Polio Particles - Issue 3

Mary Westbrook

More About Polio Vaccine and AIDS

"Lost years let polio vaccine off the hook" reported the Sydney Morning Herald on 27 April 2000. Reports that AIDS is a by-product of the development of polio vaccine in the 1950s frequently appear in the press. The theory is that the AIDS virus passed to humans from the kidneys of chimpanzees that were used to make the early polio vaccine. However this new genetic study by Drs Korber and Bhattacharya shows that a number of strains of AIDS were established in humans by 1950 (and possibly as early as 1930), some years before the polio vaccines were first produced.

Going to the Dentist and Having Local Anaesthetics

Issues relating to general anaesthetics for polio survivors were discussed in Issue 31 (March 1997) of the Newsletter. Dr Richard Bruno, director of the Post-Polio Institute, Englewood Hospital and Medical Center, New Jersey, explained why polios require much less general anaesthetic than other people do when they have surgery, and why polios take longer to recover from general anaesthetics. In a recent article titled Preventing complications in polio survivors undergoing dental procedures, Bruno writes that while polios need less general anaesthetic, they require more local anaesthetic. He refers to two research studies which have shown that polios are more sensitive to pain than non-polios, "apparently as a result of poliovirus-damage to endogenous opiate-secreting cells in the brain and spinal cord". While polios need more pain medication and need it for longer periods of time, Bruno comments that polios are "extremely stoic" so "are not likely to abuse or become dependent upon narcotics". This made sense to me as I have often experienced pain after administration of local anaesthetics during dental and other surgical procedures. When I've commented that I was still feeling pain I've been reacted to with scepticism and made to feel a wimp. Support for Bruno's views is found in a recent question on the Post-Polio Central Polls that I wrote about in the last Newsletter. The poll asked polios how much local anaesthetics, such as novocaine, they need for dental and other procedures. The answers revealed that 33% need "a much larger dose than normal to keep from feeling pain" and 19% need a "little larger dose than normal". A "normal amount of anaesthetics" was required by 42%, 2% needed a "smaller dose than normal" and 4% needed "a much smaller dose". You can read Bruno's article on http://members.aol.com/harvestctr/Library/dental.html.

Recent Cases of Polio

A new case of polio in China in 1999 was reported in the British medical journal, The Lancet (12 February 2000). This has caused alarm in the western Pacific region where the last incident of polio was in 1997. "Both China and WHO are taking the case extremely seriously and have launched a mass inoculation and surveillance campaign" wrote The Lancet. Genetic testing has proved that the virus was imported from India. It is believed the 16-month-old boy who developed polio made contact with the virus at a festival held by a Chinese ethnic group that has trading links with India, though no travellers from India had visited the town recently. WHO says "The importation of the virus into China has been a tremendous demonstration of the mobility of the virus which means that no country can afford to relax or be complacent."

On 26 February 2000, The Lancet reported that south-east Asia and sub-Saharan Africa are the only two remaining major areas of wild poliomyelitis in the world. This year eradication efforts are being directed at ten countries in these zones. Half of these countries have very large, dense populations and the others have internal strife which interferes with vaccination programs. Last year 6000 cases of paralytic polio were reported worldwide but these figures are probably an underestimation. There is some concern that there will be a shortage of oral vaccine this year due to the eradication program. Last year 147 million doses of the vaccine were administered!

The March issue of Polio News, from the Post Polio Support Society New Zealand, tells of a 36-year-old Auckland woman who contracted polio last year from her polio-vaccinated (Sabin) baby. She was severely affected and still requires breathing assistance. She is being treated in a spinal injuries unit. The Society has "provided a large amount of background material on polio for the family and hospital" and one member visits regularly. The case has been given little publicity and this is a matter for concern to the New Zealand Society given the debates on whether to end the polio vaccination program in New Zealand and whether to use the Salk or live Sabin vaccine.

Ed. The 7th Edition of The Australian Immunisation Handbook has just been released by the National Health and Medical Research Council. Following on from the item in the last Newsletter (How Polio Vaccines Work, Issue 44, February 2000) which included remarks about recent changes to the American poliomyelitis vaccination schedule, readers may be interested in the Australian viewpoint on this as reflected the Handbook's section entitled Global eradication of polio. [Note that in the following quotation IPV stands for inactivated poliomyelitis vaccine (Salk, administered by injection), while OPV stands for oral poliomyelitis vaccine (Sabin)].

