One of the Great Medical Feats of the 20th Century, Research Paper Example

Any student of American history who has seen pictures of President Franklin Roosevelt in his wheelchair or standing behind a podium propped up on metal braces to help him ambulate, has seen what havoc polio is capable of wreaking on the human body. What many people in the present generation do not realize is how widespread and feared this disease was even here in America or what a massive undertaking the government took to vaccinate our people against this awful condition. This paper explores the disease in regards to its epidemiology, severity and clinical signs and symptoms, then goes on to explore the diagnosis, treatment and prevention of this condition. Due to the historical and present-day significance of vaccination in regards to this disease, much emphasis will be placed on the role that vaccination has played in the fight against the poliovirus.  The paper will then conclude with a discussion of current trends in the ongoing efforts in polio research and eradication.

Polio: Epidemiology, Severity, Clinical Signs and Symptoms

The virus which causes the polio disease is an enterovirus and belongs to the family Picornaviridae; this family of viruses is characterized by “icosahedral symmetry, small size…and absence of an envelope” (Bingham & Dowdle 286).  This virus is able to live in the gastrointestinal tract of humans despite the low pH in that particular bodily system (Center for Disease Control 1). It generally enters the body through the oral route and from there is can infest multiple sites in the gastrointestinal tract, including the oropharynx, the tonsils, the lymph nodes and the small intestines (Bingham & Dowdle 286). From the gastrointestinal tract, the virus can  then be carried on through the bloodstream to the central nervous system and infect it. When the virus comes into contact with the cells there and infects them, they take over the cell’s reproductive processes and are able to replicate themselves quickly (Smithsonian Institute 2).  This infection can affect the spinal cord (called spinal polio), the brainstem (called bulbar polio) or both together (this is known as bulbospinal polio) (Mayo Clinic 4).

One of the most important characteristics of the polio virus is that it is highly contagious. Epidemiologically, most cases are transmitted through oral secretions or “from fecal contamination of hands, eating utensils, food or drinking water” (Bingham & Dowdle 287); in other words, it is transmitted from the oral-oral or fecal-oral route.  It is so contagious, in fact, that people living in the same household or who are caring for an infected person are likely to contract the infection themselves (Mayo Clinic 7).  Persons infected are most contagious for a period of 7-10 before, then 7-10 days after the onset of symptoms, but the polio virus may be present in the feces for a matter of several (usually 3-6) weeks after that, and can still spread the infection to others during this time period (Center for Disease Control 5).

Because this virus infects the motor neurons of the CNS which control the limbs and trunk, as well as functions such as breathing and swallowing, there is a whole range of symptoms associated with this disease (Smithsonian Institute 3).  Curiously, 4-8% of patients who are exposed to the polio virus have what is known as abortive poliomyelitis and can expect to recover completely, usually in under a week.  The three groups of symptoms which clinicians look for in these cases are: gastrointestinal disturbance, respiratory infection and vague, flu-like symptoms like body ache and general malaise (Center for Disease Control). In most cases, though, recovery is not so simply and the symptoms which patients traditionally present with are based on the severity of the polio infection, which ranges from the relatively mild non-paralytic polio to the most severe paralytic polio (Mayo Clinic 3). Non-paralytic polio patients often present with a range of flu-like symptoms that can include pain and/or stiffness in the neck, back or limbs, sore throat, unexplained tiredness, and weakness; paralytic polio patients, on the other hand, can present with severe muscle and joint pain/weakness, loss of reflexes, and even meningitis (Mayo Clinic 5). In approximately one out of every 200 cases of the paralytic polio, the paralysis is permanent and irreversible. It has a mortality rate of between 5 and 10% due to the shutting down of the muscles which aid in respiration (World Health Organization 2).

Another cause for concern is the post-polio syndrome which can affect people for years or decades after they have been exposed to the polio virus.  This can last for years or even decades after someone has been exposed to the poliovirus.  Symptoms of this syndrome can include muscle weakness or even atrophy, pain, swallowing and respiratory problems, cognitive difficulties, depression, and intolerance to cold (Mayo Clinic 5).

The next section in this paper deals with the diagnosis, treatment, and prevention of polio.

Diagnosis, Treatment and Prevention of Polio

Diagnosis can be made due to the clinical signs and symptoms which the patient presents with.  Also, swabs can be taken from the throat or samples take of a patient’s feces or cerebrospinal fluid to test for the presence of the poliovirus. (Mayo Clinic 3).  If, however, the polio virus is found, further testing must be done, including “fingerprinting” or genomic mapping to determine if the “the virus is ‘wild type’ (the virus that causes the disease) or ‘vaccine type’ (a virus that could be derived from a vaccine strain)” (Center for Disease Control 6).  There is no known cure for polio.  Treatment consists of rest, the administration of pain relievers, good hydration, physical therapy if indicated to prevent muscle wasting, and a nutritious diet (Mayo Clinic 4). Historically, treatments have also included braces due to the subsequent muscle weakness of polio, and children who suffered from respiratory problems were put into iron lungs back in the 1950’s (Gilbert 1).

