# data[].attributes.body
The most revealing aspect I learned was about the disease spread and the hysteria polio first caused in society. It was interesting to see the similarities with COVID in how theories were made up about its origin and how there was a lot of fear in society about polio when it first emerged. Something that surprised me was the leadership response and the funding created by the CDC like the polio vaccine assistance act of 1955. Something I came across that should have been part of the padlet assignment was  the risk factors of the disease and preventative measures.

# data[].attributes.body
During the first couple cases of polio, around 1950s when still little was known about the disease, the main public reaction was fear. Polio terrified families leading to reactions such as isolation and social distancing. Other than little being known about the disease, polio also reminded middle-class families that they could not build worlds entirely in their control which was hard-hitting for a post WW2 society.  There was also a lot of misinformation spread and false theories made up such as the fly theory where polio was associated with flies, dirt and poverty. With the vaccine though, this hysteria subsided. The main behavior changes were hysteria and the reactions that came with that such as social distancing and fear of those infected with polio. Once society learned more about the disease and it's physical effects, theories were disproved and compliance with vaccinations helped with it's large elimination in the US.

# data[].attributes.attachment_link.readable_text
In the 1950s, the polio virus terrified American families. Parents tried "social distancing"-ineffectively and out of fear. Polio was not part the life they had signed up for. In the otherwise comfortable World War II era, the spread of polio showed that middle-class families could not build worlds entirely in their control.

For the Texas town of San Angelo on the Concho River, halfway between Lubbock and San Antonio, the spring of 1949 brought disease, uncertainty and most of all, fear. A series of deaths and a surge of patients unable to breathe prompted the airlifting of medical equipment with C-47 military transporters.

Towns Practice Extreme Social Distancing

Fearful of the spread of the contagious virus, the city closed pools, swimming holes, movie theaters, schools and churches, forcing priests to reach out to their congregations on local radio. Some motorists who had to stop for gas in San Angelo would not fill up their deflated tires, afraid they'd bring home air containing the infectious virus. And one of the town's best physicians diagnosed his patients based on his "clinical impression" rather than taking the chance of getting infected during the administration of the proper diagnostic test, writes Gareth Williams, Paralyzed with Fear: The Story of Polio. The scene repeated itself across the nation, especially on the Eastern seaboard and Midwest.

The virus was poliomyelitis, a highly contagious disease with symptoms including common flu-like symptoms such as sore throat, fever, tiredness, headache, a stiff neck and stomach ache. For a few though, polio affected the brain and spinal cord, which could lead meningitis and, for one out of 200, paralysis. For two to 10 of those suffering paralysis, the end result was death.

Transmitted primarily via feces but also through airborne droplets from person to person, polio took six to 20 days to incubate and remained contagious for up to two weeks after. The disease had first emerged in the United States in 1894, but the first large epidemic happened in 1916 when public health experts recorded 27,000 cases and 6,000 deaths-roughly a third in New York City alone.

After rabies and smallpox, polio was only the third viral disease scientists had discovered at the time, writes David Oshinksi in Polio: An American Story. But a lot remained unknown. Some blamed Italian immigrants, others pointed to car exhausts, a few believed cats were to blame. But its long incubation period, among other things, made it difficult even for experts to determine how the virus transferred.

'Fly Theory' Falsely Associated Polio With Insects

The prevalence of polio in late spring and summer popularized the "fly theory," explains Vincent Cirillo in the American Entomologist. Most middle-class Americans tended to associate disease with flies, dirt and poverty. And the seasonal surge of the disease in summer and apparent dormancy in winter matched the rise and fall of the mosquito population.

After World War II, Americans doused their neighborhoods, homes and children with the highly toxic pesticide DDT in the hope of banishing polio, Elena Conis reports in the journal Environmental History. Yet, the number of cases grew larger each season. There were 25,000 cases in 1946-as many as in 1916, writes Oshinski-and the number grew almost every year up to its peak of 52,000 in 1952.

There were signs of hope. The 1930s had seen significant improvements in the iron lung, a negative pressure chamber that could assist the breathing process for severely paralyzed patients. The March of Dimes organization campaigned aggressively to fund the development of a vaccine. And the comparable odds of contracting the disease remained small, the odds of long-term consequences minute, to say nothing of death.

