Mar 21, 2015

Prosthetist Mark Taylor’s own bout with polio brings a special touch of care to U-M’s post-polio clinic

Once a week, University of Michigan certified orthotist/prosthetist Mark K. Taylor, MLS, C.P.O, helps treat people for a disease that was declared dead in the U.S. years ago.

Many of his patients – now in their sixties or older – were the children of the 1950’s polio epidemic.
Today they suffer from joint pain, loss of balance, fatigue and weakened muscles that hinder daily activities like brushing teeth, climbing stairs, getting into a car or walking – a phenomenon known as post-polio syndrome. The U-M Orthotics and Prosthetics Center’s post-polio clinic is among few places in the region offering highly specialized therapy for these patients.

When he was just nine months old, Mark K. Taylor, MLS, C.P.O was diagnosed with polio, which paralyzed his left leg. Now a certified orthotist/prosthetist, Taylor credits orthotic interventions for helping him maintain mobility and he helps others do the same at the U-M Orthotics and Prosthetics Center’s post-polio clinic.
Taylor, 60, brings a special passion to this rare clinic. At nine months of age, before he was even old enough to walk, his left leg was paralyzed by polio.
“People don’t realize that we are still here,” Taylor says of polio patients. “Many people are still feeling the effects of polio or are experiencing symptoms for the first time decades later.
“Polio really affected my family and I’m finding that many of my patients’ stories are similar to mine. I understand where they’re coming from and how important it is to them to maintain independence and mobility.”
The summer of 1952 was heartbreaking for Taylor’s family who lived on a farm in Southern Idaho at the peak of the U.S. polio outbreak. Not only did Taylor’s mother learn her baby boy had polio – but her husband, Taylor’s father, lost his own battle with the disease.
Taylor, who uses a brace to walk, was told at age 25 that he’d be lucky if he was still mobile at 40. But as he says “I’ve cheated that by 20 years so far,” which he credits to orthotic interventions.
Post-polio syndrome affects up to half of people after the initial infection, with symptoms sometimes surfacing 15–30 years later and progressively attacking muscle strength. A sliver of patients at U-M are younger than 30, born in a country without the vaccine, and who came to the U.S. through adoption or other situations.
At three years old, Kathryn Hall contracted polio in her native country of England. She was separated from her family for three months of quarantine and one of her legs was four inches shorter than the other, which was ultimately corrected by surgery.
Hall, of Lakeland, Mich., said weak muscles in her left leg triggered chronic neck and back pain. She found relief at U-M through orthotics that provide extra support and ease muscle strains.
“It’s been tremendously helpful, lessened the pain and changed the way I walk,” the communications manager, gardener and golfer, now 64, says of the therapy. “I could have a fuller life.

Mark K. Taylor, MLS, C.P.O and clinical assistant professor Ann Laidlaw, M.D, help post-polio patient Kathryn Hall, of Lakeland, MI, adjust a supportive orthotic device on her leg, which lessens chronic pain in her neck and back. “This clinic is a refuge for me,” Hall says.
“It’s especially wonderful to have someone who knows what it means to go through this,” she adds of Taylor, who supports clinical assistant professor Ann Laidlaw, M.D. with the post-polio clinic. “This clinic is a refuge for me, the only place I could come and find people who know what I’m dealing with and how to help.”
Each year, the clinic offers hundreds of patients, prosthetics and orthotics, from crutches and walkers to braces, scooters and special shoes. Experts also provide physical therapy and help guide patients through the emotional challenges of post-polio syndrome.
“These are all patients who succeeded and thrived in life and slowing down can be devastating because they’re used to their independence,” Taylor says. “They want to do everything as good as or better than everyone else. We want to help them achieve that goal for as long as possible.”
The U-M Orthotics and Prosthetics Center celebrates its 100th anniversary this year. For more information on the center, visit their website.

México a la vanguardia en el Síndrome de Post Polio

Polio: An American Story.By Bill Gates

Talk to anyone old enough to remember polio epidemics in the U.S., and you will see the fear in their eyes as they talk about those terrible and unsettling times. For decades, no one knew why thousands of children would suddenly be stricken – usually in midsummer – with many dying or left permanently paralyzed.
Today, most of us in the U.S. don’t even think about polio. But if you go to villages in India’s Bihar Province or the northern states of Nigeria, or the southern part of Afghanistan, you will see that very same fear in the eyes of parents who worry that their child might be next.
I’m a dogged advocate for polio eradication and have written about it in many other articles on the Gates Notes. We are very close to ridding the world of this terrible disease once and for all. It will take focus and commitment to get it done, but I am confident we can.
That’s why I’m a fan of David Oshinsky’s insightful book, Polio: An American Story. (I’m not alone here, as it received the Pulitzer Prize for history in 2006.) It is a fascinating account of the search for a vaccine to stop the polio epidemics that swept the U.S. in the first half of the 20th century, and the remarkable efforts that led to its successful eradication from the U.S. and most other countries. Reading Oshinsky’s book a few years ago broadened my appreciation of the challenges associated with global health issues and influenced the decision that Melinda and I made to make polio eradication the top priority of the foundation, as well as my own personal priority.
Oshinsky retraces the steps of researchers trying to puzzle together how to create an effective vaccine. He’s a gifted storyteller who makes complex scientific subjects easy to understand and also captures the mood of a country terrorized by an invisible and little-understood disease. He describes in meticulous but never-boring detail the people and politics associated with one of the most important medical breakthroughs in history.

