Lax Vaccination Could Open Door to Viral Transmission
News that polio is lurking in the wastewater of New York City brings back stark memories of a previous epidemic that left thousands of children paralyzed, as well as the vaccine that eradicated the virus for decades. The news also sparked a question of whether there would be resistance today to polio vaccination to prevent another paralyzing epidemic.
Wastewater has become a large-scale petri dish that reveals whether a virus is circulating in a community. Wastewater has been used to detect COVID variants in circulation and how fast monkeypox is spreading. Now it is registering a renewed threat of polio, a virus once assumed vanquished, but still hanging around.
For people of my generation, memories of polio before vaccines are nightmarish. My mother contracted a mild case of polio that thankfully didn’t require placing her in an iron lung or dealing with residual paralysis. She was lucky, and I was vaccinated as a boy immediately after a polio vaccine was approved.
One of my closest college roommates contracted polio as a young child. He regained use of legs, but bore the scar of a distorted mouth and limited use of one arm. In his case, the travail of conquering polio prepared him for another tragedy – a rear-end collision that left him paralyzed from the neck down. The accident occurred after my classmate had taken and passed his law exam and he went on to become a well-known attorney in San Diego and a member of that city’s transit board where he advocated for accessibility.
The re-emergence of paralytic polio in America is instructive for several reasons. It’s a reminder vaccination can subdue an epidemic, but not vanquish it completely. It’s also a reminder that viruses are pesky and resourceful, hiding in plain sight and re-inventing themselves. The COVID virus, which can land someone on a ventilator, has the remarkable and disturbing quality of evolving very rapidly, challenging new technology that allows rapid development of safe vaccines.
For those not around in the middle of the 20th century, polio gripped America from 1948 to 1955. It had been around before then. Polio killed 6,000 people and left 21,000 mostly children paralyzed in 1916. Franklin Roosevelt, who was 39 in 1921, contracted a disease, most likely polio, featuring fever, bladder and bowel dysfunction, numbness, trouble breathing and ascending paralysis. He recovered from most of the symptoms, except for paralysis in his legs.
The spread of polio at the end of World War II led people to avoid large gatherings and especially public swimming pools, which many suspected was the preferred breeding ground for the polio virus. Children were especially susceptible to polio, and many were left paralyzed for life.
Dr. Jonas Salk began researching polio and searching for a vaccine in 1952. His team developed an efficacious vaccine in 1955. The Mayo Clinic administered its first shot April 13, 1955, the day after the vaccine was licensed. Salk developed next-generation polio vaccines in the 1960s that could be taken orally and, as a result, used more widely throughout the world.
You can declare you’re done with a virus, but that doesn’t mean the virus is done with you.
Before the recent paralytic polio case in New York, the last reported incidence of polio in the United States was in 2013. However, polio is considered endemic today in Afghanistan and Pakistan. Medical professionals say the oral vaccine relies on a weakened live polio virus that can prevent illness, but not transmission. The United States has relied on an inactivated polio vaccine since 2000 to limit transmission.
When a disease disappears, people assume it has been eliminated, which can lead to more lax attitudes about vaccination. New York public health officials are making the point that polio can be prevented, especially in children, with vaccination. However, only 86 percent of children under five in New York have received polio shots. That creates an opening for the polio virus to attack. Infectious disease experts are encouraging pediatricians who see patients with fevers and nausea to check to see if they are vaccinated.
If an illness like polio can rise again, what does that say about the future of the coronavirus that is very much alive and persistently circulating – or future viruses that may surface? It suggests vigilance cannot be transitory. You can declare you’re done with a virus, but that doesn’t mean the virus is done with you.