Polio Hysteria Finally Subsides With Vaccine

The Journal of Pediatrics, parenting guru Benjamin Spock, every expert and most editorial boards warned against irrational "polio hysteria." And yet, Oshinski tells us, headlines and images of polio victims were familiar features on the front pages in the summer months. American parents were petrified. A 1952 survey found that Americans feared only nuclear annihilation more than polio.

The random pattern the disease struck made parents feel helpless, as was the lack of a cure. As middle-class parents saw it, something like this was not supposed to happen. Infectious disease had been the leading cause of death in 1900, it was no longer in 1950. They had survived the Great Depression, fought and won World War II, and returned safely from a dangerous world. Oshinski shares this recollection of a journalist from that time: "Into this buoyant postwar era came a fearsome disease to haunt their lives and to help spoil for those young parents the idealized notion of what family life would be. Polio was a crack in the fantasy."

By 1955 epidemiological evidence had clearly established that mosquitoes and flies played no important role in polio epidemics and Jonas Salk had announced he'd developed a polio vaccine, making the issue moot. Today, new cases of polio have largely been eliminated in the United States. Salk was awarded the Presidential Medal of Freedom in 1977.

Fact Check

We strive for accuracy and fairness. But if you see something that doesn't look right, click here to contact us! HISTORY reviews and updates its content regularly to ensure it is complete and accurate.

# data[].attributes.attachment_link.title
When Polio Triggered Fear and Panic Among Parents in the 1950s | HISTORY

# data[].attributes.attachment_link.description
Since little was understood about the virus that left some paralyzed and others dead, fear filled the vacuum.

# data[].attributes.body
The disease was handeled by leadership through programs being started. Most U.S. funding for polio is provided through CDC's global immunization program. There was also the Polio Vaccine Assistance Act of 1955, passed by the last session of the United States Congress in its closing days, and signed by President Eisenhower on August 12, which made possible federal grants to the states for the purchase of poliomyelitis vaccine and for the costs of planning and conducting vaccination. The CDC also Deploys personnel and resources to support country eradication efforts. Some things leadership could have done better was focus more on the impoverished communities from the beginning but they are doing that now.

# data[].attributes.attachment_link.readable_text
Nigerian family on a motorcycle receiving the polio vaccine. By Lisa K. Esapa.
View this image or search images by topic on the Public Health Image Library (PHIL)

Polio, or poliomyelitis, is a crippling and potentially deadly infectious disease caused by a virus that spreads from person to person invading the brain and spinal cord which can lead to paralysis. 1 in 200 infections leads to irreversible paralysis. Of those paralyzed, 5% to 10% die when their breathing muscles become immobilized. Additionally, even children who seem to fully recover can develop new muscle pain, weakness, or paralysis as adults, 15 to 40 years later. This is called post-polio syndrome.

There is no cure, but there are safe and effective vaccines to prevent polio infection. Polio vaccine protects children by preparing their bodies to fight the polio virus. Almost all children (99%) who get all the recommended doses of vaccine will be protected from polio. Therefore, the strategy to eradicate polio is based on prevention by immunizing every child to stop transmission and ultimately make the world polio-free.
What is the global impact of polio?

Since 1988, more than 18 million people can walk today who would otherwise have been paralyzed, and 1.5 million childhood deaths have been averted thanks to the polio vaccine.

Four regions of the world are certified polio free-the Americas, Europe, South East Asia and the Western Pacific.

In August 2019, Nigeria marked three years without wild polio, opening the door for certification of the WHO AFRO region.

In October 2019, the certification of eradication of the type-three wild poliovirus (WPV3) signifies that the world has wiped out two (WPV2 AND WPV3) of the three wild polio strains-leaving just one more (WPV1) to go.

In 2019, cases of wild polio have increased relative to 2018, and outbreaks of vaccine-derived polio continue to spread across parts of Africa and Asia.

If a population is seriously under-immunized, vaccine-derived poliovirus can begin to circulate in a community. Circulating vaccine-derived polioviruses (cVDPVs) are extremely rare forms of poliovirus, which has circulated for a prolonged period of time uninterrupted and can mutate over the course of 12-18 months.

