Mar 13, 2010

The Polio Epidemic

Health and Healing in North Carolina - An Interactive Timeline

The Polio Epidemic

1944 - Institutional Event
"I won’t ever forget the feeling in my legs when I lost the use of them.
It was just such a weird feeling.
It was just like it went through me,
just a surge went through my body.
I can feel it right now just thinking about it.
It was very frightening for a little 14-year-old girl to think,
gosh, my life’s gone, you know?”

—Addie Flowers Vance, Charlotte, Mecklenburg County, 1996

The word “polio” no longer sends ripples of fear through parents across the United States. But as early as 1916, large outbreaks of 
poliomyelitis, or infantile paralysis, swept through cities and towns, crippling and killing thousands. The victims were mainly children—but not always. In 1921, at the age of 39, Franklin D. Roosevelt was left with severe paralysis from the disease and spent most of his presidency in a wheelchair. During his second term, he founded the National Foundation for Infantile Paralysis, known later as the March of Dimes.

Polio is an infectious viral disease that enters through the mouth or nose, then travels to the spinal cord. There it attacks nerves that control muscle activity, causing temporary or permanent paralysis. Usually polio affects leg, arm, stomach and back muscles. But if it paralyzes chest muscles needed for breathing, it can be fatal.

Just as World War II ended, the most severe epidemics hit the nation. Most polio outbreaks began in the summer. Since children were most frequently affected, communities reacted with dread, often closing down public swimming pools and movie theaters. The epidemic peaked in North Carolina and the United States in 1952, when a record 57,628 cases were reported nationally. Some referred to the national state of panic as “polio hysteria.”

The following year, Dr. Jonas Salk and his associates developed an injectable polio vaccine made from inactivated virus. Schoolchildren by the thousands were vaccinated, reducing the incidence of polio by almost 90 percent within two years. Later, the Salk vaccine was replaced by the Sabin oral vaccine, which was easier and less expensive to administer.

Today polio has been eradicated in the United States, where the last case caused by “wild” virus was reported in 1979. Worldwide, while vaccination campaigns continue, hundreds of new cases are still reported each year.


Polio swept across North Carolina’s western Piedmont region in 1944, centering around Catawba County.

The March of Dimes, a fund-raising organization, was founded by FDR as the National Foundation for Infantile Paralysis in 1938.

Between 1949 and 1954, 65% of those who contracted polio were children.

North Carolina children wait in segregated lines for free Salk polio vaccinations.

Post-Polio Syndrome

During the 1940s and ’50s, polio patients were told their muscles would lose strength and flexibility if not used to full capacity. So they pushed their bodies, often beyond their limits. Many recovered to the point where they no longer needed crutches, braces, wheelchairs or iron lungs.

But 30 to 40 years later, the disease took a second toll on some survivors. These former patients began experiencing new pain and muscle weakness, in some cases forcing them back into wheelchairs. Doctors now believe these symptoms result from overworked nerve cells, muscles and joints.

Today, physical therapists encourage polio survivors to abandon the old “use it or lose it” philosophy in favor of a new approach: “Conserve it to preserve it.”

The Iron Lifesaver

Polio killed many victims by paralyzing the muscles needed for breathing. But many more survived, thanks to a device invented in 1929, the iron lung. The patient lay on a bed that could slide in and out of a large metal tank. At one end was a motor-powered “bellows” that pumped air in and out of the chamber. As air pressure increased in the chamber, it pushed down on the patient’s chest, forcing air out of the lungs. When the pressure decreased, the chest expanded, taking air into the lungs.

Some patients regained their ability to breathe on their own after a few weeks or months in an iron lung. Others remained dependent on the device for years.

The cost of an iron lung was high—about $1,500 during the 1930s, the average price of a home at that time. To help families afford respiratory treatment and medical equipment such as braces and crutches, North Carolina Blue Plans began offering additional coverage for polio.


The iron lung saved many thousands of lives during the polio epidemic.

An iron lung decorated with photos and cards. The mirror above the pillow let patients see visitors behind them.

Extra healthcare coverage helped families pay the cost of polio treatment and equipment.

