“I honestly felt like it was never going to go away. The doctor told me it was 100 day cough, so I was counting the days while Googling to see if there was anything that could help. I tried everything, you name it, I tried it, and nothing worked. It came to 120 days and I couldn’t understand why it wasn’t gone. I then researched and found that babies take longer to get over whooping cough.”
Fern’s Story – Whooping Cough
Fortunately, the cough doesn’t typically last that long if you are vaccinated and still get pertussis.
Which disease was known as “the Strangling Angel?”
“The breathing became much more difficult, with a kind of rattling stertor, as if the patient was actually strangling, the voice being exceeding hoarse and hollow, exactly resembling that from venereal ulcers in the fauces. This noise, in speaking and breathing, was so peculiar, that any person in the least conversant with the disease might easily know it by this odd noise; from whence, indeed, the Spanish physicians gave it the name of garrotillo, expressing the noise such make as are strangling with a rope.”
Edward Headlam Greenhow on Diphtheria
How about “The Crippler?”
Polio, also known as infantile paralysis, was known as “The Crippler.”
The “Speckled Monster?”
Even mild smallpox, as depicted on this WHO Smallpox Recognition Card, included flu like symptoms, a few weeks of pustules, and then waiting for the lesions to scab over…
We forget these names, because we don’t see these diseases anymore.
“…for those trained in pediatrics in the 1970s, Hib (Haemophilus influenzae type b) was a horror.”
It’s easy to say that no one worried about measles in the pre-vaccine era when you are just trying to scare folks away from getting vaccinated.
That’s one of the more ridiculous arguments anti-vaccine folks make.
A measles epidemic hit New York City in 1951 and made headlines in the New York Times. That’s not surprising, as there were 683 measles deaths in the United States that year.
When was the last time that you saw a headline warning about congenital rubella syndrome?
These diseases that are now vaccine-preventable routinely made headlines in the pre-vaccine era.
Even the schools were closed in San Antonio when polio came to Texas in 1946.
And it was surviving these diseases that was considered a rite of passage, at least for those who were fortunate enough to survive.
So no, childhood diseases have not become deadlier.
They have always been serious and life-threatening!
Of course, not everyone died who got them, but they were rarely a walk in the park. Remember, even a mild case of measles includes a high fever for 4 to 7 days. That’s why folks often end up seeking medical attention multiple times, even if they don’t end up having any complications and don’t need to get admitted to the hospital
The Lassie episode about measles, in 1958, was called ‘The Crisis.” There were 552 measles deaths in the United States that year.
But what about the Brady Bunch measles episode, Is There a Doctor in the House? Is that really why you think vaccine-preventable diseases are mild?
In 1969, when that episode first aired, there were 25,826 reported cases and 41 deaths from measles in the United States.
Believe it or not, we still don’t have cures for measles, chicken pox, congenital rubella syndrome, and hepatitis B, etc. So while these diseases haven’t become any more deadly, they haven’t become any less deadly either, even with all of the advances of modern medicine.
As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks. Photo by WHO
They aren’t, but you can kind of understand why they might think that with a disease like polio, when they might never actually have known anyone to have the disease.
What Is the Morbidity/Mortality Rate of the Polio Vaccine vs the Wild Virus?
Still, even though polio is under good control and close to being eradicated, the risk/benefit ratio clearly favors getting vaccinated and protected.
That’s because the polio vaccines are very safe and if we stopped vaccinating, polio could come back.
In fact, morbidity/mortality from polio vaccines are decreasing, as we are using much less oral polio vaccine (OPV) in the transition (OPV cessation) to just using inactivated polio vaccine (IPV).
“Over the past ten years, more than 10 billion doses of OPV have been given to nearly three billion children worldwide. More than 16 million cases of polio have been prevented, and the disease has been reduced by more than 99%. It is the appropriate vaccine through which to achieve global polio eradication.”
OPV Cessation
And while most developed countries already use IPV, those that are still using OPV recently switched from a trivalent (tOPV) to a bivalent (bOPV) form of OPV. We could do this because type 2 poliovirus has already been eradicated (2015)!
Of course, the issue with the OPV vaccines is that they rarely cause vaccine-associated paralytic polio (VAPP) and circulating vaccine-derived polioviruses (cVDPV).
Fortunately, this is even less common with bOPV.
As this chart from the WHO shows, polio vaccines are very safe.
So morbidity (getting sick)/mortality (dying) from polio vaccines is low.
There were only 31 cases of wild polio in 2018, in Afghanistan and Pakistan, and an additional 102 cases of cVDPV in 7 countries.
