Category: Polio

Thesis:

The poliovirus is a highly infectious virus that causes polio, which has debilitating signs and symptoms on the body and undiscovered treatments.

Introduction

The Poliovirus has been carbon dated back at least 6000 years ago in Egyptian mummies. It was also known to be a great health issue in the United States around the 20th century. However, in the 1950’s it subsided when vaccination for the virus was developed and made available to all individuals. This, in turn, helped to reduce polio significantly, allowing for the Americas, Europe, and the Western Pacific all to experience a polio-free environment. Great progress can be seen as the World Health Organization aids to permanently eradicate poliomyelitis. This virus can be contracted from an infected person mainly via the fecal-oral route. Polio affects the individual’s central nervous system, infecting their spinal cord, allowing their ability to move taken away(paralysis). Persons who have not been vaccinated and have a low immune system is susceptible to the poliovirus. There is no cure for polio, however, a diagnosis can be made solely based on the patient’s history and symptoms they possess. The poliovirus is a highly infectious virus that causes polio, which has debilitating signs and symptoms on the body and undiscovered treatments.

(A) A detailed, comprehensive description of the related microorganism

Polio otherwise known as poliomyelitis is a disabling life-threatening disease caused by the poliovirus that affects the central nervous system, sometimes producing paralysis (Daniel and Robbins, 1999). The virus is consisting of a single strand of positive-sense Ribonucleic acid genome and a protein capsid. The three serotypes of poliovirus carry are antigenically distinct (Oshinsky, 2006). Poliovirus is transmitted from person to person by means of oral contact with secretions or faecal material from an infected individual and it is secreted in feces for a few weeks following the infection (Daniel and Robbins, 1999). The poliovirus mostly affects children five years and under. It mostly peaks in temperate climates which may include summer and autumn, but in tropical regions, this is far less pronounced. The incubation period between first exposure and first symptoms can range anywhere from 3 (three) to 35 (thirty-five) days. It can also be transmitted by contaminated food and water (Smallman-Raynor, 2006).

(B) The life cycle of this microorganism

To add, Silvera (2013) explained the life cycle of the poliovirus in the following steps. Firstly, the poliovirus approaches a nerve cell via the bloodstream. Next the nerve cell receptors attach to the virus. The protein shell (Capsid) of the virus, breaks to release its Ribonucleic acid (genetic material) into the cell. The polio RNA moves toward a ribosome, the cell’s protein assembly station. Then the polio RNA takes over the ribosome and forces it to make more polio RNA and more capsid. The new polio capsid and the new polio RNA unite to form more poliovirus. The host cell swells and bursts, releasing thousands of new viruses back into the bloodstream (p51).

(C) Causes, incidences and risk factors

Cause

Also, the poliovirus usually enters the environment in the feces of someone who is infected. In areas with poor sanitation, the virus easily spreads from feces into the water system, or, by touch, into food. In addition, because of polio contagious nature, direct contact with an individual infected with the virus can cause polio (Daniel and Robbins, 1999). Even sometimes when there are no symptoms, Individuals who carry the poliovirus can spread it via their feces for weeks. Once the virus has entered the body, it infects the cells of the intestine and throat. The virus stays within the intestines for a while before spreading to other areas of the body. After which, it moves into the bloodstream where it can spread to the entire body (Daniel and Robbins, 1999).

Incidences

Many cases have been reported of the polioviruses about individuals and how it affects them. In 1955 two incidences were reported in the United States when two children develop high fever and then later become paralyzed. Two days after, four more children became affected. A nurse recalled taking her two children to get the vaccine that has just recently develop with a fair that her children may develop the virus as they play with other children and bathe in the sea. She recalls watching patients suffer as a result of the poliovirus, the ones who mourn because they are unable to help themselves and one as she recalled cried as a result of not being able to kill himself because he is paralyzed. Poliovirus has cause many damages in previous years before a vaccine has been developed or the eradication of the virus took effect (Fitzpatrick, 2020).

Risk factors

Furthermore, risk factors associated with polio includes immune deficiency and malnutrition. Polio and outbreaks generally exist and persist due to certain risk factors, including environmental, seasonal and behavioral. To understand this is very important in our communication planning which will provide the necessary information as to where we should point our attitudinal and behavioral focus. The disease itself presents both opportunities and challenges, and potentially key information to assist with design communication interventions (Daniel and Robbins, 1999).

Additional, risk factors for contracting polio includes traveling to places where polio is widespread or endemic, especially Afghanistan and Pakistan. Living with someone infected with polio can cause the spread of polio to those living with them. Having a weak immune system also put someone at risk. Pregnant women are more vulnerable to polio, however, it does not appear to have an effect on the unborn child. Working in a laboratory where live poliovirus is kept (De La Bedoyere, 2005).

D). How does the selected microorganism cause disease in its host?

Moreover, the poliovirus has total incapacity to survive by its own means, it must invade another organism to be able to reproduce itself with the help of the machinery that this invaded organism possesses. Oshinsky (2005) talks about this invading agent we refer to as the polio virus, as a virus that has long been known to researchers, but not until late in 1930 could the

virus could be visualized with the help of an electron microscope (p.8). Polio is an enteric type infection which means that it is related to infections that occur at the intestinal level. Polio spreads through contact with fecal waste, by hands that have not been washed and contaminated food or water.

The virus enters the body through the mouth, travels in the digestive tract and is expelled in the feces. The virus can multiply in the lymph nodes of the tonsils and throat, but the most suitable environment for it to multiply is in the small intestine. Commonly the infection produces symptoms that can sometimes be confused by another type of condition, such as headaches, nausea, and sometimes even no symptoms are present. Festvag, Straghelle, Gilhus, Rike, Schanke (2019) said that “Polio eventually enters the bloodstream from the small intestine, in 1-5% of people who get this infection, the virus will invade the spinal cord destroying nerve cells. If 90% of the anterior horn cells (motor neurons) have been infected, then it will cause paralytic poliomyelitis” (p.861).

