Poliomyelitis Virus Research Articles

COMPARATIVE STABILITY OF POLIOVIRUS, HEPATITIS A VIRUS AND THEIR RNA TO THE IMPACT OF ULTRAVIOLET RADIATION

Introduction. The results of experimental studies on the comparative assessment of the effects of various doses of UV radiation on the survival of poliovirus type I LSc2ab, phage MS-2, hepatitis A viruses and their RNA in tap water are presented. Material and methods. Poliomyelitis viruses of type I strain LSc2ab (PV), viruses of hepatitis A, strain HAS-15 (HAV), phages MS-2, free RNA isolated from hepatitis viruses and poliomyelitis were introduced into model reservoirs with dechlorinated Moscow tap water. Water samples were taken from each tank and subjected to ultraviolet irradiation (UVR) with a wavelength of 254 nm with doses of 25, 40, 60, 80 and 100 mJ/cm2. PV titration was performed on a BGM monkey kidney cell transplant line; MS-2 phages were determined by the agar layer method using the E. coli K12F + Str. detector; determination of PV RNA and HAV was carried out on the Rotor GeneTM 6000 amplifier in RT-PCR reaction in real-time using appropriate test systems. Extraction and isolation of RNA from samples of PV and HAV were also performed using reagent kits of domestic and foreign production. Results. Ultraviolet irradiation in doses from 25 to 100 mJ/cm2 was shown to have a pronounced inhibitory effect on phages MS-2 and PV, determined by traditional methods in accordance with the methodological guidelines MUK 4.2.1018-01 and MUK 4.2.2029-05. At UVR doses of 80 and 100 mJ/cm2, complete inactivation of MS-2 and PV phages in water was noted. At the same time, these same doses of UVR had a less inhibitory effect on PVA, HAV RNA, as well as on isolated free PVA RNA/X and HAV, which were more stable and continued to be determined by RT-PCR in water at all doses of UVR, including 80 and 100 mJ/cm2. Conclusion. If only RNA viruses are detected in the treated drinking water and there are no other direct or indirect indices of viral contamination, it is impossible to unambiguously judge the extent of the potential epidemic hazard of the water body. This requires the development of reliable additional tests confirming the infectivity of viruses, determined only by RNA or DNA markers.

The eradication of infectious viral diseases endangered by advances in synthetic biology

The eradication of infectious diseases is one of the oldest dreams of mankind. It has been materialized only once in History with smallpox in 1980. Considerable efforts are being developed against poliomyelitis viruses since 1988, but the ultimate goal of eradication is not yet achieved. Paradoxically, while the objective of having eradicated these two viral diseases is approaching, synthetic biology multiplies the prowesses of virus "neosynthesis", imperiling at least virtually the durability of these advances. This article emphasizes the potential of a new biology on one side, and the difficult reality of the fight against infections on the other.

MODERN POSSIBILITIES OF VIROLOGICAL DIAGNOSTICS OF POLIOMYELITIS

The review presents the data from the literature of our and foreign countries devoted to modern virologic diagnostics of poliomyelitis viruses of 1, 2, and 3 types that is especially topical in connection with WHO program on complete poliomyelitis elimination in the world. There is described the role of laboratory virologic investigations in making the diagnosis of poliomyelitis infection. The classical methods of poliomyelitis viruses detection are given in detail.

Current Status and Underlying Problems of Eradication of Poliomyelitis in the Remaining Endemic Countries

