POLIO VACCINATIONS—I once reviewed a book called The Cutter Incident. It lays out the history of the development of polio vaccines. There were problems. There were BIG problems. Those problems contributed to a “natural” tendency for some to distrust the very notion of injecting foreign substances into ones body. I have always been a strong (and unapologetic) advocate of vaccinations but find the current world tugging and pushing and annoying my long-held assumptions. I recently listened to a podcast on TWIV (This Week In Virology) and a segment touched on the issue of world-wide attempts to eradicate Polio and the “resurgence” of polio in New York. Some thoughts follow:
I was vaccinated with the injectable form of polio vaccine in the 1950’s. I completed these before the oral vaccine was available. When entering medical school, my antibodies for polio were screened and were very low. I was offered and took the oral vaccination series to “boost” my immunity in the face of likely future contact. Fast forward a few decades, and I find myself contributing regularly to Rotary’s End Polio Now fund.
Is ending polio realistic—by this I mean, if everyone is vaccinated, will the disease die out, as Smallpox did and make further vaccination unecessary? The podcast found me thinking, no. The issues:
The economical distribution of polio vaccine to billions in the third world has required the use of oral polio vaccine; it can be distributed by lay people with a little training. It is inexpensive and easy to store. Imagine the logistics of giving a thousand vaccines in a village in Pakistan with oral drops vs a shot in the arm.
Why do they use oral polio vaccine in India and we don’t use oral polio vaccine in the USA given the unpopularity of “jabs?” The oral vaccine infects you with a “live” virus that is “inactivated.” It turns out that the inactivation is incomplete and it became clear in the 1990’s that rarely, oral vaccine could give polio to a susceptible kid. We are talking 10-15 cases in the whole United States in a year. This led to a programatic change back to injected Polio vaccines (using “dead” polio particles) with no chance of causing Polio.
The calculation in India of a few hundred cases of vaccine induced polio to prevent large numbers of wild polio is a logical calculus. When resources are available, they will shift to the injectable form for the same reasons that we did.
Another problem with the oral vaccine is that it lives and is excreted and can infect other people, just like wild polio. If you have been vaccinated, like Covid, you can be infected—-but you will not have serious paralyzing illness. Because so many of us have been vaccinated for polio and because there has not been a case in a native born citizen in decades, no one really cared about this until a native born child acquired polio in New York. The strain that infected them was from a mutated oral polio vaccine. Living in the gut, the inactivated polio reproduces and in doing so, mutates. A fear is that mutations that lead to a new polio strain capable of causing polio if exposed to a non-vaccinated person will arise.
Given travel across the world (the New York strain found this summer had to have come from someone vaccinated with oral vaccine outside the USA) and given the lack of faith or attention parents have about their children’s vaccination schedules (some 40% of children in the county where this first case appeared were not up to date with their polio vaccinations), it is clear that we will face this music for the foreseeable future.
I suspect a willingness to vaccinate for polio will have much less resistance than Covid did as the typical victims will be young children and not nursing home residents; we will do many things to save our children that we will not do for ourselves……or our parents and grandparents. We may need a critical mass of infected children before the message is received.
An interesting side-line. Traditionally, sewage and water treatment plants are tested by public health to see if coliform (bacteria growing in your colon) are of specific numbers or virulence; water safety is the bottom line of such testing.The experience with drinking water in Mississipi after recent floods is an example of this routine process. With Covid, the use of such testing to check on dormitories or towns was explored as a tool for screening populations for the presence of disease. This has started with Polio and may become more widespread as the fundamental question remains: “If I was vaccinated as a child for polio and am now seventy, am I truly immune if I am exposed?” In a world where everyone has been vaccinated and no one has seen polio in decades, there is no way to answer the question clearly. The present or absence of antibodies does not answer the question. In a world where 40% of people in your community may not be immunized, the surveillance will help let you know if there is polio around to get you exposed……and studies will follow if someone in their seventies who was vaccinated comes down with it.
Sleep tight!
COVID— I continue to be awed by the randomness of covid infections. Like the images from hurricane Irma there can be total devastation and in the middle of it, a house that looks untouched with the car in the driveway. People sharing households often tell me the story of the one family member who never got sick and whose testing stayed negative.
You are likely familiar with the term, “Paxlovid rebound.” A recent study demonstrated that people with and without Paxlovid treatment report the same rebound phenomena, (sick, better, worse again) and in equal percentages. Think of it as Covid Rebound and not caused by Paxlovid.
I have heard people relate to feeling so much better within a day of starting Paxlovid; the request for a booster dose is common if the “rebound” is felt. Paxlovid was never supposed to make you feel better—its value is reducing the likelihood of hospitalization and death. Feeling better as with all medications/illnesses, is icing on the cake.
EPIDEMIC OF MYOPIA? This month’s Atlantic has an article suggesting that a world wide phenomena is occurring. More kids and at younger and younger ages are being found to be myopic and in need of glasses to enhance their distance vision. This appears to be a function of modern lifestyle in that it is less apparent in children growing up without indoor “resources” like rooms, books, computers. A theory is that kids focus their vision on tablets and TV’s during a crucial stage of their eye-brain development and that this actually has an effect on the eye ball’s shape during a critical period of development….Just a theory. There are treatments and as this was first recognized in Asian communities, the treatments are more popular with Asian communities in the USA. It is worth thinking about in that the current “fix” that does not involve lenses or eyedrops is having kids focus on things at a distance ie outdoors when they are at a critical age (first ten years of life).
Good luck with that!
EMERGENCY CONTRACEPTION: Most of us are aware that there are hormones that can be taken to prevent pregnancy after unprotected intercourse. I was astounded to learn that one other approved emergency contraception is a copper containing IUD. As with all IUD’s it appears to prevent implantation. In this day and age, the technology is available to allow for no woman to become pregnant until it is a conscious choice. IUD’s are a huge part of making that a reality. Education and access to care are required and as of yet, not available/affordable to large numbers of women of child bearing age. Imagine a USA where requests for abortions plummet because of such access……
STATISTICS: My thinking on many choice points in life depends on my ability to sort statistical probabilities. I got a “C” in statistics when in Medical School. Nonetheless, I try to access that part of my mind to make decisions. This was part of my medical world when providing informed consent to patients. If you have appendicitis and are untreated, you have a double digit risk of dying from complications of that. If you have an appendectomy, you have a less than 1% chance of dying. What do you think? I assume in general, that men die before women of the same age. I have a group friends in the last few years where the statistics are not accurately predicting things ie wives are falling ill to serious disease processes before their husbands who sometimes are actually older. These illnesses have by and large caught everyone by surprise. Sometimes, despite statistical norms, things come out of left field.
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