Polio infection seen in death of Minnesotan

Received this e-mail from Dr.Bruno today on whose polio related e-mail list I am:


Polio infection seen in death of Minnesotan
The Associated Press - Tuesday, April 14, 2009

Minnesota health officials are investigating the death of a person who was infected with a strain of the polio virus.

The patient was infected with the live polio virus that was used in the oral vaccine, which was discontinued in the U.S. in 2000, the Department of Health said Tuesday. The vaccine now in use is injected and doesn't contain live virus, and officials said this case poses no risk to the general public.
"This is a very rare occurrence and does not signal a resurgence of polio," State Epidemiologist Ruth Lynfield said in a statement.
The patient died last month with polio symptoms that included paralysis, but the department said it's not known to what extent polio contributed to the death. The patient also had a weakened immune system and multiple health problems.
It's likely the patient became infected from someone who had received the live-virus vaccine before its use was stopped, the department said. Aaron Devries, an epidemiologist with the department, said testing here and at the Centers for Disease Control and Prevention showed that the patient probably acquired the virus 10 to 15 years ago and continued to carry it around all these years. He said they don't know why the patient became ill from it only recently.
The department said it was working to determine if any health care workers might have been exposed. It said only unvaccinated people or people with deficient immune systems who had direct, ungloved contact with the patient's bodily secretions would be at any risk.
Citing patient privacy laws, the department did not release any details about the victim.
Officials said this type of polio infection is very rare. Only 45 cases of vaccine-derived paralytic polio disease in people with immunodeficiencies have been reported in the world since 1961, according to the Centers for Disease Control and Prevention.
In these rare cases, the health department said, someone who has either never been vaccinated or has a weak immune system can get the polio virus from someone who has been vaccinated and is excreting the virus in their stools. Sometimes, but not always, these infections result in illness, as happened in this case.
The other reported U.S. instances of vaccine-derived polio infection also occurred in Minnesota , in 2005. Five children from the Amish community near Clarissa in central Minnesota , which had low rates of immunization, were infected but did not develop outward symptoms.
Lynfield said they suspect the reason all the U.S. cases were detected in Minnesota was because of its advanced public health reporting system.
The CDC says the oral vaccine is still used in countries where naturally occurring polio is still a threat because it's better at stopping the spread of the virus. The U.S. switched to the injected vaccine because wild polio has already been eliminated from the Western Hemisphere , and the few cases of polio that were occurring, about 8-10 per year, were caused by the oral vaccine itself, not the wild virus.
The last case of naturally occurring paralytic polio occurred in the U.S. in 1979, but health officials said the new case was a reminder for people to make sure their immunizations and their children's shots are current. Most people in the U.S. have been vaccinated against polio.
But vaccination rates against polio are dropping, warned Dr. Richard L. Bruno, chairman of the International Post-Polio Task Force and director of The Post-Polio Institute at New Jersey 's Englewood Hospital and Medical Center . He noted that the CDC estimates that more than 1 million U.S. toddlers aren't vaccinated against it. And he said there's always a danger polio could return via another country where it's endemic.
"We must do more to vaccinate America 's children against this deadly and disabling disease," Bruno said. " America 's next polio epidemic could be just a car or plane ride away."

______________________________________________________________________________

INTERNATIONAL
POST-POLIO TASK FORCE
International Centre for Post-Polio Education and Research
at Englewood Hospital and Medical Center
Englewood, New Jersey 07631 USA
877-Post-Polio 201-894-3724
PostPolioInfo@aol.com
PostPolioInfo.com

For Immediate Release

POLIO KILLS IN MINNESOTA

DEATH GIVES “NIPP IT YEAR” NEW EMPHASIS

Tuesday April 14, 2009: The Associate Press today reported the death of a person infected with the live poliovirus used in the oral vaccine that was discontinued in the US nine years ago. The health department says the patient died with polio symptoms, but it's not known to what extent polio contributed to the death. The patient also had a weakened immune system and multiple health problems. The Minnesota department of health says the patient most likely became infected from someone who had received the live-virus vaccine before its use was stopped.

"For reasons we don't understand, the live poliovirus remained inside this person for ten years, mutated and became virulent, then contributed to the person’s death,” said Dr. Richard Bruno, chairperson of the International Post-Polio Task Force. "This death is the latest sad reminder that polio may be forgotten in the US , but that it is far from gone.”

Alarming Drops in Polio Vaccination in US Border States and Ports of Entry.

Unfortunately, rates of polio vaccination have decreased in the US in spite of six other US polio cases since 2005 -- five of them in Minnesota -- caused by poliovirus imported into the US, and in spite of polio breaking free of vaccination efforts last month in Africa, with Kenya and Uganda reporting their first polio cases and deaths in twenty years.

“The latest Centers for Disease Control data show drops in polio vaccination in twenty states and in ten large US cities," said Dr. Bruno, who is also director of The Post-Polio Institute at Englewood Hospital and Medical Center . “The CDC estimates that more than one million US toddlers are unvaccinated."

“Even Minnesota has had a decrease in polio vaccination, which is obviously disturbing,” said Dr. Bruno. “It is frightening that states with the largest drops lie next to Mexico and Canada , across whose borders the poliovirus is believed to have been imported into the US since 1997.” Seventy percent of the states that border Canada had drops in polio vaccination as did Arizona , Texas and New Mexico .

City Children Living in Poverty Have Lowest Polio Vaccination Rates.

Dr. Bruno is also concerned about cities that are major points of entry into the US -- New York , Philadelphia , Houston and Seattle -- where drops in polio vaccination were also reported.

“Toddlers living in poverty have the lowest polio vaccination rates -- below 87% in Boston , Indianapolis , Memphis and Phoenix , and below 85% in Detroit , Houston and Seattle -- rates lower than in Western Pacific countries that include Cambodia , Mongolia and Vietnam ,” said Dr. Bruno. "I’m worried that those who recently had polio in the US are canaries in the mine shaft."

"NIPP IT YEAR” Underscored by Minnesota Death.

The International Post-Polio Task Force proclaimed 2008-2009 “National Immunization for Polio Prevention in Infants and Toddlers -- or ‘NIPP IT’ -- YEAR,” to prompt parents, healthcare professionals and state health officials to ensure that all American children receive four doses of the injectable, inactivated polio vaccine by age two.

“‘NIPP IT YEAR’ is intended to raise awareness of the need for polio vaccination, to stop state legislatures from allowing parents to refuse vaccinations for their children because of a “philosophically objection” to vaccines, and hopefully ‘nip’ America’s next polio epidemic in the bud,” said Dr. Bruno.

The polio vaccine has been a victim of its own success. Young parents do not vaccinate because they have not experienced the devastation, death and disability caused by diseases vaccines eliminated, or are unaware that polio remains a scourge transportable from Africa, Pakistan , Afghanistan and India .

"With the ease of air travel, what will happen when a polio-infected individual lands in one of America's potential polio pockets, like New York City, and passes poliovirus to the estimated 24,000 infants and toddlers in that city who are not immunized?” asked Dr. Bruno “We must do more to vaccinate America's children against this deadly and disabling disease. America 's next polio epidemic could be just a car or plane ride away."

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