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Polio: Poliovirus: family picornaviridae, genus Enterovirus, species enterovirus C

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Polio: Poliovirus: family picornaviridae, genus Enterovirus, species enterovirus C

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Michael Underwood, an English physician, was the first to describe the symptoms of poliomyelitis in his book, A Treatise on the Diseases of Children. The section is entitled, "Debility of the Lower Extremities" and details the accounts of young children with these symptoms as,

“…the debility of the lower extremities which gradually become more infirm, and after a few weeks are unable to support the body.”

It wasn't until 1840, when German orthopedist, Jakob von Heine, recognized poliomyelitis as a disease on its own, separate from other forms of paralysis. He called the disease infantile spinal paralysis, and would later be termed Heine-Medin's disease until it was labeled as the poliomyelitis we are familiar with today.

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More reading from “Debility of the Lower Extremities” by Micheal Underwood

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More reading from “Debility of the Lower Extremities” by Micheal Underwood

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"The disorder intended here is not noticed by any medical writer within the compass of my reading, or is not so described as to ascertain the disease. It is not a common disorder, I believe, and seems to occur seldomer in London than in some other parts. Nor am I enough acquainted with it to be fully satisfied, either in regard to the true cause, or seat of the disease, either from my own observation, or that of others; and I have myself never had opportunity of examining the body of any child who has died of this complaint. I shall therefore only describe its symptoms, and mention the several means attempted for its cure, in order to induce other practitioners to pay attention to it."

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In 1908, Karl Landsteiner, Austrian-American biologist and physician, and Erwin Popper, Austrian physician and college of Landsteiner's, originally speculated a bacterium to be the causative agent of poliomyelitis. The conclusion of a virus came about when a 9-year old boy was admitted into the hospital with initial flu-like symptoms and after 4 days of hospitalization with muscular paralysis and severe respiratory distress, the young boy died. After the boy's death, Landsteiner and Popper prepared a collection of cells and injected them into rabbits, guinea pigs, and mice with no effects. They then injected the cells into two Old World monkeys, which both developed the same spinal cord lesions identified in humans infected with the disease in question. After studying the suspected particles, which subsequently were poliovirus, were inspected closer, it was apparent what they were working with was not a bacterium, but something much more durable and different.

Within a year, they published their paper, "The Transmission of Acute Poliomyelitis to Monkeys" (1909), and came to the discovery that this is a strictly human pathogen.

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Though poliovirus was transmissible to monkeys in an experimental lab setting, it was a strain contained in apes and monkeys. The enteroviruses we know of today are not zoonotic, meaning they cannot be passed from human to animal and vice versa. This was an emerging infectious disease. Starting with few sporadic cases in the late 1800s, it grew to a global pandemic by the 1950s affecting children and adults worldwide.

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The Seattle Star, July 5th, 1916: Coverage of the 1916 NYC Polio Outbreak

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The Seattle Star, July 5th, 1916: Coverage of the 1916 NYC Polio Outbreak

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1868: First small polio epidemics appeared near Oslo, Norway of at least 14 cases

1881: Northern Sweden had 18 documented cases of "poliomyelitis anterior acuta". Epidemics are still small and localized.

1894: First major outbreak in the US in Vermont. 132 cases of permanent paralysis and 18 deaths

1905: The world's most severe outbreak up to that 1905 was located in Sweden. 1031 cases were reported and Sweden was the first country to register cases at a national level.

1905: Polio was discovered to be contagious.

1916: New York City polio epidemic infected around 27000 Americans with the disease resulting in around 6000 deaths

Mid 20th Century: Polio was worldwide and would kill or paralyze over half-a-million people every year

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Defined by Merriam-Webster, virulence is:

"the relative capacity of a pathogen (such as a bacterium or virus) to overcome a host's defenses and cause disease or damage ; the degree of pathogenicity of a causative agent of disease"

Harm can be described as damage or injury, or a reduction in host's fitness".

Virulence is a relative term describing the severity of a disease, and ranges between 0%-100%.

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Most infection with the polio virus asymptomatic, but roughly 25% of infected experience acute symptoms such as fever, sore throat, and body aches which may go away on their own in 2-5 days, also known as abortive polio.

Less than 1% of polio infections result in paralytic poliomyelitis, which occurs when the virus enters the central nervous system and replicates in the motor neurons of the spinal cord, thus injuring and destroying the motor cells which operate skeletal muscle function. The affected muscles lose their ability to move, resulting in a condition called acute flaccid paralysis. In the most severe of these paralysis cases, bulbar polio affects the brain stem, resulting in loss of function of breathing, swallowing, and speaking.

Without respiratory support, this can lead to death. Between 2-10% of people affected by paralytic poliomyelitis die.

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A pie chart displaying the percentage of types of cases developed from the poliovirus in its hosts.

