Poliomyelitis Research Articles

Dr. Thomas Francis Jr.: A Legacy of Vaccine Innovation and Public Health Advancement.

Dr. Thomas Francis Jr. was an American physician, virologist, and epidemiologist who was a professor of epidemiology at the University of Michigan from 1941 to 1969. He focused on studying infectious diseases, particularly pneumonia, influenza, and poliomyelitis, and developing vaccines and clinical trials. He earned his medical degree from Yale University in 1925. In 1941, the Armed Forces Epidemiological Board (AFEB) appointed him as the Director of the Commission on Influenza. This prestigious role underscored his expertise and leadership in combating infectious diseases and successfully developing field trials and evaluations of protective influenza vaccines. In 1954, he spearheaded the largest and most comprehensive clinical trial of the Salk polio vaccine at the University of Michigan Vaccine Evaluation Center, with vital support from the National Foundation for Infantile Paralysis (NFIP). He received the Medal of Freedom in 1946, the Lasker Award in 1947, and the Medal in Global Public Health in 2005.

Challenges in assessing the immunization status of adults in Germany—lessons from a population-based VACCELERATE survey on polio vaccination

PurposeConsidering the re-emergence of poliomyelitis (PM) in non-endemic regions, it becomes apparent that vaccine preventable diseases can rapidly develop epi- or even pandemic potential. Evaluation of the current vaccination status is required to inform patients, health care providers and policy makers about vaccination gaps.MethodsBetween October 28 2022 and November 23 2022, 5,989 adults from the VACCELEREATE Volunteer Registry completed an electronic case report form on their previous PM vaccine doses including number, types/-valencies and the time of administration based on their vaccination records. A uni-/multivariable regression analysis was performed to assess associations in participant characteristics and immunization status.ResultsAmong German volunteers (n = 5,449), complete PM immunization schedule was found in 1,981 (36%) participants. Uncertain immunization, due to unknown previous PM vaccination (n = 313, 6%), number of doses (n = 497, 9%), types/-valencies (n = 1,233, 23%) or incoherent immunization schedule (n = 149, 3%) was found in 40% (n = 2,192). Out of 1,276 (23%) participants who reported an incomplete immunization schedule, 62 (1%) never received any PM vaccine. A total of 5,074 (93%) volunteers reported having been vaccinated at least once and 2,087 (38%) indicated that they received vaccination within the last ten years. Female sex, younger age, as well as availability of first vaccination record were characteristics significantly associated with complete immunization (p < 0.001).ConclusionFull PM immunization schedule was low and status frequently classified as uncertain due to lack of details on administered doses. There is an obviousneed for improved recording to enable long-term access to detailed vaccination history in the absence of a centralized immunization register.

The CD40/CD40L dyad, an immune checkpoint regulator, plays a protective role against Mouse hepatitis virus-induced neuroinflammatory demyelination

Abstract Murine ꞵ-coronavirus, RSA59, infection results in meningoencephalitis, demyelination, and axonal loss. CD40-CD40L dyad serves as an important immune checkpoint regulator during this disease pathobiology. C57BL/6 WT, CD4-/-, CD40L-/- and CD40-/- mice were intracranially inoculated with RSA59 to study the acute phase neuroinflammation and chronic phase demyelination. Studies suggested that CD4+ T cells play a protective role against RSA59-induced demyelination because, in the absence of CD4 gene, mice were more susceptible to acute poliomyelitis and chronic demyelination with axonal bulbar vacuolation. CD40L expressed by CD4+ T cells is crucial for host immunity against RSA59. Without CD40L in activated CD4+ T cells, RSA59-infected mice experience increased disease severity, dampened microglia/macrophage activation, reduced T cell infiltration in the CNS, and impaired T cell priming in the cervical lymph node. In the chronic phase, extensive CNS virus replication leads to severe demyelination and axonopathy due to altered microglia/macrophage populations caused by the absence of the CD40L gene. CD40-deficiency revealed increased acute phase encephalitis in the RSA59-infected groups due to increased infiltrating neutrophils, leading to heightened bystander neuroinflammation. Hence, it is evident that the RSA59-induced demyelination model elucidates an extensively robust innate immune system upon which adaptive immunity is built during the chronic stage of infection.

