Dec 2, 2014

The Salk Polio Vaccine: A Medical Miracle Turns 60

The crippling disease was the scourge of the early 20th century, until Dr. Jonas Salk created a life-saving shield
Monday, December 1, 2014
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Part one of a two-part series
MONDAY, Dec. 1, 2014 (HealthDay News) -- Most American parents today can't fathom the horror that summers brought during the first half of the 20th century.
Summer meant polio season, and whole communities waited in dread for an outbreak to strike.
Ordinary life all but ground to a halt in cities and towns where polio went on its rampage, crippling or killing scores of children. Movie theaters, bowling alleys, swimming pools and beaches -- even churches -- all were shut down to prevent the spread of what was then a mysterious disease.
Fear-driven neighbors turned on each other, or fled for more isolated environs.
"My mother talks about walking my sister in the neighborhood while I was in the hospital with polio, and parents pulling their children off the street and into the house upon sight of them, for fear of catching the disease," recalled Daniel Wilson, a 64-year-old history professor at Muhlenberg College in Allentown, Pa., who has written three books on the history of polio in the United States.
Yet from that fear and urgency came one of the most extraordinary scientific experiments in American history -- the Salk polio vaccine field trial of 1954. Desperate parents offered up more than 1.8 million children to serve as what amounted to test subjects, including 600,000 kids who were injected with either the vaccine or a placebo.
The trial, which celebrates its 60th anniversary this year, remains the largest clinical trial in U.S. history, a record that probably will never be challenged. 
It also made a national hero out of an unassuming scientist named Dr. Jonas Salk.
Salk created his polio vaccine at the University of Pittsburgh in 1952, through research funded by the National Foundation for Infantile Paralysis, the precursor to the March of Dimes.
Salk's interest in polio grew out of his efforts on a flu vaccine in the 1940s, at the University of Michigan School of Public Health where he worked alongside his mentor, virologist Dr. Thomas Francis, Jr.
Epidemics emerged in early 20th century
The first major U.S. polio epidemic occurred in 1894 in Vermont, with 132 cases. New York City experienced its first large-scale outbreak in 1916, with more than 27,000 cases and 6,000 deaths.
By the 1940s, polio was a plague across the country.
Modern sanitation probably sparked the emergence of the disease in the early 20th century, said David Oshinsky, author of the Pulitzer Prize-winning book Polio: An American Story.
Before the 20th century, children were more likely to contract mild polio infection at earlier ages, achieving immunity without even knowing it. When new sewer systems and clean water supplies arrived, children were protected against dysentery and other infectious diseases, but they were also left vulnerable to contracting polio that could cripple or kill, Oshinsky said.
"The major polio epidemics don't come until the early 20th century, which is exactly the same time when we're doing things like separating waste from water, we're chlorinating our water and having waste treatment plants, we're using germ killers to wipe off tables, we're washing our hands more, and all of a sudden this disease pops up," he said.
Polio epidemics surged in frequency and size during the 1940s and early 1950s, and the virus crippled more than 35,000 Americans annually. It became one of the nation's most feared diseases.
Doctors now know that the polio virus lives silently in the throat and intestines, and spreads through direct contact with an infected person's excretions, most often their saliva or feces. The warm months of summer were especially conducive to the virus' spread.
In three-quarters of cases, an infected person showed no symptoms at all. Others had minor symptoms that resembled the flu, according to the U.S. Centers for Disease Control and Prevention.
But in one out of 100 cases, the polio virus made its way into the infected person's nervous system to attack the brain and spinal cord. Polio could permanently cripple a victim's limbs, or paralyze the muscles that control breathing.
None of this was understood in the 1940s and 1950s. But the ravages of the disease were visible everywhere in ordinary life -- particularly when it came to children.
Empty desks as school years started
"Unlike a lot of childhood diseases -- where when you recover, you're healthy again -- polio left people in wheelchairs, needing braces, in iron lungs," said Wilson. "There was always a reminder for parents of what could happen if your child got polio."
Oshinsky was a schoolboy during that time and remembers the disease was just as terrifying for children.
"School would start [again in the fall] and you'd see kids in leg braces and kids on crutches, and the occasional empty desk," he recalled. "All the newspapers would start putting box scores in -- sometimes on the front page -- about the number of children who were now entering polio wards. The numbers would rise during June and July, and spike during August."
Polio survivor Jan Nichols recalled the year 1952, which was the nation's worst, with almost 58,000 diagnosed cases.
"Parents lived in fear of warm weather -- polio weather. They adhered to all public health recommendations and warnings: avoid large public gatherings, never allow children to swim in public swimming pools, and insist upon frequent hand-washing," she wrote in an article last year for the Children's Hospital of Philadelphia.
"One of my peers remembers that her mother forbade her to eat peaches in the summer for fear that the virus could flourish in the peach fuzz. Another friend was forbidden to attend church each Sunday during the summer months," Nichols said.
Pamela Reed, who worked as an editorial assistant at the Kalamazoo Gazette newspaper in Michigan, contracted polio in September 1947, when she was 10 months old.
"I awoke from my nap feverish and stiff," Reed wrote in an article for the paper. "My frantic mother called the doctor, and he rushed right over. Taking a pin from my diaper, he poked the bottoms of my feet. No response. 'Call your husband home,' he told my mother. 'We need to get her to Children's Hospital in Detroit.'"
Reed was left with lifelong weakness in her lower left leg, which required her to use a leg brace and relearn how to walk.
Salk used the experimental vaccine on himself, his wife and sons
At the University of Pittsburgh, Salk worked "16 hours a day, seven days a week, for years" on a polio vaccine, according to published reports, using techniques based on his earlier research on the flu vaccine. His goal: to develop an "inactivated" polio vaccine that used a dead strain of the virus to prompt the body to produce antibodies to fight off polio infection.
Salk's vaccine wasn't perfect. For one thing, it was complicated, requiring three shots to provide full inoculation. Other researchers funded by the National Foundation, most notably Dr. Albert Sabin, who was working at the University of Cincinnati at the time, felt that a live-virus vaccine would be more effective and easier to administer. 
"Sabin was convinced it [a dead-virus vaccine] wouldn't work, and that the Salk vaccine was not a very good vaccine," Wilson said.
Salk reached the finish line first, however, and in 1952 launched a series of preliminary experiments to test the safety of his vaccine. 
His first safety trials involved dozens of children at two Pittsburgh-area institutions -- the D.T. Watson Home for Crippled Children and the Polk School for the Retarded and Feeble-Minded.
The Polk School trial findings demonstrated that the vaccine stimulated a high antibody response -- evidence that it had the potential to protect children against polio infection.
"It was the thrill of my life," Salk recalled.
By March 1954, Salk had proven that his vaccine was safe through the experimental inoculation of 5,320 people -- including himself, his wife and his three sons.
With the safety of his vaccine established, the drums began beating hard for a clinical trial that would test its effectiveness.
"A lot of pressure developed to move as quickly as possible, given the intensity of the polio problem in this country," said Dr. Peter Salk, Jonas Salk's son and president of the Jonas Salk Legacy Foundation. "My father was a very careful scientist, and was working hard to understand all of the issues involved in creating a vaccine. When it became clear that the pressure was irresistible to move into a large-scale trial, then this huge national field trial was undertaken."
But it remained to be seen whether the challenge of such a massive trial could be met -- and in a way that would both scientifically prove the vaccine's effectiveness and pave the way for its acceptance by the American public.
And hovering above the science and the politics was the ultimate question: Would the vaccine work?
SOURCES: Daniel Wilson, history professor, Muhlenberg College, Allentown, Pa.; David Oshinsky, author, Polio: An American Story; U.S. Centers for Disease Control and Prevention; Peter Salk, M.D., director, president, the Jonas Salk Legacy Foundation, La Jolla, Calif.

