Polio - What You Need to Know
A patient in New York State has been treated for polio, and the polio virus has been detected in the wastewater of several New York communities. Are we at risk? What can we do to protect ourselves and our families?
Featured Speaker:
Anirudh Rai, MD
Anirudh Rai, MD is a Physician at Henry Mayo Primary Care. Transcription:
Polio - What You Need to Know
Melanie Cole: A patient in New York state has been treated for polio and the polio virus has been detected in the wastewater of several New York communities. What does that mean for the rest of the nation? What can we do to protect ourselves? As if we needed yet another pandemic situation. Well, we're here to talk about it today.
Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. And joining me is Dr. Anirudh Rai. He's a family medicine physician at Henry Mayo Newhall Primary Care. Dr. Rai, it's a pleasure to have you join us. As I said in my intro, "Oy, do we need this?" We don't need this right now. Can you tell us a little bit about polio? What's the scope of the situation that we're looking at right now?
Dr. Anirudh Rai: Yeah, sure. It's a pleasure be here again. Thanks again for having me. So to give you an idea of the polio and, yeah, that article did make quite an impact. Once again, I'd like to say I have no sort of disclosures for any sort of pharmaceutical companies and there's no conflict of interest on my end. I'm just here to state the facts and what we know so far and this title, the article that came back in June 22nd, 2022, which did say that there was some detection of polio in the UK, and now we're seeing one in New York. And then, yeah, definitely people can be a bit flustered by something like this, but I'm hoping that this information would be more encouraging than not.
So to start off a little bit about this, again, from a historical standpoint, polio has been a very, very well known disease actually. We've known from the Egyptian hieroglyphics that, yeah, polios been around for quite some time. So it's been there I would say since the dawn of man, as far as we know. But it's something that has been evolving and we've been learning more about it.
So to start off the case, at least from the one that we first detected in UK in 2022, in which it was detected in the wastewater of UK and London, to give you an idea of what that really kind of entails is we generally didn't have too much capacity kind of test to see how viruses have been going. But thankfully enough, wastewater has been a pretty good endeavor for us to test particular viruses, just because it's so easy to get to and it's very easy to kind of test the particular viruses. And thankfully enough, this virus tends to shed via our GI tracts, meaning that we stool, or we kind of poop out this virus and we could test it in the wastewater.
The other benefit of that is, since it's an enclosed capsid virus, usually it's not enveloped, it tends to be more alive in those environments for a longer period of time. So it gives us the opportunity to kind of test it in those environments. So thankfully enough, we have the technology to kind of go that far. And fortunately, we did have the opportunity to kind of detect it. But what does that really mean in the outrun, I think, is the main question for just us physicians and then the general population when it comes to something like this.
It can be quite scary. As you know, historically speaking in the 1930's and even in the 1800's, polio was a pretty vast disease that we were still learning more about, and it would cause paralysis, which was unfortunately irreversible. And even from that standpoint, it was pretty much impossible to treat because we didn't know what was going at that point.
Thankfully, around 1955, where the vaccines kind of came out and, again, we're going forward with a historical perspective and the best way to kind of determine what this outbreak or what this polio sort of manifestation means is to kind of understand what that goes, because it plays a pretty crucial role about how this particular strain of polio did get introduced to New York. So to start off in 1955, we saw a drastic decrease in polio. And the reason for that was because of the vaccination that Salk made. It was an inactive polio vaccine. And the nature of this vaccine per se was a bit difficult to make just because there's three strains of polio that we know of so far, 1, 2 and 3. And unfortunately, if you get immunized from one of them, you're still not covered for the rest. So you have to have coverage for all three.
And thankfully, this vaccine came out, which inadvertently had coverage for 1, 2 and 3. And they found out during this study, it was in fact, from my standpoint, was the largest study known. At least as far as, you know, about 18 million babies were kind of tested to see, "Hey, can we prevent polio?" And thankfully enough, it did show that. So it did show that it prevents paralysis from polio. But unfortunately, it did not show that we could decrease transmission. And the reason for that is the way polio kind of works is it may sound a bit disgusting, but it is transferred via what we call fecal oral, meaning you have to actually ingest the virus via some contamination either through poop, someone touches something that's non-hygienic and it gets rubbed onto it and someone ingests something of that nature. So it is ingested in that form. And once it's in your system, your GI track, your gut, your intestines, see that and take it in. Once it's taken in, it goes to the lymphatics, which then gets circulated to the rest of your system and into your blood. And then once it's in your blood, it's technically considered viremic, meaning that the virus has been pretty much circulating through the rest of your blood. And once it gets to that point, the chance of it going to your brain and causing paralysis is about, I would say, close to 1% from what I came across in the studies, so around one out of 200 cases can cause this sort of manifestation. And we're still learning more about how this is done.