The Disconnect Between Policy Makers And Researchers &amp;ndash; Time To Build Bridges

&lt;p&gt;According to World Health Organization, Pakistan and Afghanistan are the last bastions of Poliomyelitis. Rest of the world has become Polio Free. They achieved this freedom after becoming part of Polio Eradication Initiative which was created in 1988 just after the World Health Assembly resolved to eradicate Polio Myelitis from the globe. The woes of Pakistan do not end here. According to &amp;ldquo;Health Financing Progress Matrix Assessment Pakistan 2023. Summary of findings and recommendations&amp;rdquo; by World Health Organization, the service coverage index of Pakistan despite showing a consistent surge over the years was still significantly lower with a score of 45 against an average of 58 amongst the low middle income group countries in year 2021. This calls for a need to revisit our strategic policy making in all spheres of life but especially in health and health education. Dr Vaqar Ahmed in&amp;nbsp;&lt;a href="https://global.oup.com/academic/product/pakistans-agenda-for-economic-reforms-9780199406050?cc=au&amp;amp;lang=en&amp;amp;"&gt;Pakistan&amp;rsquo;s Agenda of Economic Reforms&lt;/a&gt;, identified that this country faces a serious and lingering lack of institutional arrangement within our framework for research-based policy formulation, and post implementation feedback.&lt;/p&gt;

Longitudinal data collection in pediatric and adult patients with 5q spinal muscular atrophy in Latin America: LATAM RegistrAME study - a clinical registry study protocol.

Spinal muscular atrophy is a rare hereditary neurodegenerative disease characterized by progressive motor neuron loss. The most common form of SMA is linked to 5q (5q-SMA) and is classified into subtypes according to the age of onset and maximum motor function achieved. The severity ranges from progressive infantile paralysis and premature death (type 1) to limited motor neuron loss in adults (type 4). The LATAM RegistrAME protocol is an observational, retrospective, prospective international multicenter clinical registry study involving Latin Americans. We will include 5q-SMA patients across all age groups, from pediatric to adult, to describe their clinical characteristics and disease progression. The protocol will use an international clinical research form based on the Treat Neuromuscular Disease Global Academic Network (TREAT-NMD), which focuses on advancing research on neuromuscular disorders in patients with spinal muscular atrophy. The study will include six countries in Latin America, sampling a total of 415 patients with SMA and 5q-SMA types 1, 2, 3, and 4 of all ages and both sexes who have genetically confirmed 5q-SMA. The mean follow-up period was 24 months. The primary outcomes will be the description of general clinical characteristics, access to medications capable of modifying the course of the disease, functional assessments, motor milestones, and ventilatory support. This study will provide insights into 5q spinal muscular atrophy patients in Latin America to better understand their clinical characteristics, use of medications, and outcomes while supporting further clinical management protocols and clinical trials. ClinicalTrials.gov Identifier: NCT05475691.

Lessons learned from the successful polio vaccine experience not learned or applied with the development and implementation of the COVID-19 vaccines.

The eradication of polio during the latter half of the 20th century can be considered one of the greatest medical triumphs in history. This achievement can be attributed to the development of vaccines that received the public's almost unwavering acceptance of them, especially by parents who had been waiting/hoping for a medical breakthrough that would ensure that their children would not succumb to the devastating effects of infantile paralysis. Sixty years later, the worldwide population was now confronted with an equally devastating disease - Covid-19 - which by the 2020-2021 time period had reached pandemic levels not seen since the flu outbreak of 1918. Unlike polio, however, several vaccines against Covid-19 were rapidly developed and deployed due to advances in microbiologic and immunologic technology. But also, unlike the polio vaccine experience, there wasnot universal acceptance of the Covid-19 vaccines and this has led to continuation of the pandemic into 2023 (albeit at a reduced level). In addition, acceptance of the Covid-19 vaccines has been confronted with the uncertainty that they do not apparently prevent transmission in asymptomatic people, and the mutation rate of the virus requires periodic re-evaluation and possible upgrading of the vaccines. This review will focus on the various factors that have led to these contrasting attitudes towardthese two different vaccines and how resistance and hesitancy to vaccine use can be overcome by implementing various measures, after introducing the key roles that the sciences of microbiology and immunology have played in vaccine development over the past 250+ years.

CLINICAL AND ETIOLOGICAL PROFILE OF ACUTE FLACCID PARALYSIS IN CHILDREN

Objective: This study was conducted to determine the clinical characteristics and differential diagnosis of individual cases of acute flaccid paralysis (AFP) reporting to tertiary care teaching hospital of Jaipur. Methods: This prospective observational study was conducted among patients attending outdoor, indoor, and neurology clinics with provisional diagnosis of AFP. The diagnosis was based on the available clinical data, vaccination status, and laboratory results (stool examination, arterial blood gas analysis, thyroid profile, serum electrolytes, electrophysiological studies, cerebrospinal fluid analysis, urinary pH, and imaging). Results: A total of 60 patients were evaluated over a study duration of 1 year. About 81.7% were male. Most common presenting complaint was lower-limb weakness (100%). None of the cases were identified as acute poliomyelitis or polio-compatible. Guillain–Barré syndrome (GBS) was the most common cause of non-poliovirus AFP (75%). Most common nerve conduction velocity findings in our study were bilateral motor axonal affection of common peroneal nerve (55%). Conclusion: The most common cause of AFP was GBS in all age groups. No case was diagnosed as poliomyelitis. All of the patients of GBS had progressive muscle weakness in a roughly symmetrical distribution, with areflexia of lower limbs.