The Miracle of Hickory

When a 1944 polio epidemic quickly filled hospitals in and around Catawba County, NC, the town of Hickory and the National Foundation for Infantile Paralysis went into high gear. Almost overnight, they turned a local camp into an emergency hospital. The first patients were admitted within 54 hours—a feat that became known as “the miracle of Hickory.”

Arriving patients remained in quarantine for two weeks, isolated even from parents in case they were still contagious. Afterward, they could have visitors only on Wednesdays and Sundays. But because of distance, lack of transportation or gasoline rationing, some families found it difficult to make the trip. Spending weeks or months away from their parents made the experience doubly traumatic for many young patients, who also had to cope with the boredom of passing the long hours between physical therapy sessions, unable to move.
“You just lay there in the bed. It wasn’t no TVs to look at, wasn’t no radios to listen to.”
—Samuel Jolley, Forest City, Rutherford County, 1996

There was no cure for polio, and theories about treatment differed. Some believed paralyzed limbs should be immobilized with plaster casts to keep them from growing crooked. But more adopted the “use it or lose it” philosophy. After the disease’s acute phase had passed, the treatment included intense, persistent exercise and heat therapy, both of which could be uncomfortable or painful.

Many patients slowly regained the use of leg muscles and began to walk again with the help of crutches, leg braces and even corsets to straighten their spines.


Admission staff examines a young woman at the Hickory Emergency Polio Hospital in 1944.

Polio victims often wore heavy braces to support weakened muscles.

Because of distance, lack of transportation or gasoline rationing, some families found it difficult to visit their loved ones in quarantine. Photo courtesy of the Norfolk Public Library.

Mar 12, 2010

Síndrome Post-Polio (SPP),clasificándolo bajo el código "G14




En el mes de Febrero del 2009 en la reunión anual del Comité de Revisión y Actualización de la Organización Mundial de la Salud, que tuvo lugar en Delhi, durante el mes de Octubre de 2008, la Clasificación Internacional de Enfermedades, en su versión 10 (ICD-10) ha otorgado un lugar especial al: 
Síndrome Post-Polio (SPP)
clasificándolo bajo el código "G14" 
y excluyéndolo del código B91 
(Secuelas de poliomielitis) en el que antes ese organismo lo suponía abarcado
La información se pude leer en :

Esta disposición cobrará vigencia a partir del mes de enero de 2010, para bien de todos los afectados de polio en el mundo.
 Hoy, de hecho, Canadá ha integrado ya dicho código en la décima revisión (2009) 






Mar 9, 2010

The disease and the virus What is Polio?



The disease and the virus

The Global Eradication of Polio

  • What is Polio?

  • Poliomyelitis (polio) is a highly infectious disease caused by a virus. It invades the nervous system, and can cause total paralysis in a matter of hours. It can strike at any age, but affects mainly children under three (over 50% of all cases). The virus enters the body through the mouth and multiplies in the intestine. Initial symptoms are fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs. One in 200 infections leads to irreversible paralysis (usually in the legs). Amongst those paralysed, 5%-10% die when their breathing muscles become immobilized. Although polio paralysis is the most visible sign of polio infection, fewer than 1% of polio infections ever result in paralysis. Poliovirus can spread widely before cases of paralysis are seen. As most people infected with poliovirus have no signs of illness, they are never aware they have been infected. After initial infection with poliovirus, the virus is shed intermittently in faeces (excrement) for several weeks. During that time, polio can spread rapidly through the community.


  •  Who is most at risk of polio?

  • Polio mainly affects children under five years of age. However, immune and or partially immune adults and children can still be infected with poliovirus and carry the virus for long enough to take the virus from one country to another, infecting close contacts and contaminating sanitation systems. This could facilitate transmission especially in countries where sanitation systems are sub-standard.


  •  How is polio spread?

