polio outbreak - Page 2

[caned & able]

never mind

[ema-adama]

I think the issues are complex.

, of course they are.

If I was living in an area where polio is endemic I would be upset if my child was vaccinated with OPV (monovalent or trivalent) in a public health surge to contain an outbreak. I just do not see it as simple as polio = scary disease. Take the vaccine and all will be well.

I understand that polio is a disease that scares many people, and in it's worst form it is indeed a very scary disease and not something parents or health professionals want to be facing. I have been speaking with family members who came from Eastern Europe and 50+ years ago, where paralytic polio was a dread disease and there was very little that was done for children who had serious cases of the disease. Families were torn apart my the disease.

However, eliminating wild polio virus does not mean that parents and health professionals no longer are faced with children with Acute Flaccid Paralysis (AFP). Polio is not the only virus to cause AFP. In the first link put up, 706 cases of AFP were reported, with 458 of them identified as polio. That leaves 248 cases as presenting as polio (AFP) but being caused by something else. These children would have had AFP regardless of their vaccine status for polio. Pointing to there being more that needs to be done in the way of public health and preventative measures to keep young children healthy.

I do not think the polio vaccine is useless. I am quite sure that it is not nearly as effective as it is claimed to be. The change in diagnostic criteria (for whatever reason) does mean that comparison of pre and post vaccine figures is useless. (Not only in the USA, also here in Israel there was a similar reclassification in diagnosis). The graphs that show very dramatic declines in disease incidence associated temporally with the vaccine are unreliable. This does not mean that the vaccine is useless (I am repeating myself). It does mean that whoever is relying on a graph that is based on disease incidence with one set of diagnostic criteria prior to the introduction of the vaccine, and another set of diagnostic criteria that significantly reduced the numbers post vaccine, is on very shaky ground. I have not been able to track down the numbers from the 1950's in the USA, and I suspect that everyone is taking the numbers on faith, unless someone can dig them up of course.

I have not been convinced that eradicating WPV will eradicate AFP. I most certainly would not wish any parent to go through watching their child with AFP (whatever the cause). In my mind, understanding AFP is as important as understanding polio.

On OPV viruses mutating. It is not just in unvaccinated populations. Immune compromised individuals also present a reservoir for the virus to mutate and then spread. And without testing the entire populations for polio, there is no way of knowing to what extent it is present in the community. The case in the Amish child who was found to be carrying polio virus, with no clinical symptoms is indicative of this phenomenon in my mind. If all vaccinated and unvaccianted children were screened for polio, we might have more accurate information to look at. However, that is never going to happen. We know that vaccinated does not been immune.

The reasons why this news does not make me rush to the clinic for a polio vaccine are varied and, uh, complex. In short, I do not think that the vaccine is without it's own risk and I do think that the chance of my child (specifically) developing a serious case of polio is highly unlikely. Not impossible, but very very unlikely. I also do not think it is my responsibility to shoulder the risk of the vaccine for a public health policy that IMO is not addressing the core issue of AFP as opposed to polio.

I see a similarity between HiB and polio presentation. Both are very very scary diseases when they present in their most serious form (bulbospinal polio or HiB meningitis). And yet these presentations of the disease are not representative of the disease in the whole population. It is a very small number of exposed individual who go on to develop such serious complications. Polio vaccine does not eliminate the risk of AFP. HiB vaccine does not eliminate the risk of meningitis.

Of course, I expect my opinion to be in the minority and to not be accessible to many people.

[EdnaMarie]

I also do not think it is my responsibility to shoulder the risk of the vaccine for a public health policy that IMO is not addressing the core issue of AFP as opposed to polio.

1. Polio need not be the only cause of AFP to be a major cause that needs to be addressed. You want to ignore it until we can solve AFP across the board, forever?

2. You aren't the only one shouldering this responsibility, you know. All of us who can, and who feel obligated to protect the weak and infirm, are shouldering it with you.

I think it's incredibly callous to say that, "Well, people will die and be paralyzed anyway, and besides, why should I risk my kids to help the weak when it's not a perfect process? They might die anyway!"

Yes, it's unlikely that any given polio case will lead to AFP.
It's VERY unlikely that your healthy kids will get polio (though possible).
It's also VERY unlikely (one in a million) that your kids will get sick from the OPV.

We know for certain that every person who does not vaccinate increases the risk to the weak and infirm that cannot be vaccinated.

Of course it's your job. If you want to live depending completely by yourself, 100% off the grid, go ahead. Let me know when you all finish the road to the middle of the forest--without using a bulldozer built in Germany, or petroleum mined in the Indian Ocean, natch. My feeling is, we all benefit greatly from thousands of years of urban development and human civilization and science ('specially if you're on the Internet... this isn't a SatPhone using your own satellite, is it?), and we should appreciate that and be willing to suck it up and take one for the team.