The Autumn Ghost. How the Battle Against a Polio Epidemic Revolutionized Modern Medical Care

The Autumn Ghost. How the Battle Against a Polio Epidemic Revolutionized Modern Medical Care

The Fight against Poliovirus Is Not Over.

Poliovirus (PV), the virus that causes both acute poliomyelitis and post-polio syndrome, is classified within the Enterovirus C species, and there are three wild PV serotypes: WPV1, WPV2 and WPV3. The launch of the Global Polio Eradication Initiative (GPEI) in 1988 eradicated two of the three serotypes of WPV (WPV2 and WPV3). However, the endemic transmission of WPV1 persists in Afghanistan and Pakistan in 2022. There are cases of paralytic polio due to the loss of viral attenuation in the oral poliovirus vaccine (OPV), known as vaccine-derived poliovirus (VDPV). Between January 2021 and May 2023, a total of 2141 circulating VDPV (cVDPV) cases were reported in 36 countries worldwide. Because of this risk, inactivated poliovirus (IPV) is being used more widely, and attenuated PV2 has been removed from OPV formulations to obtain bivalent OPV (containing only types 1 and 3). In order to avoid the reversion of attenuated OPV strains, the new OPV, which is more stable due to genome-wide modifications, as well as sabin IPV and virus-like particle (VLP) vaccines, is being developed and offers promising solutions for eradicating WP1 and VDPV.

The content-analysis of normative legal regulation of medical social rehabilitation of children with infantile cerebral paralysis in the Russian Federation

The infantile cerebral paralysis is a significant medical social problem and economic burden for family, health care system and state economy in general since such children require organization of accessible environment and life-long rehabilitation maintenance. The purpose of the study is content-analysis of normative legal regulation of medical social rehabilitation of children with infantile cerebral paralysis in the Russian Federation. The analysis of main normative legal documents established that medical social rehabilitation is implemented in concordance with norms of international legislation and is regulated by provisions of Federal laws and other normative legal acts of the Russian Federation and its subjects. It was established that despite noticeable progress the legislation in this area has a number of significant shortcomings that adversely affect accessibility for children with cerebral palsy of high-quality and effective services of comprehensive medical social rehabilitation and requires improvement.

From diagnosis to treatment of post-polio syndrome: A case study

Introduction: Acute anterior poliomyelitis (AAP) can affect people of any age, despite being uncommon before six months. The viral invasion destroys the lower motor neurons of the spinal cord, brain, and brainstem. As a result, it leads to partial or complete flaccid and asymmetrical paralysis of the lower limb and spine muscles. Big names like Frida Kahlo and US President Franklin D Roosevelt were diagnosed with polio. Case Report: We present the case of a patient with AAP diagnosed at two years of age. As an adult, he gave osteomyoarticular sequelae, insomnia, new central (adynamia), peripheral fatigue, cold intolerance, joint and neuropathic pain. The patient received a clinical diagnosis of post-polio syndrome (PPS) after fulfilling Dalakas criteria. The physical examination showed some hallmarks of AAP, in addition to those primarily affected by PPS. Conclusion: Post-polio syndrome is a disorder characterized by new neuromuscular deficits that present years after the resolution of polio infection. However, far beyond the physical pain, the psychosocial impact is staggering. Therefore, in addition to surgical intervention and physical therapy, attention should be paid to the psychological follow-up of this patient, who is most often elderly.

‘A Movie Paralysis’: Defining Cinema during the Polio Epidemic of 1916

This article examines the effects of the 1916 poliomyelitis (polio) epidemic on the film industry and on popular conceptions of the definition and social function of moving pictures. When the major epidemic broke out in New York City, state and local health authorities across the Eastern United States closed motion picture theaters to children. These bans not only had significant financial ramifications on the motion picture business, but they also prompted debates among health authorities, social reformers, the film industry, and the public about the definition and social role of cinema. Relying on print sources from 1916, as well as one no-longer-extant film made about the epidemic, Fighting Infantile Paralysis (Universal, 1916), I argue that the film industry sought to avoid regulation during the epidemic by not only ensuring the safety of theaters, but also promoting the idea that cinema was a critical social utility during a time of crisis.

