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127
Little is known about the spread of poliomyelitis or what leads
only one out of many exposed to succumb. The child at the Headstone
Drive Nursery was the only child present at that time with this infection
and was the only child in that part of the district suffering from this
complaint. Then, while infection passed from a boy of six to his sixmonths
old brother, three children in the family of ages between these
limits escaped. It was earlier presumed that infection was spread mainly
by respiratory droplets, the virus entering the nervous system from the
nose. It is now known that the virus is present in the oropharynx and
in the small intestine, and it may be that the portal of entry is the mouth.
It would seem that infection can be acquired by close association with
an infected person, virus passing in the pharyngeal excretion; but
contamination of hands, immediate environment, utensils and food by
pharyngeal virus may also be involved.
The Memorandum on Poliomyelitis issued by the Ministry of Health
in 1954 advised that more stringent precautions should be taken by
contacts of those suffering from poliomyelitis than had hitherto been the
practice. These are:—
Contacts
Adults who have been in close contact with a case of poliomyelitis
should, for at least three weeks after last exposure, avoid unnecessary
meetings outside their home or business circles and take complete rest
if feeling ill. Normal measures, such as adequate ventilation, etc.,
directed against droplet infection are of importance, and more than usual
attention should be paid to hand hygiene for six weeks or more.
The institution of quarantine measures in the case of adults is not
justified in the normal outbreak. Modified quarantine, obtained by
persuasion, might, however, be applied with advantage in special circumstances.
. . . Before quarantine for adults is advised there are many
factors to be considered, not least of which is the degree of contact with
others met at work and in travelling there, and the type of employment,
e.g. handling food. If a close adult contact is employed in a community
of children, he should be suspended from work for a period of three
weeks.
In the case of children, intimate contacts should be under " home
and garden quarantine" wherever possible, for three weeks from the
latest date of possible infection.
Gatherings
1. Bathing. Although there is no evidence pointing to poliomyelitis
having been contracted from bathing in sewage-polluted rivers,
in theory, at any rate, the possibility does exist and the practice should
be discouraged. Similarly the water of swimming baths is a potential
source of contagion, but it has never been clearly implicated in the
spread of the disease. The swimming bath must be considered, however,
not only in regard to water infection but also as a place of concourse.
2. Entertainment. Unnecessary gatherings of children, when
polomyelitis is prevalent in an area, are undesirable. Closing of baths,