Spotlight on Polio

 

August is National vaccine awareness month. Vaccines have become a political football these days. This is both sad and dangerous. It is true that many things in life require a risk/benefit calculation. In the case of immunizing your children, no one who has vaccine hesitancy would be able to convince me that the risks of vaccination outweigh the benefits. I have seen too much with my own eyes. When I was working at the hospitals in the 1980s I saw children routinely die from diseases like epiglottitis. If you have never heard of that, you can thank the Haemophilus Influenzae (HIB vaccine) that babies in this generation get as a routine vaccination starting at 2 months.  Yes it may feel like kids get so many shots these days, but the diseases we are protecting against are real. Recently the spotlight has been on polio. Polio is an infectious disease caused by a virus that is serious and can be life threatening. It can affect the spinal cord causing muscle weakness and paralysis. It is spread from person to person. The polio virus enters the body through the mouth, usually from hands that were contaminated with the stool of an infected person. It can also be passed through respiratory or saliva secretions. In the late 1940’s, polio outbreaks disabled an average of more than 35,000 people a year here in the US until the vaccines became available. Dr. Jonas Salk developed the first polio vaccine in 1955. This is referred to as the IPV (inactive polio vaccine.) A second vaccine was developed by Albert Sabin in 1961. This was vaccine was made with a live but weakened, or attenuated virus. This is referred to as OPV (oral polio vaccine). These vaccinations worked and the disease numbers plummeted! When I was little our family knew many people who had been impacted by polio. My mom was very eager to get us vaccinated as soon as possible. Believe it or one of my earliest childhood memories was that first polio vaccination. Led by my older sister, we had engaged my mother in some heavy duty bargaining to ensure our cooperation for the dreaded doctor visit and for what we assumed would be an injection. Between the two of us we could create a remarkable ruckus. The deal we negotiated was a new Barbie Doll in exchange for being good patients. When we got to the front of the line, we were given a sugar cube with the oral medicine squirted on it. This was so much better than a shot. Mom kept her end of the bargain and we got our dolls. Score!  OPV became the standard part of routine childhood immunization schedules. It was easy to administer and was a bit more effective. The downside was that because it was a live vaccine, the virus could be shed in the stool of the vaccinated patient. If someone who was unvaccinated or immunocompromised came in contact with the poop they could actually get a case of polio.  As the numbers of wild polio declined due to successful global vaccination programs, it turned out that in most of the cases that were occurring were actually caused by the live vaccine.  A vaccine-derived poliovirus (VDPV) is a strain related to the weakened live poliovirus contained in oral polio vaccine (OPV).  In the year 2000, in the US, the decision was made to stop giving the OPV and to transition instead to the IPV, thus eliminating that risk. Many places in the world still rely on the OPV as part of the series. We all have enough on our plates, between covid, monkeypox and climate woes. Polio should NOT be something that we need to add to our worry list; so much effort as well as money has gone into eradicating it. But here we are. Vaccine hesitancy now has the potential for us to regress to much scarier times. So what's going on? There was a recent case in NY of an unvaccinated adult who became paralyzed from polio. The wastewater was able to link it to a strain related to the oral vaccine. The risk for paralysis is the same, regardless of the source. There is concern that this one case is just the tip of the iceberg. 75% of those infected don’t have symptoms but can still unknowingly spread the virus.  For the other 25%, most have symptoms that could be easily overlooked or confused with some other illness. Those symptoms include fatigue, fever, headache, sore throat, stiffness, muscle pain and vomiting. Roughly 1 in 200 infected people become paralyzed. Some of those will die because their lungs are also paralyzed and they can no longer breathe. There is a long incubation period and in some cases it can take up to 30 days before the first signs of illness show up. Combine the delay between exposure and infection with the fact that many people remain without symptoms, and it is easy to see how this virus has an enormous capacity to spread among vulnerable people. Here is the scary part. If allowed to circulate in under- or un-immunized populations for long enough, or replicate in an immunodeficient individual, the weakened virus can revert to a form that causes illness and paralysis. We do NOT want to regress! If most people were up to date with their vaccines, this wouldn’t be nearly as much of a concern, but in some of those counties in New York the vaccination rate for polio is as low as 59%. It isn’t just polio - all vaccinations seem to be down across the board. CDC’s public sector vaccine ordering data show a 14% drop in 2020-2021 compared to 2019, and measles vaccine ordering is down by more than 20%. The national vaccination coverage among kindergarten children during the 2020-2021 school year dropped by about 1% from the previous year - that amounts to 35,000 more children without vaccination documents. When there was a measles outbreak several years ago I came up with this analogy. Imagine that these diseases are like a spark of fire in a forest. If the forest were wet from rain, it might not be an issue. If the forest is dry, then a devastating forest fire can occur. People are the trees. Vaccinated ones are the wet trees and unvaccinated are the dry trees. It’s pretty simple. If enough are protected, then the disease can’t spread as easily. People have become complacent. Others have allowed themselves to be swayed by junk science and conspiracy theories. I know that COVID has made things feel overwhelming and complicated, but please make sure your children are current with the vaccine schedule.