Post Polio Litaff, Association A.C _APPLAC Mexico

Nov 20, 2014

Study Shows Promise in Treating Heart Disease Associated With Muscular Dystrophy

Study shows stem cells used to treat heart attacks may also help children with muscular dystrophy. Dr. Bruce Hensel reports for the NBC4 News at 5 on Monday, Nov. 17, 2014. (Published Tuesday, Nov 18, 2014)
Doctors at the American Heart Association’s Scientific Sessions announced a potential breakthrough Monday, asserting that stem cells used to treat heart attacks may also help kids with muscular dystrophy.
Stem cells are immature cells that may be used on disease areas to regrow tissue, and they’ve already been used to regrow tissue in hearts injured in a cardiac arrest. This study focused on a very unique use; inspired by a mother who wouldn’t give up.
Dusty Brandom, 22, who has muscular dystrophy, said he knows his weakened muscles are just part of the problem. Over time, as with all muscular dystrophy patients, the disease caused scarring in his heart and lungs.
Refusing to accept that, Brandom’s mom searched everywhere for an answer, and may have found one in a surprising place.
"I read an article called 'Repairing Broken Hearts' and in it, it talked about Dr. (Eduardo) Marband's treatment that he was using for adults with heart attacks," said Catherine Jayasuriya, Brandom’s mother.
Jayasuriya reached out to Dr. Marban of the Cedars-Sinai Heart Institute and not only encouraged him to consider the idea but her organization, Coalition Duchenne, raised money to help fund a study on mice with muscular dystrophy.
Marban said even he was surprised.
"It turns out the results were spectacular, much better than we expected," he said. "The mouse hearts got dramatically better."
The next step is human studies that Brandom hopes will lead to expanded uses for the treatment in the future.
"Guys like me will be able to walk again," said Brandom, of the possibilities that have arisen from the study. "That’d be really good to maybe be able to do some things I can’t do anymore."
Dr. Bruce Hensel says the next step will take time but "If it works it may save many lives."

Post Polio Litaff, Association A.C _APPLAC Mexico

Nov 11, 2014

Poliovirus is typically acquired through ingestion of contaminated matter

Poliovirus is a , placing it in a family of viruses that reproduce in the gastrointestinal tract at the start of their infection. It typically infects young children, conferring mild flu-like symptoms in the majority of cases. A small percentage of polio cases result in paralysis or other more severe symptoms. Relatives of the poliovirus include other members of the large picarnovirus family, including foot and mouth disease virus, hepatitis A virus, rhinoviruses, and coxsackie viruses. Icosahedral in shape (having 20 triangular faces and 12 corners), poliovirus contains four virus-specific protein subunits (VP1, VP2, VP3, and VP4). Sixty copies of each of these arrange to give the small, non-enveloped virus its structure. Also contained within the virus is a 7500 nucleotide RNA genome with one open reading frame encoding a 220 kD polyprotein (Hogle et al., 1985). 

Transmission and Route of Infection
Poliovirus is typically acquired through ingestion of contaminated matter and enters tissues through our gastrointestinal mucosal surfaces. The virus targets cells bearing CD155, the receptor for the poliovirus, a gene only present in humans and old-world primates. Characteristic of enteroviruses, replication first happens in the throat and intestinal-associated tissues before entering the blood and lymph. Poliovirus can infect follicular-associated epithelial cells as well as cells in the Peyer’s patches and tonsils that lie under the epithelial surface. However, damage to epithelial cells is virtually nonexistent, while significant damage is seen in the tonsils and Peyer’s patches, suggesting that most viral replication takes place here. The microfold cells (M-cells), a part of the gastrointestinal epithelium, express CD155 on both their apical and basolateral surfaces. M-cells cells transport poliovirus directly from the gut to the lymphoid follicles of Peyer’s patches. Infection is aided by the fact that these epithelial cells have little IgA or mucus secretions, exempting the virus from one of the first lines of host defense (Iwasaki et al., 2002).
In the Peyer’s patches and tonsils, the virus replicates and infects cells expressing CD155 such as follicular dendritic cells and B-cells. In non-systemic infections, virus particles are returned to the lumen by an unknown mechanism and the virus returns to the environment through bodily excretions. However, on rare occasions, the poliovirus can enter the bloodstream. Researchers postulate that this occurs as a result of damage to blood vessels (Iwasaki et al, 2002). From the circulation, the poliovirus will eventually end up in the central nervous system via transport across the blood-brain barrier or via retrograde axonal transport. Another newly proposed mechanism of CNS infection is viral transport directly from the Peyer’s patch to the CNS by way of the vagus nerve (Iwasaki et al, 2002). Neuronal cells bear CD155, allowing the poliovirus to infect them and replicate within. As neuronal cells are destroyed, paralytic poliomyelitis can result.

