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Global Polio Eradication: History, Achievements & Challenges
Global Polio Eradication: History, Achievements & Challenges
Global Polio Eradication: History, Achievements & Challenges
Poliomyelitis:
Acute inflammation of the anterior horns of the gray matter of the spinal cord,
leading to a destruction of the large multipolar cells of these horns. It is most
common in children, coming on during the period of the first dentition and
producing a paralysis of certain muscle groups or of an entire limb.
Gould’s Illustrated Medical Dictionary, 1895
History & Relevance
Poliomyelitis:
An inflammatory process involving the gray matter of the cord. An acute
infectious disease caused by the poliomyelitis virus and marked by fever, pains,
and gastro-enteric disturbances, followed by a flaccid paralysis of one or more
muscular groups, and later by atrophy.
Stedman’s, 2005
History & Relevance
In 1916, New York City experienced the first large epidemic of polio, with over 9,000 cases and 2,343 deaths. The 1916 toll nationwide was 27,000 cases and 6,000
deaths. Epidemics worsened during the century: in 1952, a record 57,628 cases of polio were reported in the United States.
Polio (also called infantile paralysis) was most often associated with children, but it affected teens and grown-ups as well. Between 1949 and 1954, 35 percent of
those who contracted polio were adults.
“Early in the summer just passed, physicians in certain parts of Rutland County, Vermont, noticed that an acute nervous disease which was almost
invariably attended with some paralysis, was epidemic … and a general feeling of uneasiness … was perceptible among the people in regard to the
‘new disease’ that was affecting the children.”
-- Dr. C. S. Caverly, reporting on the first epidemic outbreak of polio in the United States, 1894
History & Relevance
1840, Jacob Heine describes the clinical features of the disease as well as its involvement of
the spinal cord.
1894, first outbreak of polio in epidemic form in the U.S. occurs in Vermont, with 132 cases.
1908, Karl Landsteiner and Erwin Popper identify a virus as the cause of polio by transmitting the
disease to a monkey.
1916, large epidemic of polio within the United States.
1921, FDR contracts polio at age 39. Although he is open about having had polio, he conceals the
extent of his disability.
1929, Philip Drinker and Louis Shaw develop the “iron lung” to aid respiration.
1930s, two strains of the poliovirus are discovered (later it was determined that there were three).
1931, scientists create the first filter able to trap viruses.
1933, FDR inaugurated president of the United States.
1935, Maurice Brodie and John Kolmer test polio vaccines, with disastrous results.
1938, FDR founds the National Foundation for Infantile Paralysis, known today as the March of Dimes.
1940s, Sister Kenny, an Australian nurse, comes to the U.S. to promote her new treatment for polio,
using warm compresses to relax painful, contracting muscles and massage for rehabilitation.
1947 - 50, Dr. Jonas Salk is recruited by the University of Pittsburgh to develop a virus research
program.
1953, Salk and his associates develop a potentially safe, inactivated (killed), injected polio vaccine.
1954, nearly two million children participate in the field trials.
1955, news of the success of the trials is announced by Dr. Thomas Francis in a formal press conference at
Ann Arbor, Michigan, on April 12, the tenth anniversary of FDR's death. The news was broadcast both on
television and radio, and church bells rang in cities around the United States.
1955 - 57, incidence of polio in the U.S. falls by 85 - 90%.
1957 - 59, mass clinical trials of Albert Sabin's live, attenuated vaccine in Russia.
1962, the Salk vaccine replaced by the Sabin vaccine for most purposes because it is easier to administer
and less expensive.
1968, passage of the Architectural Barriers Act, requiring that all federally financed buildings be accessible
to people with disabilities.
1979, last case of polio caused by “wild” virus in U.S.; last case of smallpox in the world.
1980s, post-polio syndrome identified by physicians and people who had polio.
1980, the first National Immunization Day for polio held in Brazil.
1981, poliovirus genome sequence published.
1985, Rotary International launches PolioPlus program.
1988, Rotary International, PanAmerican Health Organization, World Health Organization, Centers for
Disease Control, UNICEF begin international campaign to stop transmission of polio everywhere in the
world.
1990, Passage of the Americans with Disabilitites Act (ADA), providing broad legal protections for people
with disabilities.
1999, inactivated polio vaccine replaces oral polio vaccince as recommended method of polio immunization
in the United States.
A bit about polio: basics
“If the ability to replicate is one of life’s attributes, then polio is a chemical with a life cycle…. Viruses are ‘living’ chemicals. They have structural
uniformity, like crystals, but can only self-replicate inside living cells. Poliovirus is made up of carbon, hydrogen, nitrogen, oxygen, phosphorus and
sulphur; from these elements, the virus forms its RNA (ribonucleic acid) genes, and its protective protein coat.”
-- Jeronimo Cello, Aniko V. Paul, Eckard Wimmer, creators of the synthesized poliovirus, 2002
Poliovirus
EMs
A bit about polio: basics
Life cycle of poliovirus
A bit about polio
Affects mostly children under 3 (50% of all cases)
Majority asymptomatic
About 10% will get ‘minor illness’: fever, nausea, vomiting
0.5 -1% infections leads to irreversible paralysis (AFP), with maximum effect taking place in
3-4 days
Legs affected more than arms; paralysis of respiratory muscles is life-threatening
Humans are the only reservoir for the poliovirus. The virus does not naturally reproduce in
any other species.
Transmission is usually fecal-oral (oral-oral is possible)
Virus sheds from stool for 4-6 weeks
No treatment; deformity and handicap can be minimized with early PT
A bit about (post) polio
20000
15000
Cases
10000
Last indigenous case
5000
0
1950 1956 1962 1968 1974 1980 1986 1992 1998
Vaccination trend in the US
VAPP Cases non-VAPP OPV doses in millions
10 25
IPV-OPV
9
8 20
7 All-IPV
6 15
4 10
2 5
0 0
90
91
92
93
94
95
96
97
98
99
00
01
02
03
19
19
19
19
19
19
19
19
19
19
20
20
20
20
Vaccination schedule in the US
Age Vaccine
2 months IPV
4 months IPV
6-18 months IPV
4-6 years IPV
Eradicating polio?
http://www.pbs.org/wgbh/aso/ontheedge/polio/
Links & References
WHO site /GPEI:
www.polioeradication.org
CDC: www.cdc.gov/nip
Acknowledgement
With thanks to David Heymann, Tim Brookes, and the American
Public Health Association (APHA)