E) Symptoms observed in the microbial host

De La Bedoyere (2005) states that polio symptoms can be grouped into nonparalytic polio, paralytic and post-polio syndrome. Typically, symptoms of polio start’ off as the common cold, include pyrexia, aches, fatigue, and nausea. These symptoms can gradually go away after a few days (2-5days). However, if the virus spreads to the central nervous system, it is then categorized as paralytic polio can happen within 3-4 days. Paralytic polio symptoms include stiffness; dyspnea, severe muscle aches and can even lead to meningitis and permanent damage like paralysis. Paralysis is the most severe effect and can subsequently lead to death because paralytic polio affects the muscles used to breathe. Years, after people who seem to recover from polio can develop post-polio syndrome, symptoms include arena, dyspnea, fatigue, atrophy and pain of the muscles. Usually, individuals who suffered severe paralysis tend to develop post-polio syndrome (p18).

F) Tests to detect the microbe in its host

According to, Evan and Kaslow (1997) methods of confirming suspected polio infection can be done through the following, firstly, by virus isolation and detection. This is where the poliovirus can be isolated from a stool specimen or pharyngeal swab. For, ideal detection two samples must be collected 24 hours apart. This should be done as soon as possible, most favorably within 14 days. To add, if the patient is noted to be unvaccinated serology testing would be useful, as can be utilized for diagnosing paralytic poliomyelitis. Again, the specimen should be ascertained, as soon as possible and 3 weeks after another convalescent specimen should be carried out. Then there is Cerebrospinal Fluid Analysis (CSF) testing, sometimes called a lumbar tap. This method looks for evidence of the poliovirus in cerebrospinal fluid (p 592).

G) Current and future treatments for the control of the spread of this disease

Polio is not curable; however, there are ways to prevent polio disease (Johnston, 2002). According, to Johnston (2002) there are two types of vaccine that can prevent polio. One the inactivated poliovirus vaccine (IPV) is given as an injection in the arm or leg, depending on the patient’s age (p.14). Two the oral poliovirus vaccine (OPV) is still used throughout much of the world (p.17). The polio vaccine aids in protecting children by preparing their bodies to fight against the poliovirus. Most children who have received all the recommended dosage of the inactivated polio vaccine will be protected from the poliovirus (p. 14).

Furthermore, Johnston (2002) expanded on the topic that certain infectious disease labs are playing a crucial role in the search for a drug that could aid the ongoing worldwide polio eradication initiative and help stop the spread of the paralyzing disease in a future outbreak or bio-attack” (p.1). They are screening compounds that could prove useful against polio. The ultimate goal of the work is to discover a broad spectrum anti-viral agent that could be developed as a therapy to treat the highly contagious poliovirus. The strategy put in place to mitigate the post-eradication exposure is by developing an antiviral drug that can fight against the poliovirus (Johnston, 2002).

Conclusion

Polio virus is an extremely life-threating virus which in turn causes the disease called polio. Individuals infected with the disease are paralyzed losing their ability to perform on their own. There are several steps that explain the process in which the virus attacks the system. Which ultimately results in the host cell releasing thousands of the virus into our bloodstream. The poliovirus is spread through fecal-oral and once released into the bloodstream it infects the entire body. Some signs and symptoms observes in the infected host include fever, pain in arms and legs, pain and stiffness in the back and neck, fatigue and vomiting. Polio is sadly being not curable but, there are measures used to prevent it. In children for example vaccinations can be given to ensure they don’t contract the virus. This has allowed the virus to become less of a risk in many individuals, however, the ultimate goal is to permanently get rid of polio is by developing an anti-viral drug which can destroy it.

Bibliography

1. Daniel, T. and Robbins, F. (1999). Polio. Rochester, N.Y.: University of Rochester Press.
2. De La Bedoyere, G. (2005). The first polio vaccine. London: Evans Brothers Limited.
3. Evans, S., & Kaslow, S. (1997). Viral Infections of Human, Epidemiology and Control (4th Edition). London: Plenum medical book company.
4. Fitzpatrick, M. (2020). The Cutter Incident: How America’s First Polio Vaccine Led to a Growing Vaccine Crisis. [online] PubMed Central (PMC). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1383764/ [Accessed 29 Feb. 2020].
5. Johnston, R. (2002). Options for Poliomyelitis Vaccination in the United States. [Place of publication not identified]: [publisher not identified].
6. Lostroh, P. (2019). Molecular and Cellular Biology of Viruses. Garland Science.
7. Oshinsky, D. M. (2005). Polio: An American Story. New York: Oxford University Press.
8. Silvera, D. (2013). Aspects of poliovirus replication.
9. Smallman-Raynor, M. (2006). Poliomyelitis. Oxford: Oxford University Press.

Claim

Vaccines are not required for the overall health of society.

Rationale

Groups such as The Australian Vaccine Network (AVN) have raised concerns over the administration of vaccines in Australia due to their perceived negative public health consequences. This led to the claim:

“Vaccines are not required for the overall health of society.”

The claim contains the following aspects; vaccines and their health consequences; the requirements and definition of overall health in society; and where the line is drawn in public health. With consideration and preliminary research into these aspects, the following broad research question was developed: Has a dangerous disease been eradicated by vaccines?

The Australian government has administered vaccines since 1932 for many pathogens that are mostly life-threatening such as Poliomyelitis (Polio), Meningococcal and Influenza (NSW Health Department, 1997). Despite the eradication of numerous diseases directly through the immunisation program, the AVN (2019) website specifically cites the Polio vaccine as ineffective and dangerous, claiming that it “has not achieved the goal…of the vaccination program”. However, Polio was a deadly disease that affected millions with crippling health consequences until that vaccine led to complete eradication of the disease in Australia (South Australia Health, 2014).

Thus, with available sources and data surrounding Poliomyelitis and the vaccination program that directly evidence against the claim, it was chosen as the focus of the investigation. Australia will be used as a case study as the AVN specifically protests Australian administration of vaccines in addition to statistics concerning Australia’s Polio epidemic being accessible. As a result of the sufficient evidence available to evidence against the claim, the following research question was developed:

Research Question

“Has the production and administration of the Polio vaccine/s affected the quality of life of children in Australia?”

Background

Vaccines were pioneered by the observation that linked exposure to a disease or a less potent version would grant ‘immunity’ to the individual (The History of Vaccines, 2019). Spurred by this observation, vaccines would be developed for the worst and most widespread diseases such as Measles, Smallpox and Polio among others.

Vaccines bolster or fortify the immune system against a specific disease using the adaptive immune response. The adaptative immune response relies on T-cells and B-cells to fight against antigens (foreign body/pathogen) through the cell-mediated response and antibody responses depicted in figure 1.