  • In the remaining polio endemic countries, poliovirus is mainly passed through person-to-person contact. Most people infected with the poliovirus do not develop polio paralysis or other symptoms of polio infection. However one in 200 people do have symptoms and can become paralyzed. The virus enters the environment through faeces of people infected then is passed to others especially in situations of poor hygiene. The poliovirus can also infect persons who have been vaccinated and can be carried by them. Such individuals will not develop polio, but can carry the virus in their intestines and can pass it to others in conditions of sub-standard hygiene. The disease may infect thousands of people, depending on the level of sanitation, before the first case of polio paralysis emerges. Individuals can carry the virus in their intestines just long enough to transmit to others. WHO considers a single confirmed case of polio paralysis to be evidence of an epidemic - particularly in countries where very few cases occur.


  •  How can polio be prevented?



  • There is no cure for polio, it can only be prevented through immunization. Polio vaccine, given multiple times, almost always protects a child for life. Full immunization will markedly reduce an individual's risk of developing paralytic polio. Full immunization will protect most people, however individuals can still contract the disease due to the failure of some individuals to respond to the vaccine.


  • POLIO PARALYSIS

  • Once established in the intestines, poliovirus can enter the blood stream and invade the central nervous system - spreading along nerve fibres. As it multiplies, the virus destroys nerve cells (motor neurons) which activate muscles. These nerve cells cannot be regenerated and the affected muscles no longer function. The muscles of the legs are affected more often than the arm muscles. The limb becomes floppy and lifeless - a condition known as acute flaccid paralysis (AFP). More extensive paralysis, involving the trunk and muscles of the thorax and abdomen, can result in quadriplegia. In the most severe cases (bulbar polio), poliovirus attacks the motor neurons of the brain stem - reducing breathing capacity and causing difficulty in swallowing and speaking. Without respiratory support, bulbar polio can result in death.

  • THE IRON LUNG

  • Large polio epidemics caused panic every summer during the 1940s and 50s in industrialized countries (US, Western Europe). At that time, people with polio affecting the respiratory muscles were immobilized inside "iron lungs" - huge metal cylinders that operated like a pair of bellows to regulate their breathing and keep them alive. Today, the iron lung has largely been replaced by the positive pressure ventilator; nevertheless, it is still in use in some countries.
    Children whose legs are paralysed by polio today often require crutches, special braces or wheelchairs in order to move around.
    Because no drug developed so far has proven effective, treatment is entirely symptomatic. Moist heat is coupled with physical therapy to stimulate the muscles and antispasmodic drugs are given to produce muscular relaxation. While this can improve mobility, it cannot reverse permanent polio paralysis.


  • POLIO IN INDUSTRIALIZED AND DEVELOPING COUNTRIES

  • Until the 1950s, polio crippled thousands of children every year in industrialized countries. Soon after the introduction of effective vaccines in the late 1950s (IPV) and early 1960s (OPV), polio was brought under control, and practically eliminated as a public health problem in industrialized countries.
    It took somewhat longer for polio to be recognised as a major problem in developing countries. However, 'lameness surveys' during the 1970s revealed that the disease was also frequent in developing countries, crippling thousands of children every year. As a result, during the 1970s routine immunization with OPV as part of national immunization programmes (Expanded Programme on Immunization, or EPI programmes) was introduced worldwide, helping to control the disease in many developing countries.
    Today, the disease has been eliminated from most of the world, and only seven countries world-wide remain polio-endemic. This represents the lowest number of countries with circulating wild poliovirus. At the same time, the areas of transmission are more concentrated than ever - 98 percent of all global cases are found in India, Nigeria and Pakistan.
    • For more information on polio in developing countries, with particular reference to prosthetic treatment of children crippled by polio, refer to excerpts from the book by Dr. Huckstep on polio in the developing world.

  • "POST-POLIO SYNDROME"

  • It is increasingly recognized that people who suffered polio as a child risk "post-polio syndrome". For more information about this condition, click here
    Programme of Work 2010 - 2012
    The Global Polio Eradication Initiative  is in the midst of a consultative process to finalise a Programme of Work  2010-2012.  The process is being driven by a Framework document for partners to discuss and achieve consensus on. Working also with  countries,  which are developing their three-year plans,  the Framework will be fleshed out into a draft Programme of Work , also to be discussed with partners. The Programme of Work will discussed during WHO's Executive Board meeting and finalized as soon as possible afterwards.


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