The things that infest the sewers - about the polio virus and defense against it

Dr. Karen Landsman's article analyzes the issue, provides a comprehensive explanation of the virus and refutes the claims regarding the danger of vaccines

From the announcement of the Ministry of Health: "The Ministry of Health announced its decision to vaccinate starting today, August 5, children born after January 1.1.2004, 2 with XNUMX drops of polio vaccine. The vaccine will protect the children and their families and prevent the spread of the polio virus. The vaccine will be given in the drops of milk in the south of the country."
"The Ministry of Health has started an operation to complete the vaccination aimed at protecting the population against the polio disease. In accordance with the ministry's recommendation, children born from 1.1.2004 onwards (who have not yet received a live attenuated OPV droplet vaccine but have received at least one dose of an inactivated IPV vaccine) will be vaccinated. "

And hence Dr. Landsman's article:

On May 28, 2013, the polio virus was isolated in a sewage system in Berhat. In fact, it was isolated much earlier, as part of ongoing monitoring of the sewage in Israel. This is a very interesting and very disturbing thing, at the same time.

monitoring

We use wastewater to irrigate fields. "Sewage" is a nice word for "sewer that undergoes treatment". To make sure that the sewage entering the wastewater treatment facilities is indeed worthy of its purification, it is monitored. Among other things, polio viruses are tested. Why? Because since 1988 we have had no cases of polio in Israel, and we want to make sure that the situation remains that way. One way to make sure things don't go wrong is to make sure we don't irrigate fields with polio viruses.

There is additional monitoring - every case of flaccid paralysis (the paralysis typical of polio), for example, must be reported to the Ministry of Health. This is in order to detect an outbreak early enough. But it's morbidity monitoring, and we're in the prevention business.

polio

We do not know how long the polio virus has accompanied humanity, but it is probably at least a few thousand years. We have a really, really cool and really, really old engraving that shows a man who, judging by the characteristic thin limb of the disease, must have survived polio. The more organized accounts of polio began around the middle of the 18th century, including descriptions of the paralysis as we know it today and outbreaks that occurred mainly in the summer and fall.

Polio is actually a family of three viruses, all similar to each other but some more destructive than others. They are transmitted by the phaco-oral route like most diarrheal diseases to be administered. Yes, that's exactly what you think. The virus reaches the digestive system, multiplies there and enters the blood. From the blood it reaches the nervous system, where it begins to feast. The "celebration" includes an ascending flaccid paralysis. "Lax", that is - the person cannot move the affected limb, in contrast to paralysis which causes stiffness of the limb. "Ascending", meaning - starting from the feet and climbing up.

But here's the nice part about polio - you never know how it will affect the sick person. In 95% of people it does not cause any signs. Sometimes it causes fever, abdominal pain, maybe stiffness of the neck. Only one out of two hundred to one thousand of the people who are exposed to polio develops the "classic" paralysis which has earned the endearing name "polio", simply because mostly children were sick. Most children who develop paralysis manage to recover, and the paralysis resolves. But in some the paralysis is permanent. About 5% of children and 30% of adults who get polio die from the disease. Even if the child recovers from the paralysis, about a quarter of the children may develop Post-Polio Syndrome, a permanent and irreversible damage to the nervous system that appears decades after recovery from polio.

And as mentioned - you never know. In the XNUMXs, during the great outbreak of polio in the USA, parents were terrified. They agreed to hear anything that could prevent their children from getting this disease, because you never know what your child will get. Will he be one of those who feel nothing, one of those who are confined to a wheelchair but can become the president of the United States, or one of those who will remain chained to a ventilator for the rest of their lives?

Then came two people - Jonah Salk and Albert Sabin who developed a vaccine against polio a year apart. One of the vaccines is a live, weakened virus given by mouth called OPV, and the other is a killed virus given by injection called IPV.

There are some differences between the two types of vaccines. The first and most important of all is that the weakened vaccine is still alive, and therefore able to multiply and even change. It can pass to the family members who take care of the baby who received the vaccine and thus vaccinate them as well. On the other hand, since it may change, it may undergo a mutation that will make it dangerous again. It should be noted that cases of lethal mutation from the live-attenuated vaccine have not yet been described. One of the dangers of the weakened vaccine is flaccid paralysis as a result of the vaccine, which is similar to the flaccid paralysis of polio. The morbidity rate as a result of the vaccine varies between one case per 2.39 million vaccine doses and one case per 13.03 million vaccine doses. Which means that if 13 million children are vaccinated, we will expect to discover one case of paralysis as a result of the vaccine. Just for comparison - if 13 million children are infected with polio, we expect to find 65,000-13,000 cases of paralysis as a result of the virus*. People with poor immune systems are at higher risk of developing paralysis as a result of the weakened vaccine, and even if they don't get sick, they may shed the virus for years after receiving the vaccine.

The killed vaccine is more expensive than the live attenuated vaccine, and since it is given by injection it requires clean syringes (a problem in some parts of the world). It perfectly immunizes the person receiving the vaccine, but does not immunize his environment. On the other hand, it does not cause paralysis at all as a result of the vaccine and its side effects are very mild.

The set of considerations for choosing one vaccine or another is complicated. But it does not change the effect of the vaccines on the morbidity of flaccid paralysis as a result of polio, which can be seen in the lovely graph to the left of this paragraph.

We don't live in the XNUMXs anymore

No more polio in the US. In fact, there is no more polio in all of America, Australia and Europe. In the late XNUMXs, the World Health Organization declared polio a candidate disease for eradication, just like smallpox. Polio can only exist in humans, there is an effective vaccine against it, and therefore, theoretically, we were supposed to get rid of it.

but no.

There are still three countries in the world that have polio - Afghanistan, Pakistan and Nigeria. All three refuse to vaccinate against the virus, each for their own reasons. In Iran, Turkmenistan, Chad and India, the neighboring countries, there is no polio at all. The difference is not in the level of hygiene or the excellent medical care in the neighbors.

The difference is in their vaccination program. The result of the refusal to vaccinate is not only injured and dead children. One of the effects of preventing vaccination is the "export" of polio cases to other countries. After all, most polio cases are asymptomatic, and people move from country to country. Once a carrier arrives in another country, he can infect others.

What to paste? Everyone is vaccinated!

Even if everyone is given the vaccine, not everyone manages to get vaccinated. Some people do not respond to the vaccine. Some people have a suppressed immune system. Some people receive medications that interfere with the immune system. There are old people whose immune system weakens, and there are babies who have not yet been fully vaccinated. All these people are vulnerable to the virus. When they are in a population that is all vaccinated, they are not in danger. As soon as unvaccinated people arrive and reintroduce the virus into the population - the most vulnerable fall first.

In the State of Israel we shouldn't have a problem. We have had no cases of flaccid paralysis as a result of polio since 1988, and except for two people in Israel who still excrete polio from the weakened strain of the vaccine (probably as a result of a problem with their immune system) - there are no isolates of polio in the sewers. This means that we have eradicated polio. We are fine, we are.

Until March 2013. The samples taken in Rahat and the surrounding area yielded polio viruses which indicated a massive infection in the Rahat area, but no patients. People from Harat travel to Kiryat Gat, Ashdod, Be'er Sheva, and slowly spread the virus there as well. As of today, polio viruses have been isolated in the sewage at almost all sampling points in the southern district, but still no patients. This is a silent outbreak - the virus only encounters vaccinated people (for now), and therefore does not cause the disease. The goal of the Ministry of Health at the moment is to prevent the virus from reaching a vulnerable population, so they are trying to vaccinate as many people as possible in the southern district who may continue to transmit the virus.

A genetic test of the virus suggested that it was "imported" to us from Egypt (where there was a similar outbreak a few months ago), where it probably came from Pakistan, according to the genetic profile of the virus.