Polio survivors still need support to maintain health and independence.”




[SYDNEY] With polio now occurring in just two countries — Afghanistan and Pakistan — investments in medical aid and healthcare are now deemed urgent for polio survivors as they battle the onset of the post-polio syndrome (PPS) decades after first contracting the disease.
 
The first Australasia-Pacific Post-Polio Conference held in Sydney (20-22 September) discussed the treatment options focusing on neurological and biomechanical decline due to PPS in ageing polio survivors as well as the challenges of preventing and treating severe deformities in young polio survivors mostly in developing countries who will need help for years to come. 

Mary-ann Liethof,Polio Australia

 

PPS is a condition with new muscle weakness or general tiredness in persons with a confirmed history of acute paralytic polio, usually occurring several decades after the acute illness, reinforcing the need for a multi-disciplinary approach and more evidence-based research on alternative and complementary therapies.
 
“Polio survivors still need support to maintain health and independence,” Polio Australia’s national programme manager, Mary-ann Liethof, tells SciDev.Net.
 
A 2001 report by The March of Dimes, a non-profit agency founded by US President Franklin Roosevelt, a polio survivor, noted that up to 20 million polio survivors around the world face the threat of new disabilities 15 to 40 years after their original illness, which could leave them using wheelchairs or ventilators for the rest of their lives.
 
“Basic rehabilitation is very limited especially in developing countries. There is an urgent need for assessing polio survivors to maximise their functionality and prevent deformities from developing through adaptable technologies, bracing, physical therapy and addressing accessibility issues,” says Carol Vandenakker Albanese, physical medicine and rehabilitation professor at the University of California Davis Medical Center in the United States.
 
Rotary’s End Polio Now zone coordinator for Australia and New Zealand, Bob Aitken, tells SciDev.Net, “We have been conducting a network of workshops for educating young health professionals in long-term treatment of polio survivors. We hope this model can be replicated in developing countries.”
 
Adds Joan Headley, director of Post-Polio Health International based in St. Louis, Missouri, “The core knowledge about PPS within the medical profession in Australia can be very useful in educating and training people in Asia and South Pacific.”
 
A study in an Italian cohort of over 100 PPS patients and their family members, together with a number of polio survivors with “stable polio”, found that nearly three-quarters of PPS patients appear to harbor “poliovirus remnants” while survivors with stable polio rarely harbour poliovirus.

However, poliovirus remnants are not transmitted from PPS patients to family members, and do not appear to be dangerous to the population or represent a possible form of poliomyelitis resurrection, explains Antonio Toniolo, microbiology and virology professor at the University of Insubria Medical Centre Varese in Italy.
 
“The results suggest that chemical antiviral therapy, possibly in addition to immunotherapy, could be of help in clearing the virus from the body and in stopping chronic inflammation and further death of motor neurons and muscle cells,” Toniolo adds.
 
This piece was produced by SciDev.Net’s South-East Asia & Pacific desk.



Post Polio Litaff, Association A.C _APPLAC Mexico

Erna Solberg: U.N. Must Work to Eradicate Polio for Good



Erna  Holberg @erna_solberg  Sept. 19, 2016 Erna Holberg is Prime Minister of Norway and co-chair of the U.N. Secretary General’s Sustainable Development Goals Advocacy Group

