Paralytic Polio Research Articles

Mexican American Women Aging With Childhood-Onset Paralytic Polio

In this study the life histories of 11 Latinas of Mexican American descent aging with permanent impairment related to childhood-onset paralytic polio were explored. These women, age 45 to 62 years, were interviewed 3 times each. Field notes, audiotaped interviews, life course charts, and demographic data were used to collect data chronicling childhood to present day. In the results we present a thematic representation of the societal and cultural influences on the life course trajectories of these women.

Anesthesia for craniotomy in a patient with previous paralytic polio

Poliomyelitis remains endemic in many developing nations. Patients may develop residual muscle weakness in one or more limbs after an attack of poliomyelitis in childhood. We report an adult patient who presented for right temporal cortical grid placement. He had childhood poliomyelitis and, while showing no evidence of postpolio syndrome, demonstrated excessive sensitivity to nondepolarizing muscle relaxants and developed prolonged muscle weakness during the postoperative period.

Post-poliomyelitis syndrome: clinical features and management

Post-poliomyelitis syndrome affects mostly women who have had paralytic polio. Most patients do very well when they are given non-fatiguing exercises in a warm environment. Patients must be correctly diagnosed with this syndrome and offered appropriate management and rehabilitation.

Universal use of inactivated polio vaccine

Changes in the international scenario have demonstrated that the risks of vaccine-associated paralytic polio (VAPP) or paralysis caused by vaccine-derived poliovirus (VDPV) are higher than the risk of paralysis caused by wild viruses requiring that the oral polio vaccine (OPV) be replaced with the inactivated polio vaccine (IPV) as proposed by Falleiros-Carvalho & Weckx. The major issues related to the introduction of IPV in routine vaccine schedules are concerned with lower gastrointestinal immunity difficult application (parenteral use) availability and costs. Recent studies have revealed that children previously vaccinated with two doses of IPV had low fecal shedding of vaccine viruses after being challenged with one dose of OPV; moreover the risk of reversion of Sabin strains to neurovirulent forms did not increase after the use of IPV. Combined vaccines containing IPV improved the acceptance of the inactivated vaccine since they provide vaccine coverage against several diseases at lowercosts. In the last few years the number of countries using IPV in sequential schemes (IPV followed by OPV) or in exclusive ones has increased; however it has been estimated that only 100 million doses can be produced every year. The technology for IPV production has been well known for over five decades but only few laboratories are allowed to produce this vaccine and production of the vaccine is limited. (excerpt)

Poliomyelitis and the Role of Risk Analysis in Global Infectious Disease Policy and Management

In 1988, when the World Health Assembly committed to globally eradicate wild polioviruses by the year 2000, no comprehensive models existed to support rigorous policy analyses that could project the human or financial resources that would be required. However, clear demonstration of an effective strategy for polio eradication by the Pan American Health Organization (PAHO) led world health leaders to anticipate significant reductions in the burden of disease, resulting in large long-term global health and financial benefits. The Global Polio Eradication Initiative (GPEI) has made remarkable progress, reducing the annual number of cases of paralytic polio from an estimated 350,000 (with wild polioviruses endemic in 125 countries in 1988) to fewer than 2,000 cases per year (with endemic circulation remaining in only Afghanistan, Nigeria, Pakistan, and India as of publication of this issue). Challenges in these remaining endemic areas differ, with vaccine campaigns in India missing children (particularly in the minority population), those in Nigeria suffering from operational and political issues, and those in Afghanistan and Pakistan limited by security issues associated with current conflicts. During the past several years, the challenges to successfully eradicating wild polioviruses and our knowledge of them increased as new risks emerged. Notably, as some polio-free countries reduced or eliminated their use of live oral poliovirus vaccine (OPV), local outbreaks occurred due to neurovirulent cir