Virus-Receptor Interactions
Poliovirus interacts with its receptor on human cells (PVR), also known as CD155, to gain entry into the cell. CD155 is expressed by various cells, including monocytes, macrophages, thymocytes, CNS neurons, M-cells, B-cells, and follicular dendritic cells (Janeway et al., 2001; is typically acquired through ingestion of contaminated matter et al., 2002). CD155 has three extracellular immunoglobulin-like domains, a transmembrane domain, and a cytoplasmic domain. The two types of CD155, resulting from alternative splicing, differ only in the length of their cytoplasmic regions. Immunoglobulin domain 1 contains the sites of viral binding, while the other two extracellular domains play a minor role in affinity (Racanicello 1996). The binding region of domain 1 is known as the C’-C” ridge, and interacts with VP1, VP2, and VP3 (Belnap et al., 2000). Each type of polio strain binds to the receptor somewhat differently, as some mutations will allow one strain to bind but not others.
Fig. 1: Poliovirus (pink) bound to a soluble form of its receptor (green), CD155. Fig. 1d. from Belnap et al., 2000 (3-D structure…). 

Certain regions of the virus are important to receptor ligation. A distinctive peak on one axis of the poliovirus is surrounded by a wide, deep chasm deemed ‘the canyon’. This area is where the C’-C” ridge of the receptor inserts and binds. Ligation occurs at multiple locations, as mutations atvarious points in this area reduce affinity.
Following ligation, CD155 induces structural changes in the poliovirus, creating an altered virus commonly called the A particle or 135S state. In this state, the N terminus of VP1, as well as VP4, is expressed on the viral surface as opposed to inside the virus (Belnap et al., 2000). In addition, this form is more sensitive to proteases. These changes give the viral coat a hydrophobic character, allowing it to insert in the host cell membrane. Research strongly suggests that this creates a transmembrane pore in the host cell. After a VP3 plug is removed, RNA can leave the viral capsid and enter the cytoplasm of the host cell (Belnap et al., 2000). Here the virus replicates and causes cell lysis, continuing the spread to other cells.
Fig.2: Viral insertion into host cell membrane and suggested mechanism for RNA transfer across cell membrane. Blue=VP1, Yellow=VP2, Red=VP3, and Green=VP4. Note insertion of VP1 into membrane and pore formation resulting in transfer of RNA (Purple). From Belnap et al., 2000 (Molecular Tectonic Model...). Permission requested. 
It has also been proposed that when CD155 binds in the viral canyon, it disrupts a hydrocarbon binding pocket, decreasing sphigosine affinity to the pocket. Subsequent release of sphigosine destabilizes the capsid, aiding the release of viral RNA (Racaniello, 1996).
Data has indicated that a physical association between CD44 and CD155 exists and that CD44 may able to transduce an apoptotic signal to the host cell on which it is located, contributing to lysis and cell damage. Additionally, anti-CD44 may be able to block virus binding to CD155 because of the close proximity of the two transmembrane proteins (Gosselin et al., 2003). However, some studies show that CD44's presence has no effect on the binding affinity of poliovirus to CD155, nor does it affect the replication of poliovirus (Racaniello, 1996). As of yet, the role of CD44 in poliovirus is still unknown; future research will reveal whether connections exist.

Types of Polio: Clinical Manifestations
Three main distinctions of polio exist. The mildest is subclinical polio, which sometimes shows no symptoms and accounts for 95% of polio cases. If symptoms are seen, they last a brief period of time and can include fever, malaise, headache, sore throat, or vomiting. Subclinical infections are contained to the gut and lymphoid-associated cells of the gut. Nonparalytic polio shows similar symptoms to subclinical polio, but in addition, patients can experience stiff neck, back and legs, fatigue, muscle tenderness and pain, and diarrhea. These symptoms typically last for 1-2 weeks until the virus is successfully eliminated. Infection can spread beyond gut lymphoid tissues, but has mild effects. Paralytic polio is a severe infection that occurs when a systemic infection moves to the CNS and destroys neuronal cells. Patients experience severe muscle pain, weak muscles, difficulty swallowing and breathing, and abnormal sensations. Paralysis can result quickly, sometimes in a matter of a week. Characterization and severity of paralysis depend on the location of infection within the spinal cord. Typically in paralytic polio, nonparalytic symptoms become progressively more severe, until paralysis results after destruction of 50-60% of the motor neurons in the spine (Todd, 1996; MEDLINEplus, Poliomyeltis, 2003).
Postpoliomyelitis syndrome displays itself 25-30 years after the initial polio infection and is seen in 25% of survivors of paralytic polio. Fatigue, muscle pain, decreased function, and difficulty performing daily activities are characteristic of this syndrome. Manifestations are more severe if initial infection was more severe or occurred later in life. Although postpoliomyelitis could be a result of a reactivation of the poliovirus, it most likely results from increased demand and strain on muscles after initial damage. Polio survirors have imbalanced muscle weaknesses, requiring them to overwork what muscles they are left with. This overuse can result in degeneration of muscle fibers and death of motor nerves, conferring postpoliomyelitis syndrome (Todd, 1996).