Who is at risk?

When you look at where wild polio cases or vaccine-derived poliovirus cases are arising today, they are all in places of unrest and with varying complex scenarios or limited access - Somalia, DRC, Lake Chad region, Syria, Pakistan, and Afghanistan.

Most people who get infected with poliovirus (about 72 out of 100) will not have any visible symptoms. Poliovirus is highly contagious, and people who don't have symptoms can still pass the virus to others and make them sick.

About 1 in 4 people infected with poliovirus will experience flu-like symptoms, such as sore throat, fever, tiredness, nausea, headache, and stomach pain.

A smaller proportion of people with poliovirus infection will develop other more serious symptoms that affect the brain and spinal cord, such as paresthesia (feeling "pins and needles" in the legs), meningitis, and paralysis.

Polio anywhere is a risk to people everywhere. All countries will be at risk of polio importation until it is eradicated globally by preventing infection through vaccination.

What is CDC doing?

CDC and its international partners have made significant progress over the past 26 years. Through the Global Polio Eradication Initiative, CDC:

Works jointly with WHO and national Ministries of Health to plan and monitor polio's spread and immunization activities in multiple countries worldwide

Evaluates risk and conducts assessments with GPEI partners for the Independent Monitoring Board, which meets quarterly to review performance of at-risk countries towards achieving polio eradication milestones

Promotes innovation and conducts research to improve immunization against polio and means to detect polio cases

Supports all 145 member labs in the Global Polio Laboratory Network with critical diagnostic services and genomic sequencing of polioviruses to help guide disease control efforts in many countries

Performs applied research for supplemental immunization activities

Deploys personnel and resources to support country eradication efforts

Trains and deploys international consultants to WHO and UNICEF through the Stop Transmission of Polio (STOP) Program

CDC is working to help stop this crippling disease forever and ensure the lessons learned and polio infrastructure continue to pay dividends to keep Americans safe and save lives around the world. For example, polio infrastructure supports health priorities beyond polio, including in these recent emergency response efforts: Ebola, cholera, measles, Marburg virus and Yellow Fever.

Checking the finger marking of a nomadic child in Pakistan
Thanks to the tremendous efforts of health workers around the world, governments, and the partners of Global Polio Eradication Initiative (GPEI), polio cases have been reduced by 99.9% since 1988. However, we have seen an increase in the number of wild poliovirus cases this year in the two remaining endemic countries - Afghanistan and Pakistan. Additionally, between Jan 2019 and as of Nov 1, 2019, globally there were 117 cases of circulating- vaccine derived polio cases in fifteen countries (Angola, Benin, Central African Republic, Chad, China, DRC, Ethiopia, Ghana, Myanmar, Niger, Nigeria, Pakistan, Somalia, Togo and Zambia). Vaccine-derived polio is extremely rare and only happens in communities where immunity levels are low. Since the eradication effort began in 1988, an estimated 18 million cases of paralytic polio have been prevented while just over 1,000 cVDPV cases have ever been detected globally.

Stopping outbreaks and limiting the risk of circulating vaccine-derived poliovirus (cVDPV) emergence requires increasing assistance to cVDPV type 2 outbreak countries; using a novel, stabilized OPV2 in future; maintaining high population immunity in all countries; and ending all OPV use after certification of polio eradication. To address current cVDPV2 outbreaks, the CDC Polio Response is working to scale up and place additional technical experts for initial deployments in countries with active outbreaks to provide technical support.

Learn More:
Polio - CDC in the News
"While we have outbreaks of circulating vaccine-derived poliovirus Type 2, (cVDPV2) at higher levels than we anticipated, the numbers are still quite low compared to the amount of paralysis that has been prevented through the Global Polio Eradication Initiative. In fact, we've seen the aversion of 18 million paralytic cases of polio. That's 18 million kids that would have otherwise been paralyzed by polio that were not."
-John Vertefeuille, chief of CDC's polio eradication branch, on CSIS's Take as Directed Podcast

NPR: Polio Is Making A Comeback - November 15, 2019
"Because of the rising number of individual outbreaks, the CDC has taken a decision to do a surge staffing effort focusing on Africa."
-John Vertefeuille, chief of CDC's polio eradication branch

