Features
Polio scourge: An addendum
MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lond), FRCPCH(UK), FSLCPaed, FCCP, Hony. FRCPCH(UK), Hony. FCGP(SL)
Specialist Consultant Paediatrician and Senior Fellow, Postgraduate Institute of Medicine
This is a scientific supplement to the excellent article, titled “The saga of the control of the dreaded disease polio,” written by my friend, Dr Jude Jayamaha, Consultant Virologist, and published in The Island newspaper on 28 October 2024. He most eloquently described the initial development of the vaccine that helped in no small measure to control this disease in children, as well as in adults.
Polio, the shortened name for the much-feared illness known by the scientific name, Poliomyelitis, is a disease caused by a virus that specifically attacks the nerves of the human body. The virus enters the body through the gastrointestinal tract in contaminated food and water. Once it spreads widely in the body, the virus causes total disruption of the functioning of the nerves and leads to paralysis of the muscles supplied by the nerves. It has three strains, or types, and all of them cause destructive effects on the nerves.
There is no specific curative treatment, no antiviral medicines that are effective against the virus, and even in those who recover to some extent, there is permanent paralysis of the affected muscles. When the muscles that are involved in breathing are affected, there is a major disturbance in respiration, sometimes leading to complete respiratory paralysis.
The so-called Bulbar Poliomyelitis that affects the nerves that supply the muscles used in swallowing produces a marked problem with swallowing, even the normal secretions in the mouth and throat being affected. The accumulation of these secretions results in aspiration of the same secretions into the lungs with intense suffocation. In every sense of the description, the disease causes intense suffering, leads to a significant number of deaths, and leaves the rest of those affected, maimed for life.
I have seen very many cases of polio in children as a Medical Student, an Intern Medical Officer, a Medical Officer in the Out Patients Department (OPD) of the Lady Ridgeway Hospital (LRH) and then as a Specialist Paediatric Registrar at LRH, over the period from the late 1960s to the mid-1970s. Many affected children died and those who managed to survive were left with terrible and permanent loss of power in some muscles and grotesque deformities. This latter lot was mutilated forever with no long-term recovery.
I have had to put babies into the so-called “Iron Lung” or negative pressure cuirass respirators with my own hands, because their respiratory muscles were paralysed, knowing very well that none of them were going to come out alive. The degree of human suffering inflicted by this little polio virus was totally unbelievable.
The original Salk vaccine, which Dr Jude Jayamaha described in detail, had to be given by injection. It was quite effective and very definitely caused waves in the affluent countries of the Western hemisphere. However, most unfortunately, it was not made available to many of the poorer countries, probably due to constraints imposed by inadequate production.
In a twist to the tale of polio, a young man of 15 years by the name of Abram Saperstejn, born to Polish-Jewish parents in the Russian Empire, emigrated on the ship SS Lapland to the United States of America (USA), and changed his name to Albert Bruce Sabin. This bright young man trained in medicine and then conducted research in the Lister Institute for Preventive Medicine in England. Much later he came back to the USA and developed an oral inactivated or attenuated vaccine using mutant strains of the polio virus, the vaccine being known as ‘polio drops’.
This oral vaccine that covered all three strains of the polio virus was licensed in the USA in 1962. It really worked like a charm but needed a very high coverage in children to provide maximum benefit with a large population that had what we call ‘herd immunity’. Following in the footsteps of Jonas Edward Salk who discovered and propagated the very first injected Salk vaccine, Alfred Bruce Sabin, too, refused to get a patent for his oral vaccine. As a result, the vaccine could be freely marketed at a relatively low price.
The Sabin trivalent oral polio vaccine (tOPV) was introduced to Sri Lanka in 1962 as part of the country’s Expanded Programme of Immunization (EPI). However, quite sadly, it took Sri Lanka approximately two decades to achieve over 90% coverage of children for polio immunization, which occurred only by the early 1980s. That is why we were still seeing cases of polio in the late 1960s and mid-1970s.
From the time I became a Consultant Paediatrician in 1978, up to the present, I HAVE NOT SEEN A SINGLE CASE OF POLIO. The success of the immunization programme in Sri Lanka, combined with other public health measures, eventually led to the elimination of polio in the country, with the last indigenous proven polio case being reported in 1993. Sri Lanka was officially certified as polio-free by the World Health Organization (WHO) in 2014.
Need we say more? The earlier article by Dr Jayamaha and this documentation are excellent examples of the wonderful achievements of modern medicine. In effect, they are also accolades of the highest level to all those lovely people, from Dr Jonas Edward Salk and Dr Alfred Bruce Sabin, to all those who have been in, and continue to be involved in, the Immunisation Programmes worldwide. Among many other things, the selfless dedication of all of them has been instrumental in protecting our people from a brutal and untreatable disease such as Poliomyelitis.