Friday, September 16, 2022 (Kaiser News) – Before that poliomyelitis Vaccines became available in the 1950s, and people who feared disabling disease were afraid to let their children go out, let alone go to school. With polio re-emerging decades after its eradication in the US, Americans unfamiliar with the dreaded disease need a primer to protect themselves and their young children – many of whom have emerged from the shock of Covid-19. pandemic.
What is polio disease?
Polio is an acronym for “polio”, a neurological disease caused by infection with the polio virus. Of the three types of wild poliovirus – serotypes 1, 2, and 3 – serotype 1 is the most virulent and most likely to cause paralysis.
Most people infected with the polio virus do not get sick and will not develop symptoms. About a quarter of those infected may experience mild symptoms such as fatigue, fever, headache, stiff neck, sore throat, nausea, vomiting, and Stomach ache. So, as with covid-19, people who don’t have symptoms can inadvertently spread it while interacting with others. But in up to 1 in 200 people with poliovirus infection, the virus may attack the spinal cord and brain. When it affects the spinal cord, people may develop muscle weakness or paralysis, including in the legs, arm, or chest wall. The polio virus may also infect the brain, causing difficulty breathing or swallowing.
People can develop post-polio syndrome decades after infection. Symptoms may include muscle pain, weakness, and wasting.
People with polio may remain wheelchair-bound or unable to breathe without ventilator assistance for the rest of their lives.
How is polio spread?
The virus that causes polio is spread through the ‘faecal-oral route’, which means it enters the body through the mouth through hands, water, food, or other objects contaminated with faeces containing poliovirus. Rarely, the polio virus is spread through saliva and upper respiratory droplets. The virus then infects the throat and gastrointestinal tract, spreads in the blood and invades the nervous system.
How do doctors diagnose polio?
Polio is diagnosed through a combination of patient interviews, physical examinations, laboratory tests, and scanning of the spinal cord or brain. Health care providers may send stool, throat swabs, spinal fluid, and other samples for lab testing. But given the rarity of polio in the United States for decades, doctors may not consider diagnosing patients with symptoms. And suspected polio tests must be sent to the Centers for Disease Control and Prevention, as not even academic centers are running the tests anymore.
How can the transmission of the polio virus be prevented?
The CDC recommends that all children be vaccinated against polio at 2 months, 4 months, 6 to 18 months, and 4 to 6 years of age, for a total of four doses. All 50 states and the District of Columbia require that children who attend daycare or public schools be immunized against polio, but some states allow medical, religious or personal exemptions. The Pediatric Vaccine Program provides free polio to children who qualify for Medicaid, are uninsured, underinsured, or are American Indian or Alaska Native. It is likely that most people born in the United States after 1955 have been vaccinated against polio. But in some areas, vaccination rates are dangerously low, like New York’s Rockland County, where it’s 60%, and Yates County, where it’s 54%, because so many families there are demanding religious exemptions.
There are two types of polio vaccine: the killed and inactivated polio vaccine (IPV) and the attenuated and live oral polio vaccine (OPV). IPV is an injectable vaccine. The oral vaccine can be given by drops in the mouth or on a sugar cube, so it is easy to administer. Both vaccines are very effective against paralytic polio, but the oral polio vaccine appears to be more effective at preventing infection and transmission.
Both wild poliovirus and attenuated live oral vaccine viruses can cause infection. Because IPV is a dead virus vaccine, it cannot infect or replicate, lead to vaccine-derived poliovirus, or cause paralytic poliovirus disease. Attenuated OPV viruses can mutate and regain their ability to cause paralysis – the so-called vaccine-derived polio.
Since 2000, IPV has only been given in the United States. Two doses of IPV are at least 90% effective and three doses of IPV are at least 99% effective in preventing paralytic polio. The United States stopped using the oral polio vaccine due to a 1 in 2,000 risk of paralysis among unvaccinated people receiving the oral vaccine. Some countries still use OPV.
Polio vaccination began in 1955 in the United States. Cases of paralytic polio dropped from more than 15,000 per year in the early 1950s to less than 100 in the 1960s and then dropped to less than 10 in the 1970s. Today, the polio virus is more likely to spread where hygiene and sanitation are poor and vaccination rates are low.
Why is polio spreading again?
The World Health Organization declared North and South America polio-free as of 1994, but in June 2022 a young adult living in Rockland County, New York, was diagnosed with vaccine-derived serotype 2 poliovirus. The patient complained of fever, stiff neck and leg weakness. The patient has not recently traveled outside the country and is presumed to have contracted the infection in the United States. The CDC has since begun monitoring wastewater for the polio virus. Poliovirus genetically related to the Rockland County case has been detected in wastewater samples from Rockland, Orange and Sullivan counties, indicative of community spread since May 2022. Vaccine-derived poliovirus has also been detected in New York City wastewater.
How do I know I’ve received a polio vaccine?
There is no national database of immunization records, but all 50 states and the District of Columbia have immunization information systems with records going back to the 1990s. Your state or territory health department may also have records of your immunizations. People who have been vaccinated in Arizona, the District of Columbia, Louisiana, Maryland, Mississippi, North Dakota, and Washington can access their immunization records using the MyIR Mobile app, and those who have had vaccinations in Idaho, Minnesota, New Jersey, and Utah can do so using the Docket app.
You can also ask your parents, your pediatrician, your current doctor or pharmacist, or the K-12 schools, colleges or universities you attended if they have records of your vaccinations. Some employers, such as health care systems, may keep records of your vaccinations in the Occupational Health Office.
There is no test to determine if you are immune to polio.
Do I need a polio booster if I received the full polio vaccination as a child?
All unvaccinated children and adults must complete the four-dose series of polio vaccines recommended by the CDC. You do not need an IPV booster if you receive an OPV.
Adults who are immunocompromised, who travel to a country where poliovirus is common, or who are at increased risk of exposure to poliovirus on the job, such as some laboratory and health care workers, may receive a one-time IPV treatment.
How is polio treated?
People with mild poliovirus infection do not need treatment. Symptoms usually go away on their own within a couple of days.
There is no cure for polio. Treatment focuses on physical and occupational therapy to help patients adapt and regain function.
Why has the polio virus not been eradicated?
Smallpox is the only human virus that has been declared eradicated to date. A disease can be eradicated if it affects only humans, if the viral infection induces long-term immunity to infection again, and if there is an effective vaccine or other preventative method. The more contagious the virus is, the more difficult it is to eradicate it. Viruses that spread without symptoms are also difficult to eradicate.
In 1988, the World Health Assembly decided to eradicate polio by the year 2000. Violent conflict, the spread of conspiracy theories, skepticism about vaccines, insufficient funding and political will, and poor quality vaccination efforts slowed progress towards eradication, but before the Covid pandemic had The world has come very close to eradicating polio. During the pandemic, childhood immunizations, including polio vaccines, have declined in the United States and around the world.
To eradicate polio, the world must eliminate all wild polioviruses and vaccine-derived polioviruses. Serotypes 2 and 3 of wild poliovirus have been eliminated. The first serotype of wild poliovirus, the most virulent form, is still endemic only in Pakistan and Afghanistan, but vaccine-derived polioviruses continue to circulate in some countries in Africa and other parts of the world. A phased approach that includes the use of OPV, then a combination of OPV and IPV, and then IPV alone will likely be needed to eliminate polio from the planet.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and survey, KHN is one of the three major drivers of KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides information on health issues to the nation.