Thoughts on a Polio Return - DNA Science

Thoughts on a Polio Return – DNA Science

When a case of poliomyelitis presented itself in Rockland County, just north of New York, in July 2022, then polioviruses with the same genetic sequence as that of the paralyzed man were found in three samples of sewage collected near his home, public health officials are alarmed. The man, from an Orthodox Jewish community with low vaccination rates in general, had not been vaccinated against poliomyelitis.

World Health Organization definitions have come into effect.

The patient’s viral RNA sequence was close to that of the oral polio vaccine, which is “live” (weakened, i.e. attenuated). He was infected with vaccine-derived polioviruses (VDPV). Then the discovery of the telltale RNA sequence in the sewage raised the situation to circulating vaccine-derived polioviruses (cVDPV). The United States now joins 30 other countries that are experiencing a comeback of this infectious disease once thought to be nearly extinct.

About 95% of people infected with wild polioviruses have no symptoms. Others develop fever, muscle weakness, headache, nausea and vomiting. One to two percent progress to severe muscle stiffness and pain in the neck and back. For less than one percent, paralysis results. Before widespread polio vaccination, mechanical ventilation devices called iron lungs were used to help children breathe, often for months.

The role of oral polio vaccine

The term “vaccine derivative” may suggest that the vaccine causes an infectious disease to reappear, but that is not quite what is happening.

The new viruses differ slightly in their RNA sequences from the oral polio vaccine introduced in the 1950s. It was an attenuated virus that replicates along a child’s digestive tract, coming out with stool.

To develop the oral polio vaccine – aka OPV – Albert Sabin infected a series of animals with wild polioviruses. The strategy allowed mutations to accumulate that weakened the virus enough to stimulate an immune response in people without causing symptoms. Children lined up in school cafeterias to eat the pink-stained, virus-carrying sugar cubes that were the ingenious vaccine delivery vehicle. Children’s feces release weakened polioviruses into sewage, and OPV spreads protection even among those who have not been vaccinated.

Crude, perhaps, but effective. However, the virus can mutate when it replicates, as living viruses do. It may become capable, like its ancestors, of taking up residence in human neurons. The muscles weaken, in some cases to the acute flaccid paralysis of poliomyelitis.

Vaxxed people are protected – that’s most of us. But communities with low vaccination rates open a niche for new viral mutants. This is apparently happening now.

Said Dr. José R. Romero, director of the CDC’s National Center for Immunization and Respiratory Diseases when reporting the July 21 case, “Vaccination against polio is the safest and best way to fight this debilitating disease and it is imperative that members of these communities who are unvaccinated get up to date with polio vaccination immediately. We cannot stress enough that poliomyelitis is a dangerous disease for which there is no cure.

Vaccines can, in theory, rid the world of polio. In 2013, experts from 80 countries signed the Scientific Declaration on Polio Eradication, which highlighted the danger of seeking control rather than eradication:[W]We could expect to see up to 200,000 cases a year within a decade if the polio eradication effort is halted, reversing the progress made over the past 25 years. Until eradication is achieved, we will always be at risk of poliovirus reappearing anywhere in the world.

Only injected, inactivated polio vaccine is currently administered in the United States, due to OPV’s ability to mutate. And the live vaccine component that causes breakthrough cases was removed in 2014, which I covered for Medscape.

Vaccine memories

I suspect a lot of people didn’t pay attention to the polio news over the summer. The reasons varied: fatigue from COVID, just another disease after monkeypox, or unawareness of polio. Maybe they don’t remember the pink sugar cube or one of the many vaccines to protect against what used to be called “childhood diseases.”

I had a bunch of these illnesses that could empty a classroom in days, including measles for a month. So, once I was old enough to understand vaccination, I could appreciate the protection my younger sister had against measles, and then my children against rubella and mumps. They endured the spots of chickenpox, that vaccine originally reserved for children with leukemia, and other risk factors that made the infection life-threatening.

Fortunately, the vaccines beat polio in time for me. But one of my earliest memories, and the one that helped me become a scientist, is my mother’s fear of polio. In my baby book, in 1954, she wrote “April 15 – The Polio Vaccine Perfected!!!”

She had good reason to rejoice. I wrote in The Scientist:

“For parents of young children in the early 1950s, summer brought the terror of a fever that could explode in infantile paralysis,” a fear fueled by images of Franklin D. Roosevelt’s battle with the disease. Although only 1% of those infected developed severe symptoms when the virus invaded spinal cord cells, the number of cases rose enough to inspire a massive effort to develop a vaccine, including the March of the Descent Foundation. ten cents in 1938 to specifically fight poliomyelitis.