[ema-adama]

Originally Posted by EdnaMarie

1. Polio need not be the only cause of AFP to be a major cause that needs to be addressed. You want to ignore it until we can solve AFP across the board, forever?

I do not think it is necessary to ignore polio. I do think it is problematic that there is a general perception that the eradication of polio means an end to AFP. And I think it would be prudent to be identifying risk factors for developing AFP other than polio vaccination status.

2. You aren't the only one shouldering this responsibility, you know. All of us who can, and who feel obligated to protect the weak and infirm, are shouldering it with you.

In the country where I live, IPV is the polio vaccine of choice. From my understanding, this vaccine primarily protects the vaccinated individual. It is not as effective at preventing the transmission of the virus as the OPV, making it not a very strong public health tool for protecting weaker members of society.

I think it's incredibly callous to say that, "Well, people will die and be paralyzed anyway, and besides, why should I risk my kids to help the weak when it's not a perfect process? They might die anyway!"

I did not say that. You have interpreted my post to say that. As I mentioned, it is complex. If we were talking about OPV instead of IPV, there is more to discuss with public responsibility. And also more to discuss with risks. However, both in Israel and the USA IPV is the vaccine of choice, making the issue of public health less central to this discussion. OPV of course is very relevant to the discussion of what is happening in the article posted in the OP.

Yes, it's unlikely that any given polio case will lead to AFP.
It's VERY unlikely that your healthy kids will get polio (though possible).
It's also VERY unlikely (one in a million) that your kids will get sick from the OPV.

I would only adjust the 2nd sentence, to it being very unlikely that a healthy child would develop clinical polio when exposed. I am quite sure an unimmune (whether they had never been exposed via a vaccine or WPV or mutated vaccine virus) child would get polio if exposed. The question is whether anyone would even notice. It's been a while since I read the frequency with which the OPV results in paralysis of the vaccinated child or any caregivers or people in their community. I am not sure that it is 1 in a million, but do not have the time to look up a different statistic right now.

We know for certain that every person who does not vaccinate increases the risk to the weak and infirm that cannot be vaccinated.

Are you referring to IPV or OPV?

Of course it's your job. If you want to live depending completely by yourself, 100% off the grid, go ahead. Let me know when you all finish the road to the middle of the forest--without using a bulldozer built in Germany, or petroleum mined in the Indian Ocean, natch. My feeling is, we all benefit greatly from thousands of years of urban development and human civilization and science ('specially if you're on the Internet... this isn't a SatPhone using your own satellite, is it?), and we should appreciate that and be willing to suck it up and take one for the team.

I do not make the jump from benefiting from science and technology to being required to use a vaccine. I do not see why it is contradictory to use my laptop with high speed internet and choose not to vaccinate with the IPV.

[Otto]

Originally Posted by ema-adama

It's been a while since I read the frequency with which the OPV results in paralysis of the vaccinated child or any caregivers or people in their community. I am not sure that it is 1 in a million, but do not have the time to look up a different statistic right now.

The highest VAPP estimate I've seen was 2-4 per million, perhaps only counting the first dose. The order of magnitude is basically correct, though.

The annual incidence of VAPP in European countries, according to the WHO, is 0.4-3.0 per million vaccinated children. In the U.S.A., an estimated risk for VAPP ranged from 1 case per 2.5 million doses of OPV distributed in 1980-89 to 1 case per 3.2 million doses distributed in 1973-84. ... The over all risk for VAPP is approximately one case in 2.4 million doses of OPV vaccine with a first dose risk of one in 750,000.

(Footnotes omitted; refererence here.)

[bbrandonsmom]

According to some research, it's treatable. I still wouldn't get the vax, even if an outbreak was near us.
I know some one will ask, so look into Sodium Ascorbate + Polio + Dr Levy. Inside Vaccines has some terrific info on Polio as well.

[EdnaMarie]

Brandon'smom- Of course it's treatable.

It's called an Iron Lung.

In our family, we avoid that.

[CherryBomb]

Thank you, EdnaMarie, I appreciate your posts and your ability to articulate what I can't (without getting ragey and incoherent!)

[JudiAU]

I think it is terrifying and so sad. DH's had polio and the disease really limited his options in life.

[shanniesue2]

OP here...
this is turning into and interesting and educational thread for me... I haven't added a whole lot to it because I'm still learning so much and often feel like my level of knowledge is inadequate compared to some of the people on this board. Anyway, I appreciate all the dialogue! Keep it coming!

P.S. just to clarify in response to one poster... when I said "vax questioning" population, I wasn't refering to people who are anti-vax or who are doubtful of the efficacy of vax... I was referring to a population of people who ask lots of questions and do lots of research before coming to a decision about vaxing. So, I'm just as interested in the opinions of people who came to the conclusion that vaxing is effective and the right choice for them as I am in the people who came to the conclusion that vaxing is either ineffective and/or not the healthy choice for their family.

