Apr 12, 2016

Defeating Polio, The Disease That Paralyzed America

Iron lungs in a polio ward, undated.
Iron lungs in a polio ward, undated.
Tens of thousands of Americans — in the first half of the 20th century — were stricken by poliomyelitis. Polio, as it's known, is a disease that attacks the central nervous system and often leaves its victims partially or fully paralyzed.
The hallmarks of the Polio Era were children on crutches and in iron lungs, shuttered swimming pools, theaters warning moviegoers to not sit too close to one another.
On April 12, 2015, we celebrate the 60th anniversary of a vaccine developed by Jonas Salk that prevented the disease and eventually led to its remarkable decline. The introduction of that vaccine in 1955 was one of the biggest medical advances in American history.
A nurse prepares children for a polio vaccine shot as part of citywide testing of the vaccine on elementary school students in Pittsburgh in 1954.
A nurse prepares children for a polio vaccine shot as part of citywide testing of the vaccine on elementary school students in Pittsburgh in 1954.
Think of it: Between 1937 and 1997, Post-Polio Health International estimates in one table, more than 457,000 people in the U.S. — and hundreds of thousands more around the world — suffered from some form of polio. Thousands and thousands were paralyzed in this country alone.
Within two years of the 1955 announcement, U.S. polio cases dropped 85 to 90 percent, Joe Palca of NPR reported.
But, as is often the case, the statistics — even dramatic statistics — don't tell the complete story. So let's listen to a couple of contemporary Americans who lived through the horror talk about the disease — and about its defeat.
David M. Oshinsky, 70, is a history professor at New York University and director of the Division of Medical Humanities at the NYU-Langone Medical Center. His book, Polio: An American Story, won the 2006 Pulitzer Prize for History. Walter A. Orenstein, 67, is a professor of medicine, pediatrics and global health at Emory University. He is also associate director of the Emory Vaccine Center.
1) When was the polio epidemic at its worst in the United States? "Polio was at its height in the early 1950s," says Oshinsky, "just as the Salk vaccine was tested and found to be 'safe, effective and potent.' "
2) How was the public responding — what precautions were people taking, what myths were being circulated? "The public was horribly and understandably frightened by polio," says Oshinsky, who grew up in Queens, N.Y. "There was no prevention and no cure. Everyone was at risk, especially children. There was nothing a parent could do to protect the family. I grew up in this era. Each summer, polio would come like The Plague. Beaches and pools would close — because of the fear that the poliovirus was waterborne. Children had to say away from crowds, so they often were banned from movie theaters, bowling alleys, and the like. My mother gave us all a 'polio test' each day: Could we touch our toes and put our chins to our chest? Every stomach ache or stiffness caused a panic. Was it polio? I remember the awful photos of children on crutches, in wheelchairs and iron lungs. And coming back to school in September to see the empty desks where the children hadn't returned."
A nurse assists a 27-year-old patient in an iron lung in Syracuse, N.Y., in 1954.
A nurse assists a 27-year-old patient in an iron lung in Syracuse, N.Y., in 1954.
3) What cultural changes occurred in America as a result of the polio outbreaks and as a result of its cure? "Rumors spread that soft drinks were responsible — or too much rain or heat," Oshinsky says. "In some places people stopped handling paper money and refused to shake hands. But mostly people mobilized to fight the disease by raising money for the March of Dimes, which promised us a life-saving protective vaccine. And, in the end, it gave us two vaccines — the injected killed-virus version of Jonas Salk and the oral live-virus version of Albert Sabin."
4) How was the country different before — and after — the polio scares?"Word that the Salk vaccine was successful set off one of the greatest celebrations in modern American history," Oshinsky remembers. "The date was April 12, 1955 — the announcement came from Ann Arbor, Mich. Church bells tolled, factory whistles blew. People ran into the streets weeping. President Eisenhower invited Jonas Salk to the White House, where he choked up while thanking Salk for saving the world's children — an iconic moment, the height of America's faith in research and science. Vaccines became a natural part of pediatric care."
5) When and what was the process for Jonas Salk and his vaccine and when was his ah-ha moment? "Salk's 'Eureka Moment' came when he realized that his killed-virus vaccine produced high antibody levels in children, following a series of experiments in the early 1950s," Oshinsky says. "And his vaccine was validated in 1955, following the largest public health experiment in American history, involving close to 2 million schoolchildren, some getting the real vaccine, the others a look-alike placebo. It took a year to tabulate the results, which were extraordinary."
6) What did Albert Sabin contribute to eradication of the disease? "Sabin couldn't test his oral live-virus vaccine in the U.S. because so many kids were already vaccinated with the Salk vaccine," Oshinky explains. "So, in one of the great stories of the Cold War era, he was allowed to go to the Soviet Union and Eastern Europe to test there. They lined up close to 70 million children — the glories of repressive police states — and the results were fantastic. The Sabin vaccine was extremely effective, giving the world two terrific vaccines against polio."
7) What are the chances that polio will return to the U.S. or that something as serious will reach such critical epidemic levels? "The chances of a return of polio to the U.S. are slim although not zero," says Walter A. Orenstein. "The main reason is the Global Polio Eradication Initiative (GPEI). When it began in 1988, there were an estimated 350,000 persons paralyzed by polio in that year alone. In contrast, in 2014, there were only 359 cases, a greater than 99 percent reduction. In 1988, there were 125 countries considered endemic for polio. In other words, these countries had continuous circulation of polioviruses. In 2014, only three countries are considered endemic: Pakistan, Afghanistan and Nigeria. What would put the U.S. at greatest risk is failure to complete eradication and, even worse, a backing-off of the efforts to contain the virus, in which case there would likely be a global resurgence. Working in partnership with the GPEI is the best way to eliminate the risk for a return of polio to the U.S."
Dr. Albert B. Sabin (right) and Dr. Jonas Salk in Washington in 1955.i
Dr. Albert B. Sabin (right) and Dr. Jonas Salk in Washington in 1955.
Henry Griffin/AP
8) How can we prevent it? "As long as polioviruses circulate anywhere," Orenstein says, "there is the potential that the virus can be exported to the U.S. The best way to reduce that risk is to ensure our population is fully immunized in accordance with recommendations of the Centers for Disease Control's Advisory Committee on Immunization Practices and in addition, travelers to areas where polio is endemic or epidemic should receive at least one additional dose of vaccine. Long-term residents of 'polio exporting countries' — that is, countries which have exported poliovirus in recent years — should receive a dose of polio vaccine at least four weeks prior to travel outside of the country and no more than 12 months prior to travel."
9) How did Jonas Salk — and other vaccine creators — deal with people who did not believe in the vaccine? "During the period when Jonas Salk developed the inactivated polio vaccine, or IPV, there was not much opposition to vaccines," says Orenstein, who grew up in the Bronx. "People were genuinely scared about polio and the annual epidemics — which during the early 1950s paralyzed more than 15,000 people each year in the U.S. IPV was viewed as a miracle. I remember being in second grade when the Salk polio vaccine was licensed and there was to be a vaccination campaign in my school. I was none too thrilled about getting 'a shot' for something I knew nothing about. I remember my mother saying to me 'Better you should cry, than I should cry.' That's how much appreciated the vaccine was."
He adds: "It is incumbent for all of us who know something about vaccines to better educate our population regarding the risks of vaccine-preventable diseases, the benefits of the vaccines which prevent them, the risks of the vaccines and how they compare with the benefits, and the system in place to assure the vaccines we use are safe and effective."(This post has been updated.)

