History, Etiology, and Symptoms of Polio

Poliomyelitis

Polio (Poliomyelitis) is an infectious disease caused by poliovirus. The virus can cause crippling and sometimes death of young children who contract poliovirus. The disease impacts the brain and spinal cord of individuals, leaving them paralyzed.

History

The origin of polio is not fully known because some researchers believe that polio dates back to 1580-1350 B.C. This is based on finding of an Egyptian stele that depicts a man having deformed leg, a symptom and sign of polio.

Wordpress. (2010, February 23). Polio is an ancient phenomenon. Retrieved June 13, 2015, from https://kickpoliooutofafrica.wordpress.com/2010/02/23/polio-is-an-ancient-phenomenon/

According to Global Polio Eradication, the first polio outbreak in United States took place in 1894 and resulted in infantile paralysis. However, the vaccine for polio did not develop until 1952 by Dr. Jonas Salk. He developed an Inactivated Polio Vaccine (IPV) and tested on himself and his wife (PBS). More can be read about his methodology at the site bellow:

http://www.pbs.org/wgbh/aso/databank/entries/dm52sa.html

PBS. (n.d.). Salk produces polio vaccine. Retrieved June 19, 2015, from http://www.pbs.org/wgbh/aso/databank/entries/dm52sa.html

In 1958 ad 1959 the Oral (Live) Polio Vaccine (OPV) was created by Albert B. Sabine and tested on many individuals from former Soviet Union and later approved for use in United States. OPV is the type of vaccine used in present day (Roosevelt, 2011) and more information can be read about Sabine and hist invention can be read at the site below:

http://www.polioplace.org/people/albert-b-sabin-md

In 1980, there was a global approach to immunization against polio. As indicated by World Health Organization graph, since the 1980, there was a decline in number of cases of poliomyelitis reported and this can be due to an increase in the percentage of immunization against polio that is occurring worldwide.

What is Poliovirus?

Poliovirus is an enterovirus that has the RNA genome in the capsid, which is a protein shell. This virus causes polio and there are three different subtypes of it that differ in their capsid protein. According to Global Polio Eradication Initiative, type 2 polio has been eliminated worldwide, however, type 1 and type 3 are most infections and still cause paralytic polio around the world ( The Global Polio Eradication Initiative).

NMAH. (2015). Polio: How the Poliovirus Works. Retrieved June 19, 2015, from http://www.americanhistory.si.edu/polio/virusvaccine/how.htm

 NMAH. (2015). Polio: How the Poliovirus Works. Retrieved June 19, 2015, from http://www.americanhistory.si.edu/polio/virusvaccine/how.htm  

                                   


Symptoms of Poliovirus

According to Center for Disease Control and Prevention (CDC) there are various response to poliovirus depending on individual and their immune system. For example, 72 out 100 individuals do not show visible symptoms upon contraction of disease. Of those who contract the disease, one out four individuals will show symptoms such as sore throat, fever, tiredness, nausea, headache, and stomach pain with the duration of 2 to 5 days. Other individuals show critical symptoms upon contraction of poliovirus, such as paresthesia, meningitis and paralysis. Paresthesia is sensing needle-like feelings in leg. Meningitis is a type of infection that impacts brain and results in 1 out 25 individuals who have the virus. On the other hand, paralysis is the most crucial symptom of poliovirus, causing weakness of body, and is typically the symptom of one out 200 individuals who have poliovirus. Paralysis is the most dangerous symptom because according to CDC, 2 to 10 out of 100 individuals can loose their lives if they have paralysis since it can cause weakening of "muscles that help [these individuals] breathe". Individuals who depict symptoms of paralysis due to poliovirus are considered to have poliomyelitis, polio  (CDC, 2014). 

Emaze presentations. (n.d.). Disease Hall of Fame. Retrieved June 15, 2015, from http://app.emaze.com/@AOICCFCR/disease-hall-of-fame#1

How To Detect Polio and Who Are At Risk

In order to determine if an individual has polio, the amount of poliovirus in an individual needs to be detected. Doctors confirm poliovirus infection by asking for samples of throat, feces, and cerebrospinal fluid of individuals who may be have contrctred the disease. Based on these samples, the presence of virus can be detected (CDC, 2014).

