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Letter: The Contribution of Poliomyelitis to President Roosevelt’s Heart Failure. A Lesson on the Importance of Vaccinations for Cardiovascular Prevention | High Blood Pressure & Cardiovascular Prevention.

[Pay to View Full Text] [First Online: 19 November 2018]

Franklin Delano Roosevelt (1882–1945, Fig.  1), 32nd President of the United States of America, is remembered as one of the key leaders of the Allies in their struggle against the Axis Powers in WW2. A brilliant politician, he managed to restore America’s economic power and prosperity following the Great Depression through his New Deal (1933–1937). Despite his political and military success, his life had been crippled by physical disability since the summer of 1921 when, aged 39, he was diagnosed with a paralytic illness gripping his lower limbs up to the thigh, forcing him onto a wheelchair.

Fig. 1


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Afghanistan redoubling efforts to eradicate polio once and for all | GPEI.

[23/11/2018]

Afghanistan aims to reach the most vulnerable in Southern and Eastern provinces.

A frontline worker is vaccinating a child against polio.  WHO Afghanistan/R Akbar

In November, polio vaccination teams across Afghanistan targeted 5.3 million children under the age of five in high-risk provinces. The vaccination campaign came on the heels of several newly reported cases.  Afghanistan has 19 documented cases of wild poliovirus in 2018, as of November. Confirmation of even one polio case anywhere signals remaining vaccination coverage gaps which must be filled to achieve eradication.

The targeted vaccination campaign took place from 5-9 November, and with support across the board from healthcare workers, communities, religious clerics, and the government. “The Ministry of Public Health and health partners are committed to ending this disease,” said Dr. Ferozuddin Feroz, Minister of Public Health.

Afghanistan is one of the three remaining endemic countries in the world along with Pakistan and Nigeria. The endemic countries are intensifying their efforts by making sure they fully implement the strategies in their national polio emergency action plans.

Read more about the details of Afghanistan’s vaccination campaign here.

Related Resources


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Precise tracking of vaccine-responding T cell clones reveals convergent and personalized response in identical twins | PNAS.

[Open Access] [Received for review June 5, 2018; approved October 17, 2018; published ahead of print November 20, 2018]

Significance.

T cells play a key role in the adaptive immune system. The broad repertoire of unique receptors expressed by T cells is in principle able to recognize a huge diversity of pathogens, but how to extract that information from blood samples remains unclear. By sequencing and analyzing the statistics of T cell receptors of subjects vaccinated against yellow fever, we identified vaccine-specific receptors that expanded following vaccination. We show that each individual has a unique response, which is similar yet across subjects in its sequence composition, with a slightly higher similarity between twins. Our method can be used in the clinic to track disease-specific T cell clones expanding or contracting after infection, vaccination, or therapy.

Abstract.

T cell receptor (TCR) repertoire data contain information about infections that could be used in disease diagnostics and vaccine development, but extracting that information remains a major challenge. Here we developed a statistical framework to detect TCR clone proliferation and contraction from longitudinal repertoire data. We applied this framework to data from three pairs of identical twins immunized with the yellow fever vaccine. We identified 600 to 1,700 responding TCRs in each donor and validated them using three independent assays. While the responding TCRs were mostly private, albeit with higher overlap between twins, they could be well-predicted using a classifier based on sequence similarity. Our method can also be applied to samples obtained postinfection, making it suitable for systematic discovery of new infection-specific TCRs in the clinic.


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CDC launches job pressure for polio-like illness as MORE circumstances emerge | Infosurhoy.

[NOVEMBER 23, 2018]

Marta Subat writes:

Another 16 children have contracted the rare polio-like disease, acute flaccid myelitis (AFM) – bringing the total number of confirmed cases this year to 109 across 29 states, the CDC has revealed.

Another 167 children are showing tell-tale symptoms of the mysterious illness which has emerged as a major public health threat every other year since 2014.  

It seems to be caused by a combination of viruses but this year, the third time AFM has surged, the CDC is still struggling to identify exactly how and why it takes hold. 