&amp;lsquo;Iron lung&amp;rsquo; as metaphor

Negative pressure ventilators (NPVs) were used from the 1930s to keep patients with chest paralysis alive and they remained in use during the first half of the twentieth century. At the time paralysis was most commonly associated with poliomyelitis (infantile paralysis).[1] The most frequently used ventilators in the UK were the Both type, which were made of plywood to make them more cost effective. Despite their materiality, these wooden ventilators were, and are still, more commonly known as ‘iron lungs’. By considering the uses of the metaphor ‘iron lung’ prior to the invention of the NPV, I will argue that ‘iron lung’ became eponymous as it connected the material reality of the NPV with imagined sensory experiences for publics in the UK, though often in ways that contradicted earlier metaphors of modernity and sound.

Personalized Treatment for Infantile Ascending Hereditary Spastic Paralysis Based on In Silico Strategies.

Infantile onset hereditary spastic paralysis (IAHSP) is a rare neurological disease diagnosed in less than 50 children worldwide. It is transmitted with a recessive pattern and originates from mutations of the ALS2 gene, encoding for the protein alsin and involved in differentiation and maintenance of the upper motoneuron. The exact pathogenic mechanisms of IAHSP and other neurodevelopmental diseases are still largely unknown. However, previous studies revealed that, in the cytosolic compartment, alsin is present as an active tetramer, first assembled from dimer pairs. The C-terminal VPS9 domain is a key interaction site for alsin dimerization. Here, we present an innovative drug discovery strategy, which identified a drug candidate to potentially treat a patient harboring two ALS2 mutations: one truncation at lysine 1457 (not considered) and the substitution of arginine 1611 with a tryptophan (R1611W) in the C-terminus VPS9. With a protein modeling approach, we obtained a R1611W mutant model and characterized the impact of the mutation on the stability and flexibility of VPS9. Furthermore, we showed how arginine 1611 is essential for alsin’s homo-dimerization and how, when mutated to tryptophan, it leads to an abnormal dimerization pattern, disrupting the formation of active tetramers. Finally, we performed a virtual screening, individuating an already therapy-approved compound (MK4) able to mask the mutant residue and re-establishing the alsin tetramers in HeLa cells. MK4 has now been approved for compassionate use.

From the diagnosis of a probable post-polio syndrome to spina bifida: A case report of a 49-year-old man

Introduction: Post-polio syndrome is defined as a specific clinical condition that affects individuals previously affected by acute anterior poliomyelitis and, undoubtedly, is an exclusion diagnosis. Among the range of differential diagnoses, spina bifida may be one of them. Spina bifida is a condition that affects the spine and is usually apparent at birth. It is a type of neural tube defect (NTD) and can happen anywhere along the spine if the neural tube does not close all the way. When the neural tube doesn’t close all the way, the backbone that protects the spinal cord doesn’t form and close as it should. This often results in damage to the spinal cord and peripheral nerves. Case Report: We report the case of a patient, male, 49 years old, with an alleged diagnosis of post-poliomyelitis syndrome (PPS) for benefit renewal due to permanent and disabling motor disability. After a thorough clinical history and neurological evaluation, in addition to the characteristic findings of spina bifida: bilateral pes cavus, fecal and urinary incontinence, surgical incision in the lumbar region, genu varus, amyotrophyparesis in lower limbs and abolition of bilateral Achilles reflexes, spina bifida diagnoses was considered. Conclusion: This article presents some “clinical pearls” in the differential diagnoses of spinal cord diseases. The possibility of PPS was excluded and the application for the benefit for spina bifida was redone. In addition to the post-history diagnoses determined by the diagnosis of diagnostic syndrome (that were not scored by our patient), the sum of the clinical history, the neurological examination and anchored spine in the image by revisions, were the foundation for the diagnosis of the bifida spina.

