Polio-like disease expected to increase this fall

By | July 23, 2019

Polio (poliomyelitis) is a very contagious enterovirus infection that usually causes mild flu-like symptoms or no symptoms at all, and most people recover from polio without lasting health problems (nonparalytic polio).1

However, severe complications of polio can cause partial or total body paralysis, breathing difficulties and death.2 The first clinical description of this contagious disease was given by Michael Underwood, a British doctor, in 1789. The first recorded outbreak of polio in the U.S. occurred in Vermont in 1894.3

As noted by the Polio Eradication Initiative, “In the early 20th century, polio was one of the most feared diseases in industrialized countries, paralyzing hundreds of thousands of children every year.”4 According to the U.S. Centers for Disease Control, “In the early 1950s, before polio vaccines were available, polio outbreaks caused more than 15,000 cases of paralysis each year in the United States.”5

Dr. Jonas Salk began studying polio in 1947, and in the mid-1950s developed the first inactivated injectable polio vaccine (IAV).6,7 A live attenuated oral polio vaccine (OPV) was developed in the early 1960s, and quickly became the vaccine of choice around the globe.8

During the 1970s and ’80s, routine use of OPV for child vaccination programs was adopted by countries around the world and, in 1988, the World Health Assembly passed a resolution to eradicate polio by 2000. The last known case of wild type polio in the Western Hemisphere is believed to have occurred in Peru in 1991.9,10

The live attenuated polio vaccine can cause vaccine strain polio paralysis in the person vaccinated or someone who comes into contact with the body fluids (urine, stool, saliva) of a recently vaccinated person shedding vaccine strain polio virus.11

It wasn’t until 1999 that U.S. public health officials switched from recommending universal use of live OPV and started recommending the use of inactivated polio vaccine (IVP) again, “to eliminate the risk for vaccine-associated paralytic poliomyelitis.”12

Vaccine-derived polio on the rise

While the global poliovirus eradication effort appears to have been successful, the consequences of routine use of OPV are not fully known. In 2009, the World Health Organization warned that live polio vaccine may be responsible for a rise in vaccine strain polio termed Vaccine Derived Polio Disease (VDPD).13,14

Not only has live vaccine strain poliovirus been found to cause paralytic disease in some cases, but evidence also shows that mutated vaccine-derived viruses are responsible for some outbreaks.15,16 As reported by NPR in 2017:17

“For the first time, the number of children paralyzed by mutant strains of the polio vaccine are greater than the number of children paralyzed by polio itself. So far in 2017, there have been only six cases of ‘wild’ polio reported anywhere in the world …

By contrast, there have been 21 cases of vaccine-derived polio this year. These cases look remarkably similar to regular polio. But laboratory tests show they’re caused by remnants of the oral polio vaccine that have gotten loose in the environment, mutated and regained their ability to paralyze unvaccinated children

‘It’s actually an interesting conundrum. The very tool you are using for [polio] eradication is causing the problem,’ says Raul Andino, a professor of microbiology at the University of California at San Francisco.”

A year later, as further evidence that VDPD is still frustrating public health officials, the Polio Global Eradication Initiative reported that worldwide in 2018 there were 104 confirmed cases of VDPV — and only 33 cases of wild poliovirus.18

We may be going from bad to worse

A 2016 study19 in the Journal of Virology highlighted the very real problems that human populations face from mutated vaccine-derived polioviruses:

“Until this outbreak, Sabin-like viruses (in distinction to more markedly evolved vaccine-derived polioviruses [VDPVs]) were reported to cause only sporadic cases of VAPP [vaccine-associated paralytic poliomyelitis]. Consequently, VAPP cases were not considered to require outbreak-type responses.

However, the Biysk outbreak completely blurred the borderline between Sabin-like viruses and VDPVs in epidemiological terms. The outbreak demonstrated a very high disease/infection ratio, apparently exceeding even that reported for wild polioviruses.

The viral genome structures did not provide any substantial hints as to the underlying reason(s) for such pathogenicity … Altogether, the results demonstrate several new aspects of pathogenicity, epidemiology, and evolution of vaccine-related polioviruses and underscore several serious gaps in understanding these problems.”