As such, the agency today formed a task force designed to investigate the driving forces and possible treatments of AFM, and to establish what post-AFM life looks like for sufferers.   

‘I want to reaffirm to parents, patients, and our Nation CDC’s commitment to this serious medical condition,’ said CDC Director Robert R. Redfield, MD.

‘This Task Force will ensure that the full capacity of the scientific community is engaged and working together to provide important answers and solutions to actively detect, more effectively treat, and ultimately prevent AFM and its consequences.’  

AFM is not new, but cases have been on the rise since 2014.

Though the condition remains very rare – affecting only one in a million people in the United States – CDC director Dr Robert Redfield, who took the job in March this year, says it is the agency’s top priority.  

Scientists are investigating a number of causes, including viruses, environmental toxins and genetic disorders.

In previous outbreaks, a virus called EV-D68 was implicated in the development of AFM. 

‘We know that EV-D68 – as well as other enteroviruses – can cause limb weakness, but we don’t know what’s triggering AFM in these patients,’ said Dr Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases last week.

‘We want to take advantage of all of [our]resources to figure out what is causing AFM.’  

She said that the presence of pathogens in the spinal fluid is among the best indicators of AFM – but that doesn’t mean the pathogens are the cause, per se. 

‘It could be one of the viruses we’ve detected, or it could a virus we haven’t detectred, or it could be that [viruses are]kicking off another process’ – such as an autoimmune disease or response – ‘that is triggering AFM,’ Dr Messonnier said. 

It’s unlikely that the disease is transmissible from human to human, and some children recover from their paralysis, though others never do.     

Earlier today, the parents of two children who died of AFM earlier this year after their 2016 diagnoses told CNN they were outraged that that the CDC was not ‘counting’ their children’s deaths.  

Hours later, several reporters on the CDC telebriefing reiterated questions about deaths this year to Dr Messonnier. 

She said that no deaths had occurred linked to the 2018 outbreak. 

But she did acknowledge that’we have not been following every single AFM patient’ diagnosed in previous years,’ she said. 

‘It’s a gap in our understanding. We don’t understand the long-term effects’ but now she says the agency intends to ‘follow-up with patients that have gotten [AFM] in previous years.’  

The average age of those affected is four years old and more than 90 percent of cases overall are in children under 18.

The condition, caused by a viral infection, appears to start off as a common cold, before progressing to paralysis.  

Ominously, data show there seems to be a spike in cases every two years, which has also left the agency baffled.  

‘CDC’s been working very hard on this, since 2014, to try to understand causation and etiology,’ Dr Redfield said in the interview, which will be aired on Tuesday. 

‘As we sit here today, we don’t have understanding of the cause. We are, you know, continuing to strengthen our efforts, working in partnership with state and territorial health departments, and academic experts to try to figure this out.’ 

AFM is a rare, but serious condition that affects the nervous system. Specifically it attacks the area of the spinal cord called gray matter, which causes the body’s muscles and reflexes to weaken.

Symptoms often develop after a viral infection, such as enterovirus or West Nile virus, but often no clear cause is found.

Patients start off having flu-like symptoms including sneezing and coughing. This slowly turns into muscle weakness, difficulty moving the eyes and then polio-like symptoms including facial drooping and difficulty swallowing. 

‘If [AFM affects gray matter] lower in the spinal cord [paralysis will]be more in the legs and if it’s higher up, it’ll be more in the arms,’ Dr Fernando Acosta, a pediatric neurologist at Cook Children’s Medical Center, in Fort Worth, Texas, told Daily Mail Online in an interview last week.

‘Or if it’s closer to the neck, they can’t move head, neck and shoulders. We had one case of that and that was just awful.’

In the most severe cases, respiratory failure can occur when the muscles that support breathing become weak.

In rare cases, AFM can cause neurological complications that could lead to death. 

‘It’s a pretty dramatic disease; children have a sudden onset of weakness,’ said Dr Messonier.

No specific treatment is available for AFM and interventions are generally recommended on a case-by-case basis. 