Apr 6, 2016

Neighbors: Dedicated nurses cared for polio patients requiring iron lungs


Dale Stenerson, Fargo, knows about polio. He had it in 1944-1945 when he was 9.
Neighbors has carried several items from people, including Dale, about the polio epidemic. Now he tells a bit more about his experience.

He lived with his family in rural Halstad, Minn., when he came down with it and became a patient in the children's ward of St. Luke's Hospital (now Sanford) in Fargo.
His doctor, whose last name was Swanson, gave him a spinal fusion. Dale was in a body cast from his hips to his neck for six weeks.
He especially remembers the big crib where he slept.
One other patient in the ward was Tommy Monson, also 9, from Valley City, N.D. Polio left Tommy with no muscles in his left arm, causing him to swing it around like an elephant's trunk, Dale writes.
Tommy and Dale became good friends and stayed in contact over the years.
The iron lung
What was it like for polio patients who had to be in iron lungs?
For that, let's turn to Betty Simonson, Fargo.
Betty was a junior in the nursing school at Lutheran Deaconess Hospital, Minneapolis, in the summer of 1953.
"Each student nurse had to take 'contagion and pediatrics' at Minneapolis General Hospital for three months," Betty writes Neighbors. "There were many patients there with bulbar polio needing to be in iron lungs.
"There was a shortage of rooms, so a sunroom/solarium was used for four or five iron lungs. All these needed to be isolated and we all wore head coverings, masks, gowns and gloves.
"They had a shortage of nurses trained for this, so on our day off from regular classes and duty, we could work shifts specifically with this work. We were paid $10 for eight-hour shifts.
"The hospital was not air conditioned. It was very hot that July and August, and polio patients usually ran high fevers, so galvanized wash tubs were set up in rooms and ice blocks were delivered to the tubs, with fans blowing behind the ice to cool the area.
"All care was done through large rubber-cuffed porthole-like openings in the side of the iron lung. The entire person except the head was inside the lung.
"When—and if—they improved, some patients were transferred to a rocking bed. The patient was secured to the bed, and it would swing slowly from a lying down position to a near-standing position. This enabled the diaphragm and lungs to contract and expand for breathing.
"Of course, they all had oxygen for breathing and the huge tanks had to be changed by maintenance men every so many hours. It was not piped into rooms like it is now."
And that's the way it was for polio patients and their caregivers, as reported by Betty.
If you have an item of interest for this column, mail it to Neighbors, The Forum, Box 2020, Fargo, ND 58107, fax it to 241-5487 or email blind@forumcomm.com.

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