Polio historical perspective
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Poliomyelitis was first recognized as a distinct condition by Jakob Heine in 1840.[1] Its causative agent, poliovirus, was identified in 1908 by Karl Landsteiner.[1] Although major polio epidemics were unknown before the 20th century, polio was one of the most dreaded childhood diseases of the 20th century in the United States. Polio epidemics have crippled thousands of people, mostly young children; the disease has caused paralysis and death for much of human history. Polio had existed for thousands of years quietly as an endemic pathogen until the 1880s, when major epidemics began to occur in Europe; soon after, widespread epidemics appeared in the United States. By 1910, much of the world experienced a dramatic increase in polio cases and frequent epidemics became regular events, primarily in cities during the summer months. These epidemics—which left thousands of children and adults paralyzed—provided the impetus for a "Great Race" towards the development of a vaccine. The polio vaccines developed by Jonas Salk in 1952 and Albert Sabin in 1962 are credited with reducing the annual number of polio cases from many hundreds of thousands to around a thousand.[2] Enhanced vaccination efforts led by the World Health Organization, UNICEF and Rotary International could result in global eradication of the disease.[3]
Historical Perspective
The effects of polio have been known since prehistory; Ancient Egyptian paintings and carvings depict otherwise healthy people with withered limbs, and children walking with canes at a young age. The first clinical description was provided by the British physician Michael Underwood in 1789, where he refers to polio as "a debility of the lower extremities".[5] The work of physicians Jakob Heine in 1840 and Karl Oskar Medin in 1890 led to it being known as Heine-Medin disease.[6] The disease was later called infantile paralysis, based on its propensity to affect children.
Before the 20th century, polio infections were rarely seen in infants before six months of age, most cases occurring in children six months to four years of age.[7] Poorer sanitation of the time resulted in a constant exposure to the virus, which enhanced a natural immunity within the population. In developed countries during the late 19th and early 20th centuries, improvements were made in community sanitation, including better sewage disposal and clean water supplies. These changes drastically increased the proportion of children and adults at risk of paralytic polio infection, by reducing childhood exposure and immunity to the disease.
Small localized paralytic polio epidemics began to appear in Europe and the United States around 1900.[8] Outbreaks reached pandemic proportions in Europe, North America, Australia, and New Zealand during the first half of the 20th century. By 1950 the peak age incidence of paralytic poliomyelitis in the United States had shifted from infants to children aged five to nine years, when the risk of paralysis is greater; about one-third of the cases were reported in persons over 15 years of age.[9] Accordingly, the rate of paralysis and death due to polio infection also increased during this time.[8] In the United States, the 1952 polio epidemic became the worst outbreak in the nation's history. Of nearly 58,000 cases reported that year 3,145 died and 21,269 were left with mild to disabling paralysis.[10]
The polio epidemics changed not only the lives of those who survived them, but also affected profound cultural changes; spurring grassroots fund-raising campaigns that would revolutionize medical philanthropy, and giving rise to the modern field of rehabilitation therapy. As one of the largest disabled groups in the world polio survivors also helped to advance the modern disability rights movement through campaigns for the social and civil rights of the disabled. The World Health Organization estimates that there are 10 to 20 million polio survivors worldwide.[11] In 1977 there were 254,000 persons living in the United States who had been paralyzed by polio.[12] According to doctors and local polio support groups, some 40,000 polio survivors with varying degrees of paralysis live in Germany, 30,000 in Japan, 24,000 in France, 16,000 in Australia, 12,000 in Canada and 12,000 in the United Kingdom.[11] Many List of polio survivors|notable individuals have survived polio and often credit the prolonged immobility and residual paralysis associated with polio as a driving force in their lives and careers.[13]
The disease was very well publicized during the polio epidemics of the 1950s, with extensive media coverage of any scientific advancements that might lead to a cure. Thus, the scientists working on polio became some of the most famous of the century. Fifteen scientists and two laymen who made important contributions to the knowledge and treatment of poliomyelitis are honored by the Polio Hall of Fame at the Roosevelt Warm Springs Institute for Rehabilitation in Warm Springs, Georgia, USA.
Records from antiquity mention crippling diseases compatible with poliomyelitis. Michael Underwood first described a debility of the lower extremities in children that was recognizable as poliomyelitis in England in 1789. The first outbreaks in Europe were reported in the early 19th century, and outbreaks were first reported in the United States in 1843. For the next hundred years, epidemics of polio were reported from developed countries in the Northern Hemisphere each summer and fall. These epidemics became increasingly severe, and the average age of persons affected rose. The increasingly older age of persons with primary infection increased both the disease severity and number of deaths from polio. Polio reached a peak in the United States in 1952, with more than 21,000 paralytic cases. However, following introduction of effective vaccines, polio incidence declined rapidly. The last case of wild-virus polio acquired in the United States was in 1979, and global polio eradication may be achieved within the next decade.
Polio Eradication
Following the widespread use of poliovirus vaccine in the mid-1950s, the incidence of poliomyelitis declined rapidly in many industrialized countries. In the United States, the number of cases of paralytic poliomyelitis reported annually declined from more than 20,000 cases in 1952 to fewer than 100 cases in the mid-1960s. The last documented indigenous transmission of wild poliovirus in the United States was in 1979.