CDC warns polio-like disease is spreading

In 2009, WHO20 urged enhanced surveillance for acute flaccid paralysis (AFP), of which one known cause is paralysis from wild type or vaccine strain polio.21 In October 2018, the Washington State Department of Health issued a 23-page Acute Flaccid Myelitis and Poliomyelitis Reporting and Investigation Guideline.22

The guidelines advised doctors about how to conduct a routine investigation of suspected cases of Acute Flaccid Myelitis (AFM), a polio-liked disease, as well as suspected cases of wild type or vaccine strain polio:

“Any person noted to have AFM has the potential to be a polio case. Immediately obtaining information about prior immunizations and recent travel or exposure to a recent OPV vaccinee is extremely important for every suspect AFM case.”

In evaluating and determining the likelihood of a diagnosis, public health officials directed doctors to:

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Review the clinical presentation, physical exam findings (particularly flaccid weakness).

Review immunization history and risk factors for infection (e.g., recent travel to a polio endemic area or possible exposure to a person that recently received oral polio vaccine).

Obtain history of any recent viral respiratory and/or gastrointestinal illness.

Confirm that clinical criteria including CSF findings and/or MRI test results are met for AFM cases.

If pursuit of laboratory testing is indicated, facilitate timely collection of appropriate specimens and expedite transport of those specimens to PHL.

If a commercial laboratory isolates polio virus in cell culture, request that the laboratory send the cell culture to PHL for confirmatory testing immediately.

State health officials also advised that:

“For a suspected polio case, contacts must be identified and monitored for symptoms. Collection of stool and serum samples from household members and other contacts associated with possible transmission settings may be required. For a confirmed polio case, vaccination should be offered to susceptible contacts with an emphasis on persons who have an ongoing risk of exposure.”

July 9, 2019, the CDC issued a call for increased paralytic disease surveillance,23,24 urging health care professionals to be on the lookout for cases of AFM, which first drew the agency’s attention in 2014. Cases of AFM have been increasing in the U.S., but the CDC maintains the cause is still unknown.

As described by the Cleveland Clinic,25 AFM “is characterized by muscle weakness and myelitis of the spinal cord’s anterior horn cells following a viral illness.” The disease affects primarily children. During the 2018 outbreak in the U.S., the median age of confirmed cases was 5.3 years.26 As for its diagnosis, the Cleveland Clinic says:

“Children with AFM typically present with acute onset of asymmetric flaccid paralysis, often rapidly progressing from normal strength to flaccid weakness with loss of reflexes within hours to a few days. A prodromal illness (typically febrile with respiratory symptoms) a few days prior to the onset of flaccid paralysis is common.

Perplexingly, the respiratory symptoms of the prodromal illness are frequently shared by sick contacts within the household, but they are spared any signs or symptoms of AFM. Patients also frequently report pain in the affected limb at the time of weakness onset.

There does not appear to be any ethnic or racial predispositions, pre-existing comorbidities that place these healthy children at increased risk or any association with vaccination status …

Current Centers for Disease Control and Prevention (CDC) definitions for AFM require two criteria: acute onset of flaccid limb weakness and MRI evidence of a gray matter lesion spanning one or more spinal segments.”

According to the CDC, outbreaks of AFM have been recorded on a biennial basis since then, with spikes occurring in 2014, 2016 and 2018.27 While the symptoms of AFM mimic those caused by poliovirus, investigations have failed to find the poliovirus in any of the confirmed cases of AFM that were lab tested. The CDC stated in its July 2019 report that “Stool specimens from all patients with available specimens tested negative for poliovirus,” while also acknowledging that:28

“Timing of respiratory specimen collection improved in 2018 compared with that in 2016, but still occurred a median of approximately three days after the onset of limb weakness and five days after the onset of any respiratory illness. Shedding of viruses in the respiratory tract can be transient, so delays in specimen collection could contribute to negative findings.”

Mutated enterovirus D68 may be responsible

At present, other enteroviruses, especially coxsackievirus A16, enterovirus A71 and enterovirus D68, are suspected of being responsible for AFM.29

The AFM outbreak in 2014 in the U.S. occurred concurrently with an outbreak of EV-D68,30 a pathogen known to cause respiratory illness. A 2018 paper31 in Frontiers in Microbiology, “Enterovirus D68 — The New Polio?” highlights evidence identifying EV-D68 as a probable cause of AFM.

“The EV-D68 storyline shows many similarities with poliovirus a century ago, stimulating discussion about whether EV-D68 could be ascertaining itself as the ‘new polio,'” the paper states.32

The authors also cite research showing EV-D68 has undergone genetic alterations “known to affect the translational efficiency and thought to increase the virulence.” However, EV-D68 is only found in about half of all cases. Testing of samples taken during the 2014 AFM outbreak revealed EV-D68 in 47% of the samples collected within seven days of disease onset.33

Another study34 found the virus in 48% of respiratory samples collected from AFM patients. However, as noted in The Atlantic,35 the lack of active EV-D68 infection doesn’t mean the virus cannot be the trigger of AFM:

“In many neurological infections, the worst symptoms aren’t caused by the virus itself, but by the body’s disproportionate immune response. That response can continue even after the virus has been cleared, which means that patients often test negative for whatever first triggered their illness.

