Feature Polio

Polio eradication: a complex end game

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e2398 (Published 02 April 2012) Cite this as: BMJ 2012;344:e2398

Re: Polio eradication: a complex end game

Polio eradication by vaccination?

Let me quote some original seminal medical research.

Anderson et al. (1951) in his article “Poliomyelitis occurring after antigen injections” (Pediatrics; 7(6): 741-759) wrote “During the last year several investigators have reported the occurrence poliomyelitis within a few weeks after injection of some antigen. Martin in England noted 25 cases in which paralysis of as single limb occurred within 28 days of injection of antigen into that limb, and two cases following penicillin injections. In Australia, McCloskey, during a study of the 1949 outbreak, recorded 38 cases that developed within 30 days of an antigen injection, finding an association between the site of paralysis and that of the recently antecedent injection. His findings, contrary to Martin’s suggested a greater association with pertussis vaccine than with other antigens. Geffen, studying the 1949 poliomyelitis cases in London, observed 30 patients who had received an antigen within four weeks, noting also that the paralysis involved especially the extremity into which the injection had been given. In a subsequent survey of 33 administrative areas in England, Hill and Knowelden found 42 children who had been immunized within a month [of injections]…Banks and Beale3 observed 14 cases that followed within two months after immunization noting also a correlation between site of injection and location of paralysis, as well as increased severity of residual paralysis…In the discussion of this problem during the April 1950 meeting of the Royal Society of medicine, Burnett and others stressed the apparent relationship to multiple antigens containing a pertussis component”. [undoubtedly reflecting the increasing use of pertussis-containing vaccines].

Peterson et al. (1955) reported on vaccination induced poliomyelitis in Idaho as part of the trial of the Salk (injectable) vaccine (Vaccination-induced poliomyelitis in Idaho. Preliminary report of experience with Salk poliomyelitis vaccine. JAMA; 159 (4): 241-244).

The Cutter laboratories were accused of distributing vaccines containing live polioviruses, and singled out, even though vaccines produced by other manufacturers also caused paralysis (Nathanson and Langmuir 1963. The Cutter incident: poliomyelitis following formaldehyde-inactivated poliovirus vaccination in the United States during the spring of 1955 III. Am. J Hyg; 78: 61-81

Wyatt (1981) summarised cases of provocation poliomyelitis caused by multiple injections in his article “Provocation poliomyelitis: neglected clinical observations from 1914 to 1950” (Bull Hist Med; 55: 543-557).

Wyatt et al. (1992) and Wyatt (1993) warned against the unnecessary injections causing paralytic poliomyelitis in India (Trans Roy Soc Trop Med Hyg; 86: 546-549 and Lancet 341: 61-62, respectively).

Sutter et al. (1992) published an article “Attributable risk of DTP (Diphtheria and Tetanus toxoids and Pertussis toxoid vaccine injection in provoking paralytic poliomyelitis during a large outbreak in Oman”. (J Infec Dis; 165: 444-449).

According to Strebel et al. (1994. Paralytic poliomyelitis in Romania, 1984-1992. Am J Epidemiology; 140 (12: 111-124) ) although poliomyelitis due to wild virus had virtually disappeared from Romania (no cases reported between 1984-1989), the vaccine-associated paralytic poliomyelitis (VAPP) was reported at very high rates for over two decades. The overall risk of VAPP in Romania was up to 17 times higher than the reported risk in the USA.

In November 1990, to decrease the risk of VAPP, oral poliomyelitis vaccine produced in Romania was replaced by imported OPV produced by “Western European manufacturer”. However, the risk of PAPP continued unabated with that vaccine.

The history continued repeating itself all over the world wherever the poliomyelitis vaccines were used. Paralysis developed after both injectable and oral polio vaccines.

It comes as no surprise that the most recent mass polio vaccination programs fuelled by Bill and Melinda Gates Foundation resulted in increased cases of VAPP. In India, two paediatricians, Dr Neetu Vashisht and Dr Jacob Pulliel of the Department of Paediatrics of St Stephens Hospital in Delhi noted that another major ethical issue raised by the campaign is the failure to thoroughly investigate the increase in incidence “of non-polio acute flaccid paralysis (NPAFP)” in areas where many doses of vaccine were used, while noting that these cases are clinically indistinguishable from polio paralysis and twice as deadly.

They also noted that while India was declared polio-free in 2011, at the same time there were 47500 cases of NPAFP, which increased in direct proportion to the number of polio vaccine doses received. Independent studies showed that children identified with NPAFP “were at more than twice the risk of dying than those with wild polio infection”.

According to their report, nationally, the NPAFP rate is now twelve times higher than expected. In the states of Uttar Pradesh and Bihar – which have pulse polio vaccination every month – the NPAFP rate is 25 and 35 fold higher than the international norms (Ramesh Shankar, Mumbai 2012).

Ron Law (Assaulting alternative medicine: worthwhile or witch hunt? BMJ.com 10 March 2012) recently addressed the polio situation in India: eradication has been achieved by re-naming the disease. Poliomyelitis paralysis which occurs even after 30+ vaccination doses, is now called acute flaccid paralysis (AFP) or polio-like paralysis; hardly a great success of vaccination or comfort to the parents of the more than 60 000 affected children.

Earlier redefinition of poliomyelitis had been introduced in the US: a disease with residual paralysis which resolves within 60 days changed into a disease with residual paralysis which persists for more than 60 days. Cases of paralysis which resolve within 60 days (99% of cases) are diagnosed as viral or aseptic meningitis.

According to MMWR (1997; 32[29]: 384-385), there are 30 000 to 50 000 cases of viral/aseptic meningitis per year in the US. Considering that in the pre-vaccine era the vast majority (99%) of the reported cases were non-paralytic (corresponding to aseptic or viral meningitis), vaccination has actually increased the incidence of poliomyelitis. Before mass vaccination there were a few hundred or few thousand cases of polio in some outbreaks, while now it is up to 50 000 cases every year.

Figure 1 in Schonberger et al. (1984. Control of poliomyelitis in the United States. Rev infect dis; 6 (Suppl 2: S424-S426) shows the steady downward trend in the incidence of poliomyelitis stopping, and indeed increasing, when DPT and P vaccination became mandatory in the US in the mid-seventies.

The experience in northern Namibia showed that with no polio vaccination children developed natural immunity to the wild polio virus without developing paralysis (Biellik et al. 1994. Poliomyelitis in Namibia. Lancet 344: 1776).

The vaccine viruses inactivation by a 14-day treatment with 1:4000 formaldehyde solution is the subject to asymptotic factor making the inactivation incomplete (Gerber et al. 1961. Inactivation of vacuolating virus (SV 40) by formaldehyde, Proc Soc Exp Biol & Med; 108: 205-209), and, Fenner (1962. The reactivation of animal viruses. BMJ; July 21: 135-142) showed that the process is also reversible.

Evans et al. (1985. Nature ; 314: 548-550) demonstrated “Increased neurovirulence associated with a single nucleotide change in a noncoding region of the Sabin type 3 poliovirus genome”.

The only way to eradicate paralytic poliomyelitis is to stop vaccinating.

Competing interests: No competing interests
10 April 2012
Dr Viera Scheibner (PhD)
scientist/author retired
n/a
Blackheath, Australia
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