After traces of the polio virus were detected in a sample of wastewater at the Glen Valley Sewerage Treatment Works in Gaborone, the Minister of Health, Edwin Dikoloti, and his public health team have acted swiftly to prepare protocols of response that include continued surveillance. Special Correspondent DOUGLAS RASBASH reports
The government recently circulated an open letter to the public informing people that the polio virus was detected in a sample of wastewater at the Glen Valley Sewerage Treatment Works and that it is conducting a kind of track and trace to determine the source by carrying out a random house-to-house survey.
The Minster of Health, Dr Edwin Dikoloti, subsequently reiterated the actions of the ministry to The Botswana Gazette: “Beginning 19th August 2024, the Ministry of Health will be conducting a rapid community investigation of possible polio cases among children below the age of 15 in Gaborone and surrounding villages,” he said.
Visit the nearest health facility
“The target is to teach about 10 000 families. The Ministry of Health does not want to leave any stone unturned. The ministry, therefore, advises Batswana and residents of this country to immediately visit the nearest health facility when they suspect their children to be having polio.”
All of us have been vaccinated for polio which, together with stringent testing of wastewater, has made its occurrence in humans to become extremely rare.
Botswana’s fight against polio has taken a significant step forward, thanks to the vigilance and expertise of the Ministry of Health’s Public Health and Communicable Diseases Unit.
Recent detection of traces
The recent detection of traces of the polio virus in wastewater samples highlighted the team’s dedication to safeguarding public health even when human cases are nearly eradicated.
The poliovirus primarily affects the nervous system and can lead to paralysis. Despite widespread vaccination efforts that have drastically reduced the incidence of the disease, the virus can persist in the environment.
In countries where polio has been largely eradicated, the virus may still circulate silently among populations that are not fully immunised or in areas where vaccination coverage is incomplete.
Sewage samples
Polio virus detection in wastewater involves collecting and analysing sewage samples for viral RNA. This method, known as environmental surveillance, helps identify the presence of the virus even in the absence of clinical cases.
The polio virus can persist in the intestines of infected individuals and enter the wastewater system, making it possible to detect it before it causes any clinical symptoms.
Advanced molecular techniques, such as polymerase chain reaction (PCR), are employed to identify and quantify viral RNA in wastewater samples. PCR is highly sensitive and can detect minute quantities of the virus, making it a powerful tool for early warning and monitoring.
Swift response
In terms of actions being taken upon discovering the virus, Minister Dikoloti and his public health team have acted swiftly. “The Ministry routinely conducts surveillance of the polio virus in waste water areas,” he told The Gazette.
“Through such activities, some vaccine-derived polio virus was isolated from a sample collected at one of the country’s wastewater treatment sites in Gaborone. More laboratory investigations of the sample are ongoing.
“The Minister has therefore decided to conduct rapid community investigations and observations, in case there are some children with symptoms that can be associated with polio.”
Polio Symptoms
Polio (poliomyelitis) is a highly infectious viral disease that primarily affects children under the age of 5 but it can also infect older children and adults.
Early symptoms of polio can vary, but they typically appear between 7 and 14 days after exposure to the virus. The early symptoms are often mild and can resemble those of other viral infections, making them easy to overlook.
Early Symptoms of Polio:
- Fever: A sudden onset of fever is one of the most common early signs of polio.
- Fatigue: Feeling unusually tired or weak can be an early indicator of polio.
- Headache: Polio often causes headaches, which can range from mild to severe.
- Sore Throat: A sore throat is another common early symptom, similar to a cold or flu.
- Nausea and Vomiting: Some individuals may experience gastrointestinal symptoms such as nausea, vomiting or a general feeling of unease.
- Stiff Neck and Back: As the virus affects the central nervous system, individuals may develop stiffness in the neck and back, which can be an early sign of more serious neurological involvement.
- Muscle Pain or Tenderness: Early muscle pain, often in the legs, is another symptom that can indicate polio.
- Muscle Weakness: Some people may experience muscle weakness or a feeling of heaviness in the limbs, which can be an early sign of paralysis.
Progression to Paralytic Polio:
In some cases, the virus progresses to paralytic polio where the symptoms become more severe and include:
- Severe muscle weakness or paralysis, often affecting the legs but potentially other parts of the body.
- Loss of reflexes.
- Difficulty breathing if the respiratory muscles are affected.
While most people infected with the poliovirus may experience only mild symptoms or no symptoms at all (asymptomatic), it is important to recognise these early signs, especially in regions where polio is still a concern or if there has been exposure to the virus.
Early detection can help prevent the spread of the disease and allow for timely medical intervention. The advice of the Ministry of Health is to seek medical advice if those symptoms are detected.
To ensure the health of the public, there will be increased frequency and scope of wastewater testing to monitor any further viral presence.
Should it become necessary, vaccination efforts to ensure high coverage and reduce any potential reservoirs of the virus will be intensified.
Continued vigilance
Given the unfortunate prevalence of misinformation, fake news and conspiracy theories, it is necessary educate communities about the importance of vaccination and the continued vigilance needed to prevent a resurgence of polio.
The proactive approach of the Ministry of Health exemplifies a commitment to public health that goes beyond traditional measures.
By combining advanced scientific methods with rigorous public health strategies, Botswana is demonstrating a robust defence against the resurgence of polio and setting a global standard for disease prevention and control.