Psychiatric Hospitalizations in a Cohort of Danish Polio Patients

Although previous polio infection remains a considerable cause of long-term morbidity worldwide, few studies have examined the psychiatric consequences of poliomyelitis. The authors followed 4,660 polio patients hospitalized at the primary infectious disease hospital in Copenhagen, Denmark, between 1922 and 1954 as well as 19,017 age- and gender-matched Danes for psychiatric hospitalizations from January 1, 1977, to December 31, 1993. Incidence rates of all psychiatric disorders combined and of separate diagnostic groups of psychiatric diseases in the two cohorts were compared, yielding the incidence rate ratio, a measure of relative risk. Overall, polio patients had a 40% increased risk of being hospitalized for a psychiatric disorder (incidence rate ratio = 1.43, 95% confidence interval: 1.23, 1.66). Apparently, the overall increased risk of psychiatric hospitalizations could not be confined to specific groups of psychiatric disorders but seemed to be explained by slightly increased risks of several different disorders, especially milder psychiatric disorders. Finally, psychiatric morbidity did not differ between paralytic and nonparalytic polio patients. History of hospitalization for polio might be associated with subsequent risk of hospitalization for psychiatric disorders. The underlying mechanism for this association remains uncertain.

Retrospective Cost‐Effectiveness Analyses for Polio Vaccination in the United States

The history of polio vaccination in the United States spans 50 years and includes different phases of the disease, multiple vaccines, and a sustained significant commitment of resources. We estimated cost-effectiveness ratios and assessed the net benefits of polio vaccination applicable at various points in time from the societal perspective and we discounted these back to appropriate points in time. We reconstructed vaccine price data from available sources and used these to retrospectively estimate the total costs of the U.S. historical polio vaccination strategies (all costs reported in year 2002 dollars). We estimate that the United States invested approximately US dollars 35 billion (1955 net present value, discount rate of 3%) in polio vaccines between 1955 and 2005 and will invest approximately US dollars 1.4 billion (1955 net present value, or US dollars 6.3 billion in 2006 net present value) between 2006 and 2015 assuming a policy of continued use of inactivated poliovirus vaccine (IPV) for routine vaccination. The historical and future investments translate into over 1.7 billion vaccinations that prevent approximately 1.1 million cases of paralytic polio and over 160,000 deaths (1955 net present values of approximately 480,000 cases and 73,000 deaths). Due to treatment cost savings, the investment implies net benefits of approximately US dollars 180 billion (1955 net present value), even without incorporating the intangible costs of suffering and death and of averted fear. Retrospectively, the U.S. investment in polio vaccination represents a highly valuable, cost-saving public health program. Observed changes in the cost-effectiveness ratio estimates over time suggest the need for living economic models for interventions that appropriately change with time. This article also demonstrates that estimates of cost-effectiveness ratios at any single time point may fail to adequately consider the context of the investment made to date and the importance of population and other dynamics, and shows the importance of dynamic modeling.

The Cutter Incident: How America’s First Polio Vaccine Led to the Growing Vaccine Crisis

By Paul A. Offit New Haven:Yale University Press, 2005. 238 pp. ISBN: 0-300-10864-8, $27.50 This entertaining, well-written book provides valuable insights into three interrelated areas, all built around the story of the Cutter incident, a landmark case that in some ways continues to have implications for product liability and the health of the vaccine industry today. The author, Paul Offit, has an admirable ability to present complicated issues in a way that is easy to understand for both technical and nontechnical audiences, and the book should (and does) have wide appeal. The first part of the story deals with the actual incident, which involved the failure to completely inactivate the very first lots of inactivated poliovaccine licensed for use in the United States, and the resulting epidemic of iatrogenic paralytic polio. This incident holds many lessons for us today. Offit shows how the ultimate outbreak was really the consequence of multiple factors: an inactivation procedure that was not completely understood by the manufacturers, testing algorhythms that were relatively insensitive for detection of remaining live virus in the final preparations, the use of an extremely virulent virus as the starting material for one of the three strains, and, most unpredictable of all, the enormous consequences of a seemingly trivial process change—the substitution of glass filters in a critical step in the processing of the culture lysates. Most disasters are the result of multiple synergistic failures, not all of which are predictable, and the Cutter incident is a good illustration of this. The second part of the story describes the resulting product liability trial, in which the manufacturer of the vaccine, Cutter Laboratories, was found to be liable even though it was not negligent. Cutter followed all available guidelines in production of the vaccine and only released lots that had passed recommended safety tests. However, the vaccine, rather than preventing polio as it was supposed to do, actually caused polio instead. In the trial, the jury did not find Cutter to have been negligent in the manufacture of the vaccine. However, Cutter was found to have violated the implied warranty that its product, when used as directed, would be safe and effective for its intended purpose. The author makes a convincing argument that this case set a precedent for liability without negligence that ultimately almost destroyed the vaccine industry in the United States. Only the Vaccine Injury Compensation Program, in which claims against manufacturers are first arbitrated by a panel of experts, has kept manufacturers in the game. The third part of the story is a more speculative discussion of the role product liability has played in the currently tenuous situation facing our supply of critical vaccines in the United States. This complex situation involves not only product liability but the economics of the marketplace, the role of government funding for vaccines, and probably other issues as well. However, product liability clearly also plays a role, and continues to have an impact today. For example, legislation protecting manufacturers of potential pandemic vaccines against product liability claims has emerged as a critical issue, which will be required for adequate control of the current avian influenza threat, much as it was in 1976. Thimerosal, which has now been convincingly demonstrated to have no association with neurodevelopmental disorders, has in the meantime continued to be a source of liability claims and state legislation. Vaccines have had a profound influence on human health and have been responsible for the complete elimination of smallpox, the elimination of measles and polio transmission in the Western Hemisphere, and many other benefits. However, to be effective, vaccines must be administered to very large numbers of healthy individuals. For this reason, vaccine safety always has been, and will remain, a preeminent concern among those involved in controlling human disease. This book should be of value to anyone who must deal with issues related to exposure of large populations to interventions.