In 1988, the World Health Assembly of the World Health Organization (WHO) launched the Global Polio Eradication Initiative (GPEI), with the resolve to interrupt transmission of wild poliovirus (WPV) worldwide by the year 2000. Eighteen years after the intended year of eradication, that target is yet to be achieved. To investigate the reasons behind this, a check of recent publications on poliomyelitis and polio virus was carried out. The databases and websites of institutions and organizations involved in the polio eradication programme were also checked. The findings showed that although the goal of interrupting polio transmission has not been meet, a lot of progress has been made. By 2006, transmission of WPV had been interrupted in all but four countries: Afghanistan, India, Nigeria and Pakistan. In February 2012, India was delisted from the list of polio-endemic countries leaving the remaining 3 countries as the only endemic countries in the world. Wild type 2 and 3 viruses have both been eliminated from circulations. The number of polio cases in the remaining endemic countries has reduced drastically. Nigeria is close to the target, but is yet to be certified polio-free, having experienced a setback in 2016. However, as long as transmission of WPV continues in these countries, the world cannot be free from the disease, as these countries serve as reservoirs of infection and sources of export of the virus to other countries. To be able to achieve the target of interrupting the transmission of WPV in the remaining endemic countries, the identified problems, particularly conflict in the countries concerned, will have to be factored into the programmes geared toward eradication of the disease.

LIVE ATTENUATED VACCINES FOR THE IMMUNOPROPHYLAXIS

The review focuses on the history of the production of live antiviral vaccines and their use for the prevention of infectious diseases. It was noted that before the beginning of the 20th century, only three live vaccines were developed and put into practice — against smallpox, rabies, plague. The discovery of D. Enders, T.H. Weller and F.Ch. Robins of the ability of the polio virus, and then of a number of other viruses, to reproduce in vitro in cell cultures of various types, greatly expanded the studies on the production of attenuated strains of viruses for live vaccines. The historical stages of obtaining and introducing live vaccines for the prevention of smallpox, poliomyelitis, measles, rubella, and mumps are highlighted. Arguments in favor of the use of associated vaccine preparations for the prevention of viral infections are presented. Various variants of the strategy and tactics of using live vaccines, which are used for specific prevention of viral infections in different countries, are described. The review provides information on technological methods for obtaining antiviral vaccines. The publications testifying to the development of specific reactions in immunized vaccine strains of measles, mumps, poliomyelitis and rubella viruses, such as aseptic meningitis (vaccine strains of mumps virus), acute arthritis (vaccine rubella virus strains), temperature reactions, rash (vaccine strains of the virus Measles), vaccine-associated paralytic poliomyelitis (VAPP) vaccine vaccine poliovirus. It is particularly noted that the long experience of vaccine prevention both in Russia and abroad convincingly shows that the risk of developing post-vaccination complications is incommensurably lower than the risk of causing harm to health from the corresponding infections. It is concluded that despite introduction of new third and fourth generation vaccines into practice, live attenuated vaccines do not lose their significance and are used in vaccine-preventable infections as the most effective immunobiological drugs.

Treatment with L-citrulline in patients with post-polio syndrome: study protocol for a single-center, randomised, placebo-controlled, double-blind trial

BackgroundPost-polio syndrome (PPS) is a condition that affects polio survivors years after recovery from an initial acute infection by the Poliomyelitis virus. Most often, patients who suffered from polio start to experience gradual new weakening in muscles, a gradual decrease in the size of muscles (muscle atrophy) and fatigue years after the acute illness. L-citrulline is known to change muscular metabolism synthesis by raising nitric oxide (NO) levels and increasing protein synthesis. This investigator-initiated, randomised, placebo-controlled, double-blind, trial aims to demonstrate that L-citrulline positively influences muscle function and increases muscular energy production in patients with PPS.Methods/designThirty ambulant PPS patients will be recruited in Switzerland. Patients will be randomly allocated to one of the two arms of the study (placebo:verum 1:1). After a 24-week run-in phase to observe natural disease history and progression, participants will be treated either with L-citrulline or placebo for 24 weeks. The primary endpoint is change in the 6-min Walking Distance Test. Secondary endpoints will include motor function measure, quantitative muscle force, quantitative muscle magnetic resonance imaging and magnetic resonance spectroscopy and serum biomarker laboratory analysisDiscussionThe aim of this phase IIa trial is to determine if treatment with L-citrulline shows a positive effect on clinical function and paraclinical biomarkers in PPS. If treatment with L-citrulline shows positive effects, this might represent a cost-efficient symptomatic therapy for PPS patients.Trial registrationClinicalTrial.gov, ID: NCT02801071. Registered on 6 June 2016.

Between individualism and social solidarity in vaccination policy: the case of the 2013 OPV campaign in Israel.