What about morbidity/mortality from polio?
“As recently as 30 years ago, wild poliovirus paralysed more than 350 000 children in more than 125 countries every year. In 2018 there were fewer than 30 reported cases in just two countries – Afghanistan and Pakistan.”
“Zero polio transmission and health for all”, WHO Director-General gives new year’s wish to the people of Afghanistan and Pakistan
With a 99.9% drop in polio cases since 1998, your risk of getting polio in most parts of the world is very low, but you still have to consider both the morbidity/mortality of polio in the pre-vaccine era and the risk of polio returning if we stop vaccinating before it is eradicated.
What about the idea that you don’t have to worry about polio because only 1% of kids with polio developed paralysis?
“The mortality rate for acute paralytic polio ranges from 5–15%.”
Disease factsheet about poliomyelitis
Well, when everyone gets polio, even 1% is a lot.
With such a safe vaccine, why put your kids at risk of getting polio?
Do you even understand what the risks are?
No, it isn’t just the risk of wild polio in Afghanistan and Pakistan.
Since the oral polio vaccines shed, if you are unvaccinated, in addition to the risk of wild polio, there is a small risk of getting circulating vaccine-derived polioviruses (cVDPV) if you are not vaccinated and protected. No, it is not a big risk, as there were only 102 cases of cVDPV in 7 countries in 2018, but it isn’t zero either.
And the other big risk is that if enough folks stop getting vaccinated, taking their chances hiding in the herd, polio will come back and our chance to eradicate another vaccine-preventable disease will fail.
More on the Morbidity and Mortality Rates of Polio
It’s true, polio has been eliminated in the United States.
Are these folks serious with this anti-vaccine nonsense?
But that doesn’t mean that we can stop vaccinating kids against polio yet.
Why Do We Still Vaccinate If Polio Has Been Eliminated?
For one thing, the last polio case in the United States was a lot more recent than 40 years ago.
What happened 40 years ago?
That was when we had the last endemic case of polio in the United States, in 1979. After that, in addition to cases of VAPP, there were at least 6 cases of imported paralytic poliomyelitis. In fact, the last case of wild polio in the United States was in 1993, just 26 years ago.
And just ten years ago, in 2009, was the very last case of VAPP, a patient with a long-standing combined immunodeficiency who was probably infected in the late 1990s, even though she didn’t develop paralysis until years later.
But still, why couldn’t we stop vaccinating against polio in the United States, even though polio isn’t eradicated yet? After all, we stopped using the smallpox vaccine in 1972, before smallpox was declared eradicated (1980).
While that is true, smallpox isn’t as contagious as polio and there hadn’t been a case of smallpox in the United States for over 30 years when we stopped using the vaccine.
Until wild polio is eradicated and the oral polio vaccine isn’t used anymore (OPV switch), we must continue to vaccinate against polio to prevent new outbreaks.
That is the polio eradication and endgame strategic plan.
Over the next few years, the world will hopefully switch to using just the injectable form of the polio vaccines, which eliminates the risk of VAPP.
But if we are so close, why not just stop vaccinating in those parts of the world that don’t have polio?
Because we are so close to eradicating polio.
Why take the risk of polio spreading from one of the remaining endemic countries, paralyzing kids, and putting eradication efforts further behind?
Let’s continue the work and eradicate polio, once and for all!
And for the record – we don’t pump “kids full of polio” when we give them a polio vaccine. The polio shot is an inactivated vaccine, so doesn’t contain live polio virus.
More on Why Do We Still Vaccinate If Polio Has Been Eliminated?
There is a lot more interest in polio these days, but not because we are close to eradicating this deadly disease, but rather because of the emergence of cases of acute flaccid myelitis (AFM).
Although the cases have a different cause, the symptoms of AFM are the same that we used to see during the outbreaks of polio that used to hit each summer in the pre-vaccine era.
Polio
Surprisingly, in most people, the poliovirus doesn’t actually cause any symptoms. They simply have an asymptomatic infection.
In some others, the poliovirus causes flu-like symptoms, including a fever, sore throat, nausea, and a headache – symptoms that last about 3 to 5 days.
Much more rarely, the poliovirus causes meningitis or paralysis.
It is these cases of paralytic polio that most people are aware of and that panicked parents during summers in the 1940s and 50s.
In addition to respiratory problems (think iron lungs), polio causes muscle atrophy. (CC BY-NC 4.0)
After having flu-like symptoms, those kids who would develop paralytic polio can develop pain and then flaccid paralysis.
