Terry Prone: We thought we’d consigned it to history but beware — polio is back
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Back then, it was terrifying. It particularly struck schoolchildren, sometimes paralysing their chest muscles so they couldn’t breathe, sometimes crippling their legs, creating an individual and a family tragedy, leaving children changed for life. Calipers. Crutches. Wheelchairs.
And now, nearly 70 years later, some of the survivors’ old age is further complicated by post-polio syndrome. Poet Pat Ingoldsby writes that:
Not that it was confined to children. US president Franklin D Roosevelt was stricken as an adult.
In Ireland, Joan Carr, the wife of my first boss — a TV star named Bunny Carr — was pregnant with her third child when she contracted the dreaded disease. Joan was a physiotherapist, an avid golfer, accomplished sailor, and an elegant and highly competitive tennis player. Polio put paid to all that.
She was put into an iron lung — a device that looked like an oversized metal coffin with the patient’s head poking out at the top — that took over her breathing. The medical team treating her was worried sick about the birthing of the baby she carried, because, they told her husband, nobody in the world had ever delivered a baby in her situation.
The birth was agonisingly achieved and written up in the medical journals of the time. Eventually, Joan went home in a wheelchair to recover what was possible of her past life and be the adored mother of her three children.
Philo, the one born when her mother was completely incapacitated, became a nurse. Joan was sunny and fearless. Instead of concentrating on what they could no longer do, they concentrated on what they could do and made mischief together. Especially over other people’s reactions to the wheelchair.
They realised early that Joan Carr’s situation — weirdly — was enhancing, not her relatability, but the popularity of her husband. When Bunny was pushing Joan in her wheelchair into a theatre or hotel and they were recognised by passersby, the two of them played a game together, based on previous experience. They would wait until they had passed those who had recognised them, listen out for the inevitable whisper — “It’s him you’d be sorry for, really” — and giggle to themselves. They made the best of polio for the rest of their lives and it wasn’t easy.
That said, relatively few people today recall how terrifying polio was. By 2003, Europe was declared free of it. So, we might assume, polio is history. Not necessarily, according to the London sewage systems and the New York Health Commissioner.
We’ll come to the New York Health Commissioner once we’ve dealt with the sewage.
Yes, the sewage. Believe it or not, what we flush down the toilet has moved to the forefront of public health surveillance.
Which is why London, where they undertake surveillance to see if enteroviruses are to be found in waste water, found polio virus present in the human waste being tested 116 times since February.
That doesn’t mean viruses from people actually infected with polio. Not at all. It’s complicated, how the virus turned up in London’s sewage. It’s not virus shed by someone suffering from polio. It’s virus from a vaccine. One of the two kinds of vaccines. The live kind.
Lucy Jessop, the director of the National Immunisation Office at the HSE, confirmed at the weekend that; “Polio found in London is the vaccine derived polio virus from the live vaccine.”
But here’s the thing. Neither Ireland nor Britain has used the live attenuated polio vaccine since 2001. These virus fragments aren’t coming from people vaccinated in either country. So where are they coming from? The fact is that although we’ve practically forgotten it here, polio has yet to be eradicated globally.
“Some countries where the risk of polio is higher, still use the live attenuated oral polio vaccine, and the virus detected in waste water in London may have originated from someone who recently arrived from one of these countries,” Dr Jessop suggests.
It’s important to register the absence of known actual infections, here in Ireland or in Britain. But important to register, too, that last week, New York State acting health commissioner Mary Bassett confirmed a paralysing polio case in an unvaccinated adult there, and said the detection of the virus in sewage could indicate a larger outbreak is underway.
“Based on earlier polio outbreaks, New Yorkers should know that, for every one case of paralytic polio observed, there may be hundreds of other people infected,” Dr Bassett said.
New York State health officials are urgently calling for people who are unvaccinated to receive their shots as soon as possible. In London, even though they haven’t had a single infection, they’ve begun a massive urgent immunisation campaign which will offer vaccines to 1m children.
The fear is of the virus mutating into something seriously threatening and that unvaccinated people will catch the disease and suffer the miseries healthcare believed it had consigned to the anecdotal past.
The part of New York where the single case surfaced is averse to vaccination and the paralysed patient had not been inoculated.
Responding to the alerts from the US, the Health Protection Surveillance Centre here circulated information to raise awareness among clinicians about the need to fully investigate all cases of AFP [acute flaccid paralysis] to rule out polio (and not limit investigations to children under 15). So far, nothing has been found. Irish public health medics want to keep it that way.
“Parents should ensure that their children are fully vaccinated to protect them against polio and a range of other serious vaccine-preventable diseases and can speak to their GP if they have missed any appointments for their babies or young children,” Dr Jessop says.
She adds that four doses of inactivated polio vaccine are offered to children in Ireland, at two, four, and six months with a booster as part of vaccines in junior infants.
Writing about this issue puts any newspaper columnist squarely between a rock and hard place, wondering if it might be better not to let people know about it at all, fearful of creating pointless fear.
But it’s neither possible nor moral to conceal something which has paralysed someone in New York and surfaced in London’s waste water. Something largely forgotten as a threat, which limited and distorted the lives of generations before vaccination eliminated it in Europe.
The priority, according to Dr Jessop, is to make sure that parents know that the vaccines used here haven’t created this problem. They are the solution. It is those vaccines that can protect this generation as they’ve protected Irish children since 1984, when this country saw its last case of polio.