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From: iayork@panix.com (Ian A. York)
Newsgroups: alt.folklore.urban
Subject: Re: Polio (Re: Gillette kills animals?)
Date: 19 Jan 1996 17:55:12 -0500

In article <dlawsonDLEBvs.8C3@netcom.com>, Drew Lawson <dlawson@netcom.com> wrote:
>
>A quick scan turns up no references to confirm this, but I could swear
>that I'd heard a news blurb that polio was "making a comeback" in the
>US.

No. Although it certainly wouldn't surprise me if some clueless talking head reported this, particularly as these people seem to think that all diseases are more or less interchangeable, so that the difference between "tuberculosis" and "polio" is of interest only to tight-assed science geeks.

Check out the World Health Organization's page on polio eradication: <http://www.who.ch/whday/Polio.html>

Also:

Sabin AB.
Perspectives on rapid elimination and ultimate global eradication of paralytic poliomyelitis caused by polioviruses. European Journal of Epidemiology. 7(2):95-120, 1991

"Poliomyelitis caused by polioviruses has already been eradicated from industrialized countries of North America, Europe, Asia and Oceania, but the procedures by which this eradication was achieved are not adequate for the poor tropical and subtropical countries. The major challenge now is first to eliminate it rapidly from Asia and Africa where an estimated 250,000 cases and 25,000 deaths currently occur annually. The great progress toward eradication of "wild" polioviruses from poor tropical and subtropical countries in Latin America was achieved not by the procedures still recommended by the WHO Expanded Program on Immunization (EPI) but by the independently organized annual, national days of antipolio vaccination - all based on the use of large armies of well-trained non-professional,community volunteers - first used in Cuba (1962), Brazil (1980), Nicaragua (1981), Dominican Republic (1983), Paraguay (1985), and Mexico (1986). This novel approach, described in some detail in this communication, is recommended for the rapid elimination of wild polioviruses from Asia and Africa, and for ultimate global eradication with the help of a special cadre within the EPI of WHO."

Note that this refers to "wild" polio virus. The vaccine does cause very rare cases of polio, and now there are about 6-7 cases per year of vaccine-induced polio. (For contrast, before the vaccine was introduced there were around 20,000 cases per year of wild-type polio.) When the world is eradicated of polio, then it will be safe to stop vaccinating, and these last few cases can also disappear; it's also possible that a modified vaccination regimen may reduce risks still further in the mean time.

Strebel PM. Sutter RW. Cochi SL. Biellik RJ. Brink EW. Kew OM. Pallansch MA. Orenstein WA. Hinman AR. Epidemiology of poliomyelitis in the United States one decade after the last reported case of indigenous wild virus-associated disease. Clinical Infectious Diseases. 14(2):568-79, 1992

"Poliomyelitis caused by wild poliovirus has been virtually nonexistent in the United States since 1980, and vaccine-associated paralytic poliomyelitis (VAPP) has emerged as the predominant form of the disease. We reviewed national surveillance data on poliomyelitis for 1960-1989 to assess the changing risks of wild-virus, vaccine-associated, and imported paralytic disease; we also sought to characterize the epidemiology of poliomyelitis for the period 1980-1989. The risk of VAPP has remained exceedingly low but stable since the mid-1960s, with approximately 1 case occurring per 2.5 million doses of oral poliovirus vaccine (OPV) distributed during 1980-1989. Since 1980 no indigenous cases of wild-virus disease, 80 cases of VAPP, and five cases of imported disease have been reported in the United States. Three distinct groups are at risk of vaccine-associated disease: recipients of OPV (usually infants receiving their first dose), persons in contact with OPV recipients (mostly unvaccinated or inadequately vaccinated adults), and immunologically abnormal individuals. Overall, 93% of cases in OPV recipients and 76% of vaccine-associated cases have been related to administration of the first or second dose of OPV. Our findings suggest that adoption of a sequential vaccination schedule (inactivated poliovirus vaccine followed by OPV) would be effective in decreasing the risk of VAPP while retaining the proven public health benefits of OPV."

Perhaps the newscreature was thinking of tuberculosis, which is definitely making a comeback; but this is unrelated to vaccination. Again the WHO is on it:
<http://tron.is.s.u-tokyo.ac.jp/WHO/programmes/gtb/GTB_Homepage.html>
Also:

Vaylet F. Allard P. Natali F. Marotel C. L'Her P. Current epidemiology of tuberculosis.
Revue de Pneumologie Clinique. 50(3):106-15, 1994.

"A major health threat in developing countries, the incidence of tuberculosis has decreased steadily in Western countries over the last century. However, since 1986, first in the United States, then more recently in several European countries, the number of declared cases has increased...."

Or, the newsthing may have been thinking of measles, which is also becoming more prevalent, and this is at least partially because of lower vaccination rates. Note, by the way, that measles ("the most transmissible disease known to man") kills about 1.6 million children a year, so this is no minor matter.

Wood DL. Brunell PA.
Measles control in the United States: problems of the past and challenges for the future.
Clinical Microbiology Reviews. 8(2):260-7, 1995

"Elimination of indigenous measles from the United States has been a public priority since 1978. To assess the progress made toward this goal, we review the epidemiology of measles from 1963 to the present. From the 1970s through early into the recent measles epidemic, the majority of measles cases were in highly vaccinated, school-age children. This was due primarily to a 1 to 5% primary measles-mumps-rubella vaccine failure rate and nonrandom mixing patterns among school-age populations. To eliminate susceptible individuals in the school-age populations, a second dose of measles vaccine is now recommended between 5 and 6 years or 11 and 12 years by both the Advisory Committee on Immunization Practices and the American Academy of Pediatrics. Later in the epidemic, measles cases surged among unimmunized preschool children, especially among the poor in inner-city areas. Immunization rates have been documented to be low among preschool populations because of missed opportunities to administer vaccines at all health visits and barriers to access to immunizations."

Read it and weep, folks.

Ian

--

                      Ian York   (iayork@panix.com)
      "-but as he was a York, I am rather inclined to suppose him a
       very respectable Man." -Jane Austen, The History of England