Figure 1: Adaptive immune system

Vaccines don’t contribute to the cell-mediated responses that use killer T-cells to eliminate infected cells, rather utilising the antibody response (Alberts B, 2002). The Antibody response builds immunity to a pathogen. Polio vaccines introduce the 3 wild strains of Poliovirus in either an inactivated form or a live, weakened virus version. Immature dendric cells (IDCs) recept the presence of the pathogen as well as its characteristics. B-cells, now activated by the IDCs, use those identified characteristics to develop antibodies specific to the pathogen (Janeway CA Jr, 2001). The antibodies will amass to the antigen and bind using matching characteristics to inhibit it (figure 2). The slowed and incapacitated cells are thus marked for destruction through the non-specific immune response of phagocytes that ingest the antigen (Alberts B, 2002).

Figure 2: The function of antibodies: to bind and inhibit

The World Health Organisation (2019) defines quality of life as “a state of complete physical, mental, and social well-being”. A disease that inhibits a person’s physical health lowers quality of life, especially if the effects are permanent.

Poliomyelitis is a highly contagious virus that spreads quickly among children due to a long incubation period (the time between infection and first symptoms) and the method of transmission through “water…contaminated by faeces” (Sophie Ochmann, 2019). Once infected, Poliomyelitis multiplies in the mouth and pharynx (infection point) until it reaches the gastrointestinal tract. Polio is an incurable disease assisted by two effective virulence characteristics; Immunoglobulin-like bonding proteins that help in disguising the pathogen; and the ability to perform cytolysis which allows for faster infection within the body (Volney, 2001). ‘Herd immunity’ is the term used to describe a population that is immunised at a rate around or above 90%. The effect is a population that stops outbreaks of a pathogen.

Evidence and Analysis

Poliomyelitis lowers the quality of life for those that experience the effect of paralytic Polio. Polio infections lead to 72% of cases are asymptomatic but still able to communicate the disease as hosts, 24% experiencing a minor sore throat and fever and 1-5% will experience sensations and stiffness around the body. However, less than 1% will develop into paralytic Polio (CDC, 2018). This will often result in complete recovery, however, 1 in 200 infections will have a form of permanent paralysis (figure 3).

Figure 3: The risk of paralytic Polio (CDC, 2018)

Paralysis occurs when the virus enters the bloodstream from the mouth and throat and destroys the motor neurons of the brain stem (CDC, 2019). The symptom of Paralysis is most common in the spinal cord (79%), with the pronounced effect of “the asymmetrical paralysis of the lower limbs” (Flaherty, 2012). The result is the loss of motor control and mobility, restricting one’s quality of life (figure 4).

Figure 4: Spinal Polio paralysis

Bulbar Polio is a very serious type that attacks and permanently damages the motor neurons of the brain stem that leads to breathing and talking difficulty (MalaCards, 2019). However, Bulbospinal polio (2%) is a combination of the two that has a greater mortality rate range of 25-75% above the average of 30% consistent with paralysis (AIHW, 2018). Mortality is a result of breathing-related complications. Tank respirators (Iron Lungs), were developed to assist the breathing of Polio paralysis patients. While it did save many lives, it required the patient to spend upwards of 16 hours daily within a constrictive chamber that severely limited movement and speaking ability (figure 5). Many hundreds were distributed to Australia for children, then adults for a life of reliance. Polio-associated breathing difficulty either causes death or that permanent reliance on an archaic machine.

Figure 5: The Iron Lung

Poliomyelitis was not a prevalent disease in the 19th century, but it became an endemic disease in the 20th as a result of changing sanitary conditions and childhood exposure for natural immunity to develop (Figure 6).

Figure 6: Recorded deaths by Poliomyelitis during the 19th century (Smallman-Raynor, 2006)

Year Location Cases (Deaths)

1808 Göteborg, Sweden 4

1835 Worksop, UK 4

1841 Louisiana, USA 10

1841 Modums, Norway 14

From dozens of deaths over a century to many thousands, Australia had a peak of 357 deaths in a single year due to Polio. In fact, Polio-related deaths occurred for decades after the outbreaks in the middle-century, evident in figure 7. Even contracting and surviving Polio leads to a lowered life expectancy, either through the disabled limbs or Post-Polio syndrome that resurfaces the Poliovirus. Post-Polio syndrome affects 25-40% of Polio survivors and carries the risk of death or lowered life expectancy, that is the cause of Polio-related deaths still ongoing (14 in 2015) in figure 7 (NINDS, 2019).

Figure 7 (AIHW, 2018)

On the other hand, a global trend of decreasing deaths and notifications of Polio was occurring in the 1950s, figure 8 depicts Australian notifications.

Figure 8: (AIHW, 2018)

Figure 7 and 8 both illustrate a drop of deaths and notifications, the Inactivated Polio Vaccine (IPV) was introduced and administered to Australians in 1956. This led to the exponential drop in cases from 1,194 in 1956 to just 100 in 3 years. 16 years later in 1972, complete eradication of the disease occurs in Australia from decades of pandemic that saw a peak of 2,698 infected in 1938. However, there was a single spike in deaths and notifications after the introduction of vaccines between 1961-1962 as a consequence of not enough children being vaccinated. Herd immunity had not been achieved with Victoria only having 72% of children immunised (National Museum Australia, 2018). With an outbreak directly attributable to the unimmunised, the response was swift and widespread vaccinations leading to the eradication just years later.

The IPV would only result in rare, insignificant side-effects while protecting the Central Nervous System (CNS) of the individual (preventing paralytic Polio). However, an Oral Polio Vaccine (OPV) was soon developed that uses a live version of the virus with the advantage of protecting the gastrointestinal tract as well as the CNS. The OPV thus has a benefit to those unvaccinated and curbs further spread by the individual (Sophie Ochmann, 2019). OPV is only used to control outbreaks quickly in developing countries (Global Polio Eradication Initiative, 2018).

The almost complete eradication of Polio in the world significantly reduced the Polio-attributable deaths by an estimated 600,000 people a year (National Museum Australia, 2018). Consequently, reducing the deaths and afflictions caused by Polio greatly increased the quality of life for those that can go without those ill effects in the next generation.