So thankfully enough, when this vaccine came out in 1955, it was a shot that people got and it did prevent paralysis thankfully enough, because it caused the body to produce antibodies. But unfortunately, it did not cover the GI tract, meaning antibodies are produced in the blood, but there are special IgA antibodies that your gut has, meaning that there's a virus that it saw before, it can produce those antibodies to protect when it sees it in the gut so it doesn't take it in. So that system was not covered. So technically speaking, people who ingest polio will still be able to shed in their stool, but fortunately enough, they won't be able to get paralysis, which is a huge plus.
And as we kind of progressed in 1960s, there was a new introduction of the oral vaccine. It was called OPV and it was first introduced by Sabin in 1961, where they tested. And again, it covered one, two and three separately because, as we mentioned before, you have to be covered by all three of them to get proper coverage of polio. And the interesting thing about this one is you would actually have to ingest it. Unfortunately, it was what we call a live attenuated vaccine. And this is where the problem may have arisen is what we're theorizing, the way this kind of vaccine works is they modified specific genes, the capsule genes of the strain 1, 2 and 3. And they found out, unfortunately, that those who do ingest it, about one in a million can get what we call vaccine-associated paralytic poliomyelitis or VAPP. So the spread, as we did kind of note, is an oral-fecal transmission, meaning that you have to actually ingest the virus through contamination via poop or some feces that have been introduced in that environment.
Melanie Cole: So if we were vaccinated back at the '60s, talking about myself here, does that help protect us at all anymore?
Dr. Anirudh Rai: It depends how you've been vaccinated. I mean, in 2000s, they discontinued the oral polio vaccine. So either way, if you got the one where you got poked as a kid, then yes, you are protected from the paralytic form, but that doesn't keep you from spreading it if you've ever had an exposure to polio. So you could still spread it via feces, it's just that you won't have any manifestations of paralysis or anything of that nature, so you're protected in that case. That was the whole point of the campaign of eradicating polio, is to prevent the irreversible paralysis.
Melanie Cole: Yeah. And I knew a few people growing up who contracted it. Now, we hear about this article and you're on this podcast, are we concerned, Dr. Rai? Or are we just keeping vigilant of these kinds of things? Tell us a little bit about if there is a way to prevent it. Are we masking, distancing, hand washing? What are some of the things we can do if we are just being vigilant about this?
Dr. Anirudh Rai: Like we mentioned, hygiene is the best option, fortunately. So we have to keep everything nice and clean. Washing your hands after using the bathroom is vital. And there haven't been known cases of respiratory droplets, so it's not really spread via coughing or anything of that nature. And when it comes to the overall picture we have here, it is something that we have known for a while. The chance of this becoming a pandemic is very low to say the least given the data and the mathematical models that we've seen. So the likelihood this becoming more something like COVID is very, very low. In fact, I don't think that would be the cause of any concern at this point.
Melanie Cole: So before we wrap up, how would we know? And what would you like to tell people about keeping up-to-date on their vaccinations and doing the very bare minimum, like hand washing? Because I know as somebody who had C. diff, hand washing is like the key to so many of these things. So as we wrap up Dr. Rai, the importance of keeping up with our primary care providers on our vaccinations and the importance of prevention techniques, just for all of these things, .
Dr. Anirudh Rai: Yeah, absolutely. I think hand washing is one of the main causes of declining death in the past. So that's vital for particularly this organism. And getting up-to-date on your vaccinations, particularly for kids, is vital, just because paralysis associated with this organism is incredibly harsh, especially on someone who's just learning to walk. And that's part of the reason why the US had this campaign of eradicating polio in the 1980s, specifically the end of the 1980s. So vaccines, I would say I would highly encourage everyone who is at the right age to get vaccinated for polio now, just so we can get better protection and eradicate this organism.
Melanie Cole: Really important information. And I think it's so important that you mentioned that it's still really rare. This isn't something that's spreading. You don't think that it's going to become an epidemic like COVID or a pandemic or something. So I think that's important to tamper down the panic that comes with every new little bit of information. And Dr. Rai, you're a great guest as always. And thank you so much for joining us again and really helping us to keep up with these things, so there's not misinformation. And you can learn more about polio at library.henrymayo.com, just type polio into the search box. And to make an appointment at Henry Mayo Newhall Primary Care, please call 661-200-1710. And that concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole.