For those old enough to remember The Beatles, polio vaccines were part of childhood. In 1955, young people in many countries were receiving injections of the inactivated poliomyelitis vaccine from Jonas Salk. In 1962, children lined up at school, tongues sticking out to receive pink-stained sugar cubes impregnated with Albert Sabin’s live attenuated oral polio vaccine.

Neither Salk nor Sabin sought patent protection for their inventions.

I had my polio shots in May, June and October 1956. Grateful parents across the United States realized that if enough people were vaccinated, the active virus would have nowhere to infect and polio would disappear . They had an intuitive understanding of the concept of herd immunity, if not by that name.

Thanks to the vaccination campaign, the last natural cases of poliomyelitis in the United States date back to 1979, although the wild virus has continued to arrive from other places. In 1994, the WHO declared the Americas polio-free.

Encountering poliomyelitis during my career as a science journalist

The recent case of polio in Rockland County got me thinking about my few connections to the disease.

I knew older siblings of friends who had it, and one friend in college and another in college had a limp, a legacy of childhood polio.

In 1980, my roommate Cheryl Adler was part of the team that discovered the RNA sequence of a key polio virus gene that allows the virus to replicate, a landmark article in Cell. I knew her best as the first Deadhead and an excellent cook. Sadly, Cheryl died young of a neurological disease. I last saw her on a Phish show.

In 1993, I met the two people who would become my co-authors of several editions of two textbooks of human anatomy and physiology. We had half a day to kill in Chicago between flights to our editor, so, being nerds, we visited the International Museum of Surgical Sciences. Fascinated, we christened the vast display of laboratory glassware a bong museum. Our laughter stopped, instantly, when we hit an iron lung. We imagined a child trapped inside for months or even years as the bellows simulated moving lungs. Hypnotized, we appreciated, once again, the value of vaccines. How I wish vaccine hesitants would understand the history of infectious diseases! Those from childhood are unfamiliar because vaccines defeated them.

In 2014, I was the convening speaker for the March of Dimes. FDR, who contracted polio at 39 and lost the use of his legs, initially called the organization the National Foundation for Infantile Paralysis. Donations initially came from wealthy celebrities, but when polio cases spiked, Roosevelt asked the public for help. Singer Eddie Cantor jokingly asked the public to send pennies to the president. After nearly 3 million dimes showed up at the White House, the name was changed to March of Dimes.

The first speaker at the March of Dimes convocation in 1971 was Jonas Salk. I was honored when the organization asked me to participate. I spoke at colleges in four New York cities, rewarded with a mug full of M&Ms and a T-shirt.

CODA: vaccine hesitancy is already seen

I have published thousands of articles since obtaining my doctorate in genetics in 1980. One from 2004 is frightening: vaccines, victims of their own success, with the subtitle “Why public health intervention more effective elicits a mixed response from the public. He appeared in The Scientist (I wrote for them for 17 years, until a new editor came along and fired all the regulars). Some of the quotes from experts, still in their institutions, strangely could have happened today in the wake of the COVID pandemic:

“People in the United States want a quick fix, not prevention, so they prefer drugs to vaccines. Elsewhere, people are afraid of drugs and side effects and prefer vaccines,” said Shan Lu, a primary care physician at the University of Massachusetts Medical School who has worked on an HIV vaccine.

“In developed countries, we no longer have infectious diseases for which there are vaccines, so the risk of the vaccine is perceived to be greater than the risk of the disease. But it’s true because the vaccine is used,” said Stanley Plotkin, inventor of the rubella vaccine.

“In the 1950s, poliomyelitis affected all neighborhoods. Today, naturally occurring poliomyelitis is far removed from most people’s daily lives. But when a little girl in California develops side effects from the polio vaccine, it makes headlines,” said Neil Herendeen, chief of pediatrics at Strong Memorial Hospital at the University of Rochester, New York.

“In the past, medicine was delivered in a more paternalistic model, with the public trusting that they were receiving the appropriate service. Today, people are more involved in their care, know more, and expect more,” said Mark Upfal, medical director of Occupational Health Services at Detroit Medical Center.

These concerns that resonate over the decades are difficult, and sometimes infuriating, to unpack. But the underlying message that vaccine opponents seem to miss is the duty to think beyond themselves to act to protect the community.

#Thoughts #Polio #Return #DNA #Science

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