Melanie Cole, MS (Host): There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels.

Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And today, we're highlighting polio and World Polio Day. Joining me is Dr. Hannah Wunsch. She's an attending Intensive Care physician at New-York Presbyterian Hospital, Weill Cornell Medical Center, and she's a Professor of Anesthesiology at Weill Cornell Medical College - Cornell University. Dr. Wunsch, it's such a pleasure to have you join us today. And what a topic this is because, I mean, this is a pretty unprecedented time that we're in. And so, I'd like you to speak to parents. First of all, what is polio? Because we haven't seen it, not everybody really even knows what it is or how it's transmitted.

Hannah Wunsch, MD: Yeah, absolutely. And I'm thrilled you're doing this topic, because it is something that really wasn't talked about for a very long time and really has become something that we do need to talk about. And polio is what is called an enterovirus. It is a virus. And it's transmitted by what's called the oral-fecal route primarily. That means you ingest it by mouth and then people will shed it in their feces. And this is probably one of the reasons small children in particular are at risk because they tend to put balls and toys and things in their mouths, and then will pass it on to another child. And so, that's the primary root of transmission. And we really haven't had to worry about that for quite a long time. But I think now we do. And the symptoms themselves really varied. So, they could be nothing. A lot of people would have what's called asymptomatic transmission, and that would mean they would just get the virus in their body and pass it on without ever knowing they had it.

For some people, they would develop the usual childhood illness symptoms, runny nose fever, coughs, sore throat, headache, the kind of non-specific stuff where they might not actually even know that it was polio that they'd had, but then they would develop immunity from that exposure.

The problem was and is, that in a very small percentage of people and we never know who this might be who contracts polio, they will go on to develop paralysis. The virus itself will go through the gut into the bloodstream, and then attack the nerves in the spinal cord and actually can cause severe damage to those nerves. And it primarily hits the nerves that control the muscles, the muscles that allow you to use your legs, your arms, to even swallow and cough. And so, that was in a very small portion of people, but a horrific outcome for those individuals when that happened. And it was often lifelong. Some people would recover some or all function of the body parts that had been affected. But some people would never recover that.

And I'm using sort of a mix of present and past tense, I realize as I'm talking about it, just because it is a disease that really we haven't in the United States had to think much about since the 1960s. But it is out there in the world, and it is a concern that it really could come back here in the U.S.

Melanie Cole, MS: Is there any treatment if somebody does contract polio? Back then, was there a treatment and now do we have any treatments?

Hannah Wunsch, MD: The basic answer is no. There are things we can do to support an individual in terms of trying to get them through the illness, but we don't have-- it's not like we can give an antibiotic. And cure this and cause it to go away in a day or two. Once you contract polio, really all we can do is provide support.

So for instance, if you do have trouble breathing because the muscles that allow you to breathe are paralyzed, we certainly have ways now to support you with ventilators and things like that to allow people for their body to do their best to recover. But really, vaccination and preventing the illness itself is our best way to deal with this disease.

Melanie Cole, MS: Well, then, let's talk about that because I know that many parents have questions about the vaccinations because for the simple reason, Dr. Wunsch, that we haven't seen this disease. So, they say, "Well, we haven't seen it, so why do we need a vaccine for it?" So, I'd like you to speak a little bit about the evolution of this very important vaccine and why it's still so important now.

Hannah Wunsch, MD: Absolutely. If you talk to people who grew up in the '40s and '50s, they all have memories as children of returning to school and some friend or child in their class would come back in a wheelchair needing crutches, braces on their legs or on their abdomen. And it was a terrifying disease. And parents were really, really scared of it. I also heard stories of people describing their parents breaking down in tears when it came on the news that there was a polio vaccine. That gives you a sense of how terrifying this disease was.

And so, the first vaccine, what we call the Salk vaccine, came out in 1955. And to your point, it was incredibly effective. There was massive uptake over a number of years. And you see a huge drop off in the number of cases of polio, and that's been fantastic. I mean, it's really one of the triumphs of 20th-century medicine that we were able to combat polio in this way.

The challenge is, in the modern world, that polio is out there. It's not in the United States, but it's been circulating in various countries in the wastewater suggesting that people are slowly transmitting it without getting symptoms. And there are places in the world, Afghanistan, Pakistan where the virus is circulating more heavily and we see cases.