We have the power to ensure that our world is polio-free once and for all



For the first time in history, we have the opportunity, knowledge and resources to transform lives and end extreme poverty.
This September marks one year since 193 countries agreed on a historic agenda to tackle the unfinished business of the Millennium Development Goals and to address highly complex global challenges such as poverty, inequality, forced migration and global warming, while promoting good health, well-being and quality education.
As Co-Chair of the SDG Advocacy Group, a group appointed by U.N. Secretary-General Ban Ki-moon to raise awareness and spur action towards achieving the Sustainable Development Goals (SDGs), I am fully aware that this is the most ambitious global agenda the world has ever seen. But I am confident that these goals can be achieved, particularly with strong leadership and broad, effective and innovative partnerships across sectors and borders.
It is completely unacceptable that in 2016, 800 million people are living on $1.90 or less per day, that 1.5 million children will die of vaccine-preventable diseases and that 263 million children are still missing out on an education. Action has to be taken—urgently.
The holistic 2030 Agenda paves the way to the future we want. To a world in which extreme poverty and preventable diseases such as polio have been eradicated. A world in which no one is left behind.
I can think of no stronger testament to the effectiveness of the international community in achieving global progress than the results we have already attained in the area of global health. By investing and working together on immunisation and, in particular, polio eradication, we have seen polio go from a disease that plagued and crippled millions to one that is 99.9% eradicated.
An integral—if often overlooked—reason for this achievement has been the participation of women in ensuring that every last child receives the polio vaccine. Women serve on the frontlines of eradication efforts—as mothers, health workers, caregivers, community mobilisers and vaccinators. They are the unsung heroes of the polio movement, and we must continue to support them in their work to reach children living in the most remote corners of our Earth.
Despite the remarkable progress we have made thanks to the Global Polio Eradication Initiative, spearheaded by Rotary International, our work is not yet complete. The existence of polio anywhere poses a threat to all of us everywhere. There are still cases of polio in Pakistan, Afghanistan and Nigeria. In cooperation with the U.N. and other actors, these countries must do what it takes to make the final push to eradicate polio. With determination and cooperation, we can reach every last child and administer a 13-cent vaccine to ensure that children everywhere are protected from the devastating effects of the disease.
In September, world leaders will gather in New York for the U.N. General Assembly, which coincidentally marks the 100th anniversary of the 1916 polio outbreak in New York City. That outbreak resulted in 8,991 cases of polio and 2,448 deaths in New York City alone. A hundred years later, the number of cases worldwide is a fraction of what it was in New York in 1916. It is vital that we stay the course until the work is complete—we must all reaffirm our commitment to eradicating polio completely.
So far, only one disease has been eradicated by vaccination in human history: smallpox. We now have a critical window of opportunity to eradicate a second disease. The eradication of polio has the potential to yield substantial financial benefits. Moreover, the infrastructure put in place to ensure the end of polio will also help to reduce or eliminate incidences of other preventable diseases. I was pleased to see that in May this year, the G7 leaders stressed the major contribution made by polio-related assets, resources and infrastructure to improving health systems and universal health coverage.
Failure to eradicate polio could, however, result in a widespread global resurgence of the disease. I call on world leaders to commit to closing the $1.5 billion funding gap so that we can ensure that our world is polio-free once and for all. To that end, I am proud to say that Norway was the first country to commit funds to Gavi and the GPEI’s polio eradication efforts for the period 2014-2019. With global certification expected in the next few years, polio eradication could be one of the early successes of the 2030 Agenda.
I am pleased to cooperate with the Global Citizen movement in advocating action to achieve the SDGs. I encourage other leaders to join me so that, together, we can take a giant step forward for global health.

Post Polio Litaff, Association A.C _APPLAC Mexico

Outcomes of Total Knee Arthroplasty in Patients With Poliomyelitis


Abstract

Background

We report our experience with outcomes of poliomyelitis in the Asian population.

Methods

Sixteen total knee replacements in 14 patients with polio-affected knees were followed up for at least 18 months. Follow-up assessment included scoring with the American Knee Society Score (AKSS), Oxford knee score, and Short Form 36 Health Survey scores.

Results

The mean AKSS improved from 25.59 preoperatively to 82.94 at 24 months, with greater improvement in the knee score. The mean Oxford knee score improved from 40.82 preoperatively to 20.53 at 24 months. The mean AKSS pain score rose from 2.35 to 47.66 at 24 months. The Short Form 36 Health Survey physical functioning and bodily pain scores improved for all patients.

