Friday, September 16, 2022 (Kaiser News) — Front polio vaccines became available in the 1950s, people suspicious of this debilitating disease were afraid to let their children go outside, let alone go to school. As polio reappears decades after it was considered eliminated in the United States, Americans unfamiliar with the dreaded disease need an introduction to protect themselves and their young children – many of whom are emerging from the trauma of covid- 19 pandemic.
What is poliomyelitis?
Polio is short for “poliomyelitis”, a neurological disease caused by infection with poliovirus. 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 poliovirus do not get sick or have any symptoms. About a quarter of those infected may experience mild symptoms such as fatigue, fever, headache, stiff neck, sore throat, nausea, vomiting and abdominal pain. So, as with covid-19, people without symptoms can unknowingly spread it when interacting with others. But in up to 1 in 200 people infected with poliovirus, the virus can attack the spinal cord and brain. When it infects the spinal cord, people may develop muscle weakness or paralysis, including of the legs, arms, or chest wall. The polio virus can also infect the brain, causing difficulty in breathing or swallowing.
People can develop post-polio syndrome decades after infection. Symptoms can include muscle pain, weakness, and atrophy.
People with polio can remain in a wheelchair or unable to breathe without the help of a ventilator for the rest of their lives.
How is poliomyelitis spread?
The virus that causes poliomyelitis is spread by the ‘faecal-oral route’, which means it enters the body through the mouth via hands, water, food or other objects contaminated with feces containing poliovirus. Rarely, poliovirus can spread through saliva and upper respiratory droplets. The virus then infects the throat and gastrointestinal tract, spreads through the blood, and invades the nervous system.
How do doctors diagnose polio?
Poliomyelitis is diagnosed through a combination of patient interviews, physical exams, lab tests, and spinal cord or brain scans. Health care providers may send feces, throat swabs, cerebrospinal fluid, and other samples for lab testing. But because polio has been extremely rare in the United States for decades, doctors may not consider the diagnosis for patients with symptoms. And tests for suspected polio must be sent to the Centers for Disease Control and Prevention, because even academic centers no longer perform the tests.
How to prevent poliovirus transmission?
The CDC recommends that all children be vaccinated against polio at ages 2 months, 4 months, 6 to 18 months, and 4 to 6 years, for a total of four doses. All 50 states and the District of Columbia require children attending daycare or public school to be vaccinated against polio, but some states allow medical, religious or personal exemptions. The Vaccines for Children program provides the polio vaccine free to children who are eligible for Medicaid, uninsured or underinsured, or who are Native American or Alaska Native. Most people born in the United States after 1955 have probably been vaccinated against poliomyelitis. But in some areas, vaccination rates are dangerously low, such as Rockland County in New York, where it is 60%, and Yates County, where it is 54%, as many families there claim exemptions. nuns.
There are two types of polio vaccine: inactivated polio vaccine (IPV) and live weakened oral polio vaccine (OPV). IPV is an injectable vaccine. OPV can be given as drops in the mouth or on a sugar cube, so it is easier to administer. Both vaccines are highly effective against paralytic poliomyelitis, but OPV appears to be more effective in preventing infection and transmission.
Wild poliovirus and live, weakened OPV viruses can cause infection. Because IPV is a killed virus vaccine, it cannot infect or replicate, give rise to vaccine-derived poliovirus, or cause paralytic poliomyelitis. Weakened OPV viruses can mutate and regain their ability to cause paralysis – the so-called vaccine-derived poliomyelitis.
Since 2000, only IPV has been administered 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 poliomyelitis. The United States has stopped using OPV due to a 1 in 2,000 risk of paralysis in unvaccinated people receiving OPV. Some countries still use OPV.
Vaccination against poliomyelitis began in 1955 in the United States. Paralytic poliomyelitis cases fell from more than 15,000 a year in the early 1950s to less than 100 in the 1960s and then to less than 10 in the 1970s. Today, poliovirus is most likely to occur spread where hygiene and sanitation are poor and vaccination rates are low.
Why is poliomyelitis spreading again?
The World Health Organization declared North and South America polio-free beginning in 1994, but in June 2022, a young adult living in Rockland County, New York, was diagnosed with poliovirus-derived serotype 2 vaccine. The patient complained of fever, stiff neck and leg weakness. The patient had not recently traveled outside the country and was likely infected in the United States. The CDC has since begun monitoring sewage for poliovirus. Poliovirus genetically linked to the Rockland County case was detected in sewage samples from Rockland, Orange, and Sullivan counties, demonstrating community spread as early as May 2022. Unrelated vaccine-derived poliovirus was also detected in New York City wastewater.
How do I know if I have been vaccinated against poliomyelitis?
There is no national database of immunization records, but all 50 states and the District of Columbia have immunization information systems with records dating back to the 1990s. Your state or territory’s health department may also have records of your vaccinations. People vaccinated in Arizona, District of Columbia, Louisiana, Maryland, Mississippi, North Dakota and Washington can access their vaccination records using the MyIR Mobile app, and those who are vaccinated in Idaho, Minnesota, New Jersey and Utah can do so. using the Folder app.
You can also ask your parents, your children’s 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 also keep records of your vaccinations in their occupational health office.
There is no test to determine if you are immune to poliomyelitis.
Do I need a polio vaccine booster if I was fully vaccinated against polio as a child?
All unvaccinated children and adults should complete the CDC-recommended four-dose polio vaccination series. You do not need an IPV booster if you received OPV.
Immunocompromised adults, traveling to a country where poliovirus is circulating, or at increased risk of exposure to poliovirus at work, such as some laboratory and healthcare workers, may receive a one-time IPV booster.
How is poliomyelitis treated?
People with mild poliovirus infection do not need treatment. Symptoms usually go away on their own within a few days.
Paralytic poliomyelitis is incurable. Treatment focuses on physical and occupational therapy to help patients adapt and regain function.
Why hasn’t the poliovirus been eradicated?
Smallpox is the only human virus declared eradicated to date. A disease can be eradicated if it infects only humans, if viral infection induces long-term immunity against reinfection, and if there is an effective vaccine or other means of prevention. The more contagious a virus is, the more difficult it is to eradicate. Viruses that spread asymptomatically are also more difficult to eradicate.
In 1988, the World Health Assembly decided to eradicate poliomyelitis by 2000. Violent conflict, the spread of conspiracy theories, vaccine skepticism, insufficient funding and political will and shoddy immunization efforts have slowed progress towards eradication, but before the covid pandemic the world was on the verge of eradicating polio. During the pandemic, childhood vaccinations, including polio vaccinations, have plummeted in the United States and around the world.
To eradicate poliomyelitis, the world must eradicate all wild polioviruses and vaccine-derived polioviruses. Wild poliovirus serotypes 2 and 3 have been eradicated. Wild poliovirus serotype 1, the most virulent form, remains 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 step-by-step approach involving the use of OPV, then a combination of OPV and IPV, then IPV alone would likely be needed to finally eradicate 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 polls, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.