Journal of Rehabilitation Medicine 51-11

J Rehabil Med 2019; 51: 861–868 ORIGINAL REPORT POLIO AND POST-POLIO SYNDROME IN NON-WESTERN IMMIGRANTS: A NEW CHALLENGE FOR THE HEALTHCARE SYSTEM IN NORWAY Lillian Vigdis FESTVÅG, PT, Cand.Mag 1,2 , Johan Kvalvik STANGHELLE, MD, PhD 3,4 , Nils Erik GILHUS, MD, PhD 5,6 , Per- Ola RIKE, PhD 7 , Cand.Psychol and Anne-Kristine SCHANKE, Cand.Psychol 8, 9 From the 1 Sunnaas Rehabilitation Hospital, Nesoddtangen, 2 National Society of Polio Survivors, LFPS, Norway, 3 Sunnaas Rehabilitation Hospital, Nesoddtangen, 4 Institute of Clinical Medicine, Medical Faculty, University of Oslo, 5 Department of Clinical Medicine, University of Bergen, 6 Department of Neurology, Haukeland University Hospital, Bergen, 7 Sunnaas Rehabilitation Hospital, Nesoddtangen, 8 Sunnaas Rehabilitation Hospital, Nesoddtangen and 9 Department of Psychology, University of Oslo, Oslo, Norway Objective: To explore the health situation and iden- tify specific health challenges in non-Western immi- grants with polio in Norway, by comparing their sta- tus with Western immigrants with polio and native Norwegians with polio. Design: A questionnaire covering demographics, po- lio history, life satisfaction, medical, psychological and social conditions was answered by 1,408 per- sons with polio, among them 34 immigrants from non-Western countries and 32 immigrants from Western countries. Results: The non-Western immigrant polio group had a mean age of 46 years, were highly educated, reported high frequency of mental health problems and only one-third was working. Mean age for cont- racting polio was 2.8 years. Only 30% was hospitali- zed in the acute phase and 80% reported severe leg weakness. Use of a powered wheelchair was repor- ted by 72%. Post-polio symptoms had started at a mean age of 31 years. The non-Western immigrant group reported more fatigue, pain and loneliness, and a high proportion reported insufficient assistan- ce from the public health system. Conclusion: The group of non-Western immigrants with polio in Norway reported more health and so- cial problems than the group of Western immigrants with polio or the native Norwegian group with po- lio, even though they were younger and more highly educated. Their complex psychological and social si- tuation requires active intervention from the health system, and health professionals need extra skills to deal most effectively with their situation. Key words: polio; poliomyelitis; post-polio syndrome; immi- grants; non-Western; health; social conditions; psycho-social health. Accepted Oct 29, 2019: Epub ahead of print Nov 6, 2019 J Rehabil Med 2019: 51: 861–868 Guarantor address: Lillian Festvåg, Sunnaas Rehabilitation Hospital, Bjørnemyrveien 1, Bjørnemyr, 1453 Norway. E-mail: Lillian.Festvag@ sunnaas.no P oliomyelitis is a viral disease that still represents a major challenge for individuals and healthcare services worldwide. Poliovirus enters the bloodstream from the intestine in 1–5% of those infected and in- vades the spinal cord, where 90% of the anterior horn LAY ABSTRACT Immigrants with polio coming to Norway are younger and have a different medical history, social background and health challenges than native Norwegian polio-in- jured subjects. The aim of this study was to explore the health situation among non-Western immigrants to Nor- way with polio. A questionnaire covering demograph- ics, polio history, life satisfaction, medical, psychological and social conditions was answered by 34 immigrants from non-Western countries, and compared to Western immigrants with polio and native Norwegians with po- lio. The immigrant polio group was highly educated, re- ported a high frequency of mental health problems, and one-third was working. Not more than one-third was hospitalized in the acute phase. The immigrant polio group reported more fatigue, pain and loneliness than the native Norwegian patients. Use of a wheelchair was reported by 7 out of 10, and a high percentage reported insufficient assistance from the public health system. The complex psychological and social situation for non- Western immigrants with polio requires extra consider- ation from the health system, and health profession- als need specialized information in order to provide the most appropriate treatment for these patients. cells have to be infected to cause paralytic poliomy- elitis. Symptoms are fever, headache, irritability, and localized paralysis. Motor nerve cells, but not the sensory nerve cells, are impaired or destroyed (1, 2). The introduction of poliovirus vaccines in 1955 led to a sharp reduction in poliomyelitis in the indu- strialized countries, but not necessarily throughout the world (3). Thus, the majority of individuals living with late effects of poliomyelitis in Western countries are middle-aged to elderly (4). In tropical and subtropical regions, poliovirus can survive all year round, leading to relatively constant incidence rates, which present as endemic disease, in contrast to noticeable epidemics. Combined with high infant mortality rates, endemic polio was largely overlooked and not recognized as a major challenge, until surveys conducted during the 1970s documented its high prevalence (5). Vaccina- tion was introduced worldwide as part of national and World Health Organization (WHO) immunization programmes, and resulted in a 99% reduction, from an estimated 350,000–400,000 paralytic cases per year, to This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2624

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