BackgroundDuring the summer of 2013, after samples of poliomyelitis virus were found in sewage, Israel launched an intensive national oral polio vaccine (OPV) campaign. The clinical objective of the campaign was rather clear. With not a single case of infantile paralysis and with a population already highly protected with IPV (a dead version of the vaccine), the goal was to foster collective immunity so that risk populations could also be protected. This, however, entailed a rather unusual issue: how to persuade parents whose children already received an IPV to re-vaccinate their children, now with a live yet attenuated version of the virus that was excluded from the national vaccination program in 2004. The challenge therefore was a call for social solidarity - asking parents to vaccinate their children mainly for the sake of protecting unknown at risk populations and to take part in the larger global goals of the polio eradication program. This challenge stands at the core of our investigation. We see the OPV campaign of summer 2013 as a good case study of the tension between individualism and social solidarity in seeking the cooperation of the public.MethodsWe draw on a qualitative study that included participant observation, document reviews and interviews with policy-makers, parents, journalists, public health experts and community leaders. These data were analyzed in order to unravel the ways in which self-interest, community and solidarity were conceived by different agents during the vaccination campaign.ResultsThe family as a metaphor for social solidarity was the main discursive item in the public campaign. Tensions, dissonances and inconsistencies were found between different registers and agencies as to what is at stake and what is required.ConclusionsWe discuss the ethical and social implications of our findings in order to better understand how persuasion was used in the current case and for its future role in similar events, within and outside Israel, when global efforts to eradicate polio are ongoing.

Etiological monitoring and analysis of cases of acute flaccid paralysis in Hebei Province in 2011-2014

Objective: To identify poliomyelitis(polio)virus, the VP1 gene, and its nucleotide sequence in fecal samples from patients with acute flaccid paralysis(AFP)in Hebei Province in 2011-2014. Methods: A surveillance system for AFP was established in Hebei Province in 2011-2014 and registered in 2014. Stool samples, each weighing 5 g, were collected from 1 504, 15-year-old symptomatic patients with AFP, resulting in a total of 3 001 samples(1 497 patients provided duplicate samples and 7 provided single specimens). Poliovirus nucleic acid was extracted, the RNA was reverse transcribed, and a VP1 gene fragment was amplified with real-time PCR. The PCR products were sequenced to construct a phylogenetic tree and check the relatedness of the strains to the Sabin vaccine strain. A χ2 test was used to compare the differences in the incidence of infection in different years. Results: Poliovirus was isolated from 50(1.7%)of the 3 001 stool samples, 10 of which were type Ⅰ strains, 15 were type Ⅱ strains, 16 were type Ⅲ strains, and 9 were mixed-type strains. The positive rates for poliovirus in the years 2011-2014 were 1.0%(9/890), 1.5%(12/824), 2.2%(17/770), and 2.3%(12/517), respectively(χ2=2.24, P=0.525). Analyses of the VP1 nucleotide and amino acid sequence homologies revealed that the type Ⅰ, type Ⅱ, and type Ⅲ poliovirus strains shared nucleotide sequence homologies with the Sabin vaccine strain of 98.8%- 100%, 99.1%- 100%, and 99.2%- 100%, respectively, and amino acid sequence homologies of 98.6%- 100%, 98.3%-100% and 98.6%-100%, respectively. A VP1-based phylogenetic analysis showed that the variation rates for the poliovirus type Ⅰ, type Ⅱ, and type Ⅲ strains were 0.66%, 0.66%, and 0.55%, respectively. Conclusion: Only one poliovirus strain was detected in Hebei Province in 2011-2014, except for the type Ⅱ vaccine-derived poliovirus. The remaining strains were all similar to the Sabin vaccine strain, with high VP1 homology.

Currents issues in cardiorespiratory care of patients with post-polio syndrome.

