public Health (IVZ) about the risk of a polio outbreak in Slovenia.

Last week a number of media cited two German epidemiologists who claim that the polio outbreak in Syria is a serious threat to Europe, which has officially eliminated polio in 2002. Is there a threat to Slovenia, too?
The National Institute of Public Health has been following the reports of polio from around the world very closely. Before the introduction of vaccination in mid-1950s, polio was spread in all parts of the world. Vaccination decreased the number of the infected substantially and in some parts of the world, the disease was rooted out as early as 1980s. Starting in 1988, the World Health Organization has been leading a global campaign for a complete elimination of polio. Since the start of the campaign, the number of the infected has decreased by more than 99 per cent globally, but the disease and the circulation of viruses are still present in some parts of central Africa and South Asia (Pakistan, Afghanistan, Nigeria, the Horn of Africa). The re-appearance of the disease in Syria, where polio had already been rooted out, has undoubtedly attracted additional attention and calls for a disease-preparedness plan. Given the current conditions in Syria and extensive migration of people, the neighbouring countries in particular are at risk of a polio outbreak. The possibility for the disease to enter the European Union cannot be fully eliminated due to refugees seeking shelter in Europe. If refugees from endangered areas came to Slovenia, the risk of spreading would still be small, owing to high vaccination rates. However, if the rates decreased, this could occur very quickly. What is also important is that travellers to countries that haven’t eliminated polio get vaccinated.

What are the vaccination rates among Slovenian children?
Until 1962 polio was present in Slovenia in the form of epidemics. Between 1948 and 1962, there were a number of bigger epidemic outbreaks that resulted in deaths and permanent defects in children as well as adults. After the introduction of vaccination in 1957, first with inactivated Salk vaccine and then in 1961 with oral, attenuated Sabin vaccine, the number of the infected decreased substantially. The last epidemic outbreak in Slovenia occurred in 1978, when nine children fell ill, and no other cases have been recorded since. Obligatory vaccination of children in their first year, consisting of three shots of vaccine, was implemented in 1964. Over 95 per cent of Slovenian children are vaccinated against polio and other infectious diseases every year, thus maintaining a solid level of population protection, which can prevent polio from spreading in the case of poliovirus entering the country.
Recently a campaign that warns about dangers of obligatory vaccination has been spreading in Slovenia. How much has the vaccination rate declined? Is the number alarming?
Despite this campaign, a high share of Slovenian children are vaccinated against polio and other infectious diseases. But we’re finding that there are kindergartens and school where up to 50 per cent of children are not vaccinated, since their parents refuse vaccination. These kinds of environment face a high possibility of infectious diseases spreading if they appear.

Is it true that the reason why the less effective, non-oral version of the vaccine is used in Europe today, is the fact that the oral vaccine that was used in the past was more dangerous and in some cases caused paralysis? Which type of the vaccine is used in Slovenia?
In the past 10 years, many countries around the world have opted for the inactivated vaccine (that is injected) instead of the spoon-fed attenuated vaccine. The switch was made especially in countries where poliovirus stopped circulating to prevent the circulation of vaccination strains of poliovirus through faeces of vaccinated individuals. Both types of vaccines provide good protection. The attenuated vaccine is typically used if there’s an active circulation of the virus, since the organism of the vaccinated creates antibodies very quickly. The antibodies do not appear that quickly when using an inactivated vaccine, but if there is no active circulation, there is no need for it.

Polio vaccination is compulsory for all children. How much time after the last recorded outbreak of the disease can a certain vaccination be removed from the list of obligatory vaccinations?
The WHO plan for the eradication of polio does not intend to stop vaccinations until it can be sufficiently proven that polioviruses do not circulate anywhere in the world and that they are not present in either people or the environment.

Which measures can people take to help limit diseases like polio from spreading?
The general measures are the same as for other infectious diseases. A consistent hygiene is necessary, such as washing the hands after using the toilet and before preparing lunch. It's imperative that the sewage system is well-constructed, so that people have access to drinkable water, and that the food is prepared with proper standards of hygiene. Timely vaccination is crucial, as well as ensuring a high rate of vaccinated people in all groups, so that those who cannot be vaccinated due to health problems are protected, too.

Which groups of the population are endangered? Can adults contract polio, too?
Unvaccinated children and adults can contract poliovirus. The disease is severe regardless of the age and may cause permanent paralyses of the limbs or even death due to the failure of muscles of respiration.