All the researchers I spoke to think AFM likely behaves in this way, especially since there can be a seven-day gap between the condition’s initial coldlike symptoms and the severe paralytic ones.

By the time parents seek medical help, their children could be suffering from their body’s misplaced attempts to fight an enemy that’s no longer there.”

The ignored vaccine-paralysis link

However, while researchers are trying to pin down the viral cause, there may be something else going on here. For decades, it’s been known that injections, including injections of vaccines, sometimes can cause paralysis under certain conditions — a phenomenon referred to as “provocation polio.” Yet this issue is being largely, if not entirely, ignored in today’s discussions about AFM.

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In response to the 2016 BMJ article36 “Conflicts of Interest Compromise U.S. Public Health Agency’s Mission,” Allan S. Cunningham, a retired pediatrician, questioned whether Americans can “trust the CDC to honestly investigate the current AFM outbreak”37 specifically. In his response, Cunningham points out how the CDC is avoiding the well-recognized link between injections and paralytic disease:

“Antecedent injections have been suggested as possible co-factors by clinician-scientists who remember ‘provocation paralysis;’ Hill and Knowelden, for example, found a 20-fold risk of paralytic polio in children who received the DTP shot during the 1949 British polio epidemic …

During the 1990s the NEJM published a study in Romania linking vaccine-associated paralytic polio (VAPP) to penicillin injections. Tissue studies have shown how muscle damage by an injection can provide a portal of entry to the CNS for neurotropic viruses.”

Cunningham describes a conversation he said he had with an unnamed public health official about the 2016 AFM outbreak in Washington State, alleging the health official was aware of the provocation paralysis theory but was “wary of anti-vaccine forces who would misuse data suggesting a serious adverse effect of vaccinations,” and that “for this reason he indicated that statistical details of the CDC’s investigation would not be released to the news media.”

“The CDC, the AAP and many public health officials are afraid that any bad news about vaccines will cause the public to turn away from life-saving vaccines,” Cunningham writes.

“Along with the manufacturers, they are also afraid of the effect such news might have on incomes and careers. Will the CDC do an unbiased, thorough and transparent investigation of the current AFM outbreak?”

Similarly, in a November 2016 article,38 Marcella Piper-Terry, a biomedical consultant and founder of VaxTruth.org, pointed out that AFM following routine childhood vaccination is “nothing new.” “The connection between childhood vaccination and provocation paralysis has been known since the polio outbreaks in the 1940s and 1950s,” she wrote.

The history of provocation polio

Indeed, the 2014 Lancet paper,39 “Polio Provocation: Solving a Mystery with the Help of History,” by Stephen Mawdsley, recounted this history, observing that “Evidence of this correlation was first published by German doctors, who noted that children who had received treatment for congenital syphilis later became paralyzed in the injected limb.”

French and Italian studies corroborated the link between injections of DPT vaccine and provocation polio paralysis, Mawdsley stated, and by the end of World War II, “injection-induced polio emerged as a public health concern.” He explained:40

“The application of epidemiological surveillance and statistical methods enabled researchers to trace the steady rise in polio incidence along with the expansion of immunization programs for diphtheria, pertussis, and tetanus.

A report that emerged from Guy’s and Evelina Hospitals, London, in 1950, found that 17 cases of polio paralysis developed in the limb injected with pertussis or tetanus inoculations.

Results published by Australian doctor Bertram McCloskey also showed a strong association between injections and polio paralysis. Meanwhile, in the USA, public health researchers in New York and Pennsylvania reached similar conclusions. Clinical evidence, derived from across three continents, had established a theory that required attention.”

The mounting scientific evidence that emerged during the 1950s fueled concerns to the point that booster shots were discouraged whenever there was a polio outbreak and “laws mandating pediatric vaccinations before school attendance were relaxed.”41

Immunization practices were also reformed and, according to Mawdsley, “Most health professionals … accepted that seasonal factors and cycles of disease were important to consider before immunizing children.”42

Polio vaccine swept ‘provocation polio’ under the rug

The link between provocation paralysis and vaccine injections quickly receded with the advent of the polio vaccine and mass vaccination programs, however. Mawdsley stated:43

“Once polio vaccination programs established herd immunity among children and adults, the corresponding risk of toxoid-based injections inciting polio paralysis was effectively eliminated.