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Since poliovirus is an RNA virus, it has a higher chance of mutating, and though the mortality rate of polio before the vaccine was much higher, when speaking of harm done to a host, the poliovirus has not made any comparable change in it's virulence since it was first discovered in 1840. This could possibly be that 184 years has not been a long enough time for the virus to evolve its virulence. It is also possible that the virulence of the poliovirus is "happy" where it's at. It's highly contagious which allows transmission of the infection and it has a low mortality rate which allows for a longer infectious period.

The polio vaccine could also be a reason that the virulence of the virus has remained steady, because the virus no longer infects as many host as before, thus lowering the chance for a higher virulence to develop.

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Paul Alexander, a practicing lawyer, with polio lived in the iron lung for 72 years since he was a 6 year old boy. He passed on March 11, 2024 at the age of 78.

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For the less than 1% of people affected with the poliovirus, breathing became extremely difficult or impossible. The invention of the iron lung allowed those affected to breath "on their own". Devised in 1929 by Philip Drinker at Harvard University, the iron long, or also referred to as the tank respirator, used an electric motor and two vacuums to pull air in and out of the lungs by adjusting the pressure inside the metal tube.

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In 1931, John Haven Emerson, improved the design of the iron lung by adding port holes to the side to access the patient and allowing the bed to slide in and out of the chamber. This new model was called the Drinker respirator.

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In the early 1950s, Jonas Salk, a US physician, created and tested an inactive-virus vaccine (IPV) on his family in 1953, and on April 12th, 1955 he announced his results and the vaccine was licensed on the same day. By 1957, annual cases dropped from 58,000 to 5,600 and by 1961, only 161 cases remained. In a 1955 interview with Salk about the vaccine, he was asked who owns the patent for the vaccine and he responded with,

"Well, the people, I would say. There is no patent. Could you patent the sun?”

Soon after, the oral polio vaccine (OPV) was tested and used across the world. This vaccine uses a weak live version of the virus, and had an added benefit of its ease of administration.

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National Foundation for Infantile Paralysis (NFIP)

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National Foundation for Infantile Paralysis (NFIP)

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In the 1930s, during the time Franklin D. Roosevelt was affected with polio, the National Foundation for Infantile Paralysis (NFIP) made grants available to prepare nurses for care to polio patients

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In 1988, the World Health Assembly made action to end polio, which lead to the development of the Global Polio Eradication Initiative. The goal of this initiative it to irradicate polio by aiming to give every child in the world the polio vaccine. Since the launch of GPEI, polio cases have been reduced by 99%. Two countries still remain where polio is an epidemic: Pakistan and Afghanistan. The GPEI is actively working to continue its efforts in irradicating polio in all countries.

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In the early 1900's, it was believed to be by the public and government that polio was a "whites only disease". At the time there was much fewer reported cases of African American people with polio, so it was thought they were not as susceptible to the disease. This assumption resulted in a decrease in adequate care for black people with polio, and they were not included in the original vaccine trials. Though black children were now allowed to receive the vaccine, they still were not allowed to use the bathrooms of the white schools they waited in front of for the vaccine.

Retrospectively, cases were seemingly lower for black communities as a result of medical racism and neglect. Black people affected by the disease at the time did not always have access to quality healthcare, and there was a lack of recognition for those cases that were confirmed.

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Rita Reed, the first African American March of Dimes poster child, 1947

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The Georgia Warm Springs Foundation was a rehabilitation center for polio patients and was founded by President Franklin D. Roosevelt who was a victim of polio in 1927. Warm Springs was only open to white patients due to Jim Crow laws, which further pressed that polio was a "whites only disease".

Black activists pressured President Roosevelt and the March of Dimes to address the reality of lack of healthcare to black polio patients, which lead to the opening of Infantile Paralysis Center at Tuskegee Institute in 1941. This was a center for African American patients of polio.

The Infantile Paralysis Center was closed in 1975 and Warm Springs in 1980 as segregation changes had come a long way with improvement and due to a lack of demand for a polio rehabilitation center.

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Infantile Paralysis Center at Tuskegee Institute, Tuskegee, Alabama, 1945

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Much like other epidemics, people reacted to protect themselves and their families. Many parents didn't allow their children to play with others, and performed regular check ups on them. People would distant themselves from each other. Public places like pools, because of the fear it was waterborne, would close. With each epidemic that effects different generations, we learn a bit more of how to handle the chaos and fears they bring.

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A map showing the change in location of polio cases between 1988 and 2017

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With the polio virus ravishing worldwide, we had to collectively come together to stop the spread of it and find out more about it. Many nations had a part in discovering its source, mode of transmission, effects on the body, and ultimately: the two polio vaccines. The world came together to fight this disease, and our efforts have lead to a 99% decrease in wild polio virus infections today.