Polio Outbreak Occurs Among Amish Families In MinnesotaBy David Brown
Friday, October 14, 2005
The first outbreak of polio in the United States in 26 years occurred earlier this fall in an Amish community in central Minnesota, state and federal health officials reported yesterday.
Four children have been infected with the virus, although none has become paralyzed. The Amish typically decline to vaccinate their children. The last large outbreak of polio occurred in numerous Amish communities in several states in 1979.
The outbreak poses little threat to children outside the Amish community. About 98 percent of Minnesota's children are vaccinated against polio, said Harry Hull, the state epidemiologist.
The outbreak was discovered by chance on Sept. 29 after the first child -- a 7-month-old infant with a severe immune deficiency disease -- was tested for another problem in August. Yesterday's announcement reveals the microbe is circulating among healthy children in the isolated community, which has about 200 people in 24 families.
Polio causes paralysis in about one in every 200 infections.
The virus that all four children are carrying is derived from the oral polio vaccine. That vaccine has not been used in the United States since 2000, in part because it causes paralysis in about one of every 13 million doses administered. American children now get an injected vaccine, which also prevents infection.
The oral vaccine, which is still used in most places in the world, is made of a live but severely weakened strain of polio virus. The vaccine virus can be passed person to person, although it rarely becomes part of a prolonged "chain of transmission" because most people in a population are vaccinated and cannot be infected.
Occasionally, however, a vaccine strain circulates for years, passed from one unvaccinated child to another. When that happens, it undergoes genetic mutation that can restore the dangerousness of the "wild" virus.
Jane Seward, a vaccine expert at the federal Centers for Disease Control and Prevention, said genetic fingerprinting of the Minnesota strain shows it is about 2.3 percent different from the vaccine strain. This suggests it has been circulating for a little more than two years.
Where it was circulating, however, is a mystery. Hull said it is likely the virus was imported from a country where the oral vaccine is still in use, but the Amish have little contact with people outside their community. The first infected child had no known exposure to foreigners.
Public health officers are going door to door offering polio vaccine and requesting stool samples of all children. About 35 samples have been collected and 32 tested. Fewer than 20 children have been vaccinated, Hull said.
Polio - The Panic!!!!!
Polio occurred primarily in July, August, and September and hit regardless of geographic region, economic status, or population density. Relatively few people showed any symptoms and even fewer died or experienced paralysis, but the physical effects were dramatic. Communities reacted with dread because no one understood how or why people got it, and because children were the most frequently affected. The first known polio outbreak in the United States was in Vermont in 1894. The last cases of wild (naturally occurring) polio in the United States was quite recently, in four states, among Amish residents who had refused vaccination.
Polio (also called infantile paralysis) was most often associated with children, but it affected teens and grown-ups as well http://tiny.cc/hBCPa.
Between 1949 and 1954, 35 percent of those who contracted polio were adults. "Many inspectors.... stationed themselves at railroad stations, ferries, and boat landings along the Delaware River .... to bar all children under 16 years of age who attempted to cross into Pennsylvania without certificates of health." Los Angeles Times - August 9, 1916 In 1916, New York City experienced the first large epidemic of polio, with over 9,000 cases and 2,343 deaths. The 1916 toll nationwide was 27,000 cases and 6,000 deaths. Epidemics worsened during the century. In 1952, a record 57,628 cases of polio were reported in the United States. The fear of polio was a fear of something you had no defense against, something that hit without logic or reason. Yesterday, it was the man down the block. Today it could be you or your children. —Larry Alexander, 1954 During a polio epidemic, individual rights often clashed with the need for public safety. Travel and commerce between affected cities were restricted. Public health officers imposed quarantines on homes where someone was diagnosed with polio. They required the affected person to be isolated in a hospital, often against the will of the parents or family. The same practices and conflicts are seen today where SARS (Severe Acute Respiratory Syndrome) breaks out. "Unable to obtain a physician, he put the boy into an automobile and drove to the Smith Infirmary, but the child died on the way and the doctors at the hospital would not receive the body.... He drove around Staten Island with the boy's body for hours looking for some one who would receive it." —New York Times, July 26, 1916
Parents outside of a hospital window trying to make contact with child in isolation ward Polio produces no, or only minor symptoms in 95% of those infected. In about 5% of cases, a mild form results in flu-like symptoms of fever, stiff neck, nausea and fatigue, or a slight temporary paralysis. About 1% of those with polio symptoms experience a severe form called paralytic polio that has lasting effects. In the worst cases of paralytic polio, 2% to 5% of children and 10% to 20% of adults die. Humans are the only reservoir for the polio virus. The virus does not naturally reproduce in any other species.
Spinal Tap! Lumbar puncture, or spinal tap, was introduced in 1891 as a way to relieve children with hydrocephalus (pressure on the brain from accumulation of fluid) and quickly began to be used as the primary way to diagnose polio.
"Well, it’s like this. This is the only real way we can tell what breathing you have left.... We find the amount of air you can blow into this counterbalanced floating cylinder with the gauge — that's all." —Larry Alexander, 1954.