Conclusion

Primary total knee arthroplasty of poliomyelitis-affected limbs shows good outcomes, improving quality of life, and decreasing pain.
Post Polio Litaff, Association A.C _APPLAC Mexico

When Polio Walked the Earth



It is hard to capture the sense of panic that once gripped cities and towns in North America during “polio season”—summer and early fall. Parents kept children indoors, public places were deserted, quarantines were put in place, and victims were isolated from the healthy. Every year for forty years, from 1910 to 1950, an outbreak of polio took place somewhere in North America, as well as in Europe and in huge swaths of Asia and Africa. The 1953 epidemic was the peak of a new series of infections that had begun in 1949. During those five years, 11,000 Canadians came down with polio, 9,000 in 1953 alone. Newsreels and newspapers depict a country in panic. The medical system was overwhelmed and there was a severe shortage of doctors, nurses, and therapists to deal with the tsunami of cases. City and town councils argued with school officials and public-health officers about whether schools should be opened and pools kept closed, and sometimes vice versa. In big cities, those who had the means fled to cottages and resorts deep in the woods, away from population centres. In a recent Discovery Channel survey of the ten worst epidemics to affect humans, polio still gets top billing, over the 1918 Spanish flu, the Black Death, hiv/aids, and malaria.
Polio is a devastating disease, highly infectious, easily transmitted, and with no known cure. The disease attacks the spinal cord and the nervous system, and depending on the severity of the infection and the location on the spinal cord, it can paralyze muscles and tendons.
There are three basic classifications of paralytic poliomyelitis: spinal, bulbar, and bulbospinal, which are simply markers of the region of the central nervous system affected and the amount of inflammation and damage that result. The most common form, spinal, attacks motor neurons associated with the movement of muscles; while it can occasionally affect muscles on both sides of the body, it is usually asymmetrical. About 21 percent of all cases of paralytic polio are bulbar or bulbospinal, and these cases dramatically affect the ability to breathe. When you hear polio and you think iron lung, it is patients with these forms you are picturing.
My parents and their generation were no better equipped to deal with polio than their parents or grandparents had been. Polio was first identified in 1840 and the virus isolated in early 1908, but there is clear evidence stretching back at least as far as ancient Egypt of periodic outbreaks and documented occurrences of the disease.
When I was born, contracting polio was truly a crapshoot. The disease was almost Biblical in the sense of a plague sent down by God and touching houses seemingly at random. My mother and father, like any affected parents in 1953, would have been bewildered as to why their house was targeted and not the family two doors down. Doctors weren’t of much comfort, lacking any explanation for why some caught the virus and others didn’t.
Much of what we now know about polio was just conjecture in the year I was born. Research has proven that polio is transmitted orally from person to person through exposure to fecal matter, which goes some way to explaining why children not yet fully toilet trained are such a prime target. Places where people gather and the virus can easily spread—swimming pools, for instance—are probable hot zones.
Polio is a disease rife with truly tricky numbers, almost inexplicable. For every thousand children under the age of five infected by the virus, only one will show any symptoms; the other 999 move about as normal, except that each is a carrier. The incubation period between infection and the appearance of symptoms is anywhere between three and thirty-five days, and everyone is most infectious in the ten-day period before symptoms can appear. The numbers are crueller for children older than six, and adults, with one out of every seventy-five showing symptoms. The majority will experience what is called “abortive polio” or “non-paralytic polio,” whose symptoms include “fever, sore throat, headache, vomiting, fatigue, back pain or stiffness, neck pain or stiffness, pain or stiffness in the arms or legs, muscle spasms or tenderness, and meningitis.” The unlucky few, just 1 to 3 percent of those who show any symptoms at all, contract paralytic polio and experience loss of reflexes, severe muscle aches or spasms, and loose and floppy limbs, often worse on one side of the body. The onset of the actual paralysis will be sudden and is most often irreversible.
