Jul 14, 2015

The Great U.S. Polio Panic of 2015




A new virus in the same family as polio may have caused one of the 100 mystery paralysis cases. The panic that’s resulted from this case study is missing the point: No one has polio.

When children come down with an illness that renders them temporarily paralyzed, public health officials tend to want to know why.
In 2014, there was a nationwide outbreak of a viral illness known as enterovirus D68. Part of a family of viruses that often spread during the summer, this particular outbreak caused  in thousands (possibly millions) of children across the country, in many cases quite severe. Around the same time, a number of children were afflicted with some form of paralysis, leading to concern that the two phenomena were connected. This connection was not firmly established at the time, though ultimately over 100 children were affected.
A new case study reported in the journal Emerging Infectious Diseases suggests that a different virus may have been responsible for at least one case of virally-induced paralysis. Researchers from the University of Virginia School of Medicine describe the case of a 6-year-old girl who was admitted to their medical center with weakness of her right arm in fall of last year. These symptoms had been preceded by a mild upper respiratory illness, with low fever, cough, and runny nose. Shortly before she started having trouble moving her right arm, she also had pain in the limb and under the arm.
When a sample taken from the back of her nose was analyzed, it came back positive for the enterovirus C105. Though from the same family as the virus that caused the outbreak of respiratory illnesses last year, this virus is different.
As the authors of the study note, enterovirus C105 was first detected five years ago in patients from both South America and Africa. Though it is newly discovered, thus far most identified infected patients have had some kind of respiratory illness. However, for some patients in the Congo, it was associated with fatal flaccid paralysis.
Though the symptoms some of the paralyzed patients experienced last year were polio-like, and the poliovirus is part of the same family of viruses as this new virus, it is important to note that these patients did not have polio. That illness, which caused paralysis in tens of thousands of patients in the middle of the past century (PDF), is nearing worldwide eradication thanks to a vigilant vaccination campaign. Children who came down with a paralytic illness last year weren’t infected with a vaccine-preventable illness.
In the case of the girl in Virginia, after several months she had made a near-complete recovery. Whether or not enterovirus C105 was responsible for any of the other cases of paralysis in children last year has not been established. However, there also appears to be little evidence linking the outbreak of the respiratory infection to those cases, either. Of 41 patients tested for enterovirus D68, only eight were positive, and no patients were found to have that virus in their spinal fluid. Though the authors cannot totally exclude the possibility that the D68 strain had also infected the patient they describe, they note that there was no outbreak of that illness in Virginia in 2014.
Whatever the cause of the paralytic illness in children last summer, there is no cause for anyone to be alarmed now. While it’s important to determine as best as possible what causes any illness that threatens public health, and the appearance in this country of a virus previously only identified in patients on other continents is an interesting development, it was only confirmed in one patient. While vigorously knocking on wood, I note that this summer has thus far been free of another outbreak of either form of enterovirus.
But even if enterovirus C105 never causes another illness in the United States, it’s good to be closer to an answer as to what paralyzed over 100 children last year. While the Ebola scare dominated the headlines at the time, these illnesses actually affected many more people in this country. This new case report may be an important clue in figuring out why.

Post Polio Litaff, Association A.C _APPLAC Mexico

Jul 12, 2015

Post-polio syndrome (PPS) refers to the late development of new neuromuscular symptoms


Post-polio syndrome (PPS) refers to the late development of new neuromuscular symptoms in previously stable poliomyelitis patients. 

Whether psychological disturbance plays a role in the manifestation of symptoms in these patients is unclear. We examined 22 patients fulfilling the clinical criteria for PPS with the Minnesota Multiphasic Personality Inventory-II (MMPI-II), (Beck Depression Inventory, Spielberger State-Trait Anxiety Scales, Chapman and Chapman Psychosis-Proneness Scales,)

Fatigue Scales, a neurobehavioral rating scale, and Cognitive Symptoms Self-Report Scales. The overwhelming majority of scale scores were within normal limits, and there was no indication that psychopathologic symptoms were associated with the development or severity of new muscle weakness in PPS patients.