Centers for Disease Control and Prevention (CDC). (2014, May 1). Our Progress Against Polio. Retrieved June 15, 2015, from http://www.cdc.gov/polio/progress/  

Although there is no cure to polio, it still has decreased dramatically since the 1980 global immunization and according to World Health Organization, "polio cases have decreased ... from an estimated more than 350,000 cases to 416 cases in 2013". However, there are only three nations in the world, Nigeria, Pakistan, and Afghanistan, that still show transmission of polio (WHO, 2014). This is still dangerous given that polio is an infectious disease that could be introduced through immigration and outbreaks could occur if children are not vaccinated against it. As outlined in the video linked below, nations like Pakistan struggle to get their children immunized against polio due to social problems and poverty. 

https://www.youtube.com/watch?v=b5-MVm3Itdk

Sources:

Centers for Disease Control and Prevention (CDC). (2014, May 1). Our Progress Against Polio. Retrieved June 15, 2015, from http://www.cdc.gov/polio/progress/

Centers for Disease Control and Prevention (CDC). (2014, October 15). What Is Polio? Retrieved June 19, 2015, from http://www.cdc.gov/polio/about/

Emaze presentations. (n.d.). Disease Hall of Fame. Retrieved June 15, 2015, from http://app.emaze.com/@AOICCFCR/disease-hall-of-fame#1

The Global Polio Eradication Initiative. (2010). Polio. Retrieved June 19, 2015, from http://www.polioeradication.org/Polioandprevention/Thevirus.aspx

PBS. (n.d.). Salk produces polio vaccine. Retrieved June 19, 2015, from http://www.pbs.org/wgbh/aso/databank/entries/dm52sa.html

Roosevelt Warm Springs Foundation. (2011). Polio Place. Retrieved June 19, 2015, from http://www.polioplace.org/people/albert-b-sabin-md

Wordpress. (2010, February 23). Polio is an ancient phenomenon. Retrieved June 13, 2015, from https://kickpoliooutofafrica.wordpress.com/2010/02/23/polio-is-an-ancient-phenomenon/

World Health Organization (WHO). (2014, October 1). Poliomyelitis. Retrieved June 19, 2015, from http://www.who.int/mediacentre/factsheets/fs114/en/

Polio Transmission and Prevention

Polio Transmission and Prevention

Polio Transmission

Polio is excreted from the body through its fecal matter, in other words, it is transmitted through feacal-oral route. Poor hygiene such as not washing hands or drinking of contaminated water can cause the spread of disease and the reentry of virus into the body. The virus can multiply in the intestine and act on brainstem and spinal cord causing paralytic symptoms (WHO). 

Polio Life Cycle. (n.d.). Retrieved June 16, 2015, from http://www2.cedarcrest.edu/academic/bio/hale/bioT_EID/lectures/poliolifecycle.html

Treatment

According to MayoClinic, polio is one of the disease that has no cure once the disease is contracted. However, there is a supportive treatment, which includes actions such as resting in bed, carrying out physical exercises in order to limit the deformation and function of muscles, respiratory exercises and use of ventilators to assist breathing as polio can weaken the respiratory muscles, and taking medications as needed for pain as well as having a balanced diet (Mayo Clinic, 2014).

Prevention

As discussed in the earlier post, vaccination against poliovirus is the best preventative measure for polio. Nicole Green from KidsHealth organization mentions the success of IPV (inactivated polio vaccination) over OPV (oral polio vaccine) as few paralytic cases in 1979 occurred with OPV immunization. IPV is the preventative method used in United States and according to KidsHealth organization and American Academy of Pediatrics (AAP), the IPV should be administered to children three times in their lifetime, before 18 months and between 4 to 6 years. This requirement is highly enforced when individuals are traveling outside of United States to areas where polio is still present (Green, 2014)

Global Transmission and Prevention

According to GlobalPolioEradicationInitiative organization, polio cases in 2014 were present in countries such as Pakistan, Afghanistan, Nigeria, Somalia, Equatorial Guinea, Iraq, Cameroon, Syrian Arab Republic, Ethiopia, South Sudan and Madagascar. The number of cases is fully outlined in the chart below (The Global Polio Eradication Initiative). 

