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Health Matters

Return of polio concerns experts

Recent headlines out of New York City grabbed international attention. The discovery of a confirmed case of polio in an unvaccinated adult along with detection of the virus in sewage could indicate a larger outbreak is underway. To many Americans, polio is a forgotten disease, something relegated to the history books. But in those few countries where it remains endemic, children and adults alike can be seen out on the street with the characteristic deformities particular to polio.

As many are aware, polio is a viral disease caused by, of course, the poliovirus of which there are three types that cause human infection. Most people who are infected with the virus will have no symptoms, which occurs about three-fourths of the time. Another roughly 25 percent of the time, they are that of a common flu, with aching and fatigue. Both of these groups are those who have no involvement of the central nervous system.

When there is, paralysis is the result. An essential question is what muscle or group is affected. When the diaphragm is affected, breathing may be impaired. The deformities that can be seen with polio are the result of this muscle paralysis phenomenon. When it develops in an extremity of an infant, the muscle group opposing the paralyzed one will overpower the joint, pulling the limb, and the bone, out of position. A significant deformity can result.

This virus is highly contagious, and noticeably more common in under-developed countries with inadequate sanitation. When someone is infected, viral particles are released in their waste matter, exposing someone else downstream (quite literally). They are then transferred to the mouth via unwashed hands or ingested in contaminated food and drinks. Poliovirus particles can survive in soil and water for months.

Polio epidemics started sometime around the latter part of the 19th century, but it is an ancient disease. An Egyptian tablet from 1500 BC depicts a figure with a deformity characteristic for polio. Polio was a common cause of paralysis in children prior to the development and deployment of safe and effective vaccines in the mid-20th century. Documented cases of poliomyelitis, the technical name for this illness, have become exceedingly rare. This is true primarily thanks to worldwide vaccination efforts. These have been so successful that polio was felt to be eliminated in most countries, with some experts theorizing polio could be completely eradicated.

Unfortunately, when people stop getting vaccinated, polio can return. And the reports out of New York give some weight to these concerns. The recent discovery of a case of polio in New York has the CDC contemplating additional boosters for children and the immunocompromised. Fears are high in London as well, after confirmation of an individual with polio, the first in 40 years. Consequently, London officials have also recommended additional boosters of the vaccine.

Those who are not vaccinated are most at risk. 99 % of the children who have completed immunization are protected from the disease. Those who travel to or live in an area where polio hasn’t been eliminated are at greater risk, with outbreaks identified in Pakistan, Afghanistan, and parts of Africa. Similarly, those in an area with poor sanitation also should be concerned. Younger children are considered more susceptible to polio for various reasons.

Pertinent to this discussion is the nature of viral organisms. Can they truly be considered living creatures? In the late 1800’s, researchers thought viruses were the simplest of all life-forms but that changed in 1935. Researchers developed a technique allowing them to visualize the make-up of a viral particle. They noted it consisted of a package of complex biochemicals but lacked the essential systems necessary for the biochemical activity of life.

For nearly the last century, scientists have repeatedly waffled on the topic of viruses and whether they are life forms. Historically, we thought of them as simply poisons, then as truly alive, then simply as biological chemicals. Current thinking places them in a gray area between living and nonliving since they cannot replicate on their own. They require a living cell to invade, hijacking the cells internal machinery to replicate the virus.

This brings the conversation to the topic of treatment (which some might consider more important than the nature of the disease.) For the most part, there are none. Other than a few select infections, we have no antibiotic, no medicine that will “cure” the disease. All we can do is treat the symptoms, hoping to lessen the suffering or discomfort. Our therapies for most viral diseases are supportive. Once the virus has been transmitted and the infection has developed, we have no means of ending it.

This limitation is inherent in the nature of viruses. Because viruses enter our cells and hide inside, our currently available drugs do not recognize the presence of the virus. The viral particles remain hidden inside cells, taking over the machinery of the cell. Once there, we can only wait for our body’s innate immunity to vanquish the infection. Our only effective approach is prevention, achieved through the administration of a vaccine.

We have a greater appreciation now for the fundamental role viruses have played in the history of life on Earth. Because of their dependence on host cells, viruses lead a borrowed life. They cannot reproduce on their own. And vaccines remain the only substantial deterrent to their spread. The concept of vaccination, and their practice, has been successfully utilized to fight all these deadly and dangerous viral diseases since their development.

The production and disbursement of the different Covid vaccines was a tremendous success for modern virology. How or why a deadly disease became a political debate is one for the sociologists to discuss. To physicians even moderately knowledgeable on the topic, vaccines remain the only effective prevention for the deadly contagion that is polio, as well as every other viral infection known to man.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula. Dr. McLean’s practice, Superior Foot and Ankle Centers, has offices in Marquette and Escanaba, and now the Keweenaw following the recent addition of an office in L’Anse. McLean has lectured internationally, and written dozens of articles on wound care, surgery, and diabetic foot medicine. He is board certified in surgery, wound care, and lower extremity biomechanics.

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