A search for papers was made in the databases Bireme, Scielo and Pubmed with the following keywords: post polio syndrome, cardiorespiratory and rehabilitation in English, French and Spanish languages. Although we targeted only seek current studies on the topic in question, only the relevant (double-blind, randomized-controlled and consensus articles) were considered. Certain features of PPS such as generalized fatigue, generalized and specific muscle weakness, joint and/or muscle pain may result in physical inactivity deconditioning obesity and dyslipidemia. Respiratory difficulties are common and may result in hypoxemia. Only when evaluated and treated promptly, somE patients can obtain the full benefits of the use of respiratory muscles aids as far as quality of life is concerned.

Ethnobotanical Survey, Antimicrobial and Anticomplement Activities of Guinean Medicinal Plants Traditionally Used in the Treatment of Inflammatory Diseases in Conakry and Dubreka

Based on an ethnobotanical survey related to inflammatory diseases, 67Guinean plant species belonging to 35 botanical families were inventoried. Some plant species frequently used in the treatment of rheumatism, skin diseases and microbial infections were selected and submitted to a biological investigation including antimicrobial and anticomplement activities. At a concentration of 1mg/ml, all the tested extracts were devoid of any activity against the tested fungi viz Candida albicans, Aspergillus niger, and Trichophyton rubrum and showed a cytotoxicity varying from 0.25 to 500 µg/ml which prevented the evaluation of possible antiviral effects against herpes simplexvirus type 1, Coxsackie-B2, Measle Edmondston A, Poliomyelitis virus type 1, Semliki forest L10 and Vesicular stomatitis virus for viruses. At 1mg/ml, only the extracts ofAgeratum conyzoides, Alchornea cordifolia, Acanthospermum hispidum, Erythrina senegalensis, Harungana madagascariensis, Hymenocardia acida, and Lophira alata showed an antibacterial effect against Bacillus cereus and/or Staphylococcus aureus. All the tested extracts exhibited an inhibitory effect on the Alternative Complement Pathway complement except for Bambusa vulgaris. Only the extracts of Ageratum conyzoides and Hymenocardia acida interfered with both activation pathways of the complement system. The results of the present work support the anti-inflammatory traditional use of some selected plant species which could be explained, at least partly, by their anticomplement properties.

Production of CMAH Knockout Preimplantation Embryos Derived From Immortalized Porcine Cells Via TALE Nucleases

Although noncancerous immortalized cell lines have been developed by introducing genes into human and murine somatic cells, such cell lines have not been available in large domesticated animals like pigs. For immortalizing porcine cells, primary porcine fetal fibroblasts were isolated and cultured using the human telomerase reverse transcriptase (hTERT) gene. After selecting cells with neomycin for 2 weeks, outgrowing colonized cells were picked up and subcultured for expansion. Immortalized cells were cultured for more than 9 months without changing their doubling time (~24 hours) or their diameter (< 20 µm) while control cells became replicatively senescent during the same period. Even a single cell expanded to confluence in 100 mm dishes. Furthermore, to knockout the CMAH gene, designed plasmids encoding a transcription activator-like effector nuclease (TALENs) pairs were transfected into the immortalized cells. Each single colony was analyzed by the mutation-sensitive T7 endonuclease I assay, fluorescent PCR, and dideoxy sequencing to obtain three independent clonal populations of cells that contained biallelic modifications. One CMAH knockout clone was chosen and used for somatic cell nuclear transfer. Cloned embryos developed to the blastocyst stage. In conclusion, we demonstrated that immortalized porcine fibroblasts were successfully established using the human hTERT gene, and the TALENs enabled biallelic gene disruptions in these immortalized cells.

Benzohydroxamic acids as potent and selective anti-HCV agents

A diverse collection of 40 derivatives of benzohydroxamic acid (BHAs) of various structural groups were synthesized and tested against hepatitis C virus (HCV) in full-genome replicon assay. Some of these compounds demonstrated an exceptional activity, suppressing viral replication at sub-micromolar concentrations. The compounds were inactive against key viral enzymes NS3, and NS5B in vitro assays, suggesting host cell inhibition target(s). The testing results were consistent with metal coordination by the BHAs hydroxamic group in complex with a target(s). Remarkably, this class of compounds did not suppress poliomyelitis virus (PV) propagation in RD cells indicating a specific antiviral activity of BHAs against HCV.