In spite of this, the AVN still raises concerns over the efficacy and safety of the Polio vaccine-specifically due to Vaccine-Induced Polio (VIP). VIP can occur through rare phenomena and the improper administration of the OPV. Vaccine-Associated Paralytic Polio (VAPP) is a rare phenomenon that occurs in but 1 of 2.7 million doses without the characteristic of infectivity (WHO, 2015). Circulating Vaccine-Derived Poliovirus is a more infrequent anomaly that arises when communities have not been sufficiently immunised against the virus, however, only 760 cases have occurred after 10 billion doses (WHO, 2017). Despite the risk of OPV, an estimated 16 million cases of paralytic Polio have been averted since 1988 (Sophie Ochmann, 2019). Moreover, OPV is only used is outbreaks and is not available in the US or Australia, the safe IPV is used. Australian Anti-Vaccination groups have no standing to claim that the Polio vaccine has ‘not achieved the goal…of the vaccination program” as the widespread positives of Australia being Polio free overshadow the rare effects of OPV.

Evaluation of Sources

The evidence provided does contain some issues that arise with the use of historical data in the field of medicine. The most affected data is the standard of recording the true number Polio cases as Ochmann (2019) describes, “with 72% of polio infections not leading to any symptoms – and 99.5% of cases resulting in only temporary symptoms…it is difficult to record all cases of Polio.’ To combat this, speculative/estimative data has been avoided for analysis in favour of the more precise metric of ‘Polio notifications’, which is not necessarily how many Polio cases but is more accurate in tracking outbreaks and eradication than a speculative data set. The choice for Australia as the focus of the investigation narrowed the available data sets as Australia uses the Department of Health to collate the data on deaths and notifications. Thus, the data is only available from them leading to gaps within the data as seen in figure 8 for 1942 and 1950 cannot be filled except by further investigation into speculative data analysis that would come at the cost of accuracy. Background information of Polio and vaccines is well-documented and comes from reputable government agencies such as the CDC and State health departments.

However, further investigation would have to involve the broadening of the research to contain not only the Polio epidemic and control that led to the increased quality of life, but other vaccines and pathogens. Vaccines that have had negative health effect, as well as those that have eradicated other diseases (smallpox), would assist in categorically refuting the claim.

Conclusion

With consideration of the evidence obtained, the claim “vaccines are not required for the overall health of society”, is tentatively refuted concerning the pathogen Polio. The specific research question assisted a focused investigation and analysis to prove that vaccines have reduced Polio, thus increased the quality of life for children that don’t have to experience the effects of paralysis and decreased life expectancy. However, vaccines immunise against many diseases and Polio is but one example. An examination of many pathogens and their vaccines would broaden the research greatly but could lead to a categorically refuted claim about vaccines not being a benefit to the overall health of society.

The claim ‘It is increasingly important that Australia maintains strong quarantined measures to protect its environment’ was made. The claim is saying that if Australia doesn’t keep ontop of the diseases, bugs or plants coming into the country then will the countrys ‘herd immunity’ be affected. Herd immunity is the stop of the spread of a contagious disease within a population that results if a sufficiently high proportion of individuals are immune to the disease, especially through vaccination (Google Dictionary, 2019). It was then thought that if a disease that was eradicated in Australia came back, would there be a breakout. Then several diseases were looked at in detail, such as, Smallpox, Rinderpest, Dracunculiasis and Poliomyelitis (polio). All of the diseases were research and it was found that the disease with the most amount of information was polio. Polio was eradicated by vaccine. Therefore the research question of, ‘If Australia doesn’t enforce vaccinations for polio, will the disease come back?’ was created. The reason why the research question of, ‘If Australia doesn’t enforce vaccinations for polio, will the disease come back?’ was created was to find out what would happen if Australia didn’t inforce that their population was vaccinated what would happen.

The research question created directly relates to the initial claim of, ‘It is increasingly important that Australia maintains strong quarantined measures to protect its environment.’ The question relates to the claim by asking if a disease was to come back would it affect the environment. The question uses the population as the ‘enviroment’ and relates it to herd immunity. The question also asks if Australia needs to inforce the vaccine for polio relating to the part of the claim there it states that it is important that Australia maintains stron quarantined measures.

‘If Australia doesn’t enforce vaccinations for polio, will the disease come back?

Background:

A disease is a disorder of a bodies structure or function (Google Dictionary, 2019). Diseases will produce specific symptoms that will affect certain areas of the body that are in relation to the disease. There are four main types of diseases, infectious diseases, deficiency diseases, hereditary diseases and physiological diseases. (Wikipedia, 2019). Infectious diseases such as, hepatitis C, polio, influenza (A and B), and Dengue fever are diseases that are normally harmless, however, these diseases will do damage to the immue system but in some cases they have been found to be helpful. Infectious diseases can be passed from person to person and in some cases cause death (Christian Nordqvist, 2017).

Diseases occurs when the cells in your body are damaged as a result of infection or if the disease is passed on by contamination. Some diseases will stay dormant in the bodys system for months and sometimes even years, whereas some diseases will have signs and symptoms of an illness appear days or even hours after contamination (Mayo Clinic Staff, 2019).

Polio is a highly contagious viral illness that causes nerve injury sometimes leading to paralysis, difficulty breathing and sometimes death. In the Australia the last wild case of naturally occurring polio was in 1972. Despite a worldwide effort to wipe out polio, poliovirus continues to affect children and adults in parts of Asia and Africa. When traveling to another country there is always at risk of catching polio. Adults who have been vaccinated against polio and are planning to travel to an area where polio is still present they should receive a booster dose of inactivated poliovirus vaccine (IPV) to make sure that they are completely vaccinated against polio. In serious cases polio can cause death, the majority of people who are infected with the virus are not aware they’ve been infected.

Signs and symptoms, which can last up to 10 days, include:

• Fever
• Sore throat
• Headache
• Vomiting
• Fatigue
• Back pain or stiffness
• Neck pain or stiffness
• Pain or stiffness in the arms or legs
• Muscle weakness or tenderness

The fist major recored out break in Australia in 1937. There was houses filled with sick and dying families. For more than half a century from 1930’s-1950’s Australians were absolutely terrified by the reoccurring cases of polio that could leave its victims paralysed, sometimes permanently. Paralyzed patients bandaged into splints that their families built to move around around filled all the hospital wards. It was estimated that 20,000–40,000 Australians developed paralytic polio between 1930 and 1988.