Women with PPS had significantly more somatic complaints, but were less socially isolated than men with PPS. This study confirms that the development or severity of new muscle weakness in carefully diagnosed PPS patients is not due to, or influenced by, underlying psychopathology.
- See more at: http://postpolioproblemadediscapacidad.blogspot.mx/#sthash.ZlPBZh5F.dpuf


Post Polio Litaff, Association A.C _APPLAC Mexico

Truly Unbelievable | POLIO TIPS AND TECHNIQUES by Dr. Richard L. Bruno


Truly Unbelievable
| POLIO TIPS AND TECHNIQUES
by Dr. Richard L. Bruno
Let me tell you an unbelievable story—and I mean literally unbelievable.
Sweden, 2004—“Xepol” was described in a Karolinska Institutet press release headlined “Promising anti-inflammatory treatment for postpolio syndrome.” Sixteen polio survivors with muscle weakness were treated with Xepol, which is intravenous immunoglobulin (IVIG), a standard treatment for inflammatory diseases. “Most patients reported improvements in their physical status. However, the value of this is unclear, since this first study did not include a placebo group.” Value unclear without a placebo group? No kidding.
Sweden, 2006—A Xepol study was finally published in a medical journal. IVIG was given to 73 polio survivors and placebo to 69, then given again in three months. There was no improvement in fatigue, general muscle strength, pain, walking speed, balance or sleep quality. There were only four benefits: A “selected study muscle” increased in strength by 2%, a greater decrease in “significant pain,” a 10% increase in reported “vitality” and a 19% increase in physical activity compared to the placebo group.
Did Xepol help polio survivors? First, the placebo group had worse symptoms than the Xepol group to begin with, making it harder for them to show any benefit. Second, this was not a placebo-controlled study. IVIG subjects had noticeable and unpleasant side-effects as compared to the placebo group: 30% reported itching and rash with IV, 29% reported headache, 19% reported nausea and 10% reported feeling cold. Since as many as 30% of the Xepol subjects could have figured out that they were getting IVIG, any improvements could be due to the placebo effect.
Sweden, 2008—A press release trumpeted, “Pharmalink Reports Positive Results for Xepol,” “effective and well tolerated” in the same subjects reported in the 2006 journal article, but who were now one year post treatment. Pain, walking ability and self-report of health “all showed significant and clinically meaningful results,” the release hailed. Said Pharmalink’s managing director, “We are very excited about this data as patients in the treated group have experienced a reduction in disease symptoms after just 12 months.”
Whoa! First, the published six-month study showed no significant improvement in pain or walking ability. Second, since the new twelvemonth data hasn’t been published, so we can’t know if any of the new results produce a “significant and clinically meaningful reduction in disease symptoms.” Third, even the release said that the placebo group also reported a decrease in pain and improved walking after 12 months. Finally, the company was “very excited” because polio survivors had a reduction in symptoms Òjust 12 months” after taking Xepol?” ”Just 12 months?” Can you imagine any drug company excitedly proclaiming, “New Headache Medication Works Just 12 Months after Taking the Pill?”
North America, 2009—I received e-mails from polio survivors in the US and Mexico. Doctors were making presentations about Xepol to post-polio support groups and then asking polio survivors for donations to perform studies using Xepol.
Sweden, 2010—“Pharmalink AB, today announced agreement with Grifols for the acquisition of Xepol (R)…human immunoglobulin for the treatment of (PPS). This agreement marks a significant milestone in Pharmalink’s corporate development. Grifols will develop the PPS product opportunity. In several clinical trials lead by a team of physicians at Karolinska Institutet, immunoglobulin has shown significant and clinically meaningful results in pain, walking ability and quality of life by down-regulating the inflammatory process in the nervous system of PPS patients.”
“Significant and clinically meaningful results in pain, walking ability and quality of life?” Not in the one published study. And, none of the studies, published or not, even measured “down-regulating the inflammatory process.”
What is “significant” is the “milestone in Pharmalink’s corporate development,” having sold Xepol to a company with the cash to “develop the PPS product opportunity” without polio survivors having to fund it.
I’ve been around long enough to remember an 1995 NIH study that found that high doses of prednisone, the king of anti-inflammatory drugs, didn’t decrease PPS symptoms but did cause horrible side effects. A 2007 Norwegian study found no change in polio survivorsÕ Ò fatigue and muscle strength” three months after IVIG treatment.”
One post-polio boat sailed long ago: Inflammation does not cause PPS. That is unless you’re a corporation that “publishes” research via “very excited” press releases and happens to have a “product opportunity” that may make you a buck… or 1,500 bucks, the cost of just one Xepol treatment.
Dr. Richard Bruno is Chairperson of the International Post-Polio Task Force and Director of The Post-Polio Institute and International Centre for Post-Polio Education and Research. Contact him at PostPolioInfo.com