Frida Kahlo and Infertility: A Retrospective Diagnosis of Asherman's Syndrome

The Mexican painter Frida Kahlo (1907–1954) experienced numerous medical conditions in her lifetime. Beginning in her childhood at six years of age, Kahlo contracted the poliomyelitis virus. While the physical and emotional consequences of the poliovirus caused her much pain and embarrassment, the observations of her disease may have initiated a lifelong interest in human anatomy and biology. Having survived poliomyelitis, Kahlo decided upon a course of premedical studies at the National Preparatory School in Mexico City. However, a streetcar accident changed her life when a metal handrail pierced her adolescent body. The penetrating trauma severely damaged her skeletal framework and internal organs – including the uterus. Her survival defied prognostications by her physicians. Later in life, Kahlo would suffer numerous miscarriages and at least three therapeutic abortions. Her lifelong pathologies eventually manifested in her artwork – with many works illustrating the female organs of reproduction. Numerous historians have offered reasons for Kahlo's infertility, though without direct connection to the streetcar accident. To explain her infertility, a retrospective diagnosis of Asherman's syndrome is presented. Kahlo's history of uterine trauma and subsequent obstetric record supports a diagnosis of Asherman's syndrome.

INTERFERENCE INTERACTION OF VIRUSES IN THE REGULATION OF AN EPIDEMIC PROCESS

A long-term trend in the incidence of viral hepatitis A (VHA) in relation to vaccine prevention of this disease and poliomyelitis were analyzed in the Krasnodar Territory. There were lower VHA morbidity rates, which coincided with the period of additional mass immunization of children against poliomyelitis. Comparison of the frequency of polio vaccination and the trend in VHA incidence suggests that the viral interference phenomenon is involved in the regulation of its epidemic process, as a result of which vaccine poliomyelitis virus suppresses naturally circulating hepatitis virus A.

Immunity status of adults and children against poliomyelitis virus type 1 strains CHAT and Sabin (LSc-2ab) in Germany.

BackgroundIn October 2007, the working group CEN/TC 216 of the European Committee for standardisation suggested that the Sabin oral poliovirus vaccine type 1 strain (LSc-2ab) presently used for virucidal tests should be replaced by another attenuated vaccine poliovirus type 1 strain, CHAT. Both strains were historically used as oral vaccines, but the Sabin type 1 strain was acknowledged to be more attenuated. In Germany, vaccination against poliomyelitis was introduced in 1962 using the oral polio vaccine (OPV) containing Sabin strain LSc-2ab. The vaccination schedule was changed from OPV to an inactivated polio vaccine (IPV) containing wild polio virus type 1 strain Mahoney in 1998. In the present study, we assessed potential differences in neutralising antibody titres to Sabin and CHAT in persons with a history of either OPV, IPV, or OPV with IPV booster.MethodsNeutralisation poliovirus antibodies against CHAT and Sabin 1 were measured in sera of 41 adults vaccinated with OPV. Additionally, sera from 28 children less than 10 years of age and immunised with IPV only were analysed. The neutralisation assay against poliovirus was performed according to WHO guidelines.ResultsThe neutralisation activity against CHAT in adults with OPV vaccination history was significantly lower than against Sabin poliovirus type 1 strains (Wilcoxon signed-rank test P < 0.025). In eight sera, the antibody titres measured against CHAT were less than 8, although the titre against Sabin 1 varied between 8 and 64. Following IPV booster, anti-CHAT antibodies increased rapidly in sera of CHAT-negative adults with OPV history. Sera from children with IPV history neutralised CHAT and Sabin 1 strains equally.ConclusionThe lack of neutralising antibodies against the CHAT strain in persons vaccinated with OPV might be associated with an increased risk of reinfection with the CHAT polio virus type 1, and this implies a putative risk of transmission of the virus to polio-free communities. We strongly suggest that laboratory workers who were immunised with OPV receive a booster vaccination with IPV before handling CHAT in the laboratory.