Scientific American: Two Strains of Polio Down, One to Go - October 23, 2019
"She probably didn't comprehend it, but she had given that child the possibility of a life without polio. What an incredible thing it will be when we can do that for every child, from here until the end of time."
-John Vertefeuille, chief of CDC's polio eradication branch

STAT News: 'The switch' was supposed to be a major step toward eradicating polio. Now it's a quandary - September 13, 2019
"Dr. Stephen Cochi, senior advisor to CDC's global immunization program, said it would also help if the WHO agreed to treat each discovery of type 2 vaccine viruses as what's known as Level 3 emergency, the way a discovery of wild poliovirus would be. Currently they are deemed a Level 2 event."

Download Animationmedia icon - View Text Alternative

October 24, 2019 is not only World Polio Day, but also the 30th anniversary of the Global Polio Eradication Initiative (GPEI). CDC has collaborated with our partners for decades to work towards eradicating this disease across the globe. In those 30 years, the world has made incredible strides against polio - reducing wild polio cases by over 99% and wiping the wild virus from all but two countries (Pakistan and Afghanistan). Additionally, two of three strains of wild poliovirus have been eradicated, a benefit to future generations and signal of our potential to wipe out all forms of the poliovirus for good.
"The two-remaining polio-endemic countries must reach all children with polio vaccine to achieve zero wild poliovirus cases, and ultimately for the world to achieve polio eradication."
-Dr. Rebecca Martin, Global Health Center Director

A Nepalese child receives his polio vaccine during an immunization campaign.

It takes a village to work towards eradicating polio.

Vaccinators mark the pinkies of children who received their polio vaccine with purple markers to keep track of whose been vaccinated.

# data[].attributes.attachment_link.keywords[]
when their breathing muscles become immobilized

# data[].attributes.attachment_link.description
Polio, or poliomyelitis, is a crippling and potentially deadly infectious disease caused by a virus that spreads from person to person invading the brain and spinal cord which can lead to paralysis. 1 in 200 infections leads to irreversible paralysis. Of those paralyzed, 5% to 10% die when their breathing muscles become immobilized.

# data[].attributes.body
In late 1940's when polio outbreaks were at an alltime high, fear of polio was rampant. As a result, public health officials imposed quarantines  on homes and towns where polio cases were diagnosed. Once there was a polio vaccine, the number of polio cases fell rapidly. Vaccines used were: the oral polio vaccine (OPV) and the inactivated polio vaccine (IPV), the only vaccine used in the United States since 2000. Some technologies used to eradicate wild polio in the African regions were GIS mapping,  Auto Visual AFP Detection and Reporting, electronic surveillance for real time monitoring of field activities, Digital Elevation Modelling – improving environmental surveillance, and eLQAS – electronic tracking of vaccination campaign quality.

# data[].attributes.attachment_link.provider_name
Centers for Disease Control and Prevention

# data[].attributes.attachment_link.description
The U.S. is polio-free, thanks to a successful vaccination program.

# data[].attributes.body
Virulence means the degree to which an organism can cause disease, the severity of a disease.
Polio is a highly infectious disease with the most virulent type being paralytic polio. Person-to-person spread of poliovirus occurs via the fecal-oral or oral-oral routes.  One in 200 infections leads to irreversible paralysis (usually in the legs). Among those paralysed, 5–10% die when their breathing muscles become immobilized.Poliovirus has cell surface receptors that function as the virulence factor in the pathogen. The mutation rate of polioviruses based on several studies is approximately 3 × 10(-2) mutations/synonymous site/year in the gene encoding viral protein 1. Virulence has changed over time as up to the 19th century, populations experienced only relatively small outbreaks but around the beginning of the 20th century major epidemics occurred.

# data[].attributes.body
Polio is believed to have first existed during ancient Egyptian times, where images show children walking with canes, with withered limbs characteristic of the disease.  The first known clinical description of polio was by British doctor Michael Underwood in  1789, and it was formally recognized as a condition in 1840 by German physician Jakob Heine.

There was a major outbreak of polio in New York City in 1916 that killed over 2000 people, and the worst recorded US outbreak in 1952 killed over 3000.

