How Are People in the U.S. Impacted By Polio Around the World?
On October 24th, Rotary International will host the fourth annual World Polio Day event to raise awareness, funds and support to #EndPolioNow.
Since Rotary and its partners launched the Global Polio Eradication Initiative nearly 30 years ago, the incidence of polio has plummeted by more than 99.9 percent, from about 350,000 cases a year to 26 confirmed as of Sept. 19, 2016. Today, polio remains endemic in three countries – Afghanistan, Nigeria and Pakistan.
Until poliovirus transmission is interrupted in these countries, all countries remain at risk of importation of polio, especially vulnerable countries with weak public health and immunization services and travel or trade links to endemic countries. Without full funding and political commitment, this paralyzing disease could return to previously polio-free countries, putting children everywhere at risk.
Before we engage in the global discussion on polio eradication next week, we’ve asked Every Child By Two Board Member and infectious disease specialist, Paul A. Offit, MD, to elaborate on the “State of the ImmUnion” for polio here in the United States.
This is what he had to say:
What is the most striking fact about polio that you wish people knew?
That once people are affected, there isn’t much you can do to make them better. The only real weapon against polio is the vaccine. Everything else—iron lungs, braces, hot packs, and occupational therapy—are far too little far too late.
How would you describe the current “State of the ImmUnion” for polio? Are there still cases of polio in the U.S.? Are enough people protected? How could people in the U.S. get polio?
Because of the vaccine, polio was eliminated from the United States by the 1970s. But it is likely that because only 1 of every 200 people who are infected are symptomatic, and that because people can unknowingly shed poliovirus in their stools for months, people from regions where poliovirus is still circulating probably walk into this country every year. If we let our guard down, and immunization rates decline, polio could come back.
Have you ever seen or treated polio? If so, what was the experience like?
When I was 5 years old, I was hospitalized following repair of a congenital foot abnormality. I was in a ward in a chronic care hospital that was filled with children with polio. It made a lasting impression. And, frankly, is probably why I chose pediatrics and later pediatric infectious diseases as a specialty.
What would you say to a parent who feels his/her child doesn’t need the polio vaccine because polio has been eliminated in the U.S.?
I would say that it is likely that people shedding poliovirus unknowingly walk into airports in Los Angeles or New York every year. And that they should know that polio always has a chance to once again rear its ugly head. The vaccine is safe and it works. There is no good reason not to take it.
What lessons can we learn from the elimination of polio in this country that we can apply to efforts against other diseases?
We could learn that if we really put our minds to it, as we did in the 1940s and 1950s, we can eliminate a disease from our country. But we did it because everyone rallied around the scientists and vaccine makers who participated in this effort.
Cases of acute flaccid myelitis (AFM) have recently been reported in children in multiple U.S. states. Media headlines have called the disease, which has caused paralysis in some children, a “polio-like illness.” How is AFM similar to or different from polio? Could there ever be another polio-like disease (AFM or another disease) on the rise, and, if so, would we ever see a vaccine for it?
Acute flaccid myelitis (AFM) is caused by enterovirus D68. The virus attacks cells on the spinal cord responsible for movement. Poliovirus is also an enterovirus and also infects the same types of cells in the spinal cord. Said another way, enterovirus D68 mimics poliovirus. And as was true for poliovirus, there is very little that can be done to affect the outcomes of these children. We have seen a handful of cases of enterovirus D68 in our hospital, and the care has been extremely frustrating. Basically, there is very little we can do to make a difference. It will be important over the next few years to see just how commonly this disease occurs.
Dr. Offit has dedicated his career to vaccines and infectious diseases. He currently serves as the Chief of the Division of Infectious Diseases and the Director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. In addition, Dr. Offit is the Maurice R. Hilleman Professor of Vaccinology and a Professor of Pediatrics at the University of Pennsylvania School of Medicine. He has been honored with many awards and has authored several books.
In his book Autism’s False Prophets, he elaborates on the personal experiences that led him to become an infectious disease specialist. He explains that at the age of five he had surgery on his foot which resulted in a three-week hospital stay in a polio ward.
“I stayed in a large, dark room with twenty other children, all of whom had polio. Because this was a polio ward, access to the hospital was restricted; my parents could visit me on Sundays only, from two to three o’clock in the afternoon. My mother, who had had an appendectomy while pregnant with my brother, was bedridden- she never visited me. I remember just lying there, my leg strung up in a cast, staring at the front door of the hospital through a window next to my bed, hoping my parents would come. I also remember how hard it was for the other children in the ward, horribly crippled and disfigured by polio. I remember seeing them as vulnerable and helpless and alone. As I got older, the image of those children remained. I wanted to protect them, to make them feel better, to champion their causes. So I became a pediatrician and later a pediatric infectious disease specialist. (This experience also provided the emotional impetus for a book I later wrote about polio and the polio vaccine.)”