Polio - What You Need to Know
Melanie Cole: A patient in New York state has been treated for polio and the polio virus has been detected in the wastewater of several New York communities. What does that mean for the rest of the nation? What can we do to protect ourselves? As if we needed yet another pandemic situation. Well, we're here to talk about it today.
Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. And joining me is Dr. Anirudh Rai. He's a family medicine physician at Henry Mayo Newhall Primary Care. Dr. Rai, it's a pleasure to have you join us. As I said in my intro, "Oy, do we need this?" We don't need this right now. Can you tell us a little bit about polio? What's the scope of the situation that we're looking at right now?
Dr. Anirudh Rai: Yeah, sure. It's a pleasure be here again. Thanks again for having me. So to give you an idea of the polio and, yeah, that article did make quite an impact. Once again, I'd like to say I have no sort of disclosures for any sort of pharmaceutical companies and there's no conflict of interest on my end. I'm just here to state the facts and what we know so far and this title, the article that came back in June 22nd, 2022, which did say that there was some detection of polio in the UK, and now we're seeing one in New York. And then, yeah, definitely people can be a bit flustered by something like this, but I'm hoping that this information would be more encouraging than not.
So to start off a little bit about this, again, from a historical standpoint, polio has been a very, very well known disease actually. We've known from the Egyptian hieroglyphics that, yeah, polios been around for quite some time. So it's been there I would say since the dawn of man, as far as we know. But it's something that has been evolving and we've been learning more about it.
So to start off the case, at least from the one that we first detected in UK in 2022, in which it was detected in the wastewater of UK and London, to give you an idea of what that really kind of entails is we generally didn't have too much capacity kind of test to see how viruses have been going. But thankfully enough, wastewater has been a pretty good endeavor for us to test particular viruses, just because it's so easy to get to and it's very easy to kind of test the particular viruses. And thankfully enough, this virus tends to shed via our GI tracts, meaning that we stool, or we kind of poop out this virus and we could test it in the wastewater.
The other benefit of that is, since it's an enclosed capsid virus, usually it's not enveloped, it tends to be more alive in those environments for a longer period of time. So it gives us the opportunity to kind of test it in those environments. So thankfully enough, we have the technology to kind of go that far. And fortunately, we did have the opportunity to kind of detect it. But what does that really mean in the outrun, I think, is the main question for just us physicians and then the general population when it comes to something like this.
It can be quite scary. As you know, historically speaking in the 1930's and even in the 1800's, polio was a pretty vast disease that we were still learning more about, and it would cause paralysis, which was unfortunately irreversible. And even from that standpoint, it was pretty much impossible to treat because we didn't know what was going at that point.
Thankfully, around 1955, where the vaccines kind of came out and, again, we're going forward with a historical perspective and the best way to kind of determine what this outbreak or what this polio sort of manifestation means is to kind of understand what that goes, because it plays a pretty crucial role about how this particular strain of polio did get introduced to New York. So to start off in 1955, we saw a drastic decrease in polio. And the reason for that was because of the vaccination that Salk made. It was an inactive polio vaccine. And the nature of this vaccine per se was a bit difficult to make just because there's three strains of polio that we know of so far, 1, 2 and 3. And unfortunately, if you get immunized from one of them, you're still not covered for the rest. So you have to have coverage for all three.
And thankfully, this vaccine came out, which inadvertently had coverage for 1, 2 and 3. And they found out during this study, it was in fact, from my standpoint, was the largest study known. At least as far as, you know, about 18 million babies were kind of tested to see, "Hey, can we prevent polio?" And thankfully enough, it did show that. So it did show that it prevents paralysis from polio. But unfortunately, it did not show that we could decrease transmission. And the reason for that is the way polio kind of works is it may sound a bit disgusting, but it is transferred via what we call fecal oral, meaning you have to actually ingest the virus via some contamination either through poop, someone touches something that's non-hygienic and it gets rubbed onto it and someone ingests something of that nature. So it is ingested in that form. And once it's in your system, your GI track, your gut, your intestines, see that and take it in. Once it's taken in, it goes to the lymphatics, which then gets circulated to the rest of your system and into your blood. And then once it's in your blood, it's technically considered viremic, meaning that the virus has been pretty much circulating through the rest of your blood. And once it gets to that point, the chance of it going to your brain and causing paralysis is about, I would say, close to 1% from what I came across in the studies, so around one out of 200 cases can cause this sort of manifestation. And we're still learning more about how this is done.