In 1937 Rebecca Round who lived in the small town of Railton was infected with polio, at the age of 7. Rebecca was hospitalized and put into Thomas’s splints. The process sees patients bandaged in at ankles, knees, hips, waist. The upper body and head An upper body are also bandaged down. The headpiece keeps the arm joints in neutral positions and if neck muscles are involved in paralysis, the head is ‘blinkered’. Rebecca spent 3 years in hospital, in her Thomas splints. When she eventually left hospital, Rebecca wore callipers. Calipers are re devices that enable people to walk and thereby remain mobile. (Professor Joan McMeeken, 2019).

Evidence:

The fist vaccine for polio was developed in 1952, by Jonas Salk. Salk experimented with the vaccine on his family. When Jonas found that the vaccine he had created had kept his family for contracting the illness, he started a trial of more patients in 1954. In 1955 the results from the trail were realised, Salk stated that, “The vaccine was 80-90% effective against paralytic polio”, making the trial successful. By 1995 polio had been eliminated in America and in 1997 the last Australian case of polio was recored, and then in 2000 Australia was declared polio-free. (History of Vaccines, 2019).

Figure 3: a map of the world showing percentage of people vaccinated against polio in 1980.

Figure 4: a map of the world showing the percentage of people vaccinated against polio in 1995.

Figure 5: a map of the world showing the percentage of people vaccinated against polio in 2015.

Polio only has one preventative, an inactivated polio vaccine (called IPV) is given by injection (a “shot”) or an oral polio vaccine (called OPV) is given by drops in the mouth (Fam Physician, 1999). When the vaccine was first put into use, less than half the world’s countries were vaccinated for polio (figure 3). As the years went by and the vaccine was becoming more successful and people put their trust in the vaccine as seen in figure 2. By 2015 according to figure 5, approximately 90% of the world is now vaccinated against polio.

Although Australia is now polio-free, other countries are not. If foreigners travel to Australia and are infected with the disease there is a high chance that the disease will be passed on to others in Australia. In Australia today 91.15% of children are vaccinated, therefore if someone who is infected with polio comes to Australia and infects a non-vaccinated Australian citizen it could all go wrong.

Polio normally occurs during the tropical rainy seasons, mainly affecting young children. Because there is 8.85% of Australian children are not vaccinated there is a high risk of children being infected. Approximately 2,124,000,000 children are unvaccinated against anything in Australia. Polio thrives in the tropics, in Australia, the tropics are in north Queensland. As of March 2019, there is 5,000,000 people living in Queensland Australia. Come to the conclusion that if the 8.85% of children is spread evenly over the 7 states in Australia it would mean that 1.2% of the 8.85% of the unvaccinated children are from Queensland. Making that 60,000 children from Queensland are unvaccinated (Australian Government of Heath, 2019).

North Queensland is a tourism hot spot for Australia; It is where the great barrier reef is located. Tourists are constantly visiting north Queensland making it extremely easy for a tourist infected with polio to come in contact with one of the 60 thousand children that are unvaccinated. If one of the children that are unvaccinated becomes infected with polio, it will spread very quickly. The 60 thousand unvaccinated children are children that are not vaccinated against anything. That means there is still a fair amount of children that are unvaccinated for polio. This would make it extremely easy for the disease to make its way from far north Queensland all the way down to Victoria.

The initial question of, ‘If Australia doesn’t enforce vaccinations for polio, will the disease come back?’ was further looked at and taken into consideration. If Australia does harden down on people getting vaccinated against polio, the whole of Australia may be at risk again.

While polio has become a distant memory in most parts of the world, the disease has managed to resurge in countries where it was once eliminated like, Syria, Papua New Guinea, Indonesia, Myanmar and Philippines, where the latest case of polio outbreak has been recorded. Poliomyelitis, commonly known as polio, is an incurable and highly contagious disease that is caused and transmitted by poliovirus which are members of the Enterovirus genus (Ochmann & Roser, 2017). And recently last year, the Philippines had declared its epidemic state of the said disease With a total of nine cases recorded as of December 2019. The World Health Organization (WHO), United Nations Children’s Fund (UNICEF), and other partners of the Global Polio Eradication Initiative (GPEI) are now in alliance with the Department of Health and local health authorities to help in eradicating the disease in the country. According to the article of Makati Medical Center (2019), “Polio Outbreak in the Philippines: Should you be scared?”, there are actually three main reasons why polio re-emerged in our country: first, the declining number of children who get vaccinated, next, the inability to detect early symptoms of the disease, and lastly, the practice of poor sanitation in communities. The Department of Health sees low vaccination coverage, poor early surveillance of polio symptoms, and substandard sanitation practices as culprits in this re-emergence (Paris, 2019).

Surely, the disease has been plaguing humankind for thousands of years. Dating back to early 1403-1365 BC, a carving of a man with a leg deformity depicted in an Egyptian stele (rock carving), showed similar symptoms with a paralytic polio. The disease’s origins are not exactly identified, however, according to Ochmann & Roser (2017), the epidemiologists were still able to identify how the disease evolved and spread across the world throughout the years based on its characteristics. Polio is also known as infantile paralysis as children below 5 years of age are the most vulnerable to the disease. The disease targets the person’s nervous system and can be fatal as it causes paralysis, breathing problems, or even death, in worst cases. These viruses travel through the oral-fecal route and spreads through intake of water and food and contact with objects contaminated by the feces of an infected person. Most of the cases of polio are asymptomatic or do not shows any symptoms, making it hard for the disease to be detected. However, when symptoms appear, it differs depending on which type it is.