[Lisa1970]

I have given up most vaccinations but not the polio. I just feel that is one of the original ones and least likely to give a problem and we travel a little bit so it is possible we would come in to contact with something. The disease is devastating enough that we did it.

That being said, I would never tell someone else they should get the polio shot as it is so highly unlikely, I mean, almost impossible, for a person living in the US to get the disease. Even if I personally do not know of complications from the shot, there probably are some and the shot still involves the injecting of chemicals in to a child's body.

[pregnant@40]

Originally Posted by mamadelbosque

I'd call that expected. Honestly, IMHO polio hasn't gone away. We've just renamed it: aseptic meningitus. That disease did not exist pre-vaccine. After the vaccine they *CHANGED THE DEFINITION OF POLIO*:

Pre-1954:
Signs and symptoms included:
~ Partial or complete paralysis of one or more muscle groups
~Paralysiss detected on two exams 24 hours apart.

After 1954
Signs and symtpoms included:
~Residual paralysis at 10-20 days and again at 50-70 days after onset of illness.

So, what was once lumped in with "polio" we now call aseptic/viral meningitus. It hasn't gone away. We just call it something different. Polion never went away in the US or anywhere else, We just renamed it. Elsewhere they still test for the polio virus. 95-99% of cases of polio were *always* asymptomatic of paralysis (ie was just a cold). So, tbh, it could easily still be circulating in the US too. We just don't bother to test for it and call it viral/aseptic meningitus.

Polio is caused by a specific virus, poliovirus. Aseptic meningitis is a generic term that can be applied to many different causes, and did not just suddenly appear w/ the polio virus!

[ema-adama]

Originally Posted by Otto

The highest VAPP estimate I've seen was 2-4 per million, perhaps only counting the first dose. The order of magnitude is basically correct, though.

(Footnotes omitted; refererence here.)

Thanks for that.

Originally Posted by EdnaMarie

Brandon'smom- Of course it's treatable.

It's called an Iron Lung.

In our family, we avoid that.

I am not sure if you are insinuating that all cases of polio end up in iron lungs, but that is most definitely not the case. It does happen, but the vast vast majority of infected persons do not end up in an iron lung.

Originally Posted by CherryBomb

Thank you, EdnaMarie, I appreciate your posts and your ability to articulate what I can't (without getting ragey and incoherent!)

I think there is much that can be discussed without becoming incoherent. The issues are not always straightforward, and questioning the assumption that the vaccine is always preferable does not mean that the reality of the disease is dismissed. I do think it is important to address issues like whether the IPV is the vaccine of choice when it comes to creating herd immunity in a population with no circulating WPV and no use of OPV.

[EdnaMarie]

Originally Posted by ema-adama

Thanks for that.

Too bad it is:

(a) not double-blind;
(b) not a placebo trial;
(c) has no control group;
(d) is far too small to prove anything, since at worst polio will lead to paralysis (temporary) in 1/200 people, and that only has 60 people which is not only not statistically significant, it's not even interesting.

Same goes for the rest of his anecdotes and experiments.

I am not sure if you are insinuating that all cases of polio end up in iron lungs, but that is most definitely not the case. .

I was not. When polio does end up needing treatment, it's often of that type. 1/1000000 vs. 1/1000... tough choice

[bbrandonsmom]

As far as IPV vs OPV for herd immunity, this may be of some use? They do speak about using one where WP is prevalent vs if it is not. http://www.abtassociates.com/reports...7280_88928.pdf

I think understanding the disease necessary. As a pp mentioned, a vaccine is not a 100% fix. What about those children who get the Polio vax and then have either a confirmed case of Polio, or a case of AFP? What's causing the AFP? Sure, the doctors might heave a huge sigh that it's not Polio, but you still have to deal with it.

[bbrandonsmom]

Originally Posted by nicky85

Even in third world countries where polio vaccination is well under way, polio continues to be epidemic. This was an interesting article in the Wall Street Journal: (http://online.wsj.com/article/SB1000...239615022.html) Bill Gates' polio vaccination efforts haven't led to an eradication of the disease. They really need to focus on clean water and sanitation first.

Here's an interesting tidbit-and if you look up Uganda Genocide + OPV you'll find more.
Immunosuppressed individuals should not take the Oral Polio Vaccine, and should avoid contact with persons who have received the Sabin vaccine for two weeks post vaccination. This includes people with AIDS, HIV infection.... Should vaccination against polio be deemed necessary for these individuals, they should be vaccinated with IPV.

Hmm, exactly a lot of the population where they are using OPV. So my take, is even if the outbreak the op was referring to is WP, you can still be exposed to the OPV strain, right?