“A short journey through Infantile paralysis”

"That was a disease which disabled thousands of young life's across the globe, leaving them as a 

Painful reminder to the society, hence for a time it was called as infantile paralysis. "

This is nothing but Poliomyelitis often called polio or infantile paralysis, is a crippling and potentially Deadly infectious disease caused by a virus that spreads from person to person invading the brain and Spinal cord and causing paralysis.¹

History:

An Egyptian carving from 1300 BC depicts a man with crippled leg similar to the one caused by 

polio, this indicates that, polio has plagued humans from thousands of years.

               

The first clinical description of polio was given by Dr. Michael Underwood in his work “Debility of lower Extremities" in 1789.

Poliomyelitis was first recognized as a distinguished condition by Jacob Heine in 1840.³

Contagious nature of polio virus was identified in 1905 after a series of polio epidemics in Sweden.⁴

Three years later in 1908 Karl Landsteiner, and Erwin Popper discovered that infectious agent in Polio Was a virus, and is called as polio virus which is an enteric pathogen

Who are effected???

 Polio can strike at any age, but is more prevalent in children under the age of five. ⁵

How it enters ???

Transmission – two routes of transmission

Fecal- oral is an intestinal source and oral-oral is an oropharyngeal source.

Pathophysiology –

Polio virus which entered the body, if never extends beyond the small intestine, it will not cause any apparent damage. If it enters the blood stream, it will then target the nerve cells and cause serious damage

 Symptoms –

Most infected people (90%) have no symptoms or very mild symptoms and usually go unrecognized. In others, initial symptoms include fever, fatigue, headache, vomiting, and stiffness in the neck and pain in the limbs. 

Moderate to acute conditions –

 Headache, vomiting, fever, and stiffness of the back or legs. Less than 1% of polio patients, about one in two hundred infections, result in paralysis. 

Why is it a Public health problem?

Polio survived as a quite endemic pathogen until 1800’s.

First ever documented Polio epidemic occurred in 1894 in Rutland County, Vermont, United states of America.

 Small localized paralytic polio epidemics began to appear in Europe and the United States around 1900. 

By 1910, much of the world experienced a dramatic increase in polio cases and epidemics became regular events, primarily in cities during the summer months.

In 1916 New York City polio epidemic was reported, which took the lives of about 6,000 people, leaving about thousands more paralyzed. 

Summer epidemics became common in this era and would lead to widespread in areas like, closures of Pools, amusements parks, and other places where children gathered. 

In 1952 there was a worst polio outbreak in the United States history. 58,000 cases were reported That year, among them 3,145 died and 21,269 were left with mild to disabling paralysis.

All these epidemics heightened parents’ fears of the disease and an immediate need for a vaccine Urged worldwide.

Eradication:

An enormous fundraising effort called "March of dimes" raised tens of 1000's of dollars, much of which went to the effort to find a vaccine.

 Researchers were working hard to explore about the causative organism, etiology of this disease and cure. Some studies were successful giving more details about the polio virus and strains, whereas as some studies were disastrous killing innocent children, on whom the then supposed vaccine was tried.  

Finally in 1955 Dr. Jonas Salk  developed the first safe and effective polio vaccine from inactivated or dead polio virus, with the support of the March of Dimes.

“Safe, effective and potent “

With these words Dr Jonas Salk is declared a hero and hailed as

“The man who saved children”

Albert Sabin in 1957 developed a vaccine using attenuated polio virus which was licensed in 1962.

They were a tremendous success, the average number of polio cases in the U.S before the discovery of vaccine was more than 45,000. By 1962, that number had dropped to 910. 

Lameness survey between 1970 to 1980 demonstrated that polio is widespread in many developing countries, which gave birth to  "Global eradication of poliomyelitis"

Epidemiological patterns:

The epidemiological pattern of polio depends upon the degree of the socioeconomic development and health care services of a country.

The pattern of the disease has been considerably modified by widespread immunization.

According to the WHO-

Three epidemiological patterns have now been delineated:

Countries with no immunization: the virus infects all children, and by age 5 years almost all children develop antibodies to at least one of the 3 types of polio virus. In that pattern paralytic polio cases are frequent in infants.

Countries with partial immunization: In these countries, wild polio virus is largely replaced by vaccine virus in the environment.

Countries with almost total immunization coverage: in these countries polio is becoming rare, however, sporadic cases do occur rarely

Global eradication of poliomyelitis !!!!

 Established in 1988, it is a public-private partnership led by national governments and spearheaded by the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC), and the United Nations Children’s Fund (UNICEF). Its goal is to eradicate polio worldwide.

Achievements:

Huge achievements have been made in the global fight against polio since 1988.

The number of polio cases worldwide has decreased by more than 99%, from 350 000 in 1988 to less than 2000 cases in 2009 and to less than 1000 cases today. 

1994- The WHO Region of the Americas is certified polio-free

2000- The WHO Western Pacific Region is certified polio-free

2002- The WHO European Region is certified polio-free.

2011- India is certified polio free

 The number of endemic countries has decreased from over 125 in 1988 to just three –

Afghanistan, Nigeria and Pakistan by the end of 2011.

Challenges:

Tackling the last 1% of polio cases in endemic countries is proving to be difficult and expensive.

Each country offering unique challenges like Conflict, political instability, hard-to-reach populations, and poor infrastructure, to eradicating the disease. And this is the biggest challenge before us right now ...

As as a result, a long term strategic plan is designed, to address, “what is needed to deliver a polio free world by 2018" (2013-18)

Hope we succeed in ending this game by 2018 and save those innocent lives, which are still in danger, and waiting for our help!!!! 

REFERENCES

1 Centers for Disease control and prevention http://www.cdc.gov/polio/about/

2 What is polio http://whatispolio.weebly.com/history.html?

3 Poliomyelitis http://en.wikipedia.org/wiki/Poliomyelitis#Epidemiology

4 The history of vaccines http://www.historyofvaccines.org/content/timelines/polio

5 Polio and prevention http://www.polioeradication.org/Polioandprevention.aspx

6 Progress http://www.polioeradication.org/Aboutus/Progress.aspx