Because polio most often and most seriously affected the young, the disease was commonly referred to as “infantile paralysis.” In the year I was born, little was certain about the disease other than that name, which was enough to chill the soul of even the most devout Catholic.
Iwas infected at the height of the polio season, in August 1953, just around the time Jonas Salk was performing his trials. His modern medical miracle, however, arrived too late for me. As was the norm at the time, after I fell ill, my family was quarantined. I was isolated in hospital for a year while my parents worried and prayed at home. Isolating polio victims to stem the spread of the virus was known to be futile by 1940, but the practice continued simply to calm the public by creating a sense that something was being done.
The first signs my parents noticed—a high fever, my obvious intense discomfort and stiffness—had them panicked. All babies display a range of behaviours, but this was late summer and polio seemed to be everywhere. I turned out to be one of the lucky ones, because the damage could have been much worse. It is true that my left lower leg didn’t function as such, and this would have serious ramifications over time, but at two months old at least I was alive, and I wasn’t so damaged that I needed to be confined to hospital for years, as was the case with other children. My parents were forced to stay in Deep River, Ontario, my father for work, my mother to care for my siblings. I was entrusted to the staff at the Deep River Hospital and then at Toronto’s Hospital for Sick Children for a year, with my parents visiting when they could.
At the hospital, the staff first examined my stool, then took a throat swab and subjected me to a spinal-tap procedure. These were the only tests available for a relatively quick diagnosis. The gold-standard test involved a long needle and a tricky procedure. In the spinal tap (a lumbar puncture, to use the correct medical terminology) a needle is inserted into the lower part of the spinal cord and cerebrospinal fluid is drawn out and examined for increased white blood cells, higher-than-normal protein levels and the presence of the polio virus. If all three are present, odds are you have paralytic polio. In my case, all three were present.
The procedure is painful for adults and arguably horrific for children. The patient is positioned on his side with his knees drawn up to his chest and his back and neck straightened. The patient must be kept perfectly still, rigid even. For a number of reasons, I would undergo spinal taps at numerous points in my life, and each and every time one was ordered I experienced the closest thing I can imagine to primal dread. Even writing the words spinal tap causes my skin to crawl and my nerves to cringe. In some of the accounts I have read of the panic of the triage rooms in hospitals during the polio epidemics of the 1940s and ’50s, the eeriest reports are those of babies and toddlers moaning as the procedure is performed. I may not remember my first lumbar puncture, but at my core is a clear, affective account of the experience.
In addition to taking the necessary diagnostic steps, the nurses fed me, tried to manage my fever and aches and pains, and, with the doctors and therapists, attempted all the latest treatment fads. This meant immobilizing my left leg, massaging the affected limb, and trying to exercise the other limbs. The muscles in my left leg were paralyzed and immobilizing the limb was believed to be a way to prevent further damage and possibly give the muscles time to heal. The argument over the question of immobility versus exercise went to the very heart of medical authority. I don’t know how my parents reacted to the choice of treatment options at the time, but the way they responded to later medical quandaries and dilemmas, issues I was more aware of and involved with, provided me with some clues. My mom the nurse and my dad the authoritarian were each in their own ways respectful of authority. When faced with conflicting ideas, they would have been worried, panicked, and at a loss as to what was the right thing to do, before finally deciding that leaving the decision to the doctor was both the best and the wisest course of action.
As a baby, not only did I lack the means to tell nurses or doctors what or how I was feeling, but also it wouldn’t always have been clear how I was responding to the various types of treatments and exercises I was being given. Fixing my limbs and moving my limbs would have involved a lot of guesswork and day-to-day adjustments. As a growing baby, my development was soon completely out of whack. At a point when you might expect spontaneous turning and rolling and crawling, I was doing none of that, and no one was quite sure when, how, or if I might start.
Post Polio Litaff, Association A.C _APPLAC Mexico