The problem is we're a very interconnected world. It doesn't take much for one person to get on a plane and end up in the United States with the polio virus in them. And so, we have to be vigilant. It's one of those things where it's not good enough to say, "Well, we haven't seen a case in 20, 30 years. That's okay. We can stop worrying about it." Vaccination works because everybody buys into it. And that's the important part, is that everybody recognizes they're doing it for themselves and they're also doing it for the community to ensure that we stop the transmission of the virus if it were to show up.

Melanie Cole, MS: So, speak about the vaccine for a minute, Dr. Wunsch. If we got it and we all remember getting it as kids, right? We got our vaccines in different ways back then. So, kids now-- first of all, if we got our vaccine way back then, is it still good today? Are there boosters? And what's going on with today's vaccine as far as the schedule for our children?

Hannah Wunsch, MD: So, the basic answer is we think that if you were vaccinated as a child, for the most part, you're still probably covered. I'm hedging because nobody knows for sure. Nobody knows for sure because there were different types of vaccines used for different generations. And we haven't had to worry about exposure to this virus for so long that it hasn't really been tested.

There were two types of vaccine. One was the first vaccine, the Salk vaccine, and that was an injection and that was considered very good for making sure an individual doesn't themselves develop symptoms from polio. The other vaccine is an oral vaccine, and that because it goes through the gut, increases the immunity in the gut in particular. And because of that, that really helps to stop transmission from one person to another.

Now, because there was no transmission for so many years in the United States, we have switched fully to the injection, a version of the Salk vaccine, which is I said is very, very good for making sure you don't get infected. But the problem is, it means you still technically could contract it and pass it on to someone else. And so because of that, just the fear is that for people who aren't vaccinated, for many reasons, that they would be susceptible. And so, that's why it's so important as a community that we do vaccinations on time, on schedule, because even a window where a child isn't protected when they should be. All it takes is for one individual coming off a plane from a country where polio isn't as well controlled. And it will put people at risk. And it is such a catastrophic outcome for an individual if they do contract this disease and because we have a way to combat it and a very effective schedule for vaccination. I really do urge people to, you know, of course speak with their doctors, but to really plan to vaccinate their children on time.

Melanie Cole, MS: As we are coming up on World Polio Day on October 24th, as you said, it's still a global threat, but you wrote a book about this. Can you tell us about the book that you wrote, The Autumn Ghost: How to Battle Against a Polio Epidemic Revolutionized Modern Medical Care. So, speak about that a little bit, and why it's still so important, even though we're not seeing it in this country. And as you said, Dr. Wunsch, people can get on a plane from any of these areas where it is still a global threat. Speak now about that book, and tell us why this is just as important now as it was 20 years ago.

Hannah Wunsch, MD: Absolutely. I started writing this book, which is about a polio epidemic in Copenhagen in 1952, really before people were particularly worried that polio could come back. And I was focused on it because my job is as an ICU doctor, and I put people on ventilators and support their breathing. And it turns out that polio was a disease that spurred a lot of innovation in medical care. And it forced people to figure out how do we take care of someone who can't breathe effectively? And that was really the impetus for what was called the iron lung that was developed in the 1920s. And most people may have a kind of image of that in their head, a giant machine that would seal around the neck of a child or an adult and suck their lungs open with what's called negative-pressure ventilation.

Now, in 1952 in Copenhagen, they were hit with a very large polio epidemic and without a lot of access to iron lungs and with a form of polio that wasn't really effectively treated by the iron lung, they kind of invented modern mechanical ventilation as we know it by recognizing that if you pushed air into the lungs of everybody who was struggling to breathe rather than sucking the lungs open, that it was effective to keeping them alive while their body tried to fight off the virus. And so, that's really the origins of positive-pressure ventilation, which is the term for it in medicine, and intensive care units as we know them today.

And when I started writing this book, I was really focused on that aspect of the story, this kind of amazing moment of innovation in medicine. But as I researched it, I really began to recognize that this was as much a story about what is the effect of polio on people as anything else. And the fact that the doctors, just they desperately wanted a vaccine. They didn't want to be treating children with polio, they wanted to prevent the disease. And so, that really became one of the major messages in my book.