Eradicating polio: today's challenges and tomorrow's legacy

Since its launch in 1988, the Global Polio Eradication Initiative has grown into one of the largest international health efforts in history, operating in every country and area in the world. The burden of polio disease has been reduced by over 99%, and the number of countries with indigenous virus has fallen from more than 125 to just four. As importantly, a strong surveillance and laboratory infrastructure has been established for vaccine-preventable diseases (including measles, tetanus, yellow fever, rubella and Japanese encephalitis), and a massive investment has been made in the physical infrastructure and human resources needed to deliver routine immunizations and other health services in developing countries. Between 2000 and 2003, new challenges to polio eradication emerged, threatening the interruption of the transmission of wild poliovirus globally and the eventual elimination of any residual polio disease as the result of the continued use of oral polio vaccines. By the end of 2005, a range of solutions had been developed to address these late challenges, including two new monovalent oral polio vaccines, new and robust international standards for the response to polio outbreaks, and renewed political commitment across the countries that remain infected. As importantly, a comprehensive strategy had been established for managing the long-term risks of paralytic polio, centred, ironically, on the eventual elimination from routine immunizations of the vaccine that is still central to the success of the global eradication effort.

A vision of a world without polio: The OPV cessation strategy

Once the eradication of wild poliovirus has been confirmed, the public health benefits of routine immunization with OPV will no longer outweigh the burden of disease either due to paralysis caused by OPV (vaccine associated paralytic polio), or by outbreaks caused by circulating vaccine-derived polioviruses. The eventual cessation of OPV use in routine immunization programmes worldwide will become necessary to assure a lasting eradication of polio.As the world moves towards polio eradication and its certification, preparations are therefore being intensified for OPV cessation, and the risk management framework for safe OPV cessation is being put in place. The framework includes bio-containment of all known poliovirus and potentially infected substances, development of an international stockpile of oral polio vaccine, ensuring a mechanism for continued global surveillance and response for polio after eradication has been certified, and national policies if countries decide to continue vaccinating with inactivated polio vaccine (IPV).It is ironic that the vaccine on which the world has depended for polio eradication will itself become a risk to eradication once the transmission of wild poliovirus has been interrupted. Final preparations for the eventual global and simultaneous cessation of OPV will require the same level of international cooperation and coordination that has brought the world to the verge of polio eradication.

Licensing of monovalent OPV1 vaccine

The key steps in the successful accelerated licensure of monovalent type 1 oral polio vaccine (mOPV1) of Sanofi Pasteur in Egypt required innovative parallel track evaluation from the National Regulatory Authorities (NRA), both in producing and receiving countries. The standard package of regulatory data was requested and submitted simultaneously in France and Egypt, and to WHO for prequalification purposes. The main concern of the Egyptian NRA has been thermal stability of the vaccine because it will be used in very hot conditions. However, data from the field suggest that mOPV1 has a stability profile similar to trivalent OPV (tOPV). Surveillance for Vaccine Associated Paralytic Polio (VAPP) will be important in development in tropical countries during the early introduction of mOPV since little or no recent data are currently available.