By the mid-20th century, the poliovirus could be found all over the world and killed or paralysed over half a million people every year.

# data[].attributes.body
Polio was first detected in children, by British doctor Michael Underwood.
The infectious agent for polio are small, nonenveloped viruses with a single-stranded RNA genome. The virus is spread by oral-fecal contamination. It is an emerging infectious disease.
Polio, or poliomyelitis, is a disabling and life-threatening disease caused by the poliovirus.The virus spreads from person to person and can infect a person’s spinal cord, causing paralysis (can’t move parts of the body).

# data[].attributes.attachment_link.description
Polio, or poliomyelitis, is a disabling and life-threatening disease caused by the poliovirus. The virus spreads from person to person and can infect a person's spinal cord, causing paralysis (can't move parts of the body). Post-polio syndrome (PPS) is a condition that can affect polio survivors decades after they recover from their initial poliovirus infection.

# data[].attributes.headline
 I am choosing Poliomyelitis (polio) a disease caused by poliovirus. Poliovirus is a member of the Enterovirus genus, family Picornaviridae. 

# data[].attributes.subject
 I am choosing Poliomyelitis (polio) a disease caused by poliovirus. Poliovirus is a member of the Enterovirus genus, family Picornaviridae. 

# data[].attributes.attachment_link.provider_name
Centers for Disease Control and Prevention

# data[].attributes.attachment_link.readable_text
In July 2022, CDC was notified of a case of polio in an unvaccinated individual from Rockland County, New York, caused by vaccine-derived poliovirus type 2. CDC is consulting with the New York State Department of Health on their investigation. This does not change CDC recommendations for polio vaccination. CDC urges everyone who is not fully vaccinated to complete the polio vaccination series as soon as possible. Small updates were made on these pages to emphasize vaccination recommendations for adults, clarify next steps when suspecting a case of polio, and update references.

Although poliovirus is no longer endemic in the United States, it's important that healthcare professionals rule out poliovirus infection in cases of unexplained acute flaccid paralysis (AFP) that are clinically compatible with polio, particularly those with anterior myelitis, to ensure that any importation of poliovirus is quickly identified and investigated. See the MMWR case study on AFP for more information.

There has not been a case of wild polio acquired in the United States since 1979. The last imported case of wild polio was in 1993. However, poliovirus infections still occur in some countries and could easily be brought into the United States. In the last decade, many polio-free countries have had cases of polio imported through international travel.

Transmission electron micrograph (TEM) of poliovirus type 1.

Poliovirus is a member of the Enterovirus genus, family Picornaviridae . Enteroviruses are transient inhabitants of the gastrointestinal tract and are stable at acidic pH. Picornaviruses are small, ether-insensitive viruses with an RNA genome. Poliovirus is highly contagious and causes polio, or poliomyelitis, a serious and debilitating disease.

There are three poliovirus serotypes (PV1, PV2, and PV3) with minimal heterotypic immunity between them. That is, immunity to one serotype does not produce significant immunity to the other serotypes.

Poliovirus infects only humans. Infection is more common in infants and young children. Polio occurs at an earlier age among children living in poor hygienic conditions. In temperate climates, poliovirus infections are most common during summer and autumn. In tropical areas, the seasonal pattern is less pronounced.

The virus enters through the mouth and multiplies in the oropharynx and gastrointestinal tract. The virus is usually present in nasopharyngeal secretions for 1 to 2 weeks and can be shed in stools for several weeks after infection, even in individuals with minor symptoms or no illness.

Most people infected with poliovirus will not have any visible symptoms. About one out of four people will have flu-like symptoms. These symptoms usually last 2 to 5 days, then go away on their own.

Fewer than 1% of people will have weakness or paralysis in their arms, legs, or both. The paralysis can lead to permanent disability and death.

The poliovirus incubation period for nonparalytic symptoms is 3 to 6 days. The onset of paralysis usually occurs 7 to 21 days after infection.
Polio vaccine provides the best protection against polio.
CDC recommends that children and adults who are unvaccinated or incompletely vaccinated get polio vaccine to protect against polio, or poliomyelitis.