Lately, the Philippines broke its record of being a polio-free country for 19 years and vaccine hesitancy is one of the contributing factors to the current polio outbreak, according to WHO’s representative in the Philippines, Rabindra Abeyasinghe. The lack of trust of the citizens in vaccination programs in the Philippines was brought by the controversy around the vaccine, Dengvaxia, one of the reasons why parents of children are refusing free vaccines from the government. The blow-up of news related to the deaths of children who were vaccinated by the Dengvaxia created hysteria in the country, leaving parents wary of vaccinating their children despite no confirmation of deaths linked to the vaccine to date. “There is no cure for polio — it can only be prevented with multiple doses of polio vaccines that have long been proven safe and effective” (DOH). Polio has no cure, but immunization can protect and prevent individuals from acquiring both vaccine-derived or wild forms of the virus that mainly affects children under five years of age as representative of UNICEF Philippines, Oyun Dendevnorov, stated, that “there is no other way for children to be protected against polio than getting vaccinated”. The first step in fighting the re-emergence of polio in the country is by receiving one dose of the inactivated polio vaccine (IPV) intravenously (Makati Medical Center, 2019). According to Crosta (2017), IPV consists of series of injection that starts at the child’s third month after birth and continue until the child reaches 4-6 years old. After the child has received IPV, oral polio vaccine (OPV) is given to the child through oral drops. When injected, the weakened form of the virus then replicates itself in the digestive tracts of the children, activating an immune response in the body through building up of antibodies. On the other hand, in face of the urgent need of children to get vaccinated, the data from the United Nations Children’s Fund (UNICEF) Philippines showed that polio vaccination of children dropped to 95% in 2018. Furthermore, it was also revealed that only 66% of children completed their oral polio vaccine while only 45% completed their injection of inactivated polio vaccine in 2018.

Furthermore, it is not only the low percentage of immunization that contributed to the resurgence of the disease, polio. The poor surveillance on the Acute Flaccid Paralysis (AFP) of the cities reported positive with poliovirus also led to poliovirus spreading throughout the country once again. Acute Flaccid Paralysis, as defined by the World Health Organization (WHO), is a complex clinical syndrome which triggers unforeseen paralysis or sudden weakness in any part of the body of a child whose age is below 15. AFP surveillance is essential in promoting a polio-free country as it helps “detect paralytic poliomyelitis due to wild poliovirus transmission in a population”, according to WHO. However, this so-called AFP leads to many causes, hence, this calls for the need of the health authorities to evaluate each AFP to find out if it is polio-related or not. The need of the local health authorities to act quickly in improving the environmental surveillance is a major step in strengthening the country’s immunization program and as well as improving the sanitation and environmental hygiene of the communities, thus preventing the disease from spreading across the whole country once again.

Besides the dwindling amount of people being immunized and poor polio surveillance, another crucial factor that caused the virus to spread is low sanitation in urban areas and dirty environment where strands of the virus may thrive. In the article ‘Philippines: Polio comeback due to poor sanitation, low vaccination turnout’ by Dalumpines (2019), Dr. Julinda Acosta said in an interview that the poliovirus recirculated once more because of poor environmental sanitation and lack of proper hygiene as well as the low coverage of immunization since 2014. This is mainly due to the absence of toilets in riverbanks, “It is observed that open defecation is prevalent in congested areas of the city”, Acosta said. It is stated that the host may acquire a poliovirus by ingesting a contaminated food and water may dirty objects that are being swallowed by children. In fact, children that handles objects that are dirty and contains small amount of fecal matter with strands of the virus can make them high at risk in acquiring the disease since they don’t practice proper handwashing.

In face of the arising polio outbreak in the Philippines, the DOH, in partnership with UNICEF and WHO, planned to combat the issue through performing a synchronized polio vaccination campaign in Davao, Manila, and Marawi City where strains of VDPV1 and VDPV2 were found. Furthermore, the DOH launched its “Sabayang Patak kontra Polio” campaign in Manila on August 19, where the poliovirus sample was found. The following month, Rotary Philippines launched an NCR-wide polio vaccination campaign, beginning in Quezon City. The DOH reassured the general public that aside from the door-to-door initiatives, they are also focusing to distribute resources in health centers across the nation. Aside from vaccination, WHO reminds families to practice proper hygiene, washing of hands with soap, using a toilet, eating food that is fully cooked, and drinking safe water. Moreover, the DOH said that it had also planned measures to enhance prevention of the disease in Metro Manila. Among these are the heightened AFP surveillance, as well as an immunization campaign for children below 5 years.

After the hysteria that Dengvaxia has created three years ago, the public’s mistrust to immunization campaigns related not only to dengue has caused outbreaks of highly infectious diseases such as measles and polio. The campaign on dengue vaccination campaign may have failed but that doesn’t mean that we should lose trust to vaccines that have long been proven to be safe and effective. The discovery and formulation of the polio vaccine by Jonas Salk has saved millions of lives throughout the years across the world. The resurgence of polio in the Philippines shows just how important it is for the health authorities to remain vigilant and to focus on improving the environmental surveillance across our country, for the community to continue to invest not only in polio eradication programs but also to the different immunization campaigns by the government, and to keep the environment clean as well. All of these are solid evidence to support the need for vaccination and proper sanitation in every community. Across the Philippines, DOH, UNICEF, and WHO highly encourage families to get their children vaccinated as both IPV and OPV have been proven to save millions of lives over the decades, and of course, to promote a hygienic way of living where viruses cannot prosper and endanger human lives.

Polio continues to be a global public health issue, and even though it has been eliminated from most of the republics of the world, some countries, threatens the dream of total elimination of polio from the surface of the world. The spreading of polio virus has never been eliminated in some countries, but even worse is the number of republics, both in Africa and all over the world that has been re-infected by polio virus. This report addresses the following, the causes, symptoms, and mode of transmission, complications, treatment, and the demographic of interest (mortality, morbidity, incidence, and prevalence) in regard to Polio. It focuses on the social determinants of health, the epidemiologic triangle as it relates polio, the role of the community health nurse, CDC as one of organization that addresses the polio epidemic and the global implication polio.

Polio, or poliomyelitis, is a crippling and potentially lethal communicable disease. It is instigated by the polio virus. The virus spreads from one individual to another and can strike an infected person’s brain and spinal cord, triggering paralysis. A virus is an infectious means that has the ability to increase only inside the living cells of a host and in contaminate them with the infection it carry’s.

Polio is brought about by small RNA viruses. They are constituents of the retrovirus group of the Picornavirus family. There are three categories of polio infections they comprise of; Type 1, 2 and 3. Type 1 is the leading cause of around 85% of all paralytic infections. These types are antigenic ally different strains of infection and viruses or immunity to one type does not safeguard against the other two types, nevertheless, if immunity is created to one or all of the three strains, immunity is lifetime. The challenge that these viruses cause is the obliteration of spinal cord cells. The incubation period of polio is in between 3 and 35 days; as for paralytic cases, it is between 7–14 days.