In 1985, the member countries of the Pan American Health Organization adopted the goal of eliminating poliomyelitis from the Western Hemisphere by 1990. The strategy to achieve this goal included increasing vaccination coverage; enhancing surveillance for suspected cases (i.e., surveillance for acute flaccid paralysis); and using supplemental immunization strategies such as national immunization days, house-to-house vaccination, and containment activities. Since 1991, when the last wild-virus–associated indigenous case was reported from Peru, no additional cases of liomyelitis have been confirmed despite intensive surveillance. In September 1994, an international commission certified the Western Hemisphere to be free of indigenous wild poliovirus. The commission based its judgment on detailed reports from national certification commissions that had been convened in every country in the region.
In 1988, the World Health Assembly (the governing body of the World Health Organization) adopted the goal of global eradication of poliovirus by the year 2000. Although this goal was not achieved, substantial progress has been made. One type of poliovirus appears to have already been eradicated. The last isolation of type 2 virus was in India in October 1999.
The Americas were declared polio-free in 1994.[14] In 2000 polio was officially eradicated in 36 Western Pacific countries, including China and Australia.[15][16] Europe was declared polio-free in 2002.[17] In 2009, polio remained endemic in only four countries: Nigeria, India, Pakistan, and Afghanistan.[18]
References
- ↑ 1.0 1.1 Paul JR (1971). A History of Poliomyelitis. Yale studies in the history of science and medicine. New Haven, Conn: Yale University Press. pp. 16–18. ISBN 0-300-01324-8.
- ↑ Aylward R (2006). "Eradicating polio: today's challenges and tomorrow's legacy". Ann Trop Med Parasitol. 100 (5–6): 401–13. PMID 16899145.
- ↑ Heymann D (2006). "Global polio eradication initiative". Bull. World Health Organ. 84 (8): 595. PMID 16917643.
- ↑ "Center for Disease Control and Prevention (CDC)".
- ↑ Underwood, Michael (1793). Debility of the lower extremities. In: A treatise on the diseases [sic] of children, with general directions for the management of infants from the birth (1789) (fee required). Early American Imprints, 1st series, no. 26291 (filmed); Copyright 2002 by the American Antiquarian Society. 2. Philadelphia: Printed by T. Dobson, no. 41, South Second-Street. pp. pp. 254&ndash, 6. Retrieved 2007-02-23.
- ↑ Pearce J (2005). "Poliomyelitis (Heine-Medin disease)" (free registration required). J Neurol Neurosurg Psychiatry. 76 (1): 128. PMID 15608013.
- ↑ Robertson S (1993). "Module 6: Poliomyelitis" (PDF). The Immunological Basis for Immunization Series. World Health Organization. Geneva, Switzerland. Retrieved 2007-05-08.
- ↑ 8.0 8.1 Trevelyan B, Smallman-Raynor M, Cliff A (2005). "The Spatial Dynamics of Poliomyelitis in the United States: From Epidemic Emergence to Vaccine-Induced Retreat, 1910–1971". Ann Assoc Am Geogr. 95 (2): 269–293. PMID 16741562.
- ↑ Melnick JL (1990). Poliomyelitis. In: Tropical and Geographical Medicine (2nd ed. ed.). McGraw-Hill. pp. p. 558–76. ISBN 007068328X.
- ↑ Zamula E (1991). "A New Challenge for Former Polio Patients". FDA Consumer. 25 (5): 21–5.
- ↑ 11.0 11.1 "After Effects of Polio Can Harm Survivors 40 Years Later". March of Dimes. 2001-06-01. Retrieved 2007-08-07. Check date values in:
|date=(help) - ↑ Frick NM, Bruno RL (1986). "Post-polio sequelae: physiological and psychological overview". Rehabilitation literature. 47 (5–6): 106–11. PMID 3749588.
|access-date=requires|url=(help) - ↑ Richard L. Bruno (2002). The Polio Paradox: Understanding and Treating "Post-Polio Syndrome" and Chronic Fatigue. New York: Warner Books. pp. 105–6. ISBN 0-446-69069-4.
- ↑ "International Notes Certification of Poliomyelitis Eradication—the Americas, 1994". MMWR Morb Mortal Wkly Rep. Centers for Disease Control and Prevention. 43 (39): 720–2. 1994. PMID 7522302.
- ↑ "General News. Major Milestone reached in Global Polio Eradication: Western Pacific Region is certified Polio-Free" (PDF). Health Educ Res. 16 (1): p. 109. 2001.
- ↑ D'Souza R, Kennett M, Watson C (2002). "Australia declared polio free". Commun Dis Intell. 26 (2): 253–60. PMID 12206379.
- ↑ "Europe achieves historic milestone as Region is declared polio-free" (Press release). European Region of the World Health Organization. 2002-06-21. Retrieved 2007-11-07. Check date values in:
|date=(help) - ↑ "Update on vaccine-derived polioviruses" (2006). MMWR Morb Mortal Wkly Rep 55 (40): 1093–7. PMID 17035927