Polio

We are looking for Rukhsar Khatoon, the young girl with the last reported case of wild poliovirus in India, when we set out for Shahpara village, near Kolkata in the Indian State of West Bengal. It had already been a long day of monitoring a polio immunization campaign and as we walk on, we see groups of vaccinators, lugging “vaccine carriers” and notebooks, headed back to the health center where they started the day’s activities.

Rukhsar, the focus of our search, was just 18 months old when she was paralyzed by polio in January 2011. Although her two siblings received polio vaccinations, Rukhsar was often sick with diarrhea and despite encouragement from local health workers her parents had thought it was safer for her to avoid the vaccine.

We find Rukhsar’s father on the broad, cobbled path that runs through the heart of the village and he leads us to his home. He, like most others in Shahpara, is an embroidery worker who spends long hours creating intricate designs with colorful thread and beads, the famous zardozi work that adorns beautiful clothing worn throughout the country. More

In honor of National Infant Immunization Week (April 23-30), we’re highlighting diseaseson our blog  this week that are preventable by vaccination of infants. Polio is one of these diseases, and it has a remarkable background: it was scarcely visible through much of human history, was epidemic from the early- to mid-20th century, and is nearly eradicated today. The development of the polio vaccine was an important U.S. cultural phenomenon, involving the monetary contributions of millions of citizens, scientific breakthroughs by medical researchers, and the largest clinical trial ever conducted.

Few diseases frightened parents more in the early part of the 20th century than polio did. Polio struck in the warm summer months, sweeping through towns in epidemics every few years. Though most people recovered quickly from polio, some suffered temporary or permanent paralysis and even death. Many polio survivors were disabled for life. They were a visible, painful reminder to society of the enormous toll this disease took on young lives. More

Today's blog post is contributed by Dora Vargha, RutgersUniversity , Philadelphia Area Center for the History of Science Research Fellow.

The small airplane of the Swiss company Belair was already two and a half hours late, when it finally appeared above the skies of Budapest after 6 pm on July 13, 1957. A quite prestigious group greeted its West German pilot at the airport. The Communist party official shook the hands of the Western hero in the name of all Hungarian mothers, while experts from the Health Ministry and the National Public Health Institute inspected the cargo: a long-awaited shipment of polio vaccines. It had been a difficult summer with a record number of children becoming paralyzed with the disease, which caused growing concern since the beginning of the decade.

Polio epidemics hit Hungary more severely than ever before in the 1950s. Preceding World War II, poliomyelitis epidemics appeared usually every four years in Hungary, but as in many parts of the globe, outbreaks became more frequent and more deadly from 1952 and were perceived as a constant threat until 1959. Polio symbolized a destructive threat to the communist and modernist projects. It affected children in a war-stricken society, leaving crippled bodies behind at a time of heightened industrial production and recuperation from the war. The communist state, which positioned itself as a provider of free childcare and healthcare, was facing a serious challenge with the epidemic that worked against all of its ideals of production. Vaccinating the population in Hungary became a top priority soon after the vaccine became available. More

History of Vaccines blog readers have been sending us their recollections from the landmark 1954 trial of Jonas Salk’s inactivated poliovirus vaccine. We had posted several of their stories to our blog as comments on an earlier blog post, but they disappeared in a transition to our new website.

Recently, a kind blog reader saw our request for a photograph of a Polio Pioneer card. So we’re using this as an opportunity to post the photo and assemble the recollections of the Polio Pioneers and polio survivors who have written to us. Clearly, they all have vivid memories of their part in the trial, and most look back with pride on their contribution.

Mrs. K___ sent us a photo of the card (reproduced here) marking her participation in the trial. As Mrs. K____ wrote, "I remember lining up to get the shots. I thought I was in kindergarten, but it turns out I was probably in 1st grade. There were 2 lines. Some of the children got the real vaccine, and some got the placebo (we thought it was water). There was a series of three, so we always had to go on the line we were sent to. After the test was over our parents were told who had gottten the real vaccine and who had gotten the placebo. Lucky for me I had gotten the real because the children that did not get the real had to get the shots all over again. I was glad I didn't have to go through it again.” And, also from Mrs. K____, a bit later: “As I recall now, I remember there were three rows.  I just remembered the two rows because I wouldn't have had any thought of what the children in the third row had gotten (or not), so I just remembered the two rows. Now that I saw the picture, from Kansas, on your website, that was exactly what it was like.”

Indeed, Mrs. K____’s memories are probably correct: kindergartners were not enrolled in the trial. Children in grades 1-3 were included: in some communities, first graders received the injections, and in others, children in all three grades were vaccinated.

Mrs. K____ participated in the trial in Queens, New York, and was obviously enrolled in one of the vaccinated/placebo parts of the trial. (In some areas, community members objected to employing a control group that received injected placebos. Rather, these communities established observed control groups of children who did not receive any type of injection and who were simply observed for signs of polio infection.) More

A worldwide program to eradicate polio, the Global Polio Eradication Initiative, (GPEI) began in 1988. Since then polio has steadily disappeared from countries around the world, leaving only four with endemic polio by 2006: Afghanistan, India, Nigeria, and Pakistan.