I found it interesting that the first recorded polio epidemic in the U.S. didn’t occur until 1894, in rural Vermont. By 1908, Karl Landsteiner, a Viennese researcher who later won a Nobel Prize for his discovery of the different human blood types, isolated the poliovirus by injecting monkeys with an emulsion from the spinal cord of a boy who had just died of polio. It was one of several important breakthroughs in the early 20th century battle against killer infectious diseases, including malaria, tuberculosis, diphtheria, typhoid, and syphilis.
In 1916, a polio outbreak in New York City quickly spread to adjacent states. Despite intensive sanitation measures of the kind that had helped control other epidemic diseases such as cholera and typhoid fever, 27,000 people died that summer. In New York City, 80 percent of those who died were under five.

I knew that Franklin Delano Roosevelt contracted polio, but did not realize until reading Oshinsky’s book how significant an influence FDR had on the search for a vaccine. He was struck in the fall of 1921 while on a family vacation in Canada. The news stunned Americans, who at the time believed the disease mainly occurred among poor children in slums. FDR was 39 and from a wealthy New York family.
For thousands of polio victims, Roosevelt symbolized that life could go on for those disabled by the disease. He helped found the National Foundation for Infantile Paralysis, now known as the March of Dimes, which provided aid to victims and funded polio research. I was impressed that even as president, FDR would often respond personally to letters sent to him by other victims. Yet, Roosevelt also went to great lengths – abetted by a cooperative press corps – to hide the fact that he needed leg braces and handrails to stand, and a wheel chair to get around. I can’t imagine an American president being able to do that today, but FDR was greatly admired at a time when the nation was dealing with a world war and the Great Depression. Somehow, he persuaded the media that obscuring the extent of his disability was necessary to reassure the public that he was healthy and capable of holding public office.

I was also fascinated by the media savvy and marketing sophistication of the March of Dimes, which used famous Hollywood actors to get out its message and was the first philanthropic organization to introduce the idea that millions of Americans – not just the wealthy – could play an important role in helping solve big social problems. In 1938, Americans mailed nearly 2.7 million dimes directly to the White House in support of that year’s March of Dimes campaign.
We sometimes take for granted the speed of scientific breakthroughs today. Yet, Oshinky’s book reminded me of the painstaking efforts scientists often must undertake. Forty years after the polio virus was discovered, scientists still didn’t know what caused it. Theories ranged from rotten fruit to houseflies to contaminated milk. They didn’t know the mechanism by which it attacked the central nervous system. They didn’t know if there was just one type of polio, or many. And they didn’t know how to grow poliovirus safely, and in large enough quantities, to produce vaccines.
Also, researchers were divided over whether a “live-virus” vaccine or a “killed-virus” vaccine would be more effective. Most virologists believed a live-virus vaccine would stimulate higher antibody levels in the blood and create a lasting immunity. Advocates of the killed-virus vaccine believed it could be just as effective, and would eliminate any risk that someone receiving an immunization could contract polio.
Jonas Salk, a young researcher at the University of Pittsburgh, was one of those who believed a killed-virus vaccine would work. It had, after all, been effective against cholera, typhoid, and diphtheria. From 1949 to 1951, Salk and his team conducted extensive testing on thousands of monkeys, using samples from human polio victims and from monkeys who had contracted the virus after being injected with the human samples. Salk’s work confirmed what had been suspected but not yet proven—all of the identified and tested strains of poliovirus fit into one of three distinct types. 
About the same time, John Enders, a researcher at Harvard, figured out how to grow poliovirus that would be safe and could be mass produced. But scientists were still stymied over how the virus was transmitted and traveled through the body. Several prominent researchers had long believed that it entered through the nose and traveled directly to the central nervous system, bypassing the bloodstream. If that was the case, a vaccine that stimulated antibodies in the bloodstream would have done no good.

