Polio: Coming to a Person Near You.
Dr. Richard L. Bruno
Last November, an unusual polio outbreak occurred in The Congo Republic. A “wild” (naturally-occurring) Type I poliovirus, imported from Angola, has paralyzed at least 409 and killed 170. What is unusual is that those affected are not children under five but adults 15 to 29 and that 41% have died, versus the norm of 15% in an epidemic. Historically, more deaths do occur when older individuals get polio, but not nearly half. This epidemic, in a country that had been polio free for ten years, adds to the continued outbreaks in countries where polio remains endemic: Afghanistan, India, Nigeria and Pakistan.
There is an aspect of the Congo epidemic that is not unusual: There has been no mention of it in the American press. However, there was wide-spread attention in given to a polio outbreak in May 2010. A wild Type I poliovirus imported from India triggered an epidemic in Tajikistan that spread to three other previously polio-free countries and all the way to Moscow, affecting 476. This outbreak was more typical; 86% of those initially infected were children and 6% died.
This European pandemic caused the American Academy of Pediatricians in July 2010 to warn that “Low immunization rates in parts of U.S. could pave way for polio outbreak (showing) “how precarious our control of the disease can be when immunization rates fall below the target level of 90%. The polio immunization rate in Tajikistan is 87%.” The article goes on to warn that “polio immunization rates are lower than 90% in many areas of the United States” because of parents having “no recent experience” with polio, “concerns about vaccine safety and religious objections to immunization. With increasing globalization, the United States could be just an asymptomatic traveler away from an outbreak.” Remember, 70% of individuals infected with the poliovirus have <I>no<I> symptoms but can carry and spread the disease.
PAST TIME FOR "NIPP IT"
In 2007, the International Post-Polio Task Force began the National Immunization for Polio Prevention in Infants and Toddlers -- or "NIPP IT" – Campaign, when CDC reported drops in polio vaccination and that <I>one million<I> US infants and toddlers were unvaccinated against polio. The NIPP IT motto: “America's next polio epidemic could be just a plane ride away.”
This theme was adopted by an August 2010 “Houston Chronicle” editorial: “Polio's return to Tajikistan has raised some unsettling questions. International medical activists had planned to snuff out the disease by 2000. What's going wrong? The ongoing problem seems to be a mix of factors. Some are political, such as Muslim leaders in Nigeria who originally branded the vaccine a western sterilization plot. Meanwhile, isolated tribes or subcultures can harbor the disease.”
Not mentioned were the effects of war and corruption, lack of sanitation, basic public health and medical infrastructure and that the Sabin oral vaccine mutates and actually <I>causes<I> polio.
The editorial concludes, “Houston residents have reason to watch this battle and wish its warriors well. Even if polio is almost gone, the last cases will always be only a plane ride away from our own city.”
Indeed, Houstonians need worry. CDC found that Houston has the lowest polio vaccination rate of any reported US city -- 87% -- a drop of 5% from last year.
"Polio outbreaks highlight our global vulnerability to infectious disease," said Dr. Robert Scott, chair of Rotary’s polio eradication effort. "It reinforces the fact that polio 'control' is not an option, and only successful eradication will stop the disease."
Unfortunately, eradication is not happening in spite of $800 million spent on vaccination. In 2010, polio was at all time high in Pakistan, primarily in the war-torn Tribal Areas bordering Afganistan.
Perhaps it is time to admit that polio eradication is not possible given the political and social conditions in the Third World. Perhaps the millions being raised for polio eradication would be better spent, as the Chronicle proposed, “improving health care or hygiene more broadly,” and, as Dr. Scott prescribed, a "fast, large-scale, high-quality immunization response” to any polio outbreaks, plus treatment for polio survivors and those with Post-Polio Sequelae.
The International Post-Polio Task Force has proclaimed 2011 “The Year of Getting Serious About Polio,” serious about vaccinating America’s children, about treating the world’s <I>20 million<I> polio survivors who have Post-Polio Sequelae and about containing -- not eliminating -- polio