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Post-Polio Health (ISSN 1066-5331)

Vol. 14, No. 1, Winter 1998

Polio and Post-Polio in The Netherlands

The Past

Since 1924, doctors in The Netherlands have had to report poliomyelitis under the Law on Infectious Diseases. Most years the number of cases was relatively low, but some years showed peaks.

A number of these polio survivors fully recovered or were left with mild limitations. In most cases, they were able to achieve positions in society and to live productive lives, including those who have used appliances for years.

In 1957, the Salk vaccine was introduced as part of the National Vaccination Programme. For some years following, all children born after 1945 were vaccinated in a "catching-up" campaign. From then on, all babies were vaccinated within the programme. This is how, in the long run, the vaccination percentage of 96 was reached.

Unfortunately, polio occurs again in a small number of cases. This is typical for The Netherlands, where vaccination is not mandatory and where some of the Dutch population refuse vaccination on ideological grounds. These groups include the orthodox Protestant religious community, and the anthroposophist (centering on man, not God), macrobiotic (extremely restricted diet) and Christian Science movements.

In 1971, 1978 and 1992-93, a few minor epidemics occurred exclusively among people who had not been vaccinated, with 39, 110 and 71 cases respectively. In 1992, the poliovirus type 3 (not endemic) must have been imported, but the infection remained within the boundaries of religious communities living in contiguous areas. (People in "The Bible Belt "relate closely within their own group, having their own schools.) The virus came to a dead end in the well-vaccinated surroundings.

When comparing the age structure of this latest outbreak with the previous one, we see the average age rising each time:

Also, in 1992-93, persons over the age of 20 experienced a greater loss of function than persons under age 20. In 1978, there were no statistically significant differences between these age groups.

The Present

The Princess Beatrix Fund has offered financial support to polio survivors since 1956, as support is not covered by social welfare. Psychological support was not available.

In 1980, one of our group read an article in Rehabilitation Gazette (Saint Louis, Missouri, USA) about new problems after polio. We contacted each other and were able to join VSN, The Dutch Association of Neuromuscular Disorders, an association for people experiencing various neurological diseases. (Each disease has its own support group.)

Cooperating with VSN and our support group, "Polio Out of the World" has been active for several years now. Counting among its members a virologist, a neurologist and a rehabilitation specialist, this committee initiates projects to assist in banishing polio worldwide by the year 2000.

One of the committee's projects was a conference which resulted in the publication of Polio en de gevolgen, a book which discusses medical topics of the acute phase including recovery, the eradication of the poliovirus, and the rehabilitation methods for the late effects of polio.

In 1988, we started up our post-polio support group of 50 members. In 1997, we numbered 650. The Netherlands has an estimated 13,000 polio survivors, many of whom have already been (or are likely to be) confronted with post-polio syndrome.

What are the aims of our post-polio support group?

Prof. Dr. M. de Visser, a neurologist, and Dr. F. Nollet, a rehabilitation specialist, are favourable exceptions and serve as pioneers in the field of post-polio syndrome in The Netherlands. Together we are working at spreading information among doctors. They do so through publications and presentations for their colleagues. We urge our members to take medical information on their visits to physicians.

We have sent mailings to all general practitioners, neurologists and rehabilitation specialists in the country. So far, this information appears to have primarily infiuenced the rehabilitation specialists. The general practitioners fail to be very interested, partly due to the fact that they rarely see a person with or who had polio.

VSN operates a documentation centre on the late effects of polio, accessible to (para)medical persons and members. Last but not least, VSN encourages scientific research. Our support group actively promotes research on post-polio syndrome with The Princess Beatrix Fund providing the necessary funds.

To provide information on post-polio syndrome to others. Society in general has little knowledge and understanding of the late effects of polio "What are you talking about?" "Polio is past tense." Many of these persons are often unaware of the phenomenon of post-polio syndrome. We aim to educate, among others, the executors of social legislation and the medical examiners dealing with the requests for partial work or fulltime disability.

The Future

As a post-polio support group, we have a goal of a time when we shall have a well-functioning national medical centre, where all knowledge about the problems of polio and its late effects is concentrated. We hope that some day neurologists and rehabilitation specialists will work together with physiotherapists, ergotherapists and social workers in order to help those who come with questions and concerns.

We are also planning a translation into English of Polio en de gevolgen, so it can be distributed in other European countries. This might lead to improved interaction between European post-polio organizations, a European conference on post-polio syndrome, and a stronger European post-polio network.

Find out more about Postpolio Support Group of the Dutch Association for Neuromuscular Diseases (VSN) by visiting their website at www.vsn.nl.