Two scientists working independently, Dorothy Horstmann at Yale and David Bodian at Johns Hopkins, upended the prevailing thinking with a breakthrough discovery. Previous researchers had been unable to detect poliovirus in the blood because they were not looking for it soon enough. Horstmann and Bodian discovered that the poliovirus is in the bloodstream for only a brief period of incubation before the body’s immune system creates antibodies that destroy it. 
Salk was relentless in his pursuit of a vaccine. He began human trials against the backdrop of the worst outbreak of polio on record in the U.S.—57,000 cases in 1952. By the spring of 1954, more than 1.3 million children had taken part in the largest vaccine trial in history. It took a year for the results to be reported, and when they were, church bells tolled, factory whistles rung, and then-President Dwight Eisenhower—a war hero—broke down in tears.
Although not 100 percent effective, the Salk vaccine was considered a huge success and a great relief for an edgy nation. In 1956, the number of polio cases in the U.S. dropped by 50 percent compared to the year before, and by another 50 percent the following year. 
Meanwhile, Sabin was about to undertake the largest medical experiment in world history—a live-virus vaccine administered to 10 million children in Russia. It, too, proved a success. Considered more effective and easier to administer than the Salk vaccine, Sabin’s oral vaccine won out by 1963. 
Oshinsky’s narrative ends at about this point, but the quest to completely eradicate polio is still ongoing. In 1987, the World Health Organization launched a global initiative to eradicate polio worldwide. Since that time, about 2.5 billion children have been vaccinated, and the number of polio cases has decreased by 99 percent. Last year there were fewer than 1,500 cases in just four countries—India, Nigeria, Pakistan, and Afghanistan.

While this is fantastic progress, the last remaining cases pose a serious danger. If not completely eliminated, polio will spread back into countries where it has previously been eradicated, killing and paralyzing perhaps hundreds of thousands of children.
The foundation is deeply involved in this final push, and I am personally committed to doing what I can to rid the world of this dreaded disease once and for all.

Post Polio Litaff, Association A.C _APPLAC Mexico

Mar 19, 2015

Polio this week as of 18 March 2015

Polio this week as of 18 March 2015 
  • As per risk assessment criteria set by the International Health Regulations (IHR) Emergency Committee on the international spread of wild poliovirus, Syria and Ethiopia have now been re-classified as countries ‘no longer infected by wild poliovirus, but which remain vulnerable to international spread’, following no detection of wild poliovirus in more than 12 months. More

  • In Pakistan, efforts are continuing to tighten up strategies and ensure implementation of the ‘low season’ emergency operations plan. Strong coordination of activities by Emergency Operations Centres (EOCs) at federal and provincial level is helping to evaluate implementation and enable corrective measures as necessary. See ‘Pakistan’ section below for more. 


      Wild poliovirus type 1 and Circulating vaccine-derived poliovirus cases
      Total cases
      Year-to-date 2015
      Year-to-date 2014
      Total in 2014 
      - in endemic countries 
      - in non-endemic countries 

      Case breakdown by country

      Year-to-date 2015
      Year-to-date 2014
      Total in
      Onset of paralysis of  most  
       recent case
      Pakistan19029430621 24-Feb-1513-Dec-14 
      Nigeria001630 24-Jul-1416-Nov-14 
      Somalia00 0511-Aug-14N/A 
      Equatorial Guinea0 01 05003-May-14N/A 
      Iraq00 02007-Apr-14N/A 
      Cameroon03 0509-Jul-14N/A 
      Syrian Arab Republic001021-Jan-14N/A 
      South Sudan 0 0 0 0N/A 12-Sep-14 
      Madagascar 0 0N/A 29-Sep-14 
        Circulating vaccine-derived poliovirus cVDPV: Madagascar is cVDPV1, all others cVDPV2. NA: onset of paralysis in most recent case is prior to 2014. cVDPV is associated with ≥ 2 AFP cases or non-household contacts. VDPV2 cases with ≥ 6 (≥ 10 for type1) nucleotides difference from Sabin in VP1 are reported here.


      • No new cases of wild poliovirus type 1 (WPV1) have been reported in the past week. The most recent case had onset of paralysis on 21 January in Reg district of Hilmand province. The total number of WPV1 cases for 2014 remains 28, and 1 for 2015. Most of the cases from 2014 were linked to cross-border transmission with neighbouring Pakistan. 
      • Two WPV1 positive environmental samples were confirmed this week, from Hilmand and Kandahar (dates of collection: 25 and 26 January), confirming ongoing circulation of the virus in the country. 


      • No new wild poliovirus type 1 (WPV1) cases were reported in the past week. Nigeria’s total WPV1 case count for 2014 remains 6. No cases have been reported in 2015. The most recent case had onset of paralysis on 24 July in Sumaila Local Government Area (LGA), southern Kano state. 
      • No new type 2 circulating vaccine-derived poliovirus (cVDPV2) cases were reported this week. The most recent case had onset of paralysis on 16 November in Barde Local Governmental Area of Yobe state. The total number of cVDPV2 cases for 2014 in Nigeria remains 30. 


      • Three new wild poliovirus type 1 (WPV1) cases were reported in the past week, one from Khyber in Federally Administered Tribal Areas (FATA) and two from Sindh, bringing the total number of WPV1 cases to 19 in 2015. The most recent case had onset of paralysis on 24 February (from Khyber, FATA). The total number of WPV1 cases in 2014 remains 306. 
      • No new type 2 circulating vaccine-derived poliovirus (cVDPV2) cases were reported in the past week. The most recent case had onset of paralysis on 13 December. The number of cVDPV cases reported in 2014 remains 21. 
      • Efforts are ongoing to strengthen implementation of the ‘low season’ emergency operations plan. 
      • Strong, functional Emergency Operations Centres (EOCs) are now operational both at the federal and provincial. 
      • Strategies are focusing on clearly identifying reasons for missed children, and putting in place area-specific mechanisms to overcome area-specific challenges. 
      • Independent monitoring is strengthened and rolled out across wider geographic areas to provide a clearer assessment of quality and associated gaps. 
      • Activities are focusing on known infected areas, but also areas deemed at high-risk but which have not reported polio cases. Environmental surveillance indicates widespread transmission of the virus, not just in known infected areas but also in areas without cases. Environmental surveillance is proving to be an instrumental supplemental surveillance tool enabling a clearer epidemiological picture.  

        Central Africa

        • No new wild poliovirus type 1 (WPV1) cases were reported in the last week. In 2014, 10 cases were reported in central Africa: 5 in Cameroon and 5 in Equatorial Guinea. Over 8 months have passed since the last WPV1 case had onset of paralysis in central Africa (in Cameroon, onset of paralysis on 9 July). 
        • National Immunization Days (NIDs) are planned in Chad and Gabon, and Subnational Immunization Days (SNIDs) in Cameroon in March. In April, NIDs are scheduled in Equatorial Guinea and Chad, staggered NIDs in Central African Republic, and a SNID in the Democratic Republic of the Congo.   

        Horn of Africa

        • No wild poliovirus type 1 (WPV1) cases have been reported in the last week. The most recent case, which had onset of paralysis on 11 August 2014, was from Hobyo district of Mudug province, central Somalia. The total number of WPV1 cases that were reported in the Horn of Africa in 2014 was 6: 1 in Ethiopia (date of onset of paralysis on 5 January) and 5 in Somalia. 
        • No cases of type 2 circulating vaccine derived poliovirus (cVDPV2) have been reported in the last week. The most recent case of cVDPV2 had onset of paralysis in South Sudan on 12 September. In 2014, 2 cases were reported in South Sudan. 
        • National Immunization Days (NIDs) are planned in South Sudan from 24 – 27 March. Supplementary Immunization Activities are planned in Somalia and NIDs in Yemen (30 March to 2 April). Subnational Immunization Days (SNIDs) are also planned in Ethiopia and Somalia in March and in Kenya, Sudan and Ethiopia in April. 

        Israel and West Bank and Gaza

        • Wild poliovirus type 1 (WPV1) has not been detected in environmental samples in Israel or the West Bank and Gaza Strip for more than 11 months. The most recent WPV positive sample was collected in southern Israel on 30 March 2014. All environmental samples collected since April have been negative for WPV.

        Middle East

        • No new wild poliovirus type 1 (WPV1) cases have been reported in the last week. Three cases of WPV1 were reported in the Middle East in 2014 - 2 in Iraq and 1 in Syria. 
        • The most recent case reported from Syria had onset of paralysis on 21 January 2014, while the most recent case in Iraq had onset of paralysis in Mada'in district, Baghdad-Resafa province, on 7 April. 
        • Phase III of the Middle East outbreak response is continuing to further strengthen vaccination services for vulnerable populations and to strengthen surveillance for polioviruses across the region. 

        West Africa

        • No wild poliovirus type 1 (WPV1) cases have been reported in the past week. The most recent WPV1 case in the region occurred in Tahoua province, Niger, with onset of paralysis on 15 November 2012. 
        • Even as polio programme staff across West Africa help to control the Ebola outbreak affecting the region, efforts are being made in those countries not affected by Ebola to vaccinate children against polio to create a buffer zone surrounding the affected countries. The Ebola crisis in western Africa continues to have an impact on the implementation of polio eradication activities in Liberia, Guinea and Sierra Leone. Twenty two surveillance medical officers from the National Polio Surveillance Programme (NPSP) in India have been deployed for 3 months to strengthen surveillance systems and data collection for the Ebola response, demonstrating the polio legacy in action. Read more
        • On 10 – 13 April, National Immunization Days (NIDs) are planned in Benin, Burkina Faso, Cote d'Ivoire, Mali, Niger and Senegal. NIDs are planned for the three Ebola-affected countries of Guinea, Liberia and Sierra Leone in April and May.

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