Évaluation de la durée de vie des marquages sur l'ongle pendant les vaccinations polio au Tchad

SID (Supplemental Immunization Days) is a special strategy intended to accelerate eradication of poliomyelitis in countries where it is still endemic (India, Afghanistan, and Pakistan in Asia, and Nigeria in Africa). This strategy is also applied in Nigeria's neighbours (Cameroon, Chad, Niger and Benin). Since the poliomyelitis virus was imported from Nigeria in 2001, Chad has reported cases of poliomyelitis every year. After 30 SIDs in Chad and the inaccurate or false attribution of side-effects to polio vaccines, some groups persistently refuse polio vaccination. To ascertain the true coverage of SID, the Ministry of Health and several partners (WHO, UNICEF and Rotary) conduct external coverage evaluations, to identify the under-vaccinated areas where population may be refusing immunization. The nails of the children receiving vaccinations are marked with indelible ink and those markings are the best indicator of the area's actual SID coverage. When coverage investigators arrive and propose vaccination to all children not immunized during SID, mothers who wish to refuse vaccination may claim that the children's markings disappeared after a few days, due to bathing. WHO experts have found that markings applied to their own nails with the WHO-recommended markers persist a few weeks, but others suggested that the markings may disappear much faster among children living in a traditional tropical environment. Until now, the lifetime of these markings has not been tested among children in Africa. To determine the lifetime of the fingernail markings after SID and factors that influence this lifetime in children young than 5 years old in Chad. This prospective cohort study of 200 children (aged 0 to 59 months) took place from March to May 2009 in Milezi, a health zone north of Ndjamena, the capital of Chad, in central Africa. These children received nail markings on their left little finger with an indelible marker pen provided by WHO. The finger was monitored for 35 days, visually and by photographs, to determine the factors associated with the lifetime of the markings. Kaplan-Meier and log-rank methods were applied to estimate their survival curve and the variables significant for their lifetime; the Cox proportional hazard model was used to determine multivariable-adjusted hazard ratios. Of the 184 children surveyed through the end of the study, the markings disappeared after 35 days of follow-up for 35% of them. The average lifetime of markings on these children was 28 days (SD: 4.95) and was associated, according to the Cox model, with 3 variables: the quality of the marking (RR = 0.335, 95% CI: 0.182-0.617, p < 0.001), playing with soil or mud (RR = 0.38, 95% CI: 0.208-0.697, p = 0.002), and living in different blocks, after stratification for the variable of application of chemical products on the nail. The latter could not be included in the Cox model because it made the markings disappear instantly. WHO experts were right in stating that the lifetime of the markings was sufficient to estimate coverage accurately when external evaluation takes place one or two weeks after SID. The only action found to make markings disappear rapidly was the application of chemical products. Mothers who tell SID attendance evaluation teams that the marking disappeared with bathing are expressing a tacit refusal of vaccination. These evaluations, which take place well before the disappearance of markings, help to determine the precise coverage of SID.

Epidemiology of SV-40 Simian Virus in Different Regions of the Russian Federation

Multiplication of poliomyelitis virus for vaccine production in 1955-1961 was realized in kidney cell culture from M. rhesus naturally infected with SV-40 simian virus. Hence, some lots of the vaccine were contaminated with this virus. It was found that SV-40 is oncogenic for laboratory rodents. Since 1963, in accordance with WHO recommendation, green monkey kidneys containing no SV-40 were used instead of M. rhesus kidneys. Overall vaccination of the population with poliomyelitis vaccine in 1955-1961 led to infection of many humans in Russia and many foreign countries with SV-40. The possibility of horizontal transmission of the virus was demonstrated. As a result, virus (its DNA sequences) was detected in individuals who were never vaccinated. Hundreds of reports, often contradictory, discuss this problem. Our study is based on the analyses of 460 blood specimens from subjects living in different regions of Russia (Krasnodar region, Moscow, Novosibirsk region, Krasnoyarsk territory). The percent of individuals infected with SV-40 varies from 16 to 49%.