“The most severe form, paralytic poliomyelitis, which is seen in less than 1% of patients, presents as excruciating episodes of pain in back and lower limbs. In children, the disease may present in biphasic form—a period of prodrome followed by a brief symptom-free period of 7 to 10 days and then appearance of asymmetrical paralysis of limbs. Flaccid paralysis is the hallmark with loss of deep tendon reflexes eventually.”
Mehndirattta et al on Poliomyelitis Historical Facts, Epidemiology, and Current Challenges in Eradication
Of course, polio wasn’t always called polio.
Other names have included infantile spinal paralysis, infantile paralysis, Heine-Medin disease, poliomyelitis anterior acuta, and acute anterior poliomyelitis.
The first use of the name “polio” came from Adolph Kussmaul, with his use of the term poliomyelitis anterior acuta, which was derived from the Greek polios “grey” and myelos “marrow” and itis “inflammation.” It was because he knew that it was caused by inflammation of the spinal cord gray matter, even if he didn’t know why.
Polio History
Polio didn’t just suddenly appear in the middle of the 20th century though, it was likely around for ages.
That one of this Ancient Egyptian priest’s legs is smaller than the other and he uses a staff to walk could suggest that he had polio.
In addition to an Egyptian funeral stele (a stone slab used as a monument) portraying Roma the Doorkeeper from 1500 BCE that suggests he had paralytic polio, archeologists have found evidence of polio in skeletons as far back as the Neolithic period.
A medical book from 1789 likely describes people with polio.
Still, we don’t really know how long polio has been around and we don’t know why we began to see more cases in the mid-20th Century, although there are theories, including, ironically, about hygiene. While we often credit improved sanitation and hygiene for helping to reduce mortality from many diseases, some think that this actually set us up for polio outbreaks, as we were no longer exposed as infants, when we still had some maternal immunity.
The one thing that we do know is that we are on the verge of eradicating polio, as there are very cases now, in just a few countries.
Polio Timeline and Milestones
In addition to the more ancient discoveries about polio, there is a lot to learn about vaccines and vaccine-preventable diseases if we look at the major milestones of this important disease.
Although in the end it is a success story, the road to figuring out what caused polio symptoms and how polio could be prevented was very long.
Michael Underwood describes what is thought to be paralytic polio in his book A Treatise on the Diseases of Children, with General Directions for the Management of Infants from Birth in a section on “Debility of the Lower Extremities” (1789)
first reported outbreak of polio in Worksop, England (1835)
Jacob von Heine, head of an orthopedic hospital in Germany, publishes a monograph that describes 29 cases of paralytic polio, and actually attributes the condition to inflammation of the anterior horns of the spinal cord, although the cause was still not known (1840)
first use of the term poliomyelitis by Adolph Kussmaul (1874)
Nils August Bergenholtz reports on an outbreak of paralytic polio in Sweden (1881)
Karl-Oskar Medin, a pediatrician who reported on a polio epidemic in Sweden (1887), later presents his findings at the Tenth International Conference in Berlin (1890)
the first major outbreak in the United States is documented in Rutland County, Vermont and causes 132 cases of paralysis and 18 deaths (1894)
Ivar Wickman tracks cases of polio during an epidemic in Sweden in 1905 and was the first to suggest that polio was contagious and that you could get it from “those afflicted with the abortive type” (1907)
although they don’t actually identify the poliovirus, Dr. Karl Landsteiner and Dr. Erwin Popper identify that a virus causes polio when they inject material from the spinal cord of a child who had recently died with polio into the peritoneum of two monkeys, both of which soon developed paralytic polio (1908)
Simon Flexner, first discovers polio antibodies (1911), but unlike other researchers at the time, pushes the theory that polio was spread by the olfactory route, instead of the fecal-oral route, which was why we saw the development of nose sprays, etc., to try and prevent polio, none of which worked of course
a large polio epidemic in the United States causes at least 27,000 cases and 6,000 deaths (1916)
Philip Drinker and Louis Agassiz Shaw invent the first iron lung, the Drinker respirator (1929)
Frank M. Burnet and Jean Macnamara proposed that there were antigenically different strains of poliovirus (1931)
John R. Paul and James D. Trask help figure out how polio was spread by identifying the polio virus in human waste and sewage samples (1932)
Maurice Brodie and John Kolmer have unsuccessful field trials of early polio vaccines, including allergic reactions and vaccine induced polio because of poor attenuation (1935)