The Global Polio Eradication Initiative. (2015, June 17). Polio this week. Retrieved June 18, 2015, from http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx  

Some of these countries face poverty and social violence that prevents the children from becoming immunized. This matter further outlined in the video with the link provided below that discusses the difficulties certain nationalities (such as Pakistan) face when it comes to immunization. 

https://www.youtube.com/watch?v=mGOMfAtE7Lk

My Opinion

I believe that vaccination against poliovirus should be mandatory for every individual and more attention should be given to funding the immunization programs. If polio vaccine can cause 99% decrease since 1988 in the number of cases reported, according to World Health Organization, then every child should be allowed equal access to the vaccination. Poverty and violence should not be the reasons for a child being at risk for polio because of limited access to its vaccination. An organization such GlobalPolioEradicationInitiatve that also cooperates with government should seek funds and volunteers to help vaccinate children in undeveloped nations (WHO).


Sources:

Green, N. (2014). Polio. Retrieved June 9, 2015, from http://kidshealth.org/parent/infections/bacterial_viral/polio.html#

Mayo Clinic. (2014, March 11). Polio. Retrieved June 19, 2015, from http://www.mayoclinic.org/diseases-conditions/polio/basics/treatment/con-20030957

The Global Polio Eradication Initiative. (2015, June 17). Polio this week. Retrieved June 18, 2015, from http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

World Health Organization (WHO). (2014, October 1). Poliomyelitis. Retrieved June 19, 2015, from http://www.who.int/mediacentre/factsheets/fs114/en/

Review on "Polio in Pakistan: Drop of 70% recorded this year"

"Polio in Pakistan: Drop of 70% recorded this year" - Is this enough?

Polio is a highly infectious disease that can be transmitted through fecal-oral route with poor hygiene or oral-oral route with drinking contaminated water. Pakistan is still one of the nations that has cases of polio reported each year. According to BBC, Pakistan and Afghanistan report the highest number of polio in the world (BBC, 2015). This news reflects on the decline of polio cases in Pakistan and how Pakistan's Prime ministerial polio adviser Ayesha Raza, details the success of this reduction.

BBC has claimed that as of June 3, 2015, there has been only 25 cases of polio reported. The main concern is how infants are not being allowed to become vaccinated against polio and the cause of this, as mentioned by BBC is how "militants have targeted health teams" who seek to vaccinate children. 

On the other hand, Pakistan's Prime ministerial polio adviser Ayesha Raza, elaborates on the decline of polio cases by valuing the army for its help and protection of vaccination teams in order to immunize infants of Pakistan. Raza further emphasized on how the officials have "access to populations in Waziristan after more than two years. [They] have also now penetrated some formerly no-go zones in Karach". This is a great news not only for children of Pakistan but also everyone around the world because immigration can allow for transmission of the disease to other nations who do not have their children vaccinated against poliovirus, either due to poverty, social threat, or personal belief. However, I feel that this is unjust for children of Pakistan. We have the choice to live freely, and recently, the option to vaccinate our children, while children in Pakistan and Afghanistan are forced to remain unvaccinated. I believe that whether a child gets vaccinated or not should be the decision of someone besides the parents or the guardians, and the officials are acting very quick in Pakistan, It should not take 2 years for the officials to gain access and immunize children of Waziristan. This should be a matter of national unification to immunize these children. Infants and young ones cannot defend themselves against harsh militants and it should be the responsibility of everyone in the world to look after them as we wished for someone to look after us if the situation was reversed. 