Until polio is eradicated, however, all countries remain at risk for imported polio cases--especially those countries with low vaccination rates. In 2009, increased circulation of wild polioviruses in Nigeria led to imported cases and outbreaks in 12 countries in West Central Africa, three of which (in Mali, Mauritania, and Sierra Leone) continued into this year.

Recently the reintroduction of polio into the European region, which has been polio-free since 2002, has also become a concern. In June 2009, the European Regional Commission for the Certification of Poliomyelitis Eradication specifically identified Tajikistan as an area at high risk for polio transmission if wild poliovirus was introduced to the region, particularly because of low immunization rates. In April of this year, wild poliovirus type 1 was identified in stool specimens from individuals with acute flaccid paralysis cases in Tajikistan. As of November 1, 458 laboratory-confirmed cases of wild poliovirus type 1 had been reported in Tajikistan, with 26 deaths, of whom 15 were less than five years old. More

Mütter Museum Curator Anna Dhody describes the iron lung featured in the museum's new exhibit, Rarely Seen. This exhibit offers visitors a glimpse of objects that have  not been displayed for decades or are recent acquisitions that have never been exhibited. Some of the instruments represent the pinnacle of medical knowledge for their time, while others had mixed and sometimes detrimental medical results.

Many people remember when the threat of polio was omnipresent. Public pools and movie theaters were closed and parents lived in fear that their children could be struck down at any moment, unable to move or breathe. No one was safe: while the poliomyelitis virus affected mainly children, adults were also susceptible. The iron lung became one of the most iconic objects of the polio scourge, a symbol of the epidemics of the 1940s and 50s. More

A global effort to eradicate polio began in 1988. At the time, the disease was endemic in more than 125 countries; by 2006, only Afghanistan, India, Nigeria and Pakistan still saw endemic polio transmission. Still, despite this progress, the disease has stubbornly refused to disappear completely.

The Center for Vaccine Ethics and Policy blog took note this week of a Lancet Infectious Diseases article titled "Reflection and Reaction: Reconstructing the past of poliovirus eradication efforts". The blog post suggested that a review of the eradication initiative’s historical record, and a more cautious outlook toward its potential outcomes, might be wise.

This post was unfortunately coincidental with news of expanding polio outbreaks in Africa. The World Health Organization (WHO) announced on Friday, October 1 that a continuing outbreak of polio in Angola must be stopped to prevent “international consequences.” The disease is spreading not only within Angola but also into the Democratic Republic of Congo. It is the only expanding African outbreak of the disease, and puts the continued progress of the eradication program at risk. More

Here at The College of Physicians of Philadelphia, our own Mütter Museum is preparing an exhibit entitled Rarely Seen: Hidden Collections of the Mütter Museum. Visitors will have the chance to see some rarely or never before seen items. Too large to display in the permanent museum galleries, these fascinating objects will briefly have a home in our temporary exhibit space.  Of particular interest to the History of Vaccines project is an iron lung manufactured by J.H. Emerson Co. as well as  a bacterial incubator used by Robert Austrian, MD, a pioneer researcher in pneumococcal disease and developer of the polysaccharide pneumococcal vaccine. This exhibit will be on display from October 2010 through January 2011.

Over the next few days we’ll post more pictures of the iron lung along with the tale of how it came to the Mütter Museum. More

On April 13, The New York Times reported on promising results in global efforts to eradicate polio. Eliminated from endemic spread in the Americas in 1991, polio persists in other areas, particularly in India and Nigeria.

The World Health Organization reports that recorded polio cases are down 75% this year from the same period a year ago. Muslim leaders in Nigeria have begun to support vaccination campaigns, a sharp reversal from earlier claims that vaccination programs had secret aims of sterilizing the population or spreading HIV. And vaccination efforts have focused on remote regions in India, where polio vaccination coverage had been poor.

The Times quoted D.A. Henderson, MD, former director of the World Health Organization’s Smallpox Eradication Programme, on the possibility of polio eradication. Henderson, whom we interviewed a short time ago,  seemed encouraged by the new figures, but also called attention to the dangers of polio infection from vaccine virus types. (In 1 in every 2.5 million oral polio vaccine recipients, vaccine-derived poliovirus can mutate to a virulent form. And, in areas with low vaccination coverage, circulating vaccine-derived polio viruses from OPV have led to polio outbreaks and even deaths. See a WHO information sheet for more on this topic.) More

Were you a polio pioneer, or are you related to someone who was? We’re looking for people who participated in the groundbreaking trial for Jonas Salk’s killed-virus polio vaccine in 1954.

We’d love to talk with you about your experience. We’re also hoping to get photograph of a Polio Pioneer card, a card given to children for participating in the first national tests of a trial polio vaccine conducted during 1954. (For reference, see a photograph of a Polio Pioneer card on the Smithsonian National Museum of American History’s excellent web exhibit on the history of polio vaccine development.) Email us at vaccines@collegeofphysicians.org to let us know about your experiences as a Polio Pioneer. More