Spate of polio outbreaks worldwide puts scientists on alert

https://www.nature.com/articles/d41586-022-02233-6

by Brajeshwar • 4 years ago

123 97 4 years ago

Herd immunity for sars-cov-2 may have become impossible in highly vaccinated regions due to maladaptive immune response.

Now we have the problem that people constantly get reinfected in omicron waves which puts a heavy burden on the immune system and damages the system.

debacle2• 4 years ago

It's hard to talk about the COVID vaccine in the context of other vaccines.

The history of our attempts at developing traditional vaccines for this type of virus goes back 50 years, and we've been very unsuccessful at it, not for lack of trying.

I don't think it's unreasonable to believe that we wont ever be able to develop a vaccine for this type of virus in the same manner that we have for e.g. polio.

noselasd• 4 years ago

On the upside, that is not an issue for polio vaccine.

Metacelsus• 4 years ago

Note, this is vaccine-derived polio. This is when the oral polio vaccine (which uses a live poliovirus) mutates and reverts to a more virulent form. This version of the polio vaccine is rather outdated, and in fact a new one with much better genetic stability is already being produced. https://polioeradication.org/nopv2/

We really need to switch away from the old vaccine ASAP.

debacle2• 4 years ago

Is this vaccine-derived polio "medically resistant" (or vaccine resistant), or does it just infect people who may have waning immunity, no immunity, etc?

HarryHirsch• 4 years ago

The latter - it is attenuated virus from the live oral vaccine that has reverted to a form causing paralysis. Both forms of the polio vaccine are still effective against it.

<s>Why worry? Poliomyelitis is mild, most cases are asymptomatic, only one in 200 cases result in paralysis, and fatality rates are even lower.</s>

Rebelgecko• 4 years ago

It can hang out in the gut biomes of people who get the vaccine, but typically with no ill effects unless the unvaccinated person comes into contact with the excretions of an orally vaccinated person who's carrying polio with a certain mutation.

kurupt2132• 4 years ago

The benefit of the attenuated live virus is that it can replicate and go on to infect others, spreading protection from virulent polio to unvaccinated people.

One of the covid-19 origin theories was that China was trying to make an attenuated live virus SARS vaccine that would self propagate through the population

makomk2• 4 years ago

A lot of the news coverage dances around the issue, but the direct cause of this actually seems to be a catastrophically failed attempt to switch away from the previous polio vaccine. Vaccine-derived poliovirus outbreaks used to be pretty rare because the vaccine kept them under control, but there was always the fear that some war or other disruption to vaccination would trigger a major outbreak. So the WHO came up with a plan: everyone around the world would stop using oral polio vaccines with the type 2 poliovirus components (which is the main culprit and protects against a variant that's been eradicated in the wild), they'd estroy all their old trivalent vaccines and switch to bivalent type 1 and 3 ones, any outbreaks of vaccine-derived poliovirus would be mopped up with a special type 2 only vaccine reserved for that purpose, and then it'd be gone for good. Instead vaccine-derived poliovirus outbreaks exploded all over the world. The nOPV2 vaccine was then rushed out through development and into production to try and patch up the mess. (In theory they could've just switched back to the old vaccine temporarily, but that would mean admitting failure and besides they didn't have the big stockpiles of it anymore.)

lucb1e5• 4 years ago

To be sure I understood correctly, it sounds like the WHO's plan was a good one, given the information available and outlook at the time, and it had a good chance of success, except the low chance of failure materialized? (Aside from the part where they avoided admitting defeat afterwards, although given "and besides they didn't have the big stockpiles of it anymore" it wouldn't have been a solution anyhow.)

JumpCrisscross3• 4 years ago

a catastrophically failed attempt to switch away from the previous polio vaccine

There are broadly two types of polio vaccines: the kind that inoculates the gut (OPV), taken orally, and the kind that inoculates in the blood (IPV), administered intravenously [1]. (the "I" stands for inactivated.) Both prevent polio, the disease. But only the former is sterilizing, i.e. keeps you from spreading poliovirus. It is also, unfortunately, the one that can leave the vaccinated person's gut to infect someone who is unvaccinated.

So if you have a polio outbreak in a vaccine-deficient population, administering non-sterilizing vaccine will keep those people unparalyzed. But it will do nothing to stop the spread. The sterilizing vaccine will help stop the spread. But at the cost of introducing vaccine-derived polio into the mix.

We had the luxury of using only the non-spreading, non-sterilizing vaccine in America. That's the benefit of elimination: you can switch to the lower-risk version. It does not seem that we were able to keep it.

[1] https://en.wikipedia.org/wiki/Polio_vaccine

_s• 4 years ago

From my understanding - there are two main “strains” for polio; one that is “wild”; endemic to Afghanistan and Pakistan, and one derived from the oral vaccine, endemic in Africa and a lot of conflict zones, from Asia to Europe to Central / Southern Americas.

The oral vaccine in use in a lot of the world contains a weakened version of the virus, and allows your body to fight it off without any negative effects. This is usually a 3 or 4 course vaccine.

This specifically engineered weakened virus has been shown to mutate and infect other partially or non vaccinated individuals, including causing paralysis, and is the one now popping up in more developed / inoculated areas - but again, in unvaccinated individuals.

Note - from what I have read, you can still get and spread polio even if you are vaccinated (much like Covid), but it’s an incredibly low chance - and furthermore, your risk of serious disease / paralysis / death is even lower (so we know the vaccines work). The oral vaccine (weakened virus) efficacy is much higher than the injected (inactive virus) vaccine too, and boosters are offered for those who had the vaccines as children and are now adults.

There is also another oral vaccine, with a weakened virus, that has been engineered to prevent certain mutations that cause it to spread (if I read some articles correctly), but is not currently approved for use in the US / UK.

Polio was one of the first few horrible diseases almost eradicated by vaccines. Whatever your stance on getting vaccinated, do understand that Polio has a 1 in 200 chance of resulting in severe symptoms and paralysis, and there is no treatment for it - only prevention via inoculation. It is not like Covid where mostly the older, more immunocompromised suffer - it will ravage children and healthy adults too.

pm90• 4 years ago

Im tired of saying this but it’s absolutely mind boggling how fucked up it is that one of the main exports from America today is vaccine hesitancy.

Science skepticism has always been a thing; its only in recent years though that internet has allowed the rapid spread of disinformation. Glossy content created for misinforming Americans inspires copycats in other countries. It’s really depressing.

ryandrake• 4 years ago

You're very kind calling it "hesitancy", too! I know that's the soft euphemism that the media has coalesced around, but "hesitancy" implies that one is on the fence, unsure, open to debate and open to being convinced. That's not what America is exporting.

America's Anti-Vax movement is religiously sure of itself. They aren't on the fence. They're not weighing the pros and cons. They're convinced that they know the secret capital-T Truth, and that spreading their gospel saves lives. COVID brought it mainstream, but if you look back at the "Anti-vax Moms groups" long before COVID, there was still no hesitancy. Their minds were also made up.

swatcoder4• 4 years ago

Science skepticism has always been a thing; its only in recent years though that internet has allowed the rapid spread of disinformation. Glossy content created for misinforming Americans inspires copycats in other countries. It’s really depressing.

It may be depressing, but it's not helpful to associate it with "science skepticism".

The vaccine "hesitant" you refer to are not skeptical of science. They freely use the language and processes of science as their argument. You or I may think they misuse the language, make unconvincing assumptions, etc, but there's nothing to it that's skeptical of science.

Where vaccine hesitancy is rooted in science skepticism, you see the hesitant relying on alternative means of knowing why vaccines aren't right for them. You can think of the classic faith healing communities l̶i̶k̶e̶ ̶C̶h̶r̶i̶s̶t̶i̶a̶n̶ ̶S̶c̶i̶e̶n̶t̶i̶s̶t̶s̶ ̶a̶n̶d̶ ̶J̶e̶h̶o̶v̶a̶h̶'̶s̶ ̶W̶i̶t̶n̶e̶s̶s̶e̶s̶ as an example of that.

The contagious skepticism that you're talking about is of institutions and authority. They don't trust Fauci or the CDC or the WHO or Pfizer or whomever to to communicate honestly, objectively, and in their own interests. They believe that these institutions can not be trusted to communicate scientific knowledge free of political bias.

And when you look at it that way, of course America is the exporter of that. While responsible for founding some impressive modern institutions, the founding myth of the nation is all about skepticism of institution and authority. The country is constitutionally designed to live in perpetual tension with itself, and that's what's getting exported now.

bvoq• 4 years ago

Yeah, I wish it was only America, but the UK have their own antivaxx propagandists. What's the motivation behind this anyways? Aren't there other topics to make money off off, like spreading flat earth information?

beambot• 4 years ago

To be fair, America-induced vaccine hesitancy isn't just a byproduct of the modern zeitgeist; the CIA has been using vaccine drives as cover for foreign operations for decades, including the most recent documented use in 2011.

https://www.theguardian.com/world/2011/jul/11/cia-fake-vacci...

spaceman_2020• 4 years ago

I’ve been pro vaccine since forever but the idea that vaccines with decades of testing have the same risk profile as an experimental vaccine rushed through the labs to combat a deadly new disease is absurd.

ChrisCinelli• 4 years ago

Apparently it is not only an American thing.

José María Fernández Sousa-Faro, the founder, CEO and president of the European pharmaceutical giant PharmaMar, a pharmaceutical company that creates and distributes drugs to treat coronavirus, was caught with fake paperwork that stated he was fully vaccinated.

I am not sure why someone leading a large pharmaceutical company would decide not to take the vaccine and pay a large sum of money to get fake paperwork with the risk of being caught but he was also obviously VERY hesitant.

You would think he knows better...

hilbert427• 4 years ago

I dispair. That people can think so irrationally that they'd risk dying in preference to being vaccinated has truly shaken my faith in humanity.

SideburnsOfDoom2• 4 years ago

It is not only an American thing. Andrew Wakefield's actions have contributed to this problem since 1998, and he is British, so it's not just being lead from the USA, it's an international con.

https://en.wikipedia.org/wiki/Andrew_Wakefield

And more recently there's Piers Corbyn and co

https://en.wikipedia.org/wiki/Piers_Corbyn

Nokinside2• 4 years ago

Some old pictures of what it looked like in hospitals: https://www.google.com/search?source=univ&tbm=isch&q=images+...

Horrible disease.

brippalcharrid• 4 years ago

At least some of the images that come up in that Google Images search are from the Cutter Incident, which was caused by a Polio vaccine, much like the current outbreaks that we're seeing, so that probably wasn't the best example.

hilbert427• 4 years ago

Whilst the attenuated polio virus vaccine may carry a tiny risk it cannot be reasonably compared with the dangers of not being vaccinated.

Anti-vaxxers and those who've not gotten around to being vaccinated should look very carefully at those photos especially the one with the rows of poor kids in iron lungs, it's so tragic I want to cry.

I know, I lived through that 1950s/60s polio epidemic and whilst I was lucky and didn't get polio other kids at my school did. One died and another in my class ended up not being able to walk without calipers on his legs. It was terrible.

I've since had both the Salk and Sabin vaccines, back then when the vaccines finally arrived everyone rushed to them (despite a few tragic mishaps with a bad batch of early vaccine).

At that time the term 'anti-vaxxer' didn't exist - as the concept was almost inconceivable.

cute_boi• 4 years ago

While we are on it, if people dont know, CIA used polio vaccine to carry out secret operations creating distrust in vaccines.

CamelCaseName• 4 years ago

It was the CIA organizing a fake hepatitis vaccine drive in Pakistan to get the DNA of Bin Laden's children.

As a result, there have been a number of targeted attacks on polio vaccination workers that continue to this day. [0]

It is no surprise then, that as the grand parent comment mentions, this is the last region where polio exists.

[0] https://www.voanews.com/a/attack-on-pakistan-anti-polio-team...

contingencies• 4 years ago

China definitely had a lot of polio in the early 20th through mid 20th century. There are still some young people (~late 20s) who were affected as children.

WalterBright2• 4 years ago

Two years ago I read an article that said a recent polio vaccination offered some crossover immunity (5%) against Covid, so I got re-vaccinated against polio.

A friend of mine at Boeing told me he spent a year in an iron lung as a kid.

lucb1e5• 4 years ago

An iron lung is a type of negative pressure ventilator (NPV), a mechanical respirator which encloses most of a person's body, and varies the air pressure in the enclosed space, to stimulate breathing.

Holy crap that sounds uncomfortable, I already hate the few mbar pressure difference between ground level and 6th floor, let alone doing that 30 times a minute (resting breathing rate: 12-15 breaths/minute -> switching from breathing in, to breathing out, means 2 pressure changes per breath). Surely there are more comfortable solutions to operating one's chest, something like shaving and a (number of) large suction cup(s) to operate the chest, perhaps aided by weak glue around the edges?

Edit: "in which a person is laid, with their head protruding from a hole in the end of the cylinder" whew. Does make me wonder how to prevent hyperventilation (too high a rate) while providing enough oxygen at all times (like during stress or other exertion, resting rate may not be enough).

Positive pressure ventilation systems are now more common than negative pressure systems. Positive pressure ventilators work by blowing air into the patient's lungs via intubation through the airway [...] [this has] the advantage of not restricting patients' movements or caregivers' ability to examine the patients

Doesn't sound that much better, as I've heard that intubation is its own kind of hell. (On intubation, Wikipedia just mentions "Patients are generally anesthetized beforehand.")

WalterBright2• 4 years ago

BTW, polio is spread through poor bathroom hygiene.

lucb1e5• 4 years ago

I wasn't sure what you meant, so I looked it up: "poor bathroom hygiene" is not like toilet seat wiping or other in-bathroom stuff, but rather about pathways that make trace amounts of someone else's feces end up in your mouth.

[Polio] is transmitted primarily via the fecal–oral route, by ingesting contaminated food or water. (--en.wikipedia.org/wiki/polio)

This can take many forms, some obvious such as if someone doesn't wash their hands after using the toilet, shakes your hand, and you later eat something; others less obvious such as if someone poops into la Meuse in France and someone gets some water in their mouth in what is known as de Maas in the Netherlands. (Not sure how many pathogens survive French wastewater treatment or how many people swim in Maas-connected water bodies during hot weather, but you get the idea.)

More info on this route at https://en.wikipedia.org/wiki/Fecal%E2%80%93oral_route

est31• 4 years ago

You are not wrong that polio spreads through feces of infected individuals, your intestines are where it usually replicates. I might add though that in the 20th century counterintuitively it was the improvements in bathroom hygiene in the western world that have caused the high ratios of polio induced paralysis. Mostly because with really bad bathroom hygiene, even babies get infected with the virus, who still receive antibodies through their mother's milk and are protected by them. The immune system can deal with an infection and gain immunity in a safer environment. Now, in places with improved bathroom hygiene more children get exposed at later ages, like e.g. the toddler age. At that point, polio is way more dangerous as the immune system is not helped by the mother's antibodies.

https://nextnature.net/story/2014/how-modern-sanitation-gave...

m0llusk• 4 years ago

The 1 in 200 chance is an old statistic. Since that time obesity and Vitamin D deficiency have both increased along with various other measures of health. There is good reason to believe that modern people have immune systems that will be less effective against polio infections and negative outcomes.

culi2• 4 years ago

Makes me wonder if we should be specifically engineering really weak but way more infectious strains of dangerous infectious diseases. Let them spread and outcompete the harmful strains

vibrio2• 4 years ago

As someone that worked with viruses for a couple decades, I do not endorse this. Life finds a way.

(I know viruses aren't 'alive')

mistrial9• 4 years ago

Is it true more-or-less that the technology chains involved in the USA/Western Covid-19 vaccines, are under development as a 'platform' for new, novel treatments for a wide range of illness? Is it possible that the billions upon billions of dollars that have changed hands in the last thirty months, are an incentive to "pile on" new treatments, and perhaps new required treatments in the future?

robbiep• 4 years ago

Wtf are you getting at? Yes mRNA vaccines are under development for many many other diseases. It’s a new technology. Would you expect the invention of a new technology to have a single application and then be put on a shelf somewhere, perhaps in that secret government warehouse where they store the Ark, and maybe the Lindbergh baby?

FYI mRNA vaccines were first developed 5-10 years prior to the events of the past few years, and deployed in veterinary medicine. Having a global pandemic led to the urgency to adapt them to human conditions where they have saved millions of lives

logic_beats_pro2• 4 years ago

Having a global pandemic led to the urgency to adapt them to human conditions where they have saved millions of lives

They've been trying for 10 years to get approval for human use. COVID was just the battering ram used to get them authorized for emergency use.

And your last point on saving millions of lives is complete speculation which is unknowable and unprovable. I can just as easily make the claim that cross reactive immunity from a precious Coronaviris infection saved millions of lives.

makomk2• 4 years ago

I don't think anyone's tried to push mRNA vaccines for polio yet, and if they did it would be a really obvious swindle - they'd run right into the same problems with the vaccines not being sterilizing that we already did with Covid and with the existing, well-tested inactivated polio vaccines that almost everyone in the developed world already has. In principle it's more or less the same problem even (inadequate mucosal immune response, though in different mucosa...) They'd just be harder to manufacture, ship, and give to people than the existing inactivated vaccines, when those are already the main problems stopping the existing ones being deployed more widely around the world.

t0bia_s2• 4 years ago

Similar story from 1955 - Cutter incident.

The mistake produced 120,000 doses of polio vaccine that contained live polio virus. Of children who received the vaccine, 40,000 developed abortive poliomyelitis (a form of the disease that does not involve the central nervous system), 56 developed paralytic poliomyelitis—and of these, five children died from polio.

https://en.m.wikipedia.org/wiki/Cutter_Laboratories

JumpCrisscross3• 4 years ago

Similar story from 1955 - Cutter incident

The Cutter incident is a story of bad vaccines. The viruses were supposed to be inactivated. Cutter's were not [1].

That is not what is happening here. Nobody got a bad vaccine. This is the story of an unvaccinated individual being exposed to a weakened poliovirus, administered instead of the inactivated kind because it's sterilizing, and then going home to a community of other unvaccinated people who had no protection against polioviruses of any kind.

[1] https://en.wikipedia.org/wiki/Cutter_Laboratories#Cutter_inc...

t0bia_s2• 4 years ago

In both stories, vaccines are reason of infection.

I personally know few people that get Covid few days after vaccination. I don't know if they get infection in vaccination centre from others or from vaccine itself, but again... Vaccine was a reason of spreading infection.

gregwebs• 4 years ago

If you understand the limitations of the two types of vaccines, then polio showing up in the wastewater in international cities seems expected.

The US and England vaccinate with the non-live version. This non-live version cannot mutate, but it is non-sterilizing- the vaccinated can still become infected in their gut- the vaccine prevents it from getting into their bloodstream and becoming poliomyelitis.

So Polio will continue to spread among the fully vaccinated going unnoticed- particularly in international cities where they can import new cases. And we have seen a tragic outcome where someone is not vaccinated and ends up acquiring poliomyelitis.

Nokinside2• 4 years ago

It’s only when you have low enough vaccine coverage that the strains can circulate. Rockland County, NY where it first started in the US had only 60% vaccine coverage.

Children missing vaccine appointments due Covid19 and pockets of vaccine hesitancy have created this situation. For example, Hasidic Jews have anti-vaxxer tendencies.

babypuncher3• 4 years ago

If this only affected adults, then I'd be fine; those idiots choose not to get vaccinated so they get to live (or die) with the consequences.

Unfortunately polio heavily impacts children, who aren't given a choice. As far as I'm concerned, anti-vaxxers are murdering kids and getting away with it.

lucb1e5• 4 years ago

In case it is an on-topic story: given the amusing contradiction between username and content, may I ask where your username comes from?

srvmshr• 4 years ago

Honest query: Since I didn't see this asked in other answer threads, are only children at risk or adults can contract it too? How likely is it to spread from indected individual. The vaccination is done in childhood. I received three doses before 8 y.o., but I am not certain if this is relevant to adults & getting infected in e.g 30s. Thx in advance

samus• 4 years ago

Isn't it time to retire the live vaccine and sponsor complete eradication using the inactivated vaccine? Yes, it's more expensive, but we live in an era where we face many challenges from new diseases like Covid-19, Monkey Pox, super-resistant bacteria strains, and the antivaxxer movements. We should finally tie up that loose end and create a success story for modern medicine.

hilbert427• 4 years ago

You're probably correct. The trouble is that it's so much easier to put a couple of live vaccine drops on the tongue than to vaccinate by needle.

No matter how painless modern injections are people still don't like having them thus the deterrence rate is higher. It's a key factor if we're trying vaccinate the whole population.

ars2• 4 years ago

The live vaccine is a sterilizing vaccine, the inactivated is not. Additionally because it's live it confers immunity to tons of people near the person being vaccinated.

It's not easily replaced, even if you had the money.

Spate of polio outbreaks worldwide puts scientists on alert

Related Stories