Ebola vs Polio

What if we can eradicate a LIFE-THREATENING virus like EBOLA ?

At a recent meeting commemorating World Polio Day (October 24), members of the Rotary Club of Ajijic learned about the similarities of the Polio virus and Ebola.

- See more at: http://portal.clubrunner.ca/8212#sthash.2mZecjyY.dpuf

Although the Ebola virus has been the subject of many Apocalyptic movies due to a virus and has been on most daily headlines for the past couple of months and has been responsible for more than 2000 deaths so far in Africa and panic in the U.S. due an infected patient traveling to Dallas, there has been one virus that is equally as dangerous to mankind and has almost been eradicated on this earth.

The Polio Virus has even infected one of the United States’ most well known presidents, Franklin D. Roosevelt(FDR) and yet it seems that little has been publicized or in the news lately about it, it’s history and how devastating a Polio infection can be. In the United States, the 1952 polio epidemic became the worst outbreak in the nation’s history. Of nearly 58,000 cases reported that year 3,145 died and 21,269 were left with mild to disabling paralysis. During FDR’s tenure as the U.S. president and probably due to the fact he was a wartime president, few photographs exist of him showing the extent that polio incapacitated him. In fact, only 4 photographs exist showing FDR in a wheelchair. It is no wonder why it is not a subject worthy of a major Hollywood movie or newspaper selling headlines.

The Polio virus shares many similarities with other viral infections during it’s infectious course. Poliovirus is transmitted by fecal-hand-oral contamination. During epidemics, it also may be transmitted by pharyngeal spread. Ninety to 95 percent of poliovirus infections are asymptomatic. There is an incubation period of 7 to 14 days. An asymptomatic primary (minor) transient viremia occurs, with spread of virus to the systemic reticuloendothelial tissue. In 4 to 8 percent of individuals, a second major viremia occurs, causing symptoms of the "minor illness" (abortive polio), which resembles the usual viral infection, including headache, sore throat, fever, nausea, vomiting, malaise, and fatigue. In a fraction of those with major viremia and abortive polio, involvement of the central nervous system then occurs. In some of these patients, the poliovirus then causes selective destruction of motor neurons, characterized by severe back, neck, and muscle pain, and the development of motor weakness. This paralysis occurs in only about 0.1 percent of all poliovirus infections. But an infection can lead to respiratory depression and for those old enough to remember, can bring to memory the images of children laying in their IRON LUNGS.

Weakness due to poliomyelitis may range from involvement of one muscle or group of muscles to quadriplegia and respiratory failure. Tone is reduced, nearly always in an asymmetric manner. Proximal muscles usually are affected more than distal ones, and legs are affected more commonly than arms.

As with many viral infections that attack the central nervous system or the brain, the definitive diagnosis is made by sampling cerebrospinal fluid findings. The gold-standard method for confirmation of the diagnosis is polymerase chain reaction amplification of poliovirus RNA from the cerebrospinal fluid . The diagnosis also can be confirmed by virus isolation, but this method is less sensitive. From a practical clinical perspective, the illnesses which most resemble poliomyelitis are other enterovirus infections, West Nile Virus, and Guillain-Barré syndrome. The differential diagnosis of acute flaccid paralysis includes a multitude of other conditions.

There is NO TREATMENT or CURE for polio, not even an experimental one as is the case for Ebola. Treatment of poliomyelitis is supportive. Respiratory failure may develop, requiring mechanical ventilation. Patients with bulbar involvement require close monitoring of cardiovascular status because of the association with blood pressure fluctuations, circulatory collapse, and autonomic dysfunction. Patients infected with polio may not present in a manner that will sell movie tickets but are nonetheless very devastating effects and are a reason why we should eradicate it.

Polio eradication — Vaccination against polio has had a profound effect. The last case of endemic, naturally occurring poliomyelitis in the United States was reported in 1979 The last such case in the Western Hemisphere was reported in Peru in 1991. The only known wild poliovirus infections in the Americas after 1991 were imported cases.