For specific vaccination recommendations visit: Polio Vaccination: For Healthcare Providers.

Adults who had paralytic poliomyelitis during childhood may develop noninfectious post-polio syndrome (PPS) 15 to 40 years later. PPS is characterized by slow and irreversible exacerbation of weakness often in those muscle groups involved during the original infection. Muscle and joint pain also are common manifestations. The prevalence and incidence of PPS is unclear. Studies estimate that 25-40% of polio survivors suffer from PPS.

Background

Acute flaccid paralysis (AFP) is a manifestation of a wide spectrum of clinical diseases. Worldwide, children younger than 15 years are the age group at highest risk of developing polio and some other forms of AFP. Even in the absence of laboratory-documented poliovirus infection, AFP is expected to occur at a rate of at least 1 per 100,000 children annually. It can result from a variety of infectious and noninfectious causes. Known viral causes of AFP include enterovirus, adenovirus, and West Nile virus. However, AFP caused by these agents is very uncommon in the United States. A study examining AFP in 245 children younger than 15 years in California from 1992-1998 found the most common diagnoses were Guillain-Barré Syndrome (23%), unspecified AFP (21%), and botulism (12%).

Polio Case Definition and Diagnosis

A probable case of polio is defined as an acute onset of flaccid paralysis of one or more limbs with decreased or absent tendon reflexes in the affected limbs, without other apparent cause, and without sensory or cognitive loss.

Paralysis usually begins in the arm or leg on one side of the body (asymmetric) and then moves towards the end of the arm or leg (progresses to involve distal muscle groups). This is described as descending paralysis. Many patients with AFP will have a lumbar puncture and analysis of cerebrospinal fluid (CSF) performed as part of their evaluation. Detection of poliovirus in CSF from confirmed polio cases is uncommon, and a negative CSF test result cannot be used to rule out polio.

Consider polio in patients with polio-like symptoms, especially if the person is unvaccinated, incompletely vaccinated, recently traveled abroad to a place where polio still occurs, or was exposed to a person who recently traveled to one of these areas. Only healthcare workers with evidence of complete polio vaccination should attend to the patient.
If you suspect polio:

Practice good hand hygiene and contact precautions when interacting with the patient.

Evaluate the patient for flaccid weakness and document tone, reflexes, and muscle strength.

Poliomyelitis has been classified as immediately notifiable, extremely urgent. Contact the state or local health department immediately to report a patient with suspected poliomyelitis.

Work with the state and local health department to order poliovirus testing:

Collect appropriate stools (whole stool) and throat specimens (OP swab): 2 specimens of each taken at least 24 hours apart during the first 14 days after onset of paralytic disease.

Store specimens at -20 degrees celsius and ship frozen.

For questions, contact the CDC Emergency Operations Center at 770-488-7100.

The rapid investigation of suspected polio cases is critical to identifying possible poliovirus transmission and implementing proper control measures. For more information see CDC poliomyelitis guidelines for epidemiologic, clinical, and laboratory investigations of AFP to rule out poliovirus infection.

Paralytic polio has been classified as "Immediately notifiable, Extremely Urgent," which requires that local and state health departments contact CDC within 4 hours.

Non-paralytic polio has been classified as "Immediately notifiable, Urgent," which requires that local and state health departments contact CDC within 24 hours.

CDC (Emergency Operations Center, 770-488-7100) will provide consultation regarding:

The collection of appropriate clinical specimens needed for poliovirus detection

The initiation of appropriate consultations and procedures to rule out or confirm poliomyelitis

The compilation of medical records

For more information about what should be collected as part of a case investigation see:

Each state and territory has regulations or laws governing the reporting of diseases and conditions of public health importance. These regulations and laws list the diseases to be reported and describe those persons or groups responsible for reporting such as healthcare providers, hospitals, laboratories, schools, daycare and childcare facilities, and other institutions. Contact your state health department for reporting requirements in your state.

Page last reviewed:

# data[].attributes.attachment_link.description
In July 2022, CDC was notified of a case of polio in an unvaccinated individual from Rockland County, New York, caused by vaccine-derived poliovirus type 2. CDC is consulting with the New York State Department of Health on their investigation. This does not change CDC recommendations for polio vaccination.