Sister Elizabeth Kenny establishes a clinic in Australia to treat polio survivors (1932) and later publishes her treatment recommendations, Infantile Paralysis and Cerebral Diplegia (1937)
the National Foundation for Infantile Paralysis is founded by FDR to stop polio (1937)
Carl Kling found traces of the poliovirus in the Stockholm sewage system (1942)
the Sister Kenny Institute is built in Minneapolis, as her treatment methods become widely accepted after years of controversy (1942)
the U.S. Army Neurotropic Virus Commission, including Albert Sabin, gets a grant from the NFIP to study polio in North Africa (1943)
Isabel Morgan actually developed the first inactivated polio vaccine, but only tested it on monkeys (1949)
John Enders, with T. H. Weller and F. C. Robbins, received the Nobel Prize in 1954 for their work on the cultivation of the poliomyelitis viruses (1949)
David Bodian creates the monkey model using field isolates of poliovirus and with Jonas Salk, identifies the three poliovirus serotyes (1950s)
Hilary Koprowki develops the first oral, live polio vaccine, (1950) although Sabin’s vaccine eventually gets licensed because it is thought to be less neurovirulent in monkeys and undergoes more testing
there are 58,000 cases of paralytic polio in the United States (1952)
Renato Dulbecco, with Marguerite Vogt, successfully grows and purifies polio virus (1952)
the Polio Pioneers vaccine field trial, led by Thomas Francis Jr., that proves that Jonas Salk’s polio vaccine is safe and effective begins (1954)
improperly inactivated polio vaccine from Cutter Laboratories (Cutter Incident) causes 40,000 cases of polio, 200 cases of paralysis, and kills ten people (1955)
Albert Sabin develops the first live, oral polio vaccine, which replaced Jonas Salk’s inactivated polio vaccine (1961)
that polio survivors can develop new, late complications or post-polio syndrome begins to get reported (1969)
last endemic case of polio in the United States (1979)
the National Foundation for Infantile Paralysis officially changes its name to the March of Dimes Birth Defects Foundation (1979)
the World Health Assembly adopts a resolution for the worldwide eradication of polio by 2000 and the the Global Polio Eradication Initiative is launched (1988)
last imported case of polio in the United States (1993)
the WHO Region of the Americas is declared polio free (1994)
“last” case of VAPP that was acquired in the United States (1999)
last case of wild poliovirus type 2 (1999)
the WHO Western Pacific Region is declared polio free (2000)
the United States switches back to using the an inactivated polio vaccine because of concerns over VAPP (2000)
the WHO European Region is declared polio free (2002)
outbreak of vaccine derived polio among a group of unvaccinated Amish in Minnesota (2005)
last case of VAPP that was acquired outside the United States, an unvaccinated 22-year-old U.S. college student who became infected with polio vaccine virus while traveling in Costa Rica in a university-sponsored study-abroad program (2005)
last case of VAPP in the United States, a patient with a long-standing combined immunodeficiency who was probably infected in the late 1990s (2009)
last case of type 3 poliovirus (2012)
seasonal reports of acute flaccid myelitis in the late summer and early fall, which might be caused by a non-polio enterovirus, are reminiscent of polio epidemics in the early part of the 20th century (2014)
type 2 poliovirus eradicated (2015)
Bob Sears says that it is okay to delay the polio vaccine on his alternative vaccine schedule because “we don’t have polio in the United States” (2015)
a global switch from trivalent OPV to bivalent OPV in routine immunization programs (2016)
polio remains endemic in just two countries, Afghanistan and Pakistan (2018)
So it should be clear, that despite what some folks think, polio wasn’t conquered overnight. And Salk and Sabin obviously had a lot of help, although those are the names we most commonly hear connected with polio eradication.
“Until poliovirus transmission is interrupted in these countries, all countries remain at risk of importation of polio, especially vulnerable countries with weak public health and immunization services and travel or trade links to endemic countries.”
Global Polio Eradication Initiative on Endemic Countries
Breaking News – 158 cases of AFM in 36 states have been confirmed so far this year, with an additional 153 cases under investigation.
Since 2014, we have seen several outbreaks of acute flaccid paralysis (the sudden onset of weakness in one or more arms or legs) across the United States.
Why?
We don’t know, except we do know that these folks don’t have polio, even though folks continue to get confused because the kids are described as having a “polio-like” disease. Every case undergoes extensive testing, including testing for polio and other viral infections.
Do Vaccines Cause Acute Flaccid Myelitis?
Tragically, like some other conditions of unknown cause, some people have grasped onto the idea that AFP could be caused by vaccines.