Most people who get affected with poliovirus (around 72 out of 100) will not have any noticeable symptoms. Around 1 out of 4 individuals with poliovirus disease will have flu-like symptoms that may comprise—fever, sore throat, tiredness, headache, nausea and stomach pain. These symptoms typically last 2 to 5 days then they disappear on their own. A smaller percentage of people with poliovirus infection will acquire other more severe symptoms that affect the spinal cord and brain which include: meningitis (is the disease of the covering of the brain or spinal cord and it strikes in about 1 out of 25 individuals with poliovirus infection); paresthesia (is the abnormal sensation of the body, such as burning, tingling or numbness, these sensations may be felt in the hands, fingers, toes, or weakness in the arms, legs, or both, happens in about 1 out of 200 individuals with poliovirus infection); paralysis is the most critical symptom connected with polio because it can steer to death or permanent disability. Amid 2 and 10 out of 100 individuals who have paralysis from poliovirus infection pass on since the virus affects the muscles that assists them in breathing. Children who seem to fully recover can experience the post-polio syndrome which is characterized by development of new muscle pain, paralysis as adults or weakness.

Poliovirus only affects humans. It is very transmissible and spreads from one person to another through contact. The virus resides in an infected person’s intestines and throat. It comes into the body via the mouth and spreads by way of contact with the feces of an infected individual and, though not quite common, through drops from a cough or sneeze. One can get infested with poliovirus if they have feces on their hands and they touch their mouth. Also, one can get infected if they put in objects in their mouth like toys that are infected with feces (poop). An infected individual may spread the infection to others instantly and at about 1 to 2 weeks after symptoms emerge. The virus can survive in an infected person’s feces for several weeks. It can pollute water and food in unhygienic conditions. People who don’t have the symptoms can still surpass the virus to other people and make them ill.

When the virus that brings about polio has infected an individual, there is no cure that will treat polio. Early analysis and supportive treatments such as, pain control, bed rest, good nutrition, and physical rehabilitation to prevent deformities from happening over time can assist in reducing the lasting symptoms due to muscle damage. Polio vaccine protects the children by making their bodies ready to attack the polio virus. Almost all children who get all the proposed doses of vaccine will be protected from polio.

There are two categories of vaccine that can ward off polio: oral poliovirus vaccine (OPV) and inactivated poliovirus vaccine (IPV). The adults who are at risk for being infected with polio should receive a booster dosage these adults consists of: 1) those who are traveling to republics with high rates of the polio, such as Nigeria, India, Pakistan and Afghanistan; 2) health care workers who come into contact with patients who may have been infected by the polio virus; 3) laboratory workers dealing with the samples that may contain polio virus.

Reportable diseases are diseases thought to be of great importance to the public health. In the United States, local and national agencies necessitate that these diseases be conveyed when they are identified by doctors and laboratories. Polio is a reportable disease and it should be reported to the US Centers for Disease Control and Prevention (CDC). It is the obligation of the health care to report cases of the polio disease. Reporting assists researchers in identifying disease trends and track disease epidemics. This knowledge can assist in controlling future outbreaks. Poliomyelitis is a ‘crucial’ notifiable state and must be informed by medical physicians and pathology facilities with immediate effect by telephoning upon preliminary diagnosis (probable or confirmed). Pathology facilities must follow up with written statement within five days.

Social determinants of health are social and economic conditions that effect the health of people and the society. These conditions are formed by the amount of power, resources and money that people have, all of which are prejudiced by policy choices. Social determinants of health influence factors that are associated with health outcomes. The main social factor in polio is the way that individuals are handled while they have polio. This is majorly witnessed in Pakistan, Afghanistan and Nigeria. When people are affected with polio many are often afraid of associating with so as not to be infected so they end ups excluding the infected person from everyday life mainly due to fear. This generates a problem that influences the social aspects of people’s lives. This makes people socially secluded as well as creating a division in cultures that influences the way they live.

The economic determinant in polio is mainly about the financial status of those affected with polio. People with a low financial status would have a difficult time recuperating through any health problem particularly polio. Since polio cannot be cured it’s quite difficult to maintain the disease since it’s quite expensive. This makes the lives of those affected difficult.

The Epidemiologic Triangle is a paradigm that researchers have established for learning about health problems. It helps in understanding infectious diseases and how they spread. The Triangle has three vertices: agent, or microbe this is the causes the disease; host, are organisms, mostly humans or animals, which are subjected to and harbor an infection; environment, or those external factors that cause or allow disease transmission. An epidemic or an outbreak comes into existence when there are more instances of a particular infection than expected in that given region, or among a particular group of people, over a specific period of time. The task of an epidemiologist is to disrupt at least either of the sides of the Triangle, breaking the connection between the agent, the host, and the environment, and stopping the spreading of disease.

When it comes to the Epidemiologic Triangle of the polio, the contributing agent is the polio virus which has three serovar 1, 2, and 3. Most epidemics of paralytic polio are due to type 1 virus. The Host – human intestine and throat. Environment – crowded and unhygienic surroundings. Polio virus can thrive for long episodes in the external environment. In a cool environment, it can survive in water for up to 4 months and in faces for up to 6 months. The virus is well adapted for fecal oral route of transmission. Nevertheless the virus can be quickly inactivated by pasteurization and a diversity of physical and chemical means. Vector – the virus is located in the faces and oropharyngeal secretions of an infected individual.

The Community Health Nurse implements, surveillance, disease control and follow-up activities in relation to the polio diseases. They assist in the outbreak organization by offering communicable disease control advice, advice-giving service to other health professionals, educating members of the public, institutions, schools and child care centers. The community health nurse is also responsible with the follow up and improved surveillance of notifications connected to Polio.

Demographics consists of an array of socioeconomic data, comprising of the breakdown of a population by age, gender, income, ethnicity, employment status, internet access and home ownership. Demographics offer a simplification of a particular specific population, based on a sampling of individuals in that geography. The information that is collected on the patient demographic data such as: gender, age, race and cultural background becomes a part of the patient’s examination record. This demographic information assists the care team to interconnect efficiently with patients, as well as to comprehend a patient’s culture, which may influence their health.

One of the organization that deals with Polio is the Centers for Disease Control and Prevention (CDC). It is a tactical partner in the overall effort to eliminate polio worldwide. CDC offers scientific knowledge to many polio eradication activities and programs. CDC’s laboratories provide analytical diagnostic facilities and genomic sequencing of polioviruses to assist in guiding disease control efforts in many countries. In 2014, this comprised of support for application of improved laboratory processes that have improved sensitivity to notice and check new polio infection.