Post Polio Litaff, Association A.C _APPLAC Mexico

Jul 9, 2015

End Polio Sanofi

A polio free future

A polio-free future for all children in the world:

that’s the vision of Sanofi Pasteur, Sanofi’s vaccines division, which has partnered with international organizations to support countries that want to provide their children with a future free of polio. Nepal is the first of 73 countries to have embarked upon this route, supported by the Vaccine Alliance (Gavi).
On September 18, 2014, Nepal entered into vaccination history as the first country – supported by the Gavi (the Vaccine Alliance which helps poorest countries in access to vaccines) – to introduce the inactivated polio vaccine (IPV)1 in its immunization schedule. The goal: to enable 600,000 children born each year in Nepal to live a future without polio.
As the first vaccinations were administered in Kathmandu, the Nepalese Minister of Health and Population, Shri Khaga Raj Adhikari, accompanied by Sanofi Pasteur Chairman and CEO, Olivier Charmeil, said:
“Today we are beginning to make sure that not one of our children will have their fate broken or dreams destroyed by this disease.”
In Nepal, Mina Shrestha works with families and patients to promote vaccination
October 6 2014, the Philippines followed suit, even though the last case of polio in this country was recorded in 1993. So, why continue to vaccinate and why the choice of this vaccine? These public health policies respond to World Health Organization (WHO) recommendations, which support the plan to eradicate polio by 2018 (Eradication & Endgame Strategic Plan) in which Sanofi Pasteur is a key partner.
One of the essential elements of the eradication plan – supported by more than 400 scientists – is the introduction of at least one dose of injectable inactivated vaccine, IPV, in the normal vaccine schedule to complement and progressively replace the attenuated oral polio vaccine (OPV)2 and 3.
Polio Hero in Philippines: Guiller Tumangan
To end polio and change the course of history, Sanofi Pasteur provides the IPV vaccine to Nepal and the Philippines and will soon supply other countries in the world – over 120 countries will implement the WHO recommendation by the end of 2015. Sanofi’s vaccines division is a longtime force in the fight to prevent polio, dating to its first IPV vaccine in 1955. Sanofi Pasteur is also a partner to international organizations (Gavi, WHO, UNICEF, the Bill & Melinda Gates Foundation) in line with a vision of a world where vaccination would ensure that no one would suffer or die from a preventable disease. It is a commitment to provide quality vaccines at affordable prices, giving everyone the same opportunity to have access to the vaccination.
Photo Credit : Aiko Kawamura / Emotion Tokyo

References:
  1. IPV injectable inactivated poliovirus vaccine
  2. OPV attenuated oral polio vaccine
  3. OPV, a simple to administer oral vaccine, has enabled a considerable decrease in polio to be achieved, but slows the circulation of the attenuated virus contained in the vaccine. IPV, injectable inactivated vaccine, enables definitive interruption of virus circulation and complete eradication
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