“Of 14 patients with available information, 12 had previously received polio vaccine; one child and one adult were unvaccinated because of personal belief exemptions.”
Acute Flaccid Paralysis with Anterior Myelitis — California, June 2012–June 2014
It shouldn’t be surprising that there is absolutely no evidence that this is any type of vaccine injury.
Of nearly 350 cases of the acute flaccid myelitis (AFM), or the subtype of AFP that we have been seeing since 2014, we know that:
most cases occur in children
they have a magnetic resonance image (MRI) showing spinal cord lesion largely restricted to gray matter and spanning one or more vertebral segments
AFM can be caused by viruses, environmental toxins, and genetic disorders, although no common etiology has been found in recent cases
cases are occurring sporadically – after 120 cases in 34 states in 2014, there were only 24 cases in 17 states in 2015, but then 149 cases in 39 states in 2016 and 33 cases in 16 states in 2017. And there have been at least 62 cases in 22 states in 2018.
most cases occur in the late summer and early fall
most had symptoms of a preceding viral illness, including respiratory symptoms or diarrhea
the ages of affected children has ranged from 5 months to 20 years
some patients have recovered, while others have persistent paralysis
there has been at least one death
some, but not all, were positive for enterovirus D68
in Colorado this year, 9 of 14 cases were linked to EV-A71 infections
although there was a national outbreak of EV-D68 in 2014 that coincided with the first AFM cases, we didn’t see this kind of outbreak in the following years
So what’s causing these kids, with a median age of about 7 years, to develop acute flaccid myelitis?
We don’t know, but there is certainly no reason to think that it could be a vaccine, as some anti-vaccine folks suggest.
For one thing, several of the kids were completely unvaccinated!
And then, if it was a vaccine, why the seasonal pattern?
Would a vaccine injury have such a seasonal pattern – even skipping a year?
And why don’t cases occur in all states and at the same rates each year?
Also, why the big range in ages? After all, what vaccines do a 5 month old and a 20 year old have in common?
And the CDC has been looking at all possible causes.
“Our medical team has been reviewing vaccine records when available during this year’s investigation and do not see a correlation.”
Kristen Nordlund, CDC spokeswoman
Acute flaccid myelitis is not caused by vaccines. Hopefully we will soon find out what really is causing it and can figure out how to prevent it.
Want to prevent a type of acute flaccid paralysis right now?
brought the Morbidity and Mortality Weekly Report to CDC
investigated the swine influenza virus vaccine incident, when it was thought that some people developed GBS after getting the new swine flu vaccine in 1976
His work saved the lives of hundreds of thousands of people.
Don’t believe any propaganda or quotes without sources attributed to Dr. Alexander Langmuir.
Did he ever tell folks to not get a flu shot?
Was he ever concerned about mercury in flu shots?
Considering that Dr. Langmuir died in 1993, before folks became concerned about thimerosal in vaccines, that’s unlikely. That’s especially so considering that the only place you can find these types of quotes are on anti-vaccine websites.
Still, Langmuir was critical of flu shots.
“From this appraisal of the experience in the past three and one-half years, it is apparent that progress in the control of influenza has not been impressive.”
Langmuir et al. on The Epidemiological Basis For The Control Of Influenza
He didn’t think that they worked well enough. Or more importantly, he didn’t think we had enough information about how well they worked.
“Our information regarding the occurrence of influenza is largely qualitative. Schools close, absenteeism increases, medical services become taxed, virus isolations and serological identifications are made in great numbers, and daily accounts appear in our newspapers and on television. We know we have an epidemic and we know its specific cause, but we have few quantitative measures of incidence, age- and sex-specific attack rates, and character and severity of complications. Further- more, we have only crude data regarding mortality. We do not know what proportion of excess deaths occurs among reasonably active and productive citizens in contrast to deaths among persons who are already invalids suffering from severely debilitating pre-existing disease. Despite this serious deficiency we base our recommendations for vaccine use largely on mortality experience. We undertake major efforts to produce influenza vaccine in large amounts, but we have no meaningful information regarding its actual distribution. We do not know to what extent it actually reaches persons at highest risk.”
Langmuir et al. on A Critical Evaluation of Influenza Surveillance
“The availability of potent and effective measles vaccines, which have been tested extensively over the past 4 years, provides the basis for the eradication of measles in any community that will raise its immune thresholds to readily attainable levels.”
Langmuir et al. on Epidemiologic Basis For Eradication Of Measles In 1967
And concerning all that he did in the field of public health, he is certainly not someone that anti-vaccine folks should be quoting.