The single best way to prevent polio is through vaccination.  It is recommended that children be given a series of vaccination shots at 2 months, 4 months, 6-18 months, and again between the ages of 4-6 years before entering school.  (Mayo Clinic 6).  The history of polio vaccination is an incredible story of one of the most important medical breakthroughs in the 20^th century.  Outbreaks of polio had been reported in the US since 1843 but by the 1950’s they had reached epidemic proportions which peaked in 1952 with some 21,000 reported cases (Center for Disease Control 4). This disease caused panic in the communities affected, particularly as knowledge about transmission was vague: schools and public facilities like swimming pools were closed, and many hospitals refused to admit polio patients due to contagion, forcing them to be treated at home, although some children with polio-related respiratory difficulties had to be put in iron lungs (Gilbert 1).  People were panicked that their community would be next, and money flowed to the National Foundation for Infantile Paralysis (known later, more famously, as the March of Dimes) to fund research to help end this terrible condition.  (Gilbert 1).

It was in 1955 that Dr. Jonas Salk made his ground-break invention of a polio vaccine, which helped to bring incidents of polio in the United States from approximately 20,000 a year in the 1950’s to about 1,000 in the early 1960’s.  Then, in 1961, Dr. Sabin came along with his invention of his oral polio vaccine; beginning in 1963, the oral vaccine was used in a mass campaign and by 1979 transmission had stopped in the United States. (Gautam 1).

Vaccinations, however, are something that people in the developed world can sometimes take for granted; this vaccines have not always been available to people in the developing world with the result that many people, who are already living below the poverty level and with little access to good medical care, have also suffered greatly from this disease.  The World Health Organization has tried to change that.  In 1988, at its 41^st World Health Assembly, the WHO began its Global Polio Eradication Program, a cooperative effort with governments and non-governmental organizations (NGO’s) like the Rotary Club and the Center for Disease Control with support from private organizations like the Bill and Melinda Gates Foundation.  The results have been astounding: since 1988, when this initiative was first launched, cases of polio worldwide have gone down by 99%. (World Health Organization 5).

Current Trends

In regards to current trends for polio treatment and prevention, there is both good news and bad news.

The good news: The WHO’s eradication program led to the Americas to be declared a “polio free” zone in 1994; Europe followed in 2002.  This year, however, marked a major advancement towards the goal of polio eradication: the Southeast Asia zone, a band of 11 countries from India to Indonesia, has just been declared polio free, which means that some 80% of the world’s population now lives in a certified polio free zone (World Health Organization).

More good news: Last year, a study came out in the New England Journal of Medicine that was done in Cuba and found that for 90% of babies studied, two fractional doses of IPV given on schedule could induce seroconversion; this could potentially reduce the cost of vaccination from the current $6 per dose down to $1.20 per dose (Resik, et. al. 423).  This would mean that the same amount of funding for polio vaccinations would go further than it has before, and help get even more children immunized.

The bad news: despite the massive efforts of the World Health Organization, three countries still remain polio endemic: Afghanistan, Pakistan and Nigeria (World Health Organization 2). Also, the continuing conflict is Syria is having a negative impact on the spread of this disease: Iraq has just reported the first case of polio in 14 years. A baby living in Baghdad was confirmed to have this disease, and it was found to be of the same strain as cases that have recently been reported in Syria, particularly in poor, rebel-held territory along the border with Iraq.  These cases in Syria, in turn, are apparently being brought there from Pakistan (again, this is one of only three polio endemic countries left) (Arie 212).

In conclusion, the poliovirus has caused a lot of misery in human history, both here in the United States and all over the world. It is a highly contagious enterovirus that is easily spread from the infected person to others and its effects can be devastating, even deadly, with symptoms like pain, paralysis, difficulty breathing or swallowing and even death. While there is no known cure, and the treatment is basically symptomatic, however, the good news is that the disease can easily be prevented through vaccinations. Due to the ground-breaking work of men like Salk and Sabin, and the efforts of the World Health Organization, the majority of the world’s population now live in “polio free” zones, with only three countries now polio endemic. Research is underway to make these vaccines more cost effective and thus increase the chance of more children receiving this important medical treatment. However, because of conflicts like those in Syria, this eradication program will still likely have continuing challenges in its future and the fight against this serious viral infection is far from over.

Works Cited

Arie, S.  “Polio Virus Spreads to Iraq”.  British Medical Journal.  2014. 348(24). 212-216.

Bingham, M.& Dowdle, W. “The Biologic Principles of Poliovirus Eradication”.  Journal of Infectious Diseases.  175(1) 286-292

Gautum, K. “A History of Global Polio Eradication”.  UNICEF Website.  2012. Web. 25 April 2014

Gilbert, K.  “Salk, Sabin, and the Race against Polio”.  Smithsonian Institute Website. 2012. Web. 25 April 2014

“How the Poliovirus Works”.  Behring Center at the Smithsonian Institute.  2014. Web. 25 April 2014.

“Polio”. Mayo Clinic Website.  2012. Web. 25 April 2014.

“Poliomyelitis”.  Center for Disease Control Website.  2010. Web.  25 April 2014.

“Poliomyelitis Fact Sheet” World Health Organization Website.  2014. 25 April 2014.

Resik, S. et. al. “Priming after a Fractional Dose of IPV”.  New England Journal of Medicine. 2013. 368(2) 416-424