Because of the rapid progress in global polio eradication and diminished risk of wild virus associated disease, IPV is now preferred in the USA for all 4 polio vaccine doses. This change also came about because of concern about the 8-10 cases of vaccine-associated paralytic poliomyelitis (VAPP) out of a birth cohort of 2 million per year, or 4-5 cases per million children, reported each year in the USA. The advantage of using IPV was considered to be a potential cessation of VAPP. The disadvantages of IPV are the complexity of the schedule, the increased number of injections required at each vaccination visit for young infants, and the very much greater cost of the IPV than OPV in countries such as Australia, compared with the USA. The WHO strongly supports the use of OPV to achieve global eradication of poliomyelitis, especially in countries with continued or recent circulation of wild type poliovirus. This recommendation is endorsed by the US and European authorities including those who routinely use IPV. The polio vaccination schedule in Australia is under constant review and may change in future. There have only been 2 cases of VAPP in Australia in the past 13 years, from birth cohorts of about 260,000 children per year (0.5 cases per million children), which is 10 times lower than the US rate. When combination vaccines containing IPV are available, the feasibility and costs of changing the Australian schedule will be reviewed, bearing in mind that once polio is eradicated within a few years (possibly as early as 2007), polio vaccination will no longer be necessary.

Victorian Polio Survivors Tell Their Stories

The Victorian Women with Disabilities Network has recently published a book on the experiences of women with disabilities. Its title Oyster Grit comes from "The grain of sand - the grit in the oyster - that causes such painful irritation (but) may also produce a pearl". The 16 contributors include polio survivors Jane Trengrove who painted the cover illustration, Margaret Cooper, Chris White, Barbara Ratcliff, Ilma Lever and Betty Bone. Their stories fill more than half the book. Betty's narrative Pearls tells of contracting polio in 1937 and being hospitalised until 1960 when she moved to a hostel. She obtained work as a secretary in a sheltered workshop and, in due course, an electric wheelchair. Her story reminds us of the enormous advances in aids and quality of life for people with disabilities that have been achieved over recent decades. Betty's account of hospital life will bring back many memories. She recalls the food (remember the tapioca we called frogs' eyes?) and hiding it under the mattress until a sympathetic visitor removed it. Books were her lifeline. The tragedies and joys of Betty's life have led to profound compassion. "My unusual lifestyle has allowed me to be more understanding and empathetic towards other people's life experiences where they have endured isolating circumstances like lengthy hospitalisation, imprisonment, kidnapping, being taken hostage. All of these are conditions imposed from outside oneself, when control of one's life and actions are removed and exercised by others: the Holocaust, the Russian Gulags … economic deprivations suffered by black Africans." Margaret Cooper and Christine Ashby in an article titled Top this exchange stories of their experiences with the able-bodied e.g. the portly gentleman at the traffic lights where Margaret was waiting in her wheelchair who "hissed at me to wait till the lights were green. Did he think I was about to play in the traffic?" Ilma describes how learning to drive enriched her life. Poems such as Tiredness describe everyday disability experiences. I liked the quote from Alan Marshall that "If all the people with emotional disabilities were in wheelchairs, there'd be no room on the road for the cars."

The book sells to the waged for $12 (plus $2 postage) and to the unwaged for $7 (plus $2 postage). You can purchase a copy by sending your cheque to Betty Bone, 2 Flete Avenue, Armadale, Victoria, 3143.

Would a cure for spinal cord injury help people with polio?

A recent newspaper headline, World first: Monash team grows nerve cells, went on to say that the discovery gives hope to Christopher Reeve and others with spinal cord injury that there may one day be a cure for their condition. Will this research help people with polio? No, explains Dr Richard Bruno. "The hope with spinal cord injury is that new nerve cells would 'bridge the gap' in the damaged cord and 'heal the cut', allowing the brain to talk to the motor nerves again. This notion requires a small and relatively clean 'gap' and intact motor neurons down below the lesion. In polio survivors there are NO motor neurons, so new motor neurons would have to grow. Then, they would have to send out new axons, like telephone wires, to the muscles they used to activate, since the old axons deteriorated 40+ years ago. This is a daunting task of 'tunnel building' through legs that have the longest nerves in the body. Finally the brain would have to send out new axons (since the old axons shrunk back toward the brain 40+ years ago) and through the spinal cord to get to the 'new' motor neurons, another incredible feat of tunnel building. So the idea of rebuilding a polio-damaged spinal cord would require a hat trick of new internal wiring. Reconnecting a newly lesioned spinal cord would 'only' require a physiological home run."