Polio cannot be cured once an infection has occurred, but the symptoms can be treated while the virus runs its course of infection. Because polio cannot be cured, vaccination is the only way to avoid the paralytic risks presented by infection. Two polio vaccines exist: inactivated polio vaccine (IPV) and oral polio vaccine (OPV). Both vaccines contain constituents of all three types of poliovirus as well as trace amounts of antibiotics like streptomycin and polymycin (WHO, Adverse…, 2003).
The inactivated polio vaccine was developed by Jonas Salk in 1955 and is most frequently used to vaccinate children in the United States. Vaccination involves four injections of IPV: at 2 months, 4 months, 6-18 months, and 4-6 years (MEDLINEplus, Polio immunization, 2003). In IPV, the polio vaccine has been killed (inactivated) using formaldehyde (WHO, Adverse...,2003). The viral components are taken up and displayed by MHCII on antigen-presenting cells that migrate to lymphoids. B-cells are then stimulated to produce protective levels of antibodies to the poliovirus. After the inactivated form is cleared, memory B-cells remain that allow for a quick response when exposed to poliovirus.
The problem with IPV is that the dead virus is incapable of replication or synthesis of viral proteins in the cytoplasm of infected cells. This means that no proteins will be present that can be displayed by MHCI and illicit a CD8 T-cell response. There will be no memory T-cells to fight off exposure to the virus, only antibodies. Because of this, IPV is less potent than OPV. Also, because IPV is injected and not orally administered, it confers a much weaker gastrointestinal immunity than OPV, creating the possibility of polio infection in the GI tract that could be passed to others.
Despite these concerns, IPV is still an effective vaccination. Possible side effects are almost nonexistent, and include only redness and swelling at the site of injection. IPV cannot cause poliomyelitis, and for this reason, it can be safely given to immunodeficient patients.
The oral polio vaccine, also known as the Sabin vaccine, is a liquid administered by mouth. It contains an attenuated live virus that has been derived from wild-type strains. To make OPV, the virus is grown in a culture of human cells, isolated, and used to infect cells from another organism (typically monkey kidney cells) (WHO, Adverse...,2003). Growth on these monkey cells causes the virus to mutate so as to infect monkey cells most advantageously. This shift renders the virus much weaker at infecting and replicating within human cells, and when taken orally by humans, immunity to polio is induced. Because the virus is still alive, it infects cells and produces viral proteins that can be presented on MHCI, illiciting a CD8 T-cell response. This effectively eliminates the modified virus and creates memory T-cells that easily and quickly kill wild-type poliovirus if exposed (Janeway et al., 2001). OPV’s strength is the chief reason that the United States was able to eradicate polio, and is the vaccine recommended for use in current global eradication efforts.
Fig. 3: Creation of OPV, generalized as creation of any attenuated live virus. With OPV, blue cells are typically monkey kidney cells. Fig. 14.24 from Janeway et al., 2001. Permission requested. 
In a study of 9-month olds in Estonia and Finland immunized with OPV and IPV, respectively, the Estonian children who had received OPV had stronger T-cell responses to poliovirus type I. The children receiving OPV also expressed more IFN-gamma when exposed to the poliovirus, which increases the level of response by stimulating increased MHC expression and Ig switching, among other things (Janeway et al., 2001). This study shows conclusively that T-cell immunity to poliovirus is stronger in patients receiving OPV (Juhela et al., 1999).

The problem with OPV is the risk of developing vaccine-associated paralytic poliomyelitis (VAPP). VAPP exhibits the same symptoms as paralytic poliomyelitis, and results in paralysis 4-30 days after vaccination. It is seen in 1/2.4 million people who are administered OPV and has been the cause of every case of polio in the United States since 1979 (MEDLINEplus, Polio immunization, 2003). Strains of OPV mutate quickly in humans, occurring as a result of selective pressure from neutralizing antibodies and temperature constraints (Guillot et al., 2000). If mutation randomly occurs at very precise sites, the live attenuated virus can revert back to the wild-type virus. For example, the type 3 Sabin virus only differs from the wild type virus at 10 nucleotides, illustrating that, although rare, with many quick, precise mutations, reversion is possible. Because of these risks, OPV is never given to immunodeficient patients.
A vaccination schedule that combines IPV and OPV is sometimes used in the United States, presenting an interesting compromise between the two different vaccines. IPV is injected for the first two immunizations, conferring adequate levels of virus-specific antibodies. OPV is administered in the last two doses; at this time VAPP incidence is far less likely because humoral immunity has already been developed. This allows for both humoral and T-cell immunity, reduces risk of VAPP, and involves fewer injections than the complete IPV schedule (Zimmerman et al., 1999).

In 1988, a worldwide effort to eradicate polio was initiated by the World Health Organization. This effort, which has employed the use of OPV, has been very successful, reducing the number of cases by 99%. The countries remaining with new cases of polio include India, Nigeria, Egypt, Pakistan, Afghanistan, Niger and Somalia. In February of 2003, India launched an astronomical campaign to immunize 165 million children against polio. Eighty-five percent of new polio cases in 2002 were those reported in India, demonstrating the need for this large-scale campaign (WHO, India.., 2003).

News of Interest
In 2002, Cello et al. reported their assembly of full-length poliovirus cDNA using only oligonucleotides and the known genomic sequence. Experiments with this cDNA showed that it could be transcribed into viral RNA, which could in turn be used to synthesize infectious poliovirus. By showing how (relatively) simple the de novo synthesis of poliovirus is, Cello et al. wanted to show that bioterrorists could easily acquire the poliovirus. This knowledge suggests that although eradication of polio is proceeding successfully, it may not be safe to cease immunization.

