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Hygiene measures in the event of polioviruses

In October 2013, wild poliovirus re-appeared in Syria after 14 years. Meanwhile, the World Health Organization (WHO) has confirmed 17 suspected cases (last update: 26 November 2013). The outbreak mainly affects children under 2, who have no or inadequate vaccination. Due to the civil war, in 2012 the polio immunisation rate was 68 % only. The detected outbreak viruses are similar to viruses that were found in sewage in Egypt last year, circulate in Pakistan and, since February 2013, have been discovered in sewage in Israel, the West Bank and the Gaza Strip.

WHO considers the risk of an international spread as high. The viruses may be spread by civil war refugees and travellers to the region. International experts and the Robert Koch-Institute (RKI) see the risk of a spread to Europe. Most infected people (> 95 %) do not show any signs of disease, but excrete viruses. Hence, the spread could happen unnoticed.

Vaccination is the most effective preventive measure

The most effective measure to avoid an infection is vaccination. Additionally, the prevention of transmission requires strict hygiene measures, especially hand hygiene. In Germany, 94.7 % of school children and 85.6 % of adults are vaccinated. In some other European countries, vaccination coverage is, however, lower, for example in Austria (83 %) and Ukraine (74%). Furthermore, vaccination with inactivated polioviruses, as is common practice in Europe, protects against infection effectively, but vaccinated people may still transmit the virus. Hence, the introduction of poliovirus to Europe could cause further spread and be a risk for unvaccinated people.

Transmission path

Initially (up to 1 week after infection), polioviruses can be found in respiratory tract secretions and are excreted in faeces for up to 6 weeks. Immuno-incompetent people may even excrete the pathogen for years. The virus is excreted by sick and asymptomatically infected people. Transmission mainly occurs via the faecal-oral route, and is possible through contact with contaminated people, surfaces or food – at the beginning of the infection also via droplets.

Procedure in case of suspected poliovirus

People suspected of being infected with poliovirus must be admitted to hospital immediately and isolated. The hospital needs to be informed in advance. As stipulated by the Federal Law on the Prevention of Infectious Diseases in Humans, suspected cases, cases of infection, deaths and, provided that it suggests acute infection, detection of polio is to be reported to the responsible health authority. Details on infection control measures when dealing with refugees from Syria and infected/ill people are included in the RKI statement.

Prevention and hygiene measures

Vaccination offers the most important and most effective protection against polio infection. In Germany, it is recommended to vaccinate with inactivated polio vaccine. Vaccination should already start during infancy. In the following, you will find hygiene measures to prevent transmission of viruses via contact with droplets.

  • Hand hygiene: always disinfect your hands after each contact with pathogenic material and patients or their immediate surroundings with a virucidal hand disinfectant. In addition, adhere to the 5 Moments for Hand Hygiene. When carrying out nursing activities, always use gloves. After glove removal, disinfect your hands.
  • Disinfect all instruments, surfaces and objects that might have come in contact with pathogens with virucidal disinfectants.
  • Avoid exposure to aerosols of infected people at the beginning of their infection. If need be, the patients should wear a surgical face mask.

Inactivation of polioviruses requires products with virucidal spectrum of activity. Please follow this link to view products with appropriate activity.

Information on the efficacy of virucidal hand disinfectants

The European Norm (EN) 14476 and the DVV/RKI guideline that applies in Germany describe test methods for testing the virucidal activity of hand disinfectants. Both define poliovirus as one of the test viruses [1, 2]. A recent study investigated the virucidal efficacy of three low-alcohol hand disinfectants. The products with an alcohol content of 70 % (w/w) ethanol and 60 % (w/w) ethanol combined with 15 % (w/w) isopropanol, respectively were examined in accordance with EN 14476 and did not reach the required activity against poliovirus within any of the tested times (30 seconds, 60 seconds, 2 minutes or 3 minutes) [3]. In another study with tests according to EN 14476, two formulations with 80 % (v/v) ethanol and 75 % (v/v) isopropanol, respectively also did not yield adequate efficacy against polioviruses within 5 minutes [4].

Paul Hartmann AG offers four hand disinfectants possessing a high ethanol content, which repeatedly have been shown to be effective against poliovirus in accordance with EN 14476 (Sterillium® med, Sterillium® Gel and Sterillium® Gel pure). One of the products also proved to be virucidal in tests in accordance with the German DVV/RKI guideline. This product can also be used in case of officially ordered decontaminations in Germany. When selecting hand disinfectants, it is advisable to choose products with high ethanol content and virucidal efficacy that has been confirmed repeatedly.

1. Leitlinie der Deutschen Vereinigung zur Bekämpfung der Viruskrankheiten (DVV) e.V. und des Robert Koch-Instituts (RKI) zur Prüfung von chemischen Desinfektionsmitteln auf Wirksamkeit gegen Viren in der Humanmedizin; Fassung vom 1. August 2008. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2008. 51:937–945.

2. Chemical disinfectants and antiseptics – Quantitative suspension test for the evaluation of virucidal activity of chemical disinfectants for instruments used in the medical area – Test method and requirements (phase 2, step 2013); German version EN 14476: 2013.

3. Efficacy of hand rubs with a low alcohol concentration listed as effective by a national hospital hygiene society in Europe. Antimicrob Resist Infect Control. 2013 Jun 12; 2(1):19.

4. Virucidal activity of 2 alcohol-based formulations proposed as hand rubs by the World Health Organization. Am J Infect Control. 2010 Feb; 38(1):66-8.

Click here to view products with virucidal spectrum of activity.