Could Polio Make A Comeback?

By Lynette Norris
Greene Publishing, Inc.
In 1985, when the Rotary International launched its PolioPlus Project, the crippling, sometimes fatal disease was still rampant in 125 countries around the world.  It had been eradicated in the United States for two or three decades by then, due to the breakthrough of Dr. Jonas Salk’s vaccine and the campaign of childhood vaccinations that followed, and the mission of the PolioPlus Project was to take the vaccination program worldwide and eradicate the virus from the face of the earth (20 years later, April 12, 2005, marked the 50th anniversary of the Salk vaccine).
A few years after the project was launched, Rotary International partnered with UNICEF and began working with other international agencies as well, including the World Health Organization.  Stateside, the CDC has provided assistance, as has the Bill and Melinda Gates Foundation, pledging hundreds of millions in matching funds to purchase vaccines for children in countries where polio still threatened.
Locally, the Rotary Club of Madison has been very active in fundraising with its Purple Pinkie Projects in local schools.  School children who donate one dollar to the program have their pinkies dyed purple to mark their contribution to helping another child in another country live a life free of the fear of polio, just as in those countries where vaccination programs are ongoing, children have their pinkies dyed purple to show they have been vaccinated.
After the project was launched in 1985, the number of polio-endemic countries slowly decreased; one by one, in the countries where vaccine programs had been successful, health officials monitored lab results and field reports for polio cases and outbreaks, and eventually certified a country “polio-free.”
In 2014, cases of polio had decreased 99 percent from 1985 levels, and polio remained endemic, a common disease with recurring epidemics, in only three countries:  Afghanistan, Nigeria and Pakistan.
The prospect of being so close to total eradication has been an inspiration and encouragement to health officials, volunteers and fundraisers, but there was always a grain of caution in the knowledge that, as long as wild polio virus remained loose anywhere in the world, another outbreak, even a worldwide pandemic was a real possibility.  It has been over half a century since the repeated polio epidemics in the first half of the 1900s left children and sometimes adults in wheelchairs, braces, iron lungs, on crutches or even dead.  It is something no one would like to see repeated anywhere.
On May 5, 2014 the World Health Organization released an alarm on the spread of the polio virus.  The disease had spread into three countries so far, and this occurred during what is typically the “low season” of transmission rates.
At the very end of 2013, there were 417 cases of polio, or reports of the polio virus found in the environment in 10 countries worldwide, and 60 percent of those were linked to the international travel of adult carriers.  Pakistan, Syria and Cameroon have been urged to put preventative measures in place, such as requiring proof of vaccination from all international travelers entering or leaving their borders, because of the ten countries with active cases polio, the evidence shows that these three have allowed the disease to cross their borders and cause new outbreaks in neighboring countries: from Pakistan to Afghanistan, from Syria to Iraq and from Cameroon to Equatorial Guinea.  Syria, in particular, had not seen an active case of polio in 15 years.
The 10 affected countries include: Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia and Nigeria, which have not allowed the virus to pass beyond their borders, along with Pakistan, Syria and Cameroon.  In Israel, health officials have found no active cases of polio, but have discovered the polio virus in the stools of vaccinated children and in sewage samples.  One main concern of the WHO is that further spread of the virus would endanger countries that are currently polio free, but coping with conflict, wars, and other disruptions to their infrastructure and public health care delivery systems.
The current situation with polio spreading during a low-transmission period are in “stark contrast” to a period from January 2012 through April 2013, when spread of the virus had all but stopped.
Why hasn’t polio gone away yet?
The polio virus is part of the Picornaviridae family which also includes the rhinoviruses that cause the common cold and the enteroviruses, a group of RNA that are responsible for diseases and infections of the gastrointestinal tract and can spread to the central nervous system and other ares of the body.  The enteroviruses include hepatitis C and polio.  There are over 100 types of enteroviruses that can cause 10 to 15 millions different infections.
Dr. Steven Oberste, chief of the Polio and Picornavirus Laboratory Branch of the CDC, notes that most people who become infected with an enterovirus do not get sick or have only mild symptoms including fever, runny nose, cough, skin rash and body aches. This is often the culprit for the  “summer cold”  in children and teens who have not yet developed immunities to these viruses.  Cases typically peak in July, August and September.
Other types of the enterovirus are more serious, resulting in hand, foot and mouth disease, viral meningitis, encephalitis, heart infections and even paralysis in some patients.
The polio virus is in this more serious category.  The wild poliovirus is highly infectious, but only one in 200 cases will result in paralysis, and of those, about five to ten percent will result in death when breathing muscles become paralyzed.  The virus lives in the intestinal tract and in the feces that pass out of the body.  It travels through the fecal-oral route and can be spread through contact contaminated soil and water, or even contaminated food – there’s some evidence that flies can spread the infection from contamination in the environment to food, especially in regions with poor sanitation and hygiene.
However, since most people who harbor the virus never get sick or have any symptoms, they may never be aware that they’re infected.  While the infection runs its course, even though they have no  signs or symptoms of illness, they can still shed the virus in their stool for several weeks, or even several months.  In area with poor sanitation, a single person can potentially infect hundreds of people unawares, before the first case of serious polio appears in that area.  Even immune children and adults who aren’t infected can still be carriers, infecting other and contaminating sewage systems.   People are most contagious from seven to ten days before they become ill and seven to ten day after, although they can continue to shed the virus for weeks or months through the stool.
Of those infected, a small number of people will develop non-paralytic polio, or abortive poliomyelitus.  They will have mild, flu-like symptoms similar to many types of viruses, including a sore throat fever, vomiting and diarrhea.  Most will recover in less than a week, and unless they receive a diagnosis from a health care provider, most will probably assume they had the flu.
Another five to ten percent of infected people will develop non-paralytic aseptic meningitis, an infection of the outer covering of the brain.  The illness will last from two to ten days and include:  fever, headache vomiting, diarrhea, fatigue, back pain or stiffness, neck pain or stiffness, pain or stiffness in the limbs and muscle spasms/tenderness.
One percent of those infected will develop paralytic polio, the most serious type of polio.  The virus attacks motor neurons that transmit signals from the brain to muscle, disrupting the signal path and resulting in paralysis.  Depending on which neurons are attacked, the paralyzing effects can be worse on one side of the body that the other, confined to the lower extremities, or affect the breathing muscles.
Most of the paralysis cannot be reversed, although some damaged neurons, depending on ow severely they are affects, can regenerate enough new branches know as axions to allow some mitigation of the paralysis and allow the patient to regain partial use.
There is no cure for polio, only prevention through vaccines given in multiple doses that grant lifelong immunity.
In the United States, who is at risk?
Those who haven’t been immunized against the disease
Those traveling or who have traveled to an area where polio is endemic, or that has experienced a recent outbreak
Living with or caring for someone who may be shedding wild poliovirus
Trauma to the mouth nose or throat such as dental surgery or tonsillectomy
Extreme stress or physical activity after being exposed to the virus
Call your doctor if:
Your child hasn’t complete a series of polio vaccinations
Your child experiences an allergic reaction after receiving a polio vaccination
You had polio years ago and are now experiencing unexplained weakness and fatigue
You’re planning to travel to parts of the world where polio still occurs
Polio had been beaten back and is now confined to a small handful of countries.  Fortunately, here in the U.S. and many other countries, polio and its devastating effects are only a fading memory. But until the entire world is polio free, and the wild poliovirus is eradicated from the face of the planet, it is a safety that cannot be taken for granted.  Polio is one of the most serious vaccine-preventable illnesses still occurring today, and as recent events have show, constant vigilance, hard work on the part of thousands and thousands of health care professionals, and funding for a continued program of world-wide vaccinations are a must in keeping the virus from spreading, and eventually, someday, eradicating it altogether so that no one else, especially no more children have to suffer its lifelong effects.
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Lynette Norris

Written by Lynette Norris