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Webinar: Plagues, neurology, and rehabilitation: polio | The Hippocratic Post.

Plagues, neurology, and rehabilitation: The history of polio epidemics and how COVID-19 will affect approaches to rehabilitation:

Date and time: Tue 5 Jan 2021 from 6:00pm to 7:00pm, online webinar.

Infections affect the nervous system in very different ways giving neuroscience a constant stream of new problems to solve. Robin Howard, Consultant Neurologist at the National Hospital for Neurology and St Thomas’ Hospital, will speak on the history of polio and how it set off a series of novel management technology and strategies. These are now part of our normal panoply of interventions in both epidemics and neuro-disability. Catherine Dalton, Consultant Neuro-rehabilitation at St George’s Hospital, will consider what new issues we are seeing in patients after COVID-19 and what adaptation services are currently making. Key speakers will also discuss how this may play out with future innovations.

During this webinar delegates will:

  • Learn about the history of polio
  • See how the physical and respiratory problems required new approaches
  • Understand why the population (in terms of numbers and ages) affected led to innovations in rehabilitation delivery
  • Understand what problems COVID-19 is bringing to rehabilitation services now
  • Consider how services need to develop to face this new challenge

See source article for Programme details.

Tickets can be booked at https://www.rsm.ac.uk/events/clinical-neurosciences/2020-21/cnp53/


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Brandt's Rants Parallels of the COVID-19 and Polio Epidemics | Emergency Medicine News.

[Emergency Medicine News: September 2020 - Volume 42 - Issue 9 - p 14]


Sometimes when I find out a patient works in the medical field, I have to take a deep cleansing breath before seeing him. Doctors, nurses, and techs, well, we often make terrible patients. Sometimes the patient only tangentially works in health care, but feels entitled to some special privileges. The following is only a minimally stretched truth.

Patient: “Yeah, my sister's step-cousin works for NASA in their space nursing program, so I'm pretty sure I know what is going on. It's obviously scurvy. I did my research. SCUR-VY!”

Me: “Your sister's step-cousin?”

Patient: “I did my research. I've learned a few things.”

Me: “Didn't you come here for constipation? Why do you think it's scurvy?”

Patient: “Yar! Do I be needin' to be talkin' this way now?”

Me: “Yes, yes, you do. That's how we treat scurvy and constipation. Take some of ye ol' MiraLAX and mag citrate, and be ready for yer keelhaulin'.”

Some clinical encounters with health care workers, however, teach me a great deal. When I found out that my 91-year-old quick-witted patient had been a nurse for several decades, I had to ask her about her experiences. Grace came to the ED for her chest pain and ultimately required admission. Lucky for me, the shift allowed a little extra time to spend with her, and she proceeded to drop wisdom bomb after wisdom bomb on my brain.

As with many patients currently, our conversation drifted toward the pandemic. Grace said she started her nursing career in 1950 on the East Coast during another epidemic—polio. I knew a little about it, but Grace taught me more. In Latin, the word doctor means to teach. Occasionally, I come out of a patient's room realizing that I was the student.

Don't Give Up Hope.

“The similarities are quite disheartening,” Grace said. “Most people were scared out of their minds and rightfully so. Nobody wanted to go outside. All of the beaches were closed, the pools were closed, and all the movie theaters were closed. Day after day, I'd go into work and inspect all of the iron lungs to make sure none of them had any leaks or problems with the bellows. In a giant room, you would see contraptions lined up one next to another next to another. A whole room just full of them. The only thing you would see would be a head sticking out of the top of these things.

“You'd think that would be the worst part of the disease. It wasn't. Polio was like two separate diseases. One type made it so you couldn't breathe, one would make you lame. It was really hard as a nurse walking down the pediatric wards. We'd see all these kids, babies really, and they'd be moving around except they wouldn't be moving one leg, and we'd know that kid had a long road ahead of her.

“And some people then, just like now, would ignore health care. They'd ignore people trying to help them. They'd ignore advice from people who worked the front lines and saw the terrible tragedy day after day. I had friends, close friends, who would not follow advice.

“But we never gave up hope. We knew people were working on it. The March of Dimes and a whole lot of people were working hard. Hope, even after seeing that, kept us going.

“I still remember the day. It was April 12, 1955, when the vaccine came out. I cried. Five years I'd been a nurse dealing with lame patients and rooms full of people in iron lungs. Then, like that, we had a way to stop it. I just cried.”