A Qualitative Analysis of the Meaning of Aging for Women With Disabilities With Policy Implications

This is a report of a hermeneutic phenomenological study of the meaning of aging for women with childhood-onset disabilities due to the effects of paralytic polio. Twenty-five women aged 55-65 years were interviewed 2 to 4 times regarding their life course experiences and the meaning they assigned to aging. Field notes, audiotaped interviews, life course charts, and demographics were used in thethematic analysis that produced 5 themes: Bodies Change, Disrupted Meaning, The Unpredictibility of Aging, Slowing Down, and Changing Perspective. Overall, the findings indicate that the experiences of disability due to the result of paralytic polio could not be separated from the experiences of aging, which ultimately led the author to question policies that distribute and fund benefits based on age and disability status without an understanding of the varied experiences of women with disabilities.

Evidence for a causal association between oral polio vaccine and transverse myelitis: A case history and review of the Literature

A 6-month-old boy developed transverse myelitis 7 days after the receipt of oral polio vaccine (OPV). A paediatric neurologist confirmed the diagnosis when the boy was aged 9 years. The boy had received his first scheduled OPV at the age of 4 months and had developed immunity to serotypes 1 and 2 but not to serotype 3. A poliovirus type 3 was isolated from stool and throat specimens collected from the boy in the first 2 days after symptom onset. This was shown, in a World Health Organization accredited laboratory, to be a vaccine strain by nucleic acid probe hybridiztion and enzyme-linked immunosorbent assay. The boy subsequently developed immunity to poliovirus serotype 3. It is accepted that poliovirus infection can present occasionally as transverse myelitis. This is estimated to occur in 1:125-1:800 cases. It is also accepted that OPV can cause vaccine-associated paralytic polio with a frequency of approximately one case per 2.5 million doses of OPV distributed. It seems feasible therefore that OPV could cause transverse myelitis with a frequency of 1 in 300 million to one in two billion doses distributed. In a 1993 report from the Institute of Medicine of the National Acadamies of the United States pertaining to vaccine safety, theoretical criteria were advanced for the establishment of a causal relationship between a vaccine and a clinical outcome. The clinical history and laboratory results in this case satisfy these criteria, providing plausible evidence for the causal link between OPV and transverse myelitis.

A Hermeneutic Phenomenological Analysis of Aging with a Childhood Onset Disability

In this qualitative study, we combined multiple interviews, field notes, life history review charts, and demographic questions to explore the life course experiences of 25 women, ages 55 to 65 years, who developed impairments due to paralytic polio during childhood. Based on a hermeneutic phenomenological methodology using thematic analysis, multiple themes emerged that traced their lives from childhood to later adulthood. The women described how they pushed their bodies and dismissed their physical decline as long as possible. The women's early experiences combined with the culturally defined role expectations for women to influence their perceptions of how to react to changing physical abilities with age.

Ensuring Preparedness for Potential Poliomyelitis Outbreaks

Paralytic poliomyelitis was once endemic in the United States; however, because of high vaccination levels, the last case of wild disease occurred in 1979. Although worldwide polio eradication may be achieved in the near future, the presence of undervaccinated children in urban areas and among groups who refuse vaccination creates an outbreak risk, should importation of wild virus occur. In 1999, the Advisory Committee on Immunization Practices (ACIP) recommended that inactivated poliovirus vaccine (IPV) be used for routine immunization of the US population and that oral poliovirus vaccine (OPV) be reserved for "mass vaccination campaigns to control outbreaks of paralytic polio." Subsequently, the sole US manufacturer of OPV withdrew from the market. In 2003, a joint National Vaccine Advisory Committee (NVAC)/ACIP working group was charged with reporting to its parent bodies concerning the need for a poliovirus vaccine stockpile. Based on that working group's report, the NVAC and ACIP have concluded that stockpiles of both IPV and OPV should be maintained. In the event of an outbreak in which OPV continues not to be available, IPV should be used for control, and a stockpile of 8 million doses seems to be sufficient. Should IPV be manufactured only in combination with other vaccines, appropriate procurement actions should be taken to ensure that uncombined IPV continues to be stockpiled. Under circumstances of diminished population immunity, OPV may offer outbreak control advantages. The NVAC and ACIP recommend that the United States collaborate with international agencies to provide guaranteed and rapid access to at least 8 million doses of trivalent OPV or 8 million doses of each of the 3 types of monovalent OPV. The regulatory and practical obstacles to implementation of this recommendation will require assertive facilitation at high levels of the federal government and careful planning at the state and local levels.

