Published on: August 19, 2024
Polio Then & Now
Polio was once the most feared disease in the U.S. and although it has been around since ancient times, an epidemic in the late 40s and early 50s affected many people worldwide. Children under five years of age were mainly affected. Polio attacks the nervous system and can lead to spinal and respiratory paralysis and in some cases death. The most severe cases cause paralysis, especially in children with some going on to develop post-polio syndrome which could lead to a lifetime of muscle weakness, and limb deformity, especially in the legs. Poliovirus is highly contagious and therefore spread rapidly around the world. One well-known victim of polio was President Franklin Delano Roosevelt
Declared “polio-free” in 1979, the United States vaccinated its way to a victory against the terrible disease. However, as we will discuss in a bit, just in late July of this year (2022), a case of paralytic poliomyelitis was confirmed in an unvaccinated adult in Rockland, County, New York. This new polio case has led to the New York Governor, Kathy Hochul declaring a state of emergency for the state of New York in September 2022. It is a bit surreal to even consider this, but could Polio, this generation’s old disease, be forgotten, but not yet gone from our country? Before we aim to tackle this question, let’s look at some of the facts about Polio.
What is Polio & How Does it Spread?
Polio, or Poliomyelitis, is a disabling and potentially life-threatening disease caused by the Poliovirus. The virus spreads from person to person and, in some cases, can infect a person’s spinal cord, causing paralysis.
Incredibly contagious, polio spreads through person-to-person contact. Primarily, it spreads through contact with the feces of an infected person or droplets from a sneeze or cough. If a person gets stool or droplets from an infected person on their hands and they touch their mouth, they can become infected. Similarly, if a child puts objects, like toys, which have infected stool or droplets on them into their mouth, they can get infected.
An infected person may spread the virus to others immediately and for 1 to 2 weeks after developing symptoms. The virus can live in an infected person’s intestines for many weeks. They can contaminate food and water when they touch them with unwashed hands.
A Brief History of Polio
For a robust history and overview of the disease, we recommend taking a few minutes to watch the video below:
Polio Symptoms
People who become infected with the poliovirus will most likely not have any visible symptoms.
Usually about one out of every four people (or 25 out of 100) with poliovirus infection will present flu-like symptoms that can include:
- Sore throat
- Fever
- Tiredness
- Nausea
- Headache
- Stomach pain
These symptoms can last anywhere between two to five days, at which point they will dissipate on their own. An even smaller percentage of people who become infected with poliovirus will develop other, more serious symptoms that can affect the brain and even spinal cord. This can result in meningitis or even paralysis.
Meningitis is an infection of the covering of the spinal cord and/or brain. Meningitis can occur in about 1-5 out of 100 people with the poliovirus infection, depending on the virus type.
Full paralysis, when the person cannot move parts of their body, or even just weakness in the arms, legs, or both can occur in about 1 out of 200 people to 1 in 2,000 people, depending on virus type. Being the most severe symptom associated with poliovirus, paralysis can lead to permanent disability and death. Between 2 to 10 out of 100 people who have paralysis from polio virus infection die. This is because the virus affects the muscles which help them to breathe.
Even children who seem to fully recover from poliovirus can develop new muscle pain, weakness, or paralysis as adults, usually appearing 30 to 40 years later. This is called post-polio syndrome. Post-polio syndrome is not contagious. It is important to note that “poliomyelitis” (“polio” for short) is defined as a paralytic disease. So only people with the paralytic version of the infection, or paralytic polio, are considered to have the disease.
Polio Prevention, Treatment, & Vaccines
Unfortunately, there is no cure for paralytic polio and no specific treatment. Physical therapy and/or occupational therapy can help with arm or leg weakness caused by polio. These therapies might improve long-term outcomes, especially if started early in the course of the illness. Healthcare providers are encouraged to consider consulting neurology and infectious disease experts.
If you think you, a family member, or someone close to you has symptoms of polio, please call your healthcare provider right away or go directly to an emergency room.
The best way to guard against contracting polio is to get vaccinated against the disease. There are two types of vaccines that can prevent polio:
- Inactivated poliovirus vaccine (IPV) is given as an injection in the leg or arm, depending on the patient’s age. Only IPV has been used in the United States since 2000.
- Oral poliovirus vaccine (OPV) is still used throughout much of the world. More on the OPV below.
The polio vaccine protects children by preparing their bodies to fight the poliovirus. Nearly every child (over 99%) who receives all the recommended doses of the inactivated polio vaccine will be fully protected from polio. As with the prevention of many other infectious diseases, it is very important to practice good hand hygiene and wash hands often with soap and water. Alcohol-based hand sanitizers do not kill poliovirus.
Recent U.S. Case of Polio in New York
In late July 2022, a case of paralytic poliomyelitis was confirmed in an unvaccinated adult in Rockland County, New York. The infection was not travel-related. The NY man was infected with a type of poliovirus that came from the oral polio vaccine, called vaccine-derived paralytic polio. Because one case of paralytic polio is considered an “outbreak,” New York Governor, Kathy Hochul declared a state of emergency for the state of New York in September 2022. Since the first polio case was identified the disease has been detected in New York City sewage, suggesting the virus continues to be present.
The New York State Department of Health has detected poliovirus in sewage (wastewater) dating back to April and as recently as September in several counties in the New York City area. The virus has been detected in 70 sewage samples across Rockland, Sullivan, Orange, Nassau, Kings, and Queens counties. The CDC considers just a single case of paralytic polio to be a public health emergency. Because the vast majority of people who contract the poliovirus do not show any symptoms, this situation is an indication that the virus has been spreading silently in New York.
For the first time in more than 20 years, the Centers for Disease Control and Prevention is considering using an oral polio vaccine to stop the outbreak. The novel oral polio vaccine (OPV as mentioned above), is a safe and newer version that is more stable than IPV. It also carries a much lower risk of mutating into a poliovirus strain that can spread and cause disease in unvaccinated people. A decision to begin using the novel OPV would require approval or emergency use authorization from the Food and Drug Administration (FDA). The U.S. currently uses the inactivated polio vaccine, which is administered as a shot and contains a chemically killed virus that cannot replicate, mutate or cause disease.
Immunization Drive with IPV Shots
Even though New York state officials have begun an immunization drive with IPV shots, this vaccine has not successfully stopped the current outbreak. The IPV vaccine is very effective at preventing paralysis, but it does not stop transmission of the virus itself. This contrasts with OPV, which has proven to be much more successful at stopping transmission of the virus. The OPV has historically been used in other countries to cease outbreaks.
The unvaccinated adult in Rockland County, New York who was paralyzed in July of this year was the first known case of paralytic poliomyelitis in the U.S. in close to a decade. It was the first case in New York since 1990. There have not been any additional paralytic cases so far, but New York state officials are warning that unvaccinated people are at serious risk and should immediately get up to date on their shots.
About Infectious Disease Associates of Tampa Bay (IDATB)
IDATB provides high-quality healthcare services for patients in the Tampa Bay metro area. Our comfortable, state-of-the-art clinic can offer you and your loved ones excellent care. If you or someone who lives with you would like to be evaluated for an infectious disease, then IDATB is here to help. With decades of experience serving Floridians, IDATB has the experience and resources to serve you and your loved ones with compassion and excellence. If you have any questions or concerns about infectious diseases or Polio, then please call us at 813-251-8444.
