What is Provocation Polio?

It is well known that you can very rarely develop polio after being vaccinated with the oral polio vaccine.

VAPP or vaccine-associated paralytic polio are cases of polio that are actually caused by the polio vaccine. That’s why many countries switch over to the inactivated form of the polio vaccine once polio is under good control.

But can you get polio after an injection?

What is Provocation Polio?

You are probably thinking, sure, if the injection is full of live polio virus, right?

But this is actually the idea behind provocation polio.

No, the injection doesn’t give you polio, but if you are already infected with polio, the idea is that getting an injection could be a risk factor for developing paralytic polio.

“Provocation poliomyelitis describes the enhanced risk of paralytic manifestations that follows injection in the 30 days preceding paralysis onset.”

Plotkin’s Vaccines

Remember, most people with polio don’t actually have any symptoms, although some do have flu-like symptoms. And fewer than 1% develop paralysis or weakness when they have polio. Although that doesn’t sound like a lot, during a polio epidemic, when a lot of kids are getting polio, the cases of paralytic polio quickly add up.

What else can provoke paralytic polio?

  • strenuous exercise (paralytic polio)
  • tonsillectomy (bulbar polio)

So how does an injection provoke paralytic polio?

“Skeletal muscle injury induces retrograde axonal transport of poliovirus and thereby facilitates viral invasion of the central nervous system and the progression of spinal cord damage.”

Gromeier et al on Mechanism of Injury-Provoked Poliomyelitis

Injury to a muscle by the needle is thought to have allowed the polio virus to move through the nerves in the area to the spinal cord, as long as the polio virus was already in their blood. How do we know it was the needle and not the vaccine itself? In experiments, they injected saline, and not an actual vaccine.

Is this how everyone developed paralytic polio?

The issue of provocation polio was discussed at the The First International Conference on Live Polio Vaccines in 1959.
The issue of provocation polio was discussed at the The First International Conference on Live Polio Vaccines in 1959.

No.

Remember, kids didn’t get many vaccines around the time we were seeing polio outbreaks in the 1940s and 50s, although other injections, like penicillin were also thought to provoke paralytic polio.

Why were they getting penicillin? Often to treat congenital syphilis.

During outbreaks of paralytic polio in London in the late 1940s, fewer than 10% were related to recent injections.
During outbreaks of paralytic polio in London in the late 1940s, fewer than 10% were related to recent injections.

And although they went so far as to delay vaccines during outbreaks and to not do tonsillectomies during the summer, when polio outbreaks were more common, kids still got paralytic polio.

Could Provocation AFM Be a Thing?

Have you guessed why some folks are talking about provocation polio again, even though we are on the verge of eradicating polio?

“Seizing on a 2014 historical perspective piece on a phenomenon known as “polio provocation” in the highly respected medical journal, The Lancet, anti-vaccine forces have attempted to link the recent AFM cases (as they attempt to do with many other medical occurrences) to childhood vaccinations.”

Dr. Amesh Adalja on Clusters of polio-like illness in the US not a cause for panic

That’s right, they think that since provocation polio explained some cases of paralytic polio, then vaccines must be associated with AFM.

While it is not a bad idea, the problem with it is that vaccines are not associated with AFM.

“…is there any relationship between vaccination status and a developing acute flaccid myelitis? Meaning, are vaccines a risk factor? And the data so far says no, the overwhelming number of children who have gotten AFM have had no recent vaccination of any kind or vaccine exposure. These cases over these years have been happening before flu season and flu vaccination starts, which is one of the questions that comes up, and there hasn’t been any pattern to vaccine exposure of any kind in developing AFM. So far, we have not found a link between the two.”

Benjamin Greenberg, MD on 2018 Podcast on Acute Flaccid Myelitis

For vaccines to provoke AFM, you would have to have gotten a recent vaccine.

It is no mystery that AFM isn’t associated with vaccines – experts review patient vaccination records.
It is no mystery that AFM isn’t associated with vaccines – experts review patient vaccination records.

We aren’t seeing that and anything else all of the kids with AFM had in common that might provoke paralysis, like acupuncture, cupping,  or dry needling, would likely have come out in epidemiological reports.

More on Provocation Polio and AFM

 

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