A TYPE OF HEPATIC PORPHYRIA LEAD TO DEATH OF SIX SIBLINGS IN ONE FAMILY

Purpose: This is the 5th reported cases allover the world. The family lives in a rural area in Sharkia, Egypt, but their residence is from Turkey. The parents are 2nd degree consanguinity. They had 7 siblings, honey bunch and a chicken farm guarded by a dog, where their children were playing with it.I noticed that these children were floppy in their infancy. One day, (Aug. 1993) I heard that the smaller daughter - 2 years old - suddenly died after an attack of flue, fever, for which she received medications. Six months later the other daughter - 3 years old - died also suddenly after same sequence of events. The father told me that her urine was reddish during the attack. Three years later, one brother developed flu & U.R. T.I., and received medications. In the next morning, he felt sever leg pains followed by inability to walk then the condition progressed rapidly to ascending paralysis, pulmonary edema and death in 4 hours. In the next day: the other brother - 6 years old - developed the same condition & sequences. We could intubate him and normalize the A.B.G., but he died also after 1/2 hour from adequate ventilation. Could it be botulism (due to canned honey), Tick paralysis (playing with the Dog), Guilian - Barre syndrome or Diptheria or paralytic polio…?! After one month, the 3rd brother developed the same attack and transferred from his rural area to toxicology department in Ein Shams University, Egypt then to the Pedi. I.C.U. in the same hospital, where he received I.V. fluids imperically and put under observation. The acute attack improved partially. Then he felt abdominal pain, could not walk properly due to leg pain and backache and passed reddish urine. Hoesh test was requested and proved to be positive. The 1 ry diagnosis was put and the child was managed as porphyria. Another 3 attacks were successfully managed by me but other 2 siblings died due to sever attacks and bad management by others. Methods: Hoesh Test in urine. Determination of Delta Amino Leuvulinic Acid (ALA) level in urine and enzymatic studies in blood. Genetic studies by taking blood from the parents and the living siblings (by prof. Desnick, Sini institute, New York) Results: confirmed the diagnosis of this type of porphyria. It is delta Amino Levulinic Acid Dehydratase - ALAD - deficiency Porphyria. It is an autosomal recessive disorder Conclusions: This is the rarest type of hepatic porphyrias & the most rapidly fatal disease if the patient developed the attacκ by certain stimulations. The remainig family is living well now after proper manegment.

Polio eradication in India: some observations

In 1988, the World Health Assembly passed resolution WHA 41.28, which committed the World Health Organization (WHO) to the global eradication of poliomyelitis by the year 2000. In spite of the combined efforts by UNICEF, National Polio Surveillance Project (NPSP), Indian Academy of Pediatrics (IAP) and Rotary International, Polio Free India is still a distant dream. Though oral polio vaccine has succeeded in polio eradication from many countries but there is high incidence of vaccine failure in India. Oral polio vaccine (OPV) has failed to provide full protection to many children who have developed paralytic polio even after taking 10 or more doses of OPV. In some children, OPV has caused paralysis-vaccine associated paralytic polio (VAPP). Number of children developing polio due to vaccine is high and on increase. Reasons for this could be that even immunocompromised children are being administered OPV because IPV is not available. Vaccine failure has exaggerated the problem of VAPP. No efforts have been made to find the causes for high incidence of vaccine failure and VAPP.