Works Cited
Belnap, D., Filman, D., Trus, B. 2000. Molecular Tectonic Model of Virus Structural Transitions: the Putative Cell Entry States of Poliovirus. J. Virology. 74(3): 1342-1354.
Belnap, D. McDermott, B., Filman, D., et al. 2000. Three-Dimensional structure of Poliovirus Receptor Bound to Polivirus. Pub. Nat. Acad. Sci. 97(1):73-78. 
Cello, J., Paul, A., Wimmer, E. 2002. Chemical Synthesis of Poliovirus cDNA: Generation of Infectious Virus in the Absence of Natural Template. Science. 297:1016-1018.
Gosselin, A., Simonin, Y., Guivel-Benhassine, F., et al. 2003. Poliovirus-Induced Apoptosis is Reduced in Cells Expressing a Mutant CD155 selected During persistent poliovirus infection in neuroblastoma cells. J. Virology. 77(1): 790-798.
Guillot, S., Carno, V., Cuervo, N. 2000. Natural Genetic Exchanges between Vaccine and Wild Poliovirus Strains in Humans. J. Virology. 74(18):8434-8443.
Hogle, J.M., Chow, M., Filman, D.J. 1985. Three-Dimensional Structure of Poliovirus at 2.9 angstrom resolution. Science. 229: 1358-1365.
Iwasaki, A., Reinhold, W., Mueller, S., et al. 2002. Immunofluorescence Analysis of Poliovirus Receptor Expression in Peyer’s Patches of Humans, Primates, and CD155 Transgenic Mice: Implications for Poliovirus Infection. J. Infectious Diseases. 186: 585-592.
Janeway, C., Travers, P. Walport, M., Shlomchik, M. 2001. Immunobiology: The Immune System in Health and Disease. New York, New York: Garland Publishing. 
Juhela, S., Hyoty, H., Uibo, R. 1999. Comparison of Enterovirus-specific Cellular Immunity in Two Populations of Young Children Vaccinated with Inactivated or Live poliovirus vaccines. Clinical and Experimental Immunology. 117(1): 100-105. 

Racaniello, V. 1996. Early Events in Poliovirus Infection: Virus-receptor Interactions. Proc. Natl. Acad. Sci. 93: 11378-11381.

Todd, J. 1996. Post-Polio Syndrome: A Literature Review & Case Report. Gerontology Manual. Tacoma, WA. School of Occupational Therapy and Physical Therapy, University of Puget Sound. Accessed 2003 24 Apr.
U.S. National Library of Medecine & National Institutes of Health. Last updated 2002 27 Feb. MEDLINEplus Medical Encyclopedia: Poliomyelitis. Accessed 2003 17 Apr.
U.S. National Library of Medecine & National Institutes of Health. Last updated 2001 16 Mar. MEDLINEplus Medical Encyclopedia: Polio immunization. <> Accessed 2003 17 Apr.
World Health Organization. Adverse Events Following Poliomyelitis Vaccine. Accessed 2003 24 Apr.
World Health Organization. 2003. India launches largest ever campaign to tackle polio epidemic. Accessed 2003 16 Apr.
Zimmerman, R., Spann, S. 1999. Poliovirus Vaccine Options. American Academy of Family Pysicians. Accessed 2003 16 Apr.

Post Polio Litaff, Association A.C _APPLAC Mexico

Oct 20, 2014

Sindh’s latest polio victim received vaccine only once

By Saher Baloch

Published Sep 25, 2014 06:11am
BILAL in the lap of his uncle in their home on Wednesday.—White Star
BILAL in the lap of his uncle in their home on Wednesday.—White Star

KARACHI: Two-year-old Hazrat Bilal looks at people around him with tired eyes. His uncle, Abdul Razzaq, tries to get his attention by calling his name but Bilal looks up for a few seconds before looking away. 
Presently residing in Liaquatabad’s Khamosh Colony, Bilal is one of the five children to have contracted polio recently. 
This is the 14th case in Karachi and 15th across Sindh making its way among the 171 polio cases in Pakistan at present. 
On Wednesday afternoon, the family sat in one of the empty rooms inside their home to discuss what went wrong with Bilal. As his father, Khayal Mohammad, was busy at the roadside restaurant owned by the family, his uncle Abdul Razzaq spoke on his behalf. “He was really ill a month back,” he says as he tries to swaddle Bilal’s lower body with a wrapping sheet. “Our family doctor at the nearest Imam Zainul Abideen Hospital thought that he had got a meningitis fever as his neck arms and upper body had no movement in them. We shifted him to the National Institute of Child Health immediately soon after the doctor asked us to.”
The child had diarrhoea and fever for almost a week before being taken to the hospital, the family says. On being taken to the NICH, the doctors there asked them to wait for a ventilator to be available that alarmed the parents. “He almost made it to the ventilator but was declared ‘out of danger’ after five hours. He was admitted in the hospital for 13 days after that,” says Razzaq. 
During this time, Bilal couldn’t sit properly. His arms were also paralysed for a while until he started making some improvement but he is in a much better condition now. 
His mother Zakiya (last name not given), a 25-year-old woman, however, says that he still cries at night. “He wakes up in the middle of the night and cries till morning, and then there are times that he doesn’t wake up at all,” she says. Sitting in her lap, the child’s left foot is motionless until someone from the family touches it to make a point, making him wince in pain. Bilal is the youngest among Zakiya’s four children. She says, “I gave birth to him at home, back in my village in Tor Ghar tehsil of Khyber Pakhtunkhwa. There are no hospitals over there so he didn’t get immunised. It was only when I brought him to Karachi as a one-year-old that he got polio drops from a polio team that had come to our doorstep.” The mother said that was the only time the child had received the polio vaccine until he got seriously sick a month back. 
The home, where12 more children apart from Bilal live, houses five families, says Razzaq. “We are very scared for them now. Their immunisation was done at a private hospital after we saw what happened to Bilal. We have never refused immunisation by the polio teams. What happened to Bilal was maybe because of the sheer laziness on our part, I think. We thought nothing would happen to him,” he adds. 
The patriarch of the family, Gohar Ali Khan, moved to Karachi in the 1950s from Tor Ghar tehsil. He owns a number of restaurants in Liaquatabad, managed and supervised by his five sons. Sitting in the same room as his family, he quietly eats his lunch at the time of the interview, remarking later, “There were no immunisations during our times, and yet I survived for so long.” On hearing that, his son says that he has had a bypass surgery and is a sugar patient on medicines at the moment. 
The family has been waiting for Bilal’s reports which were sent to the National Institute of Health in Islamabad for further verification, making him, what senior paediatrician Dr Ghaffar Billo calls, a “suspected polio case”. 
Dr Billo says a polio case can be further verified after sending it to the Centre for Disease Control (CDC) in Atlanta, Georgia for gene identification, if the parents want to be completely sure. “But since we don’t have the basic practice of taking children for vaccinations, going for an advanced option like this becomes a luxury availed by only a few people,” he adds. 
Immunisation coverage
About the current crop of cases specifically in Sindh, Dr Billo says the routine immunisation programme till the 1980s “was the best period for Pakistan as it covered 95 per cent of the children. The World Health Organisation started a national immunisation programme worldwide in 1988 but in Pakistan it kicked off in 1994. That period in between, where there was no activity with regard to polio, left the space for the virus to take its hold.” 
Also, since then, he explains, “The population coverage for polio remained between 65 and 75 per cent; whereas it should be 95 per cent otherwise it won’t have the desired impact. So in a way, 35 per cent of our population has always remained uncovered with regard to polio immunisation, be it Fata, KP, Quetta or Qilla Abdullah in Balochistan.” 
In Bilal’s case, he says, “One dose a year won’t make a difference, as it takes at least seven to 10 doses, with proper monthly gaps, to ensure immunity.” 
Executive District Officer for Health Dr Zafar Aijaz says there are around “325 centres for polio immunisation across Karachi. And we, on our part, have been requesting the families to come to these centres to get their children immunised.” 
He insists that it’s not only a job of government hospitals “but community at large to ensure there is awareness about polio”. 
Like Dr Billo, Dr Aijaz also says that routine immunisation “is the main concern of our department. If routine immunisation is properly sustained and followed it will help us fight other diseases too.” 
However, Dr Billo says that unless and until, “There's proper reportage of cases and a genuine utilization of funds we’ll be faced with same problems over and over again.” 
Published in Dawn, September 25th, 2014