So thankfully enough, when this vaccine came out in 1955, it was a shot that people got and it did prevent paralysis thankfully enough, because it caused the body to produce antibodies. But unfortunately, it did not cover the GI tract, meaning antibodies are produced in the blood, but there are special IgA antibodies that your gut has, meaning that there's a virus that it saw before, it can produce those antibodies to protect when it sees it in the gut so it doesn't take it in. So that system was not covered. So technically speaking, people who ingest polio will still be able to shed in their stool, but fortunately enough, they won't be able to get paralysis, which is a huge plus.
And as we kind of progressed in 1960s, there was a new introduction of the oral vaccine. It was called OPV and it was first introduced by Sabin in 1961, where they tested. And again, it covered one, two and three separately because, as we mentioned before, you have to be covered by all three of them to get proper coverage of polio. And the interesting thing about this one is you would actually have to ingest it. Unfortunately, it was what we call a live attenuated vaccine. And this is where the problem may have arisen is what we're theorizing, the way this kind of vaccine works is they modified specific genes, the capsule genes of the strain 1, 2 and 3. And they found out, unfortunately, that those who do ingest it, about one in a million can get what we call vaccine-associated paralytic poliomyelitis or VAPP. So the spread, as we did kind of note, is an oral-fecal transmission, meaning that you have to actually ingest the virus through contamination via poop or some feces that have been introduced in that environment.
Melanie Cole: So if we were vaccinated back at the '60s, talking about myself here, does that help protect us at all anymore?
Dr. Anirudh Rai: It depends how you've been vaccinated. I mean, in 2000s, they discontinued the oral polio vaccine. So either way, if you got the one where you got poked as a kid, then yes, you are protected from the paralytic form, but that doesn't keep you from spreading it if you've ever had an exposure to polio. So you could still spread it via feces, it's just that you won't have any manifestations of paralysis or anything of that nature, so you're protected in that case. That was the whole point of the campaign of eradicating polio, is to prevent the irreversible paralysis.
Melanie Cole: Yeah. And I knew a few people growing up who contracted it. Now, we hear about this article and you're on this podcast, are we concerned, Dr. Rai? Or are we just keeping vigilant of these kinds of things? Tell us a little bit about if there is a way to prevent it. Are we masking, distancing, hand washing? What are some of the things we can do if we are just being vigilant about this?
Dr. Anirudh Rai: Like we mentioned, hygiene is the best option, fortunately. So we have to keep everything nice and clean. Washing your hands after using the bathroom is vital. And there haven't been known cases of respiratory droplets, so it's not really spread via coughing or anything of that nature. And when it comes to the overall picture we have here, it is something that we have known for a while. The chance of this becoming a pandemic is very low to say the least given the data and the mathematical models that we've seen. So the likelihood this becoming more something like COVID is very, very low. In fact, I don't think that would be the cause of any concern at this point.
Melanie Cole: So before we wrap up, how would we know? And what would you like to tell people about keeping up-to-date on their vaccinations and doing the very bare minimum, like hand washing? Because I know as somebody who had C. diff, hand washing is like the key to so many of these things. So as we wrap up Dr. Rai, the importance of keeping up with our primary care providers on our vaccinations and the importance of prevention techniques, just for all of these things, .
Dr. Anirudh Rai: Yeah, absolutely. I think hand washing is one of the main causes of declining death in the past. So that's vital for particularly this organism. And getting up-to-date on your vaccinations, particularly for kids, is vital, just because paralysis associated with this organism is incredibly harsh, especially on someone who's just learning to walk. And that's part of the reason why the US had this campaign of eradicating polio in the 1980s, specifically the end of the 1980s. So vaccines, I would say I would highly encourage everyone who is at the right age to get vaccinated for polio now, just so we can get better protection and eradicate this organism.
Melanie Cole: Really important information. And I think it's so important that you mentioned that it's still really rare. This isn't something that's spreading. You don't think that it's going to become an epidemic like COVID or a pandemic or something. So I think that's important to tamper down the panic that comes with every new little bit of information. And Dr. Rai, you're a great guest as always. And thank you so much for joining us again and really helping us to keep up with these things, so there's not misinformation. And you can learn more about polio at library.henrymayo.com, just type polio into the search box. And to make an appointment at Henry Mayo Newhall Primary Care, please call 661-200-1710. And that concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole.