AAP Voices Blog

Will Polio’s Scourge Return?

At a recent 200-attendee afternoon lecture series held in a retirement community in Washington DC, I asked audience members to raise their hand if they had either had polio or known someone who had it. Roughly two-thirds raised their hands. 

It’s a reminder that the human costs of polio have not been fully forgotten.

Most of these residents - and myself at 81 - were the last generation in the U.S. to suffer from poliomyelitis, and the first generation to benefit from the development of the polio vaccine. When the first effective polio vaccine became widely available in 1955, it was hailed as a miracle owing to the prompt decrease in flaccid (floppy) paralysis.

I believe this experience comes with a special obligation to convey the debilitating consequences of this infection and its impacts.

Most of the public knows little about it, and even fewer about the post-polio syndrome (PPS), which occurs years later in 20-40% of adults who suffered from severe flaccid paralytic polio as children. 

Ninety-five percent of poliovirus infections are asymptomatic. The virus is spread by fecal-oral contact or respiratory droplets and impacts the lymphoid tissues in the mouth, pharynx, and intestine. The incubation period from exposure to the onset of symptoms ranges from 7 to 17 days, and the virus can be shed in stool for up to 6 weeks. Boys account for 70-90% of children who experienced flaccid paralysis, a symptom attributable to the virus killing the motor neurons in the central nervous system. Only one in 100 to one in 150 infected children develop flaccid paralysis. 

Fear of transmission led to the isolation of infected children and resulted in long-term effects on development. More severe disease leads to an increased likelihood of post-polio syndrome in adulthood, which affects the same muscles that were impacted in the diseases' onset. The new weakness is not a recurrence of the viral infection but likely an exhaustion of the muscles that attempt to compensate for the muscle weakness the disease causes.

Below are the stories of 5 adults affected by polio when they were children. While powerful, their stories do not convey other aspects of childhood polio, including the extreme parental fears and anxieties associated with the 20,000 cases of paralytic polio diagnosed each year at that time. This illness can also become chronic, at times resulting in the need for an iron lung or even progressing to death. 

PB contracted polio at age 5 with flaccid paralysis of his legs and was hospitalized for approximately 5 months. As a result of the destruction of his spinal nerves, he was left with almost no muscle strength in his legs and relied on crutches for daily life. He subsequently developed severe scoliosis as a result of asymmetric loss of spinal musculature. Scoliosis led to spinal fusion surgery when he was in 8th grade, after which his body cast kept him out of school for the entire school year. After the acute infection, he walked with difficulty. As he aged, he progressed from walking with the use of a cane, followed by a walker, a wheelchair, and eventually an electric cart. In the last years of his life, his respiratory function gradually deteriorated until, as his wife said, “he died of polio.” 

JJ contracted polio at age 7 and was hospitalized in a county sanitarium with other affected boys for three to four weeks. He had flaccid paralysis of his right leg and mild paralysis in the left leg caused by substantial loss of musculature, particularly below the knee. His subsequent weakness and muscle loss required a brace on his right leg which he still uses. No visitors or radios were allowed on the ward. Instead, the air was filled with the rhythmic sounds of iron lungs used by children with impacted breathing from bulbar polio, requiring constant nursing care. He now has post-polio syndrome with progressive weakness of his right leg and relies on a cane for stability.

AI contracted polio at age 6 when he developed flaccid paralysis of his left leg, right arm and shoulder. To avoid transmission to his sisters, his mother sent her two daughters to live with relatives. His mother treated him with the Sister Kenny method of hot compresses and passive movement of the affected extremities. His paralysis slowly recovered over several months and left no apparent long-lasting impacts. A younger cousin had also contracted polio six months before AI and was hospitalized in an isolation ward, separated from others by a wall with only a small window. His feelings of abandonment persisted into adulthood. 

MW was 11 years old in 1949 when he contracted polio shortly after a summer camp in which six boys were affected and one died. The disease led to severe flaccid paralysis of his left upper leg and his core muscles. His upper and lower back muscles were also affected asymmetrically, which led to scoliosis. He was hospitalized for three months and then home bound for a further three months, missing an entire semester of sixth grade. Twenty-five years ago, he began to notice increased weakness of his left leg and core muscles and increased fatigability and was subsequently diagnosed with post-polio syndrome. 

DB contracted polio at age 10, which began with a fever and stiff neck, and progressed to sustained weakness and flaccid paralysis of her arms. Out of concern for her three siblings who had not contracted the illness, her mother sent them to live with their grandmother. She was bed-ridden for three weeks and has experienced sustained weakness and tight tendons in her arms.

The CDC recently reported that poliovirus was detected in 30 countries in the last 13 months, most of which were in Africa, but included Germany, Poland, and the United Kingdom. These were cases of flaccid paralysis as most polio infections are asymptomatic, or associated with non-specific symptoms such as fever, headache, vomiting, or sore throat. Because of its asymptomatic nature, polio is not likely to be detected. The low frequency of flaccid paralysis and the high rate of asymptomatic infections means that the poliovirus could easily be brought to the United States, especially if the growing numbers of unvaccinated children continue to increase. Furthermore, because no practicing physician in the US has seen a case of polio, the diagnosis may be missed. Screening wastewater could help identify circulating polio virus early, but only if health departments are actively looking for it.

The release of the polio vaccine led to prompt reductions in the prevalence of the disease from 58,000 cases in 1952, to 5,600 cases in 1957, to 161 cases in 1961. If rates of polio vaccinations decline further, we may well see a return to the epidemics of 70 years ago. Not everyone knows what this can bring, but we were there, and we remember.  

Pediatricians are in an ideal position to council families regarding the importance of polio vaccine. Our experience suggests that asking vaccine resistant families to talk to grandparents about their childhood friends who had polio, and sharing some of the stories we captured here may be persuasive. In addition, pediatricians are likely to be the first to see and confirm cases of flaccid paralysis due to polio and can raise the alarm with their peers and their local health department.

*The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.