Lumbar spine metastasis from squamous cell carcinoma of tongue

Introduction: Acute anterior poliomyelitis (AAP) is an endemic human disease caused by a worldwide spreading enterovirus. The late consequences of AAP include a new picture of muscle weakness together with abnormal muscle fatigue, amyotrophy, and myoarticular pain, configuring a condition known as post-polio syndrome (PPS). This new condition comprises a specific set of health problems due to the polio virus, resulting in decreased functional capacity and/or the onset of new disabilities. Case Report: A 53-year-old female, human resources analyst, reported that she had been shaken by AAP at the age of 2. Currently she was presented with gait on the knees, osteo-myoarticular pain, inadequate synergies of movements. Imaging exams showed great disproportion in the pelvic region with marked amyotrophy and liposubstitution of the muscle, more evident in the left leg. Although there was some preservation of the plantar flexor muscles, interstitial edema was evident. In the thighs there was amyotrophy with liposubstitution of the muscle, more evident on the left. In the left knee joint there was a lesion of the cruciate ligaments with extensive deep chondral erosions in the load area of the femorotibial compartment, with exposure of the subchondral bone, without edema. Osteopenia also affected it. Conclusion: Through the data obtained in this study, it can be seen that there are many reasons why patients affected by post-polio syndrome develops bone deformities and joint interferences that cause the individual to suffer losses and aggravations in health and quality of life. Nevertheless, there is a lack of theoretical framework available in the literature, justifying the importance of further studies on this topic.

A painful skeleton disarticulated by acute anterior poliomyelitis

Introduction: Acute anterior poliomyelitis (AAP) is an endemic human disease caused by a worldwide spreading enterovirus. The late consequences of AAP include a new picture of muscle weakness together with abnormal muscle fatigue, amyotrophy, and myoarticular pain, configuring a condition known as post-polio syndrome (PPS). This new condition comprises a specific set of health problems due to the polio virus, resulting in decreased functional capacity and/or the onset of new disabilities. Case Report: A 53-year-old female, human resources analyst, reported that she had been shaken by AAP at the age of 2. Currently she was presented with gait on the knees, osteo-myoarticular pain, inadequate synergies of movements. Imaging exams showed great disproportion in the pelvic region with marked amyotrophy and liposubstitution of the muscle, more evident in the left leg. Although there was some preservation of the plantar flexor muscles, interstitial edema was evident. In the thighs there was amyotrophy with liposubstitution of the muscle, more evident on the left. In the left knee joint there was a lesion of the cruciate ligaments with extensive deep chondral erosions in the load area of the femorotibial compartment, with exposure of the subchondral bone, without edema. Osteopenia also affected it. Conclusion: Through the data obtained in this study, it can be seen that there are many reasons why patients affected by post-polio syndrome develops bone deformities and joint interferences that cause the individual to suffer losses and aggravations in health and quality of life. Nevertheless, there is a lack of theoretical framework available in the literature, justifying the importance of further studies on this topic.

Rationale for the choice of material for manufacture of adaptive underclothes for disabled children

The article substantiates the choice of materials for designing adaptive underclothes for the most severe group of children with infantile cerebral paralysis – bed patients. As a rule, these are denied children, who, in principle, spend their lives in medical hospitals, require constant care by medical staff. Such children are in sharp need of specialized adaptive underclothes, which could significantly improve the quality of life of such children and facilitate care for them by medical staff. In many respects the quality of similar clothes depends on properly selected materials. Analysis of modern innovative materials that could have been used to create such clothes was conducted. Hygienic, physical and mechanical properties of existing knitted materials were studied according to standard methods for identifying the most suitable for similar clothes.

Between Simians and Cell Lines: Rhesus Monkeys, Polio Research, and the Geopolitics of Tissue Culture (1934-1954).

This essay argues that the racialized geopolitics of the rhesus monkey trade conditioned the trajectory of tissue culture in polio research. Rhesus monkeys from north India were important experimental organisms in the American “war against polio” between the 1930s and 1950s. During this period, the National Foundation for Infantile Paralysis (NFIP) expended considerable effort to secure the nonhuman primate for researchers’ changing experimental agendas. The NFIP drew on transnational networks to export hundreds of thousands of rhesus monkeys from colonial and later postcolonial India amid the geopolitical upheavals of World War II, the 1947 Partition, and the Cold War. In this essay, I trace how NFIP officials’ anxieties about the geopolitics of the monkey trade configured research imperatives in the war against polio. I show how their anxieties more specifically shaped investment in tissue culture techniques as a possible means of obviating dependence on the market in monkeys. I do so by offering a genealogy of the contingent convergence between the use of rhesus monkeys and HeLa cell cultures in the 1954 Salk vaccine trial evaluation. Through this genealogy, I emphasize the geopolitical dimensions of the search for the “right” experimental organisms, tissues, and cells for the “job” of scientific research. The technical transformation of polio research, I argue, relied on the convergence of disparate, racialized biomedical economies.

Infantile Ascending Hereditary Spastic Paralysis with Extrapyramidal and Extraocular Manifestations Associated with a Novel ALS2 Mutation.

Infantile Ascending Hereditary Spastic Paralysis with Extrapyramidal and Extraocular Manifestations Associated with a Novel ALS2 Mutation.