Polio: A Disease of Historical Proportions

I was given the following subject to cover in my Biology class:

What is polio? What is the cause of this disease? How widespread was/is it? How is this disease treated? What are the preventive measures that can be taken? What does the future look like for this disease?

I immediately looked at this as a challenge, but not because the topic was hard. The challenge was, How can I write this paper, turn it into a history piece, and still get an A? Well, I just turned it in last night, so I don’t have a grade yet, but my fingers are crossed. Anyway, here is my attempt to turn a boring biology paper into a fun history paper.

 Poliomyelitis: A Disease of Historical Proportions

With much of our world’s history, we, as intelligent human beings, can trace a lot of diseases and medicine back to that of the Ancient Egyptians. The poliomyelitis virus (polio for the layperson) is no different. With Egyptian artifacts depicting young healthy adults and children with their lower extremities emaciated in appearance or relying on canes to walk, it is likely that the disease that plagued Egyptians four thousand years ago is the same disease that Michael Underwood clinically described as “a debility of the lower extremities,” in 1789. At the turn of the 1900’s, the polio virus became prevalent, primarily among children. The disease was becoming more rampant; the number of people contracting the virus annually was in the hundreds of thousands.

Polio is an infectious member of the genus Enterovirus. All viruses found in this group are usually transmitted via the fecal-oral route, which means it is a virus passed predominately by ingestion. As cities and towns became modernized, in the early 1900’s, improving sewage systems, which gave them access to clean(er) water, the virus was introduced less and less into their systems. By decreasing the strength of the body’s immune system, the mean of those predisposed to polio increased from infants, usually 6 months or younger, to those ranging from ages five to nine years old. This led to an alarming rate of adults suffering from polio. Starting in 1950, there were hundreds of thousands worldwide showing symptoms of the polio virus. Hundreds of thousands—in a virus that only showed symptoms in 4-8% of cases! In the United States, in 1952, there were 59,000 cases with that were symptomatic, leading to roughly 3,000 deaths.

The polio virus does not have a cure. Depending on the severity of polio, there are treatments that can help. For those that have abortive polio (symptoms limited to those of the flu) or the aseptic meningitis form, non-paralytic polio, rest, antibiotics, and relief of symptoms usually leads to a full recovery in two-ten days. These two forms of polio make up the majority of the 4-8% that affects the human body. If the virus gets past the intestinal tract, the severe, paralytic polio attacks the nerves that operate the muscles in the limbs and can lead to limb paralysis and respiratory complications. If the cells in the nerves are completely destroyed by the virus, paralysis will be permanent. Treating a patient with paralysis polio requires heavy doses of antibiotics, four-six weeks of rehabilitation, and physical therapy. With current medical advancements, 50% of those that are diagnosed with paralytic polio make a full recovery, 25% recover with mild disability, and 25% are left severely disabled.

As medical professionals and scientist have yet to discover a way to cure polio, vaccinations are important. On April 12, 1955, Jonas Salk had perfected and was ready to release the much needed polio vaccine. The inactivated poliovirus vaccine (IPV) is a chemically inactivated poliovirus, which is given as an injection. Newborns, in the United States, receive four doses between the ages of two months and six years. The IPV has a 99% immunity rate to the poliovirus.

Shortly after Salk, Albert Sabin developed his version of the polio vaccine and trials of the drug were given worldwide to millions. Sabin’s vaccine, an oral polio vaccine (OPC), was administered in pill form. The OPC was slightly less effective with a 95% immunity rate and in 1 out of 750,000 cases the vaccine recipient received a bad, live virus that caused paralysis. Sabin’s OPC was inexpensive and easy to provide in any setting. For these reasons the OPC is the preferred method worldwide; however, in industrialized countries the IPV is used.

Unfortunately for polio, its future is bleak. Fortunately for us, the polio virus shows trends that are continually dropping. As previously mentioned, in 1952, just in America, there were almost 60,000 reported cases. From 1980 – 1999, there were one-hundred and fifty-two confirmed cases of paralytic polio in the United States. Six cases were acquired outside the United States and imported, the last of which occurred in 1993. The remaining one-hundred and forty-six were vaccine-associated caused by Sabin’s OPC. The World Health Organization (WHO) reported 355,000 cases in 1988, within 125 countries, and in 2004, there were only 1,255 cases.

(As I reread this, I am coming to the realization that I didn’t give it an ending…so that sucks. I guess I can quit holding my breath for an A. 🙂 )

Oh ya, you know that I enjoy crushing everyone’s misconceptions on history, so here we go. When I say polio, most of you automatically associate it with President Franklin D. Roosevelt. It is time to find someone new! In 2003, a report was released that said,

The likelihoods (posterior probabilities) of poliomyelitis and Guillain–Barre´ syndrome were investigated by Bayesian analysis. Posterior probabilities were calculated by multiplying the prior probability (disease incidence in Roosevelt’s age group) by the symptom probability (likelihood of a symptom occurring in a disease). Six of eight posterior probabilities strongly favoured Guillain–Barre´ syndrome.

So there you go, probably not polio, more likely it was Guillain-Barre syndrome. I bet five-hundred years from now, everyone will be like, “No, FDR didn’t have polio, and Columbus did not discover America….”