Source:
Polio in Pakistan: Drop of 70% recorded this year. (2015, June 3). BBC News. Retrieved June 10, 2015, from http://www.bbc.com/news/world-asia-32996624

Review of "Immunogenicity and persistence from different 3-dose schedules of live and inactivated polio vaccines in Chinese infants"

Introduction:

As mentioned in earlier posts, there are two approach to vaccination against polio, oral polio vaccine (OPV) and inactivated polio vaccine (IPV). However, according to Polio Eradication and Endgame Strategic Plan 2013–2018, the OPV vaccine is not as effective as IPV in preventing polio because it can lead to vaccine-derived polioviruses (VDPV). This plan mentions few countries that are still using OPV, including China. The article, Immunogenicity and persistence from different 3-dose schedules of live and inactivated polio vaccines in Chinese infants, by Lu et. al. compares the presence of immunogenicity and persistency between the oral polio vaccine and inactivated polio vaccine by testing on Chinese infants, as China is one of the nations following with OPV.

Methods:

The researchers choose Chinese infants as their subject with the permission of infants' parents or guardians. They set specific characteristics for their subjects, which include the infants being "between 60 and 89 days old on enrollment, have resided in Beijing for the previous 2 months, been born full term (≥36 weeks) with birth weight ≥2.5 kg, and have parents with the ability to follow the study protocol" (Lu et. al.). With these defined requirements, the study limited its borders to China alone. The infants were divided into four groups that differed in their vaccination schedule and type. The treatment groups were assigned as "IPV–OPV–OPV (I–O–O), IPV–IPV–OPV (I–I–O), IPV–IPV–IPV (I–I–I), and OPV–OPV–OPV (O–O–O)" (Lu et. al.) while the control only followed OPV-OPV-OPV (O-O-O) schedule, since OPV is the only vaccination method in China. The three types of poliovirus vaccine were given through IPV and OPV, depending on the treatment group. The IPV vaccine was injected into infant's thigh while OPV was administered through oral route. Blood samples were collected from 533 initial participants, however, as the research progressed, parents withdrew their children from the study and after every dose blood samples were collected from infants, including the remaining 84 that stayed throughout the entire study. The blood sample collected was stored and the serum "were tested for neutralizing antibodies for poliovirus types 1, 2, and 3" (Lu et. al.) followed by microneutralization assay, which determines the immunity. The solutions were diluted to 1:1,024 and readings greater than 1:8 were considered as positive protective level for naturalizing antibody. Further analysis were done such as use of ANOVA to compare geometric mean titer of treatment groups and chi-square to compare protective rates (Lu et. al.)

Results:

The antibody production reduced with both OPV and IPV methods of vaccination. The data for antibody production are shown below. 

The antibody titers before, one-month after vaccination and 18-months age.Lu, L., Li, X., Zhang, H., Liu, D., Zhang, Z., Wang, H., Liu, F., ... Pang, X. (February 01, 2015). Immunogenicity and persistence from different 3-dose schedules of live and inactivated polio vaccines in Chinese infants. Vaccine, 12.)

Discussion:

Through multiple test conducted by the researchers, Lu et. al., it became evident that I-I-I method was the most effective approach to vaccination as the antibody production is lower in comparison to other modes of vaccination such as the control, OPV only, or other treatments that had a mix of OPV and IPV. I believe that the researchers should expand this research to other nations and see if perhaps ethnicity or individual's race has an influence on this data reported. Also, it is important to consider the ethicality of this research as infants are used to be the subjects. Perhaps research can further carryout this experiment on other mammals that have similar response as humans to poliovirus. I suggest this because the data analysis may not demonstrate the entire population of China, where only 84 infants remained in the study and their blood antibody results are used for analysis. 

Sources:

Lu, L., Li, X., Zhang, H., Liu, D., Zhang, Z., Wang, H., Liu, F., ... Pang, X. (February 01, 2015). Immunogenicity and persistence from different 3-dose schedules of live and inactivated polio vaccines in Chinese infants. Vaccine, 12.)

Polio Eradication and Endgame Strategic Plan 2013–2018. (2013). Retrieved June 15, 2015, from http://www.polioeradication.org/Resourcelibrary/Strategyandwork.aspx