Polio: What It Means for Us by Dr. Hylton I. Lightman

Health & F tness Polio: What Does It Mean For Us?

By Hylton I Lightman, MD DCH (SA) FAAP

Polio, the highly infectious disease that attacks the nervous system and can lead to spinal and respiratory paralysis, and, in some cases, death, is making a comeback?

The question mark is deliberate.

Polio was eradicated in this country. Years ago. Since 1979, no cases of polio caused by the wild poliovirus have originated in the United States. There have been, however, cases of the wild poliovirus brought into this country by foreign travelers with polio. The last time this happened was in 1993, almost 30 years ago.

Now polio is back in the news.

Last month, the New York State Department of Health (NYDOH) and the Rockland County Department of Health alerted the public to a case of polio in a Rockland County resident who, unfortunately, is paralyzed now. The identity of the polio patient remains private. However, it is clear that the person was never vaccinated against polio. It is unclear whether this person is originally from this country or from abroad.

Further, there are eight known cases of polio in Israel at this time.

A little bit of history is in order here.

Polio existed for millennia, from prehistoric times. Ancient Egyptian images show children walking with canes with the withered limbs that are distinctive of polio. The first known clinical description of polio was in 1789 by the British doctor Michael Underwood. In 1840, Dr. Jakob Heine of German formally recognized it as a condition.

Polio epidemics were frequent, thereby rendering it one of the most feared diseases in the world. A polio outbreak in New York City in 1916 killed over 2000 people. The worst recorded outbreak in the United States was in 1952: polio killed over 3,000 people. As recently as the 1960s, polio killed or paralyzed over half a million people annually. For polio survivors, there could be lifelong consequences. These included deformed limbs which required leg braces. Some needed breathing devices like the iron lung, an artificial respirator invented for the treatment of polio.

It’s no wonder that developing a vaccine against polio was urgently pursued.

The first breakthrough was in 1949, when a team at Boston’s Children’s Hospital successfully cultivated the poliovirus in human tissue. Their work was recognized in 1954 with the Nobel Prize.

A few short years later, American virologist Dr. Jonas Salk created the first successful vaccine against polio. It was administered as an injection. Dr. Salk first tested the vaccine in 1953 on himself and his family and then the following year on 1.6 million children in the United States, Canada, and Finland. The results were announced in 1955, following which the vaccine was licensed. By 1957, the annual number of cases dropped from 58,000 to 5,600, and by 1961, only 161 cases remained.

At about the same time, Dr. Albert Sabin, a Polish American researcher, developed an oral vaccine against polio. Since Dr. Salk’s vaccine was successful, there was little to no interest in testing the Sabin vaccine in this country. Dr. Sabin had already tested his vaccine on himself and his family. After a team of Russian virologists visited his lab in 1956, Dr. Sabin traveled to Leningrad and Moscow to work with the team there. There were test trials in the Soviet Union in 1958 on 20,000 children, and then on 10 million children in 1959, as well on over 100,000 children in Czechoslovakia (which became the first country in the world to eliminate polio). This medical rapprochement is noteworthy because it took place during the Cold War, showing the world’s collective goal to eradicate polio.

The oral polio vaccine (OPV) is a safe and effective vaccine which induces immunity in the gastrointestinal system. It contains a combination of different live polio strains in a weakened form. This form has helped eradicate wild polio cases in most of the world (it still occurs in Pakistan and Afghanistan). The vaccine-derived poliovirus (VDPV) is a strain related to the weakened OPV. If it circulates in under-immunized communities, it may revert to a form that causes illness. Yes, I’m dating myself: I recall being in school in the 1960s in Johannesburg and given a sugar cube with the polio vaccine squirted on it as part of mass inoculation.

Interesting point: Today, Israel administers both OPV and IPV. Why? Because polio is present in the wastewater systems in Israel. More about wastewater in a moment.

As we bring our attention back to 2022, health officials are concerned about the Rockland County case. To us, it’s one case. But it’s not one case: It’s a case that did not have to happen. NYS Health Commissioner Mary T Bassett commented that every case of paralytic polio means potentially hundreds of others could be infected. Please note that it takes only one traveler with polio to bring that disease into the USA.

To officials, who monitor the sewage/ wastewater system, there is reason to be concerned. Wastewater data can be an important early warning signal of diseases pending.

How does this work?

Wastewater is a clever way of getting valuable information about sicknesses and diseases 10-to-14 days before they

are actually manifested in a clinical setting. Epidemiologists collect wastewater from various sources and then analyze them to see what disease may be brewing within a population. The National Wastewater Surveillance System (NSWW) was launched in September 2020 to coordinate and build this nation’s capacity to track the presence for the Covid-19 virus in wastewater samples collected across the country. Now, New York City Health and Hospitals is expanding its wastewater surveillance program to test for polio and monkeypox (monkeypox is beyond the scope of this article).

Evidence of the polio virus was found in wastewater samples in Rockland County in June 2022.

Simply put, this means that people who have not yet been vaccinated against the polio virus are at risk for contracting it.

The tragedy here is that a staple among pediatric vaccines – and one that has an excellent track record – is being refused. The patient is then at risk for polio. G-d forbid that the unvaccinated person has the live virus goes among infants who have yet to be vaccinated – well, that’s an unmitigated misfortune that is too tragic to fathom. The IPV prevents against naturally occurring polioviruses and VDPVs.

To summarize: • Polio is contagious. • It spreads through person-to-person contact. • It exists in an infected individual’s throat and intestines where it can live for many weeks.

Polio infects people by entering the mouth and it spreads through contact with feces, contaminated toys, or (less commonly) through droplets (sneeze or cough)

An infected person can spread the virus before and up to two weeks after symptoms appear. An asymptomatic person can still transmit the virus.

Health officials worldwide recommend that children receive 4 doses of polio vaccine by 6 years of age (2 months, 4 months, 6-18 months, and the 4th dose between 4-6 years). Adults, too, may receive the IPV. Adults concerned about their immune status are advised to speak with their internists.

Presently, and of great concern, there is a backlash against vaccines because of the handling of the Covid pandemic. Parents need to know that childhood

vaccines, including the polio vaccine, are safe. Our country’s long-standing vaccine safety system ensures that vaccines are as safe as possible. Millions of children safely receive vaccines annually. The most common side effects are mild, such as pain or swelling at the injection site. And for the anti-vaxxers who are reading this, scientific studies and reviews show no relationship between vaccines and autism. There are rare exceptions to vaccines being safe.

One might ask: Since diseases like polio and measles/mumps/German measles are rare in the USA, why bother with vaccines?

Many of these diseases thrive in other parts of the world. We live in a world where contact between places, once unheard of, now abounds. Travelers might bring the viruses back with them. Without the protection of vaccines, these diseases could easily spread again.

Warning: All the diseases prevented by vaccines are not harmless and innocuous. Who wants problems that don’t have to happen in the first place?

As the back-to-school season is upon us, now is a good time to make sure that your children’s well visits are up-to-date. Questions about vaccines and their protocol should be addressed to your pediatrician. Your children’s pediatrician wants only the best for your children. Promise.

As always, daven.

As recently as the 1960s, polio killed or paralyzed over half a million people annually.

Dr. Hylton I. Lightman is a pediatrician and Medical Director of Total Family Care of the 5 Towns and Rockaway PC. He can be reached at drlightman@totalfamilycaremd.com, on Instagram at Dr.Lightman_ or visit him on Facebook