Characteristics of 57 acute flaccid paralysis cases with polio-virus isolated from stool specimens, in Yunnan province, from 2003 to 2007

Study on the epidemiological characteristics of poliomyelitis virus in Yunnan, from 2003 to 2007. Surveillance data of acute flaccid paralysis (AFP) cases from year 2003 to 2007 was gathered. All the stool specimens were identified to contain polio virus. 1171 AFP cases were reported. Out of the total number of 1138 stool specimens from 2003 to 2007, 57 cases showed polio virus (5.0%), 159 showed NPEV (14.0%), 922 cases showed virus negative. In those virus, polio type II took the lead (31.6%). 57 AFP cases appeared in 37 (28.7%) counties in Yunnan. Most of the cases were under 2 years of age. 29 cases had taken more than 3 OPV (oral poliovaccine) dosages and 41 cases had fever before paralysis occurred. Most of the cases appeared paralysis on single lower limb, but 26 cases leaving deformity. Significant difference was found between the two groups: having received vaccination more than 3 OPV dosages or less than 3 dosages. High quality AFP epidemiological and laboratory surveillance program, together with OPV routine and supplemental immunization strategy to cover the poorly immunized area/population appeared to be most effective.

Estudios epidemiológicos y virológicos sobre la poliomielitis en Valencia (1959-1969)

Studies into the polio virus began in Valencia in 1959 with the work undertaken by the microbiologist Vicente Sanchis-Bayarri Vaillant. After his education at the Rochester University and at the Pasteur Institute, Sanchis-Bayarri Vaillant established a laboratory of cell cultures at the Faculty of Medicine in Valencia, where he developed a new diagnostic technique for the poliomyelitis virus. In addition, epidemiological studies were carried out both prior to and post the 1963 vaccination campaign, which proved that Sabin's oral vaccine was both effective and safe for use.

Religious Opposition to Polio Vaccination

To the Editor: In 1988, the Global Polio Eradication Initiative was formed, with the aim of reducing infection with poliomyelitis virus. Two decades later in 2008, a total of 1,625 children contracted acute flaccid paralysis caused by poliovirus infection (1). This finding represented a 150% increase over the number of cases in 2007 (1) and resulted in the reemergence of polio as one of the world’s deadliest infections. As of 2009, polio remains endemic to 4 countries (India, Nigeria, Pakistan, and Afghanistan); in 2008, cases were also detected in 14 other countries. Religious opposition by Muslim fundamentalists is a major factor in the failure of immunization programs against polio in Nigeria (2), Pakistan (3) and Afghanistan (4). This religious conflict in the tribal areas of Pakistan is one of the biggest hindrances to effective polio vaccination. Epidemiologists have detected transmission of wild poliovirus from polio-endemic districts in Afghanistan, most of which are located in the southern region of this country bordering Pakistan, to tribal areas of Pakistan (4). This transmission has resulted in new cases of polio in previously polio-free districts. The local Taliban have issued fatwas denouncing vaccination as an American ploy to sterilize Muslim populations. Another common superstition spread by extremists is that vaccination is an attempt to avert the will of Allah. The Taliban have assassinated vaccination officials, including Abdul Ghani Marwat, who was the head of the government’s vaccination campaign in Bajaur Agency in the Pakistani tribal areas, on his way back from meeting a religious cleric (5). Over the past year, several kidnappings and beatings of vaccinators have been reported. Vaccination campaigns in Nigeria and Afghanistan have also been hampered by Islamic extremists, especially in the Nigerian province of Kano in 2003, which has resulted in the infection returning to 8 previously polio-free countries in Africa (2). Before the Global Polio Eradication Initiative in 1988, a total of 1,000 persons/day were infected with a virus that would cripple them for the rest of their lives (6). To eradicate the disease, 1 major factor will be to gain support of those susceptible to fundamentalist propaganda. Islam is a progressive religion, and religious leaders should be asked to support polio eradication programs. The Imam of the Ka’aba and other influential religious figures should be asked to highlight the plight of children with polio. Vaccinators operating in conflict-ridden areas should be provided protection so that they are better able to perform their duties. Not only will children in these areas be safer, but the disease will not be exported to areas where wild polio transmission has been interrupted by vaccination. Further study of the attitudes of Muslim populations toward vaccination is needed.