Tuesday, October 15, 2013

1800-1987: The rise and fall of polio

One of the neat things about the poliomyelitis virus is it basically hangs around for thousands of years, staying alive in random hosts, pretending it
doesn't exist, waiting for an ideal moment to wreak.  That moment arrives at the turn of the 19th century. 

Polio, therefore, is barely a threat to society prior to the 18th century, and is  basically ignored.  Yet once it started showing up as random epidemics in Europe and the United States, people started taking notice.  The search was on to find the causative agent, and a cure. 

Jo Nugent, in his 1987 article in The Rotarian, "The historic battle against polio," explains that the disease spreads rapidly in areas with poor sewage systems, so larger cities where sewage was dumped into the streets provided a haven for the virus.  Kids playing in the streets were in constant contact with the virus.  Once on a kid's finger, it was only a matter of time before the finger was set into a mouth.  The virus went to work. 

Nugent lists the following as the critical events in the evolution of the disease, and the quest to learn about it, and get rid of it (1, page 24):
  • 1789:  Michael Underwood makes the first clinical notation of the disease
  • 1801:  First recorded epidemic occurred in Scandanavia
  • 1807:  Swedish researchers note the disease "struck otherwise healthy youngsters, and not necessarily in the poorest population samples."
  • 1840:  German orthopedist Jakob von Heine makes the first clear description of the disease
  • 1887:  Oscar Medin of Sweden is the first to recognize it as a pandemic. He was the first to describe the pathogen as a virus.  
  • 1896:  C.S. Caverly observs polio also occurs in non paralytic forms
  • 1905:  Medin's pupil, Ivan Wickman, experiences the Swedish epidemic, and "concluded that the manner of transmission was person to person."  Christian Legaard confirms Cavalry's theory in a study of over 1,000 cases.  He describes that people with passive forms of the disease are spreading it to others
  • 1908-1911:  During the Swedish epidemic it's determined the disease rarely occurs in the same rural areas oftener than every five years, since the population develops immunity to the infection at an early age.  It's learned mortality is lowest in the 0-5 age group, and mortality rises with age. 
  • 1909:  Karl Landsteiner of Viena learns the virus can be isolated in a laboratory
  • 1911-1918:  Sister Elizabeth Kenny establishes a method of "moist heat stimulation and reeducation of muscles of polio patients.
  • 1921:  While Secretary of Navy, Franklin D. Roosevelt comes into contact with polio virus.  He becomes paralyzed, and this later has a major impact on his life, and on the lives of others inflicted with the disease -- for the better.  I will write about FDR's polio impact later.
  • 1929:  Philip Drinker and Louis Shaw invent the iron lung which saves many lives, and helps give birth to the respiratory therapy profession.
  • 1940:  Kenny's methods are adapted by U.S. physicians.  Her therapy is disputed by the American Medical Association. 
  • 1949:  Dr. John Enders and associates grow the polio virus in test tubes. The March of Dimes grants over $1 million for research at four universities
  • 1951: It's found there are three types of the polio virus: Bulbar, Spinal, and Bulbar Spinal
  • 1955:  Dr. Jonas Salk introduces the inactivated poliovirus vaccine (IPV). 
  • 1959:  Dr. Albert Sabin introduce the live attenuated poliovirus vaccine (OPV).  The IPV and OPV vaccines result in a stunning decline in new cases of polio. 
Since the introduction of these two vaccinations, there have been very few cases of polio in places where children have been inoculated.  There were minor epidemics in 1972 and 1979 in the United States, although these occured in areas where there was "low vaccination coverage," according to Nugent. 

However, while polio cases are basically nonexistent where people are given the vaccine, in developing areas of the world, where the vaccine is scarcely provided to children, polio continues to climb (at least as of the time of the article in 1987).  (1, page 48)

References:
  1. Nugent, Jo, "The historic battle against polio," The Rotarian, April, 1987, 24-26, 48-49

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