The basis of the Global Polio Eradication Initiative, initiated in 1988, has been immunization and surveillance. Progress is tracked through surveillance of acute flaccid paralysis cases and testing of linked stool specimens for polioviruses, with additional testing of sewage in selected areas. In areas in which surveillance systems detect at least one case of acute flaccid paralysis per 100,000 persons aged <15 years, stool samples are collected and analyzed, and the data are used to identify locations where wild polioviruses or vaccine-derived polioviruses are circulating.

The results have been dramatic. In 1988, polio was endemic in more than 125 countries, and paralyzed at least 350,000 children per year . By 2011, the number of cases of acute flaccid paralysis due to poliovirus was reduced to 650. By 2012, there remained only three countries in which endemic wild poliovirus transmission had never been interrupted: Afghanistan, Nigeria, and Pakistan. Wild type 2 poliovirus has not been isolated globally since 1999, and so may have already been eradicated.

Despite this progress, new outbreaks of polio continue to occur, as illustrated by the following examples:

●An outbreak of wild type 1 poliovirus in the Horn of Africa (Somalia, Kenya, Ethiopia, and South Sudan) was reported in 2013.

●The first apparent outbreak of polio in 14 years in Syria was reported in October 2013.

●Polio immunization bans by the Taliban in the North Waziristan region of Pakistan have caused increasing numbers of new cases of childhood paralysis.

●Circulating wild polio virus was detected in sewage samples across Israel beginning in 2013, though the outbreak had not caused any cases of paralysis. The outbreak was unexpected because Israel has an immunization rate of ≥95 percent. The inactivated polio vaccine (IPV) is used in Israel, as it is in most developed nations, because it poses no threat of vaccine-associated paralytic poliomyelitis. However, the IPV induces a lower level of mucosal immunity than the oral polio vaccine thereby permitting transmission of the virus through the stool.

●Wild type 1 poliovirus was detected in Iraq in 2014.

Because of increasing outbreaks, the World Health Organization declared in May 2014 that the spread of polio had become a global public health emergency, posing a major threat to the global eradication effort. These outbreaks highlight the risk for wild poliovirus reintroduction due to a combination of international travel, health systems with limited resources, areas of low oral poliovirus coverage, and delays in recognizing and testing cases of acute flaccid paralysis. These risks are exacerbated in areas of military, political, and social conflict, such as Syria and Pakistan.

THE GLOBAL POLIO ERADICATION INITIATIVE PARTNERSHIP — The Global Polio Eradication Initiative partnership was launched in 1998 and is led by five organizations: the World Health Organization (WHO), the United States Centers for Disease Control and Prevention, the United Nations Children’s Fund, Rotary International, and the Bill and Melinda Gates Foundation with the Secretariat located at WHO headquarters in Geneva, Switzerland. The partnership includes numerous governmental and nongovernmental donors and the ministries of health of all affected nations who plan and carry out the program’s initiatives at an overall cost that exceeds $1 billion per year.

POLIO ERADICATION STRATEGIES — The global eradication program is based on four strategies: routine infant immunization, supplementary immunization campaigns in many middle- and low-income countries, surveillance for acute flaccid paralysis (AFP), and mop-up campaigns. Most of the gains of the eradication program have been achieved with the use of trivalent oral poliovirus vaccine (tOPV) alone. In addition, bivalent type 1 + 3 oral poliovirus vaccine (bOPV) and trivalent inactivated poliovirus vaccine (IPV) have and/or will be introduced into both routine and supplementary immunization programs. Bivalent OPV induces superior seroconversion rates to types 1 and 3 compared with tOPV. IPV is more expensive than OPV, but, dose-for-dose, results in higher seroconversion rates in low-income settings where the burden of enteric pathogens and tropical enteropathy reduces the efficacy of OPV.

I believe that although Polio may not cause the dramatic signs and symptoms in a rapid manner that a hemorrhagic virus such as Ebola, as I previously stated, it is equally if not more important that we address it’s eradication in a very pro-active manner. “WE ARE THIS CLOSE”!

Information written and compiled by Santiago Hernandez M.D.

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