And I also ended up interviewing a lot of the polio survivors from that epidemic. And what was really striking was that although all of them had residual paralysis that they lived with every day for the rest of their lives, they were so grateful for the vaccine. All of them would tell me how happy they were that their children and grandchildren and others in the world would not need to go through what they had experienced because of this miracle of a vaccine.

And so, I realized that it was also important to tell the story of the vaccine in my book. And so, I traced that as well. But it's an important story in its own right, this 1952 epidemic. And I do want to note, I wrote the book for the general public, I really wanted this not to be just for doctors or people in medicine, but really to be accessible so that people could understand the impact this has.

Melanie Cole, MS: This really is fascinating. And as we've always heard, necessity is the mother of invention, right? So, this innovation, that's so interesting the way that you described the domino effect of what we have now in medical care and modern medicine and how these things evolved. I mean, that really is so fascinating.

Now, onto a little bit of a tougher topic here. What would you like to say to parents? We're in an age, Dr. Wunsch, where people are skeptical. And they're skeptical about vaccines. There's a lot of misinformation going around. I'd like you to speak to parents now who may have questions about this vaccine and the fact that it has been so time-tested, because I know that's one of the things that people say, "Well, it's a new vaccine," or this or that, but this has been around a very long time and time-tested. So, please speak to those people now that are unsure, that have questions that are not sure why we still need it.

Hannah Wunsch, MD: Absolutely. And to your point, this is an incredibly safe vaccine. It has been out there for decades. It has saved millions of lives over the course of the past 70 years or so since it came out. And I think that it is important to go back to the history to learn about what it was like when people contracted polio, what it was like to see a child suddenly unable to move and to understand that that is what we are protecting people from.

And I think it is easy when we've lived in an age where when people are walking down the street or in classrooms or in everyday life, it is easy to forget and to become complacent. There is a very small number of individuals who either can't take the vaccine for real medical reasons, such as their immunosuppressed. And it's dangerous for them, or that they don't, for whatever reason, mount as good a response to the vaccine as most people.

And so, getting the vaccine is to protect one's own child. It is also to protect everyone else's child. And it is important, I think, that we recognize that vaccines work when communities come together to protect each other. And really, when people start to opt out of fear, that's when it all falls apart. And so, I do urge people to, of course, have conversations with their trusted doctors in their life to make an individual decision. But that individual decision should really be to get the vaccine unless one has one of these very specific medical reasons to be opting out.

Melanie Cole, MS: So, I'd love some final thoughts, even though what you just said was so great and perfect, because this is not just a story of the past, it's about protecting children and families. Now, I think somebody said that, maybe that was you who said that, but it is really true. And as scary as this is, we found something that helps.

So, wrap this up about really talking to your doctor, and I'd like you to reiterate that because I think that's such an important point, is to talk to our trusted pediatricians, ask the questions that you want to ask about this vaccine and why it is as important now as it was back when it was first invented.

Hannah Wunsch, MD: Absolutely. It is one of the great miracles of 20th-century medicine. It is really remarkable that we send our children to school every day, not worrying that they're going to come home with not just polio, but many, many other infectious diseases. But polio really left lasting impacts on people that they had to struggle with for the rest of their life. And it is remarkable when I speak to people about my book, there's always people in the audience with family members, friends who were affected. It's still out there as a disease, and it's something that we have relegated to the history books, and we can't be complacent in that way because it truly is something that could come back. I have never treated a case of polio in the ICU. And I really, really, really hope that none of my colleagues across the United States and the rest of the world have to in the coming years.

Melanie Cole, MS: I couldn't agree more. And thank you, Dr. Wunsch, for joining us today and sharing your incredible expertise on this topic and for parents, because it's important that we hear from the experts such as you to combat that misinformation so that we are well-informed, because well-informed parents really do know best and vaccinate our children. Thank you again for joining us.

And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointment at Weill Cornell Medicine. That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download, subscribe, rate, and review Kids Health Cast on Apple Podcast, Spotify, iHeart, and Pandora. For more health tips, go to weillcornell.org and search podcasts. We have so many great podcasts on there. I'm Melanie Cole. Thanks so much for joining us today.

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