Post Polio Litaff, Association A.C _APPLAC Mexico

Sep 28, 2014

Updates on CDC’s Polio Eradication Efforts

September 12, 2014

CDC Continues to Support the Global Polio Eradication Effort
The eradication of polio is an important priority for the Centers for Disease Control and Prevention (CDC). We are closer than we have ever been to eradicating polio and it is critical that we take advantage of this opportunity.
On December 2, 2011, CDC Director Thomas R. Frieden, MD, MPH, activated CDC’s Emergency Operations Center (EOC) to strengthen the agency’s partnership engagement through the Global Polio Eradication Initiative (GPEI)External Web Site Icon, which is committed to completing the eradication of polio. On December 14, 2011, Dr. Frieden enlisted the support of the entire CDC community to become active participants in an intensified effort to eradicate polio worldwide.
CDC’s Involvement
In the final push toward global polio eradication, CDC continues its close collaboration with partners, including the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), Rotary International, and the Bill and Melinda Gates Foundation to ensure a coordinated global and country-level response.
CDC polio eradication activities and staff have moved into the EOC operational structure to ensure maximum use of CDC resources to support polio eradication, and to scale up timely technical expertise and support for polio-infected countries (Afghanistan, Cameroon, Equatorial Guinea, Ethiopia, Iraq, Nigeria, Pakistan, and Syrian Arab Republic) and for countries at risk of polio outbreaks, in coordination with GPEI partners.
Since December 2, 2011, approximately 530 workers have supported CDC’s polio eradication efforts in the EOC and in the field. Of these, 161 workers have completed 721 field deployments to Angola, Chad, Cote d’Ivoire, and other areas. Each day an average of 45 people are working on polio eradication in CDC’s EOC.
Activation of the EOC has provided enhanced capacity for CDC’s STOP Transmission of Polio (STOP)program, which trains public health volunteers in the United States and globally to improve polio surveillance and help plan, implement, and evaluate vaccination campaigns. Since December 2, 2011, 793 individuals have been deployed to work with the STOP program in dozens of countries, including Chad, Haiti, and Kenya.
In addition, the EOC has provided enhanced capacity to scale up in-country technical expertise and support for – polio surveillance, planning, implementation, and monitoring of polio vaccination campaigns – strengthening routine immunization, strengthening management and accountability.
A few additional examples of CDC polio eradication activities include:
  • An in-depth review of priority countries’ polio eradication plans to assess program gaps and training needs, and elaboration of plans for CDC’s engagement in those countries.
  • Publication of several joint World Health Organization Weekly Epidemiologic Record/CDC Morbidity and Mortality Weekly Reports (MMWR) highlighting polio eradication progress related to Nigeriathe STOP Programrisk assessment for polio outbreaksglobal progress 2011-2013, and surveillance indicators.
  • Collaboration with GPEI partners on detailed country-plans for expanded technical and management support, including assistance with outbreak responses, surveillance reviews, vaccination campaign planning and monitoring, and data management.
  • The development of indicators for monitoring polio vaccination campaign performance in the areas of planning, implementation, and evaluation.
Review of WHO proposed outbreak response protocols for all polio-affected and at risk countries.
The Global Push toward the Finish Line
Polio incidence has dropped more than 99 percent since the launch of global polio eradication efforts in 1988. According to global polio surveillance data from September 10, 2014, 171 polio cases have been reported to date in 2014 from Afghanistan, Cameroon, Equatorial Guinea, Ethiopia, Iraq, Nigeria, Pakistan, and Syria. In 2013, a total of 416 polio cases were reported from the following countries: Afghanistan, Cameroon, Ethiopia, Kenya, Nigeria, Pakistan, Somalia, and Syrian Arab Republic.
On March 27, 2014, Dr. Frieden and senior CDC immunization staff were present when India, along with the other 10 countries of the South East Asia Region, was certified polio-free.  The country was once considered the most complex challenge to achieving global polio eradication. Four of the six regions of the World Health Organization have been certified polio-free: the Americas (1994), Western Pacific (2000), Europe (2002) and South East Asia (2014). 80% of the world’s people now live in polio-free areas.
While no polio cases have been detected in India for more than three years, poliovirus transmission is ongoing in the three endemic countries – Afghanistan, Nigeria, and Pakistan. GPEI’s Independent Monitoring Board considers Nigeria and Pakistan to be the greatest challenges for eradicating polio. On May 5, 2014, after receiving advice from an Emergency Committee of independent experts and in order to protect progress toward eradication, WHO Director-General Margaret Chan declaredExternal Web Site Icon the recent international spread of wild poliovirus a “public health emergency of international concern,” and issued Temporary Recommendations under the International Health Regulations (2005) to prevent further spread of the disease.
It is therefore imperative that we make this final push toward eradication one of our highest priorities. As Dr. Frieden has stated, “If we fail to get over the finish line, we will need to continue expensive control measures for the indefinite future…,More importantly, without eradication,  a resurgence of polio could paralyze more than 200,000 children worldwide every year within a decade.” Now is the time, we must not fail.

Sep 19, 2014

The fund is named in honor of Dr. Carlos Vallbona, one of the world’s foremost authorities on post-polio,

Texas Polio Survivors’ Association Makes Contribution to Assist Polio Patients at TIRR Memorial Hermann

HOUSTON - The Texas Polio Survivors’ Association will present an $80,000 check to the Memorial Hermann Foundation at a special recognition event at TIRR Memorial Hermann on Monday, April 28, 2:30 p.m. in the second floor conference room in the new Rehabilitation Research Center. The contribution will establish a fund to benefit polio patients.
The fund, named in honor of Dr. Carlos Vallbona and in memory of Nita Weil, will provide assistance to polio patients treated at TIRR Memorial Hermann in need of financial aid for essential items such as medication and equipment. Additional purposes will include support for continuing education and training for staff working with polio patients and others with mobility challenges.
Dr. Vallbona, retired consulting physician at TIRR Memorial Hermann who specialized in the management of post-polio syndrome, has been called one of the world’s foremost authorities on post-polio. He served as director of TIRR Memorial Hermann’s outpatient polio clinic, one of the few in the country that provides state-of-the-art care for patients who live daily with the effects of post-polio syndrome.
Nita Weil was a polio survivor who dedicated her life to helping the disabled. She volunteered at The Institute for Rehabilitation and Research for 43 years and served as director of volunteers. Weil co-founded the Texas Polio Survivors’ Association in 1984. She died in 2005 and is remembered for her tireless efforts on behalf of polio survivors and the disabled.
“We are pleased to make this donation to benefit polio patients in need of assistance,” said Rocky McAshan, president of the Texas Polio Survivors’ Association. “Through the Vallbona/Weil Fund, countless lives will be touched.”
“We are deeply grateful to the Texas Polio Survivors’ Association for this very special gift and honored to recognize the dedication and commitment of Dr. Vallbona and Nita Weil through this named fund,” said Carl Josehart, chief executive officer of TIRR Memorial Hermann.
For years, polio was one of the most feared diseases in America, responsible for crippling paralysis and death. In 1952, it reached its peak in the United States with more than 21,000 paralytic cases, according to the Centers for Disease Control and Prevention. Jonas Salk introduced the polio vaccine in 1955, stopping the spread of the disease and eventually eradicating it in the United States.
Nearly 1.63 million polio survivors live in the United States today; the U.S. Public Health Service estimates 140,000 survivors of the 1940 and 1950 epidemics live in Texas. It is unknown how many younger survivors contracted polio in South America and Mexico, and have immigrated to Texas. This means there are 50,000 survivors for every 8 million Americans.
More than 300,000 of the country's' polio survivors may be at risk of post-polio syndrome, which is marked by muscle weakness, pain, fatigue, breathing problems, and decreased tolerance of cold temperatures; symptoms that appear 10 to 40 years after the initial illness. The National Institute of Neurological Disorders and Stroke estimates that Post Polio Syndrome affects between 25 and 50 percent of these survivors.

About TIRR Memorial Hermann
Recognized among the leading rehabilitation hospitals in the country, TIRR Memorial Hermann is a valued resource for the Greater Houston community and beyond, serving as a model for interdisciplinary rehabilitation services, patient care, education and research. For 24 consecutive years, U.S. News & World Report has named TIRR Memorial Hermann to the list of “America’s Best Hospitals”—every year since the list was created. In 2013, it was ranked number “3” on the list of top rehabilitation hospitals.

Texas Polio Survivors’ Association Makes Contribution to Assist Polio Patients at TIRR Memorial Hermann

The fund is named in honor of Dr. Carlos Vallbona, one of the world’s foremost authorities on post-polio, and in memory of Nita Weil, a polio survivor who dedicated her life to helping the disabled.

Post Polio Litaff, Association A.C _APPLAC Mexico

Sep 4, 2014

Sanofi Pasteur to Provide 1.7 Million Doses of Oral Polio Vaccine from 2013 to 2017 for Polio Eradication -

Press Release
April 24, 2013 /3BL Media/ - Sanofi Pasteur, the vaccines division of Sanofi, announced today its commitment to provide 1.7 billion doses of oral polio vaccine (OPV) to support the Global Polio eradication Initiative’s (GPEI) strategy to eradicate polio this decade. The doses of OPV will be delivered through 2017 for GPEI polio vaccination program.
In addition to OPV campaigns, the World Health Organization’s (WHO) expert group on immunization (SAGE) recommends that all countries introduce at least one dose of injectable inactivated polio vaccine (IPV) in routine polio immunization programs. Sanofi Pasteur is responding to this strategy with the expansion of production capacities of IPV.
“Wiping out polio for good is in sight and Sanofi Pasteur intends to remain an active contributor to achieve zero polio,” said Olivier Charmeil, President and CEO of Sanofi Pasteur. “We believe that the introduction of IPV in routine polio immunization will consolidate the tremendous progress achieved over the last decades and ensure a polio-free world for the future. Sanofi Pasteur has been a leading provider of polio vaccines and a supporter of the Global Polio Eradication Initiative for over 20 years. We intend to continue to be a major supporter of WHO and its partners to finish the job.”
As a result of vaccination, polio cases have been reduced by 99% over 20 years, saving millions of children from paralysis. The GPEI has set the goal of eradicating the disease completely. Today only a few countries are still affected by polio.
“A strong and steady supply of polio vaccines will ensure that every child is fully protected against polio,” said John Hewko, General Secretary of the humanitarian service organization Rotary International, a spearheading partner in the polio eradication initiative. “Sanofi Pasteur’s commitment of 1.7 billion vaccine doses comes at a crucial moment as we make the final push needed to end polio once and for all. On behalf of Rotary’s 1.2 million members worldwide, I commend and thank Sanofi Pasteur for its steadfast support.”
Polio vaccination protects against disease from all three types of polio virus. SAGE now recommends that all countries introduce at least one dose of IPV in routine polio immunization programs to mitigate the risk of circulating vaccine-derived poliovirus (cVDPV). The introduction of IPV will pave the way for the cessation of oral poliovirus vaccine type 2 (OPV2) since wild poliovirus type 2 has already been eliminated. It is hoped that, with this new vaccination schedule, wild poliovirus types 1 and 3 will also be eradicated within the next few years.
About Sanofi
Sanofi, a global and diversified healthcare leader, discovers, develops and distributes therapeutic solutions focused on patients’ needs. Sanofi has core strengths in the field of healthcare with seven growth platforms: diabetes solutions, human vaccines, innovative drugs, consumer healthcare, emerging markets, animal health and the new Genzyme. Sanofi is listed in Paris (EURONEXT: SAN) and in New York (NYSE: SNY).
Sanofi Pasteur, the vaccines division of Sanofi, provides more than 1 billion doses of vaccine each year, making it possible to immunize more than 500 million people across the globe. A world leader in the vaccine industry, Sanofi Pasteur offers the broadest range of vaccines protecting against 20 infectious diseases. The company's heritage, to create vaccines that protect life, dates back more than a century. Sanofi Pasteur is the largest company entirely dedicated to vaccines. Every day, the company invests more than EUR 1 million in research and development.
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Post Polio Litaff, Association A.C _APPLAC Mexico

Sep 3, 2014

9 Signs of Hormonal Imbalance and How to Fix It:

Hormones work as chemical messengers in our body. We go through hormonal changes from birth to death. They cause changes in our bodies over time including:
  • Reproduction
  • Growth & Development
  • Metabolism
  • Mood
  • Sexual Function
If your hormones are imbalanced it can destroy your health even if your diet is optimized.
endocrine system
Knowing if you are suffering from hormonal imbalance is important. Here are some of the most common signs of hormonal imbalance and ways to fix it:
1- Gaining Weight Persistently
If you are gaining weight consistently despite a healthy diet and appropriate physical activity it can be a sign of hormonal imbalance. It can be due to unaddressed or emerging insulin resistance. Some thyroid problems can also cause weight gain. You need to see your doctor for further evaluation. In the meantime, it’s highly recommended to avoid processed foods, sugar (soda), and wheat. Here is a useful guide if you have thyroid problem.
2- Insomnia
If you are suffering from insomnia and having difficulty sleeping it can be a sign of hormonal imbalance. Try to optimize your sleep and take antioxidants. Make sure to include quality lean protein, especially at dinner. Try exercise and yoga to improve your sleep. Also avoid these common habits that may cause insomnia. To learn how to manage insomnia follow this link.
3- Chronic Stress
Chronic stress depletes adrenal functions which leads to low levels of progesterone and other important hormones. Try to work on becoming stress-free. A healthy diet and changing your environment can help you reduce stress. Also here are some useful ways to manage stress in your life.
9 Signs of Hormonal Imbalance and How to Fix It
4- Excessive Sweating
If you are have night sweats and hot flashes it can be due to hormonal imbalance. Write down your routine, what you eat and drink, how you feel, and what kind of emotions cause your temperature to rise. Work on these areas next time when you get hot flashes.
5- Cravings
Eating abnormally or feeling that you still want to have more even after eating can be an indicator that something is amiss. It’s due to hormonal imbalance like adrenal fatigue or insulin resistance. Eliminating sugars, dairy/ wheat products and alcohol will help you control your cravings and improve your digestion. To learn more about how to improve digestion click here.
6- Depression
Feeling depressed and rejected is a sign of hormonal imbalance. If not clinically caused it can mean you’re not feeding your body what it needs. Listen to your inner self and treat your body in a good way with a healthy diet, exercise and proper nutrients. You may want to consult with a mental health professional for further evaluation. Here is a useful guide on causes and treatment of depression.
7- Fatigue
Feeling tired by the end of first half? Or feeling sluggish while working? Hormonal imbalance could be the reason for your fatigue. A proper diet enriched with nutrients and eliminating wheat and grains may help stabilize your blood sugar. It’s very common that gluten-intolerance causes fatigue. Here is a guide to fix fatigue.
8- Low Libido
This is one of the most noticeable signs of hormonal imbalance. Often imbalance in sex hormones, thyroid or other endocrine glands is the underlying cause of low sex drive. It also happens due to lack of sound sleep. Work on your sleeping habits and optimize your sleep. To learn more about how to boost your libido visit this link.
9- Digestive Problems
Slow digestion and gastric problems are also among common symptoms of hormonal imbalance. Hormonal problems during perimenopause is one of the most common causes of digestive problems for women between the ages of 45 and 55. This is a useful guide to improve digestion naturally.
9 signs of hormonal imbalance
Disclaimer: This article is for informative purposes only, and should not be used as a replacement for expert medical advice
9 Signs of Hormonal Imbalance and How to Fix ItBy PositiveMed-Team

Edited By Stephanie Dawson
[Last Updated on March 4th 2014]
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