When I left the room, I saw so many similarities between the epidemic then and our situation now. Then and now we have misinformation. Then and now we have many in the public who refuse to listen to advice from the medical community. Especially now it seems that people are unwilling to accept a minor inconvenience (wearing a mask) to benefit people other than themselves.

But then and now we have hope.

She never gave up hope.

We should not give up hope.

Yes, this is awful, but there will be an end.

Stay safe. Stay strong. Stay together. Don't give up hope.

Share this article on Twitter and Facebook.

Access the links in EMN by reading this on our website, www.EM-News.com.

Comments? Write to us at emn@lww.com.

Dr. Brandtis an emergency physician with the Grand River Emergency Medical Group in Grand Rapids, MI. He was the winner of the 2008 Writer's Digest Short Short Story Writing Competition (http://bit.ly/1kIBaOf). Read his blog and other articles athttp://brandtwriting.comfollow him on Twitter@brandtwritingand read his past columns athttp://bit.ly/EMN-BrandtsRants.


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Safety and immunogenicity of two novel type 2 oral poliovirus vaccine candidates compared with a monovalent type 2 oral poliovirus vaccine in children and infants: two clinical trials | The Lancet.

[Open Access] [Published: December 09, 2020]

Summary.

Background.

Continued emergence and spread of circulating vaccine-derived type 2 polioviruses and vaccine-associated paralytic poliomyelitis from Sabin oral poliovirus vaccines (OPVs) has stimulated development of two novel type 2 OPV candidates (OPV2-c1 and OPV2-c2) designed to have similar immunogenicity, improved genetic stability, and less potential to reacquire neurovirulence. We aimed to assess safety and immunogenicity of the two novel OPV candidates compared with a monovalent Sabin OPV in children and infants.

Methods.

We did two single-centre, multi-site, partly-masked, randomised trials in healthy cohorts of children (aged 1–4 years) and infants (aged 18–22 weeks) in Panama: a control phase 4 study with monovalent Sabin OPV2 before global cessation of monovalent OPV2 use, and a phase 2 study with low and high doses of two novel OPV2 candidates. All participants received one OPV2 vaccination and subsets received two doses 28 days apart. Parents reported solicited and unsolicited adverse events. Type 2 poliovirus neutralising antibodies were measured at days 0, 7, 28, and 56, and stool viral shedding was assessed up to 28 days post-vaccination. Primary objectives were to assess safety in all participants and non-inferiority of novel OPV2 day 28 seroprotection versus monovalent OPV2 in infants (non-inferiority margin 10%). These studies were registered with ClinicalTrials.govNCT02521974 and NCT03554798.

Findings.

The control study took place between Oct 23, 2015, and April 29, 2016, and the subsequent phase 2 study between Sept 19, 2018, and Sept 30, 2019. 150 children (50 in the control study and 100 of 129 assessed for eligibility in the novel OPV2 study) and 684 infants (110 of 114 assessed for eligibility in the control study and 574 of 684 assessed for eligibility in the novel OPV2 study) were enrolled and received at least one study vaccination. Vaccinations were safe and well tolerated with no causally associated serious adverse events or important medical events in any group. Solicited and unsolicited adverse events were overwhelmingly mild or moderate irrespective of vaccine or dose. Nearly all children were seroprotected at baseline, indicating high baseline immunity. In children, the seroprotection rate 28 days after one dose was 100% for monovalent OPV2 and both novel OPV2 candidates. In infants at day 28, 91 (94% [95% CI 87–98]) of 97 were seroprotected after receiving monovalent OPV2, 134 (94% [88–97]) of 143 after high-dose novel OPV2-c1, 122 (93% [87–97]) of 131 after low-dose novel OPV2-c1, 138 (95% [90–98]) of 146 after high-dose novel OPV2-c2, and 115 (91% [84–95]) of 127 after low-dose novel OPV2-c2. Non-inferiority was shown for low-dose and high-dose novel OPV2-c1 and high-dose novel OPV2-c2 despite monovalent OPV2 recipients having higher baseline immunity.

Interpretation.

Both novel OPV2 candidates were safe, well tolerated, and immunogenic in children and infants. Novel OPV2 could be an important addition to our resources against poliovirus given the current epidemiological situation.

Funding.

Fighting Infectious Diseases in Emerging Countries and Bill & Melinda Gates Foundation.

Original Source Article »

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