Orthodox public health and surgical practices were restored. Although medical scientists failed to understand the epidemiological mechanism behind polio provocation, the Salk and Sabin vaccines pushed the issue to the margins of clinical attention.”

Mechanism of injection-induced polio revealed

In the 1990s, scientific advances allowed for a more thorough investigation of the link between vaccine injections and paralysis and, in 1998, the first paper44 describing the actual mechanism of injection-induced polio paralysis was published.

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The research, conducted by two State University of New York researchers, Matthias Gromeier and Eckard Wimmer, revealed “that tissue injury produced by an injection aided the poliovirus to infect the body and readily journey to the spinal cord,” Mawsdley writes, adding “For the first time, health professionals working in polio endemic regions had scientific evidence that pediatric injections could incite paralysis.”

In areas where polio was controlled through vaccination, however, vaccine-induced paralysis “was insignificant,” suggesting the polio vaccine effectively reduced the risk of other vaccinations causing paralytic disease.

A question Mawdsley does not address, however, is how the mutation of vaccine viruses affects this chain of events. We now apparently have vaccine-derived mutated polioviruses that are more virulent than the original poliovirus, and respiratory enteroviruses that are somehow able to trigger paralysis.

Mawdsley does note that concerns about provocation polio resurfaced in the 1980s when routine vaccination programs began to flourish, as the incidence of paralysis again began to rise.

Vaccination also linked to transverse myelitis

According to the Transverse Myelitis Association, AFM is a subtype of transverse myelitis,45 and this condition has also been linked to vaccinations. A 2009 systematic review46 published in the journal Lupus found:

“… 37 reported cases of transverse myelitis associated with different vaccines including those against hepatitis B virus, measles-mumps-rubella, diphtheria-tetanus-pertussis and others, given to infants, children and adults. In most of these reported cases the temporal association was between several days and 3 months, although a longer time frame of up to several years was also suggested.”

Transverse myelitis is also recognized by the U.S. Vaccine Injury Compensation Program (VICP) as a possible injury following receipt of several different types of vaccines.47,48 Piper-Terry writes:49

“In the 1980s, the United States government went on record as choosing the vaccination program over the well-being of children, publishing the following in the Federal Register (the daily journal of the U.S. government), in regard to the polio vaccine:

‘… [A]ny possible doubts, whether or not well founded, about the safety of the vaccine cannot be allowed to exist in view of the need to assure that the vaccine will continue to be used to the maximum extent consistent with the nation’s public health objectives.'”

A PDF copy of that Federal Register article, dated June 1, 1984, can be downloaded at the end of Piper-Terry’s article.50 “We need to scream from the rooftops that it is time to stop the sacrifice of our children,” she writes, adding:

“Please pray for … the families of all the children who are caught in the middle of what can only be described as a battle between innocent lives and … forces … fueled by the billions of dollars greasing the palms of those who make the decisions about mandatory vaccinations.”

Signs and Symptoms of AFM

With cases of AFM on the rise in the U.S., it’s important to be on the lookout for potential signs and symptoms of AFM, particularly in children. These include:51

Difficulty moving the eyes

Facial droop or weakness

Slurred speech

Loss of muscle tone

Drooping eyelids

Difficulty swallowing

Sudden arm or leg weakness

Loss of reflexes

If you notice any of these symptoms, seek medical care immediately as AFM can be life-threatening. The most severe symptom is respiratory failure due to flaccid breathing muscles. In this case, a ventilator may be required. Other neurological complications may also occur, some of which may lead to death.

You cannot find what you refuse to look for

Unfortunately, diagnosis can be difficult, and treatment even more so. According to the CDC:52

“There is no specific treatment for AFM, but a doctor who specializes in treating brain and spinal cord illnesses (neurologist) may recommend certain interventions on a case-by-case basis. For example, neurologists may recommend physical or occupational therapy to help with arm or leg weakness caused by AFM.”

CDC officials state there are few tools for prevention of AFM: “Since we don’t know the cause of most of these AFM cases or what triggers this condition, there is no specific action to take to prevent AFM.”

Unfortunately, unless all of the potential causes of AFM are explored, including provocation polio, which has been linked to acute flaccid paralysis, we may continue to remain in the dark about the cause of this crippling condition for quite some time.