Disease can break a lot of people. As a new film by Ken Burns and an exclusive video clip show, it helped make Franklin Roosevelt


This much is painfully certain too: somehow, the virus that inhabited the boy found its way to the man, settling first in his mucus membranes, and later in his gut and lymph system, where it multiplied explosively, finally migrating to the anterior horn cells of his spinal cord. On the evening of August 10, a feverish Roosevelt climbed into bed in his summer cottage on Campobello Island in Canada’s Bay of Fundy. It was the last time he would ever stand unassisted again.
Roosevelt’s polio, which struck him down just as his political star was rising, was supposed to be the end of him. The fact that it wasn’t is a self-evident matter of history. Just why it wasn’t has been the subject of unending study by historians and other academics for generations. This year, Roosevelt and his polio are getting a fresh look—for a few reasons.
October 28 will be the 100th birthday of Jonas Salk, whose work developing the first polio vaccine was backed by the March of Dimes, which was then known as the National Foundation for Infantile Paralysis and which itself grew out of the annual President’s Birthday Balls, nationwide events to raise funds for polio research, the first of which was held on FDR’s 52nd birthday, on January 30, 1934, early in his presidency. That initial birthday ball raised a then-unimaginable $1 million in a single evening, a sum so staggering Roosevelt took to the radio that night to thank the nation.
“As the representative of hundreds of thousands of crippled children,” he said, “I accept this tribute. I thank you and bid you goodnight on what to me is the happiest birthday I have ever known.”
This year too marks one more step in what is the hoped-for end game for the poliovirus, as field-workers from the World Health Organization, Rotary International, UNICEF and others work to vaccinate the disease into extinction, focusing their efforts particularly on Pakistan, one of only three countries in the world where polio remains endemic.
Then too there is the much-anticipated, 14-hr. Ken Burns film, The Roosevelts: An Intimate History, which begins airing on Sept. 14. It is by no means the first Roosevelt documentary, but it is the first to gather together all three legendary Roosevelts—Franklin, Theodore and Eleanor—and explore them as historical co-equals. It’s the segments about FDR and his polio that are perhaps the most moving, however—and certainly the most surprising, saying what they do about the genteel way a presidential disability was treated by the media and by other politicians in an era so very different from our own.
“We think we’re better today because we know so much more,” Burns told TIME in a recent conversation. “But FDR couldn’t have gotten out of the Iowa caucuses because of his infirmity. CNN and Fox would have been vying for shots of him sweating and looking uncomfortable in those braces.”
That’s not a hard tableau to imagine—the competing cameras and multiple angles, shown live and streamed wide. And what Americans would have seen would not have been pretty, because never mind how jolly Roosevelt tried to appear, his life involved far, far more pain and struggle than the public ever knew, as a special feature from the film, titled “Able-Bodied,” makes clear. That segment, which is not part of the broadcast and is included only on the film’s DVD and Blu-Ray versions, which are being released almost contemporaneously with the film, was made available exclusively to TIME (top).
Concealing—or at least minimizing—the president’s paralysis was nothing short of subterfuge, the kind of popular manipulation that wouldn’t be countenanced today. But it’s worth considering what would have been lost by exposing the masquerade that allowed FDR to achieve and hold onto power. Roosevelt, as the Burns film makes clear, was a man whose ambition and native brilliance far exceeded his focus and patience. It was a restlessness that afflicted cousin Teddy too, causing him to make sometimes impulsive decisions, like pledging in 1904 that he wouldn’t run again in 1908—an act he regretted for the rest of his life and tried to undo with his failed third-party presidential bid in 1912.
“Who knows what would have happened if Teddy had had the great crises Franklin had—the Depression and World War II?” Burns says. “I do know he was unstable and always had to be in motion. It fell to FDR, who could not move, to figure out a way to outrun his demons.”
George Will, in an artful turn in the “Able-Bodied” clip, observes that when the steel went onto Roosevelt’s legs it also went into his soul. That may have been true in FDR’s case, but it’s true too that suffering is not ennobling for everyone. Some people are broken by it; some are embittered by it. As polio nears the end of its long and terrible run, the things FDR achieved despite—even partly because of—his affliction remain nothing short of remarkable.

Post Polio Litaff, Association A.C _APPLAC Mexico
EVALUATION OF A PATIENT WITH PARAPLEGIA poliomyelitis

Can PPS BE DIAGNOSIS WHIT A BLOOOD TEST?

Post Polio Syndrome

VDPV Vaccine

The Polio Crusade

THE POLIO CRUSADE IN AMERICAN EXPERIENCE A GOOD VIDEO THE STORY OF THE POLIO CRUSADE pays tribute to a time when Americans banded together to conquer a terrible disease. The medical breakthrough saved countless lives and had a pervasive impact on American philanthropy that ... Continue reading..http://www.pbs.org/wgbh/americanexperience/polio/

Erradicación de La poliomielitis

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