There are four regions of the world that are confirmed to be polio free: America, Western Pacific, Europe and South East Asia. Three polio-endemic countries are: Pakistan, Afghanistan and Nigeria. In 2016, only 37 cases of polio were found in those last pockets, the smallest number of new cases in history. In 1988, polio dispersed in more than 125 republics, where it paralyzed over 350,000 children. The plans for polio eradication function when they are fully executed. This is clearly shown by India’s achievement in preventing polio in January 2011, in debatably the most technically-challenging position, and polio-free accreditation of the whole South-East Asia Region of WHO happened in March 2014. Strategies for polio eradication in India comprises of: Conveyance of Pulse Polio Immunization periods every year until polio is eliminated, Withstand high levels of repetitive immunization, Monitoring OPV treatment at dist. level and below. Improved surveillance with the capability of detecting all instances of AFP due to polio and non-polio etiology. Arranging follow ups of all cases of AFP within 60 days to inspect the samples for virus seclusion, conducting epidemic control for cases established or believed to be polio infected so to stop the spreading of the virus. Other ways include: mopping up, line listing of cases, and execution of Pulse Polio Programme. Failure to apply tactical approaches, nevertheless, leads to ongoing spreading of the virus. Endemic transmission is ongoing in Pakistan, Afghanistan and Nigeria.

Failure to prevent polio in these last outstanding areas could bring about in as many as 200 000 new instances every year, in 10 years, worldwide.

References

1. CDC Global Health: Polio. (2019). Retrieved from https://www.cdc.gov/polio/
2. M, A. (2019). Poliovirus Studies during the Endgame of the Polio Eradication Program. – PubMed – NCBI. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27795480
3. Social Determinants of Health. (n.d.). Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health?topicid=39

‘The Panic Virus: A True Story of Medicine, Science, and Fear’ by Seth Mnookin, published in January 2011. Seth Mnookin is an American writer, journalist, and media reporter for Undark Magazine’s podcast and contributing editor at Vanity Fair. Mnookin is the author of three books with a non-fiction genre, and one of these books is The Panic Virus. The book holds 24 chapters that talk about different ideas, yet they are all linked to vaccines and media somehow. Mnookin unravels the public’s story about the claim of a relationship between vaccines and autism by starting with a clinical description of a vaccine-preventable infection. Afterward, he provides a history of a vaccine used in the U.S., which was on the Laceks family. Moreover, the book focuses on the opinions of parents and who presented the information. Mnookin wrote this book to educate people that while such myths are being popularized and disseminate, vaccination rates have driven to outbreaks of deadly illnesses like Hib, measles, and whooping cough. The book contains a variety of medical issues. This report will consist of two medical problems: smallpox and The Polio Vaccine.

In the past, people feared the vaccines to the point where they neglect it, so knowing and understanding the vaccine and what it protects us from is essential for people to understand the vaccine’s importance. The most consequential and the first issue is smallpox (Thèves, 2014) or Variola vera, a term from the Latin for ‘spotted pimple’. Smallpox affected people since 1350 B.C. was the first recorded smallpox epidemic. It was the thought to date back to the Egyptian Empire, where smallpox’s telltale scars marked the mummified face of Rames V (Ann, 2016). Generation changed or ended rapidly because of smallpox’s introduction like the Aztec and Incan kingdoms and the Habsburg line of succession to destroying over a third of Washington’s army in 1776. However, there were some survivors, but they were still suffering from all cases of blindness. Variola Virus was contagious, and it caused lacerating headaches, anxiety, and crippling nausea. Within 2 to 3 days after getting infected, small rashes begin to appear on the body, which leads to hemorrhaging that causes bleeding from ears, eyes, nose, and gums. Then they transform to pimples that over a while the vesicles begin to fill with oozing pus till it gets stretched enough to burst. Researches found that smallpox produced a protein that blocks a wide range of human interferons, which leads to dying sometime. By 1717, Mary Wortley discovered a prevention process called ingrafting; however, inoculation did not stop smallpox completely; it sought to combat.

Poliomyelitis, or for short polio, is an infectious, contagious disease that affects the central nervous system. Resulting in weakness mostly in the legs, but it might involve the muscles of the head, neck, and diaphragm. It is generally spread from one person to another by a fecal-oral route. There are no symptoms in around 70 percent of infected people; however, another 25 percent have minor symptoms such as sore throat, headache, fever, and neck stiffness. As usual, it is hard to conduct that they are the polio symptoms (Johnson, 2018). People started to notice the disease when it attacks motor neurons in the spinal cord and brain, which results in paralysis. In 1916, the first outbreak of polio struck New York when people were unaware of the disease, so it was often called a mysterious and frightening childhood illness. This caused complete chaos and frightening throughout the population as people, even scientists, could not explain what was happening, its cause, and how to stop it; therefore, the March of Dimes campaign was formed. By 1954, the first vaccine was made by a man named Salk, who won the nation in 1955 (Shampo,1998). He took several different strains of the virus and inactivated them, so no cells would be infected to inject them into the people. Nevertheless, the immune system could still see them and develop IgG antibodies against them. The administration began with Eisenhower’s help to generate more of the vaccine; however, the program was shut down due to its failure to prevent polio. The scenario created mass mistrust in the administration. Cutter, a laboratory that developed the vaccine, was sued by many families as many children got polio shortly after getting vaccinations. In a supreme court case known as Gottsdanker vs. Cutter, Cutter was found responsible. The situation demonstrated the importance of educating the public to stop mass hysteria that could worsen the issue.

In conclusion, the book talks about different phases of vaccinations and their histories. Moreover, it does not only present information about the disease, but it also presents people’s perception. It describes how people act toward the disease and the vaccine by drawing on interviewing with parents, public-health advocates, scientists, and anti-vaccine activities. People’s minds can be played and programmed to believe what others want them to believe. Mnookin describes how a small talk in the media could cause a big problem and panic to society. The media’s willingness to tell a ‘fair’ story by giving equal weight to real scientific evidence and unproven theories gave substance to speculation and generated unjustified uncertainty and fear in the minds of those who were searching for knowledge (Wiznitzer, 2011).