Life-long morbidity among Danes with poliomyelitis

Nielsen NM, Rostgaard K, Askgaard D, Skinhøj P, Aaby P. Life-long morbidity among Danes with poliomyelitis. Arch Phys Med Rehabil 2004;85:385–91. Objective To estimate long-term morbidity in a cohort of Danish poliomyelitis patients. Design A historical prospective cohort study of 27,047 persons. Setting Denmark. Participants A total of 5421 persons hospitalized for poliomyelitis between 1919 to 1954 in Copenhagen, Denmark, and 21,626 age- and gender-matched Danes. Participants were followed up on average for 20.6 years, yielding a total of 555,884 person-years of follow-up. Interventions Not applicable Main outcome measures The exposed (poliomyelitis) cohort and the unexposed (control) cohort were followed up for somatic hospitalization from 1977 to 1999 in the Danish Hospital Discharge Register. The incidence rate ratio (IRR) was calculated as the ratio between the incidence rate of disease in the exposed and unexposed cohorts. Results Overall, polio patients had a 1.2- to 1.3-fold increased risk of being hospitalized with pulmonary diseases, heart diseases, gastrointestinal disorders, or diseases of the locomotive apparatus. Among paralytic polio patients, long-term morbidity seems to be associated with the acute severity of poliomyelitis, as well as young age at infection. Paralytic patients, who contracted respiratory polio under the age of 5, had the highest risk of being hospitalized with lung diseases (IRR=7.26; 95% confidence interval [CI], 3.06–18.33), diseases of the locomotive apparatus (IRR=4.05; 95% CI, 1.66–9.86), heart diseases (IRR=1.70; 95% CI, 0.65–3.98), and diseases of the digestive system (IRR= 2.23; 95% CI, 1.03–4.62). Surprisingly, patients without paralyses, especially women, also had an increased morbidity. Conclusions Overall, a history of poliomyelitis was associated with a slightly increased morbidity measured by hospitalizations. Long-term morbidity was highest among respiratory polio patients; however, patients presumably left without any residual symptoms also had an increased morbidity.

Five-year surveillance of acute flaccid paralysis in Malaysia.

The nation-wide surveillance for acute flaccid paralysis (AFP) was implemented in Malaysia in 1995 and further intensified in 1996 as part of the World Health Organization's (WHO) certification process for polio eradication in the Western Pacific Region. Clinical data on AFP cases during a 5-year surveillance period from 1997 to 2001 were compiled and analysed. Based on 517 cases of AFP reported during this 5-year period, the overall rate of AFP was 1.2 per 100 000 children below 15 years old. The major clinical diagnosis associated with AFP were Guillain-Barre syndrome (30.2%), central nervous system infection (16.2%), transverse myelitis (10.6%) non-polio enterovirus infection (6.2%), and hypokalaemic paralysis (5.2%). This unusual pattern with an excess of CNS infection and non-polio enterovirus infection was attributed to the outbreak of enterovirus 71 infection nation-wide in 1997. According to the WHO virological classification, there was no case of poliomyelitis due to wild poliovirus. Three cases were 'polio compatible', there were no cases of vaccine-associated paralytic polio (VAPP), while 62 cases (12.0%) were merely classified as 'non-polio AFP'. Overall, these data suggest the absence of circulation of wild poliovirus in Malaysia from 1997 to 2001. The pattern of AFP in this study is different from other published reports.

How to interpret normal electromyographic findings in patients with an alleged history of polio.

In some patients with a history of polio, the electromyography is normal, not showing the typical neurogenic signs. The aim of this study was to explain the normal findings in electromyography, especially in paralytic polio. Retrospective study. Concentric needle electromyography, macro electromyography (including single fibre electromyography) and neurography were performed in various combinations in 688 patients with an alleged history of polio. Thirty-five patients with paralytic polio had normal or minimally abnormal neurophysiology. In 6 patients the diagnosis of polio was rejected and was instead found to be other diagnoses. Three patients had a very atypical history. Of the 26 with possible paralytic polio, 17 showed a strong suspicion of previous paralytic polio without any neurophysiological signs of degeneration of the anterior horn cells. If neurophysiological findings are normal in patients with a history of polio, the original diagnosis may be incorrect. However, the absence of electromyography changes does not entirely exclude a previous history of polio with transient functional loss without degeneration of anterior horn cells vulnerable for later functional impairment.