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There’s something in the water

I grew up in the 1950s in the leafy North London suburb of Finchley. As a little boy with two brothers, living close by a brook flanked by a ribbon of woodland, we went out to play ‘down the woods’ with our mates most weekends. Before we left the house, my mum would warn us to keep our wellington boots on (building dams across the brook was a major sport) and NEVER to drink water from the brook – because that was how we could catch polio.

At primary school, I accepted the fact that every year group seemed to include at least one child with a withered arm, leg callipers or at least a noticeable limp, because of polio. At senior school, JP, one of my best mates, wore a leg brace and a special shoe as polio had left him with one crippled leg. Not that it bothered JP or me, we copied each other’s homework, smoked behind the bike sheds and spent the late sixties travelling to blues gigs all around North London anyway.

Once the disease strikes, the virus multiplies in the intestines, with initial symptoms of fever, headache, vomiting, extreme tiredness, and stiffness in the neck and pain in the arms and legs.

Ian Dury contracted polio as a child (Photo). Poliomyelitis is a highly infectious viral disease which attacks the nervous system and, once contracted, can lead to total paralysis within a few hours. To date, there is no cure for polio, and 1 in 200 infections result in irreversible paralysis,1 and of those paralysed, 2%–5% of children and 15%–30% of adults die from respiratory failure.2

The disease is predominantly transmitted by the faecal-oral route, person to person (my mum was forever telling us to wash our hands after using the toilet), though contaminated water or food can also provide a vector for transmission (so she was more or less correct here I guess – especially as sewage contamination to the brook was not unknown). Once the disease strikes, the virus multiplies in the intestines, with initial symptoms of fever, headache, vomiting, extreme tiredness, and stiffness in the neck and pain in the arms and legs.
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It seems especially cruel that polio most commonly afflicts children less than 5 years old. Although polio has been around for centuries (there is evidence that it was known in ancient Egypt), the epidemics of the post-war period in the USA, the UK and continental Europe were defining events. Previous attempts at cures or vaccines had all been failures (some tragically so – a vaccine tested on 10,000 children at Temple University in Philadelphia in 1935 conferred no immunity but killed nine subjects and left several others paralysed).

In 1952, a team at the University of Pittsburgh, led by Dr Jonas Salk, developed an inactivated poliomyelitis vaccine (IPV), administered by injection, and incorporating a ‘killed’ polio virus. Salk launched a human trial of unequalled scale at that time, involving nearly two million children in the US. The successful trial results were announced in April 1955, and shortly afterwards the same year, IPV was licensed and a mass vaccination campaign launched in the US.

In parallel, a team at the University of Cincinnati led by Dr Albert Sabin was developing an oral polio vaccine (OPV); this used a weakened but live virus, administered as drops applied to a sugar cube. In a fascinating twist, Sabin was unable to conduct trials for OPV in the USA (as by then the Salk vaccine was already in extensive use) so he was forced to conduct trials abroad. Initially this was in the Belgian Congo, and then in the Soviet Union on an unprecedented scale, involving ten million children (this at the very height of the cold war). In recognition of his work, Sabin was awarded The Order of Friendship Among Peoples, the Soviet Union’s highest civilian honour.

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Figure 1: Polio endemic countries

Both IPV and OPV were used in mass vaccination campaigns here in the UK, with a young and vigorous National Health Service rising to the task. My brothers and I remember having ‘polio jabs’ (obviously IPV), whereas some of my younger cousins escaped the needle and received the sugar cube-delivered OPV, which replaced IPV in UK campaigns in 1962. Today, polio vaccination in the UK is only given as part of a combined product which also protects against diphtheria, tetanus and whooping cough (pertussis); this uses acellular pertussis vaccine and incorporates IPV (OPV is no longer routinely used, though it is retained for outbreak control).

The poliomyelitis vaccination campaign in the UK has been an unquestionable success; since 1984, no cases of polio have been contracted naturally within the UK.1 Equivalent campaigns around the world have had similar, remarkable results; polio has been eradicated across Europe, the Americas and virtually everywhere else (Figures 2 and 3).3 Since 2015, the disease remains endemic in only two countries, Pakistan and Afghanistan.

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Figure 2: Polio cases in 2009-2010

Most survivors of the UK and US post-war epidemics are, like me, now senior citizens or at least heading that way. Neither my children nor my grandchildren would ever give a thought to the risk of polio – why should they after all? So they will, I suppose, never realize the gratitude they owe to Jonas Salk and Albert Sabin, neither of whom patented their vaccines. Ed Murrow, the famous CBS journalist and correspondent, once asked Salk in an interview, who held the vaccine patent. Salk simply replied, ‘There is no patent. Could you patent the sun?’


References

  1. NHS choices: Polio, September 2015. http://www.nhs.uk/Conditions/polio/Pages/Introduction.aspx
  2. The College of Physicians of Philadelphia. The history of vaccines: History of polio, March 2016. http://www.historyofvaccines.org/content/articles/history-polio-poliomyelitis
  3. WHO, Media Centre. Poliomyelitis, April 2016. http://www.who.int/mediacentre/factsheets/fs114/en
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