Children with weakness in their arms or legs may attend physical or occupational therapy.

However, physicians admit they are unaware of the long-term outcomes for those with AFM. 

The CDC does not track AFM in terms of its prevalence, but rather in outbreaks.

The agency has confirmed 386 cases since an outbreak in Colorado in August 2014, almost all of them in children.

The CDC confirmed 33 AFM cases in 2017, 149 cases in 2016, 22 cases in 2015, and 120 cases in August to December 2014.

Of the 62 cases diagnosed this year, it known that 24 have been in three states: 10 in Illinois, eight in Texas and six in Minnesota. 

‘We have not been able to find the cause of the majority of AFM cases…and we’re frustrated that we haven’t been able to identify the cause of illness,’ Dr Messonnier told reporters in a media call last week. 

The states Daily Mail Online is currently aware of with confirmed cases includes: Arizona, Colorado, Georgia, Illinois, Indiana, Iowa, Kentucky, Massachusetts, Minnesota, New Jersey, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Texas and Washington. 

A press officer for the CDC told Daily Mail Online last week that the agency would not be naming the additional states where cases have been confirmed due to ‘privacy issues’.

While the pattern of AFM most resembles an infectious disease, much remains unknown about the condition. 

Among the children infected is two-year-old Julia Payne from Chicago. She remained in the pediatric intensive care unit at Lurie Children’s Hospital for weeks on a respirator and using a feeding tube because she was unable to swallow.

She has since been discharged and transferred to Shirley Ryan AbilityLab, a rehabilitation center where she will face several weeks of physical therapy to regain strength and movement.

In Minnesota, four-year-old Orville Young was likely the earliest confirmed case in the state, according to the Star Tribune. 

Orville has been in physical therapy for the last month-and-a-half. His mobility and gait have not returned to normal, but his legs are mostly functional now. His right arm, thus far, is still paralyzed.

Fortunately many make a full or nearly full recovery of their movement as did five-year-old Elizabeth Storrie of Willow Park, Texas. 

She spent a month at Cook Children’s Hospital, in Fort Worth, on IV fluids and a feeding tube until her condition improved.

AFM has been called a polio-like illness due to its resemblance to the viral infection that impacted hundreds of thousands, particularly between the late 1940s and early 1950s. 

The CDC even states on its website that symptoms ‘have been most similar to complications of infection with certain viruses, including poliovirus, non-polio enteroviruses, adenoviruses, and West Nile virus’. 

Poliovirus is not the cause of any of the cases, but some cases have been linked to the enteroviruses EV-A71 and EV-D68, both of which are distant relatives of polio.

Some cases have also been linked to rhinovirus.

‘I’m not old enough to have seen a case of polio during my time in practice, but my colleagues who have say [AFM] is similar to what they saw back then,’ Dr Acosta said.

‘Is this a variant? Potentially, but we don’t know.’

In 1957, the US government approved the polio vaccine. After a nationwide campaign to get children immunized began, the numbers began falling drastically and, in 1979, polio was declared to be eradicated in the US.

This year, Afghanistan and Pakistan are the only two countries where cases of wild poliovirus have been confirmed – largely due to poor sanitation and low levels of vaccination coverage. 

However, global eradication is now at risk due to vaccine-derived poliovirus (VDPV) in five countries in Africa this year. 

Health experts say that this could result in silent transmission of both polio and AFM, because both can lead to paralysis if left undetected.

Anti-vaxxers have blamed childhood polio vaccines for the outbreak, despite physicians saying there is no evidence to suggest this is the case.

‘There is no evidence vaccines are causing this,’ said Dr Acosta.

‘And if we identify the agent that is causing it, the next step would be to develop a vaccine. It’s the same reason, we developed flu vaccines – to lessen the burden of disease.

‘The reason why you see lower rates of polio, whooping cough and other diseases is because we have vaccines that have made them very rare.’   

The CDC advises getting vaccinated against Poliovirus and West Nile Virus due to both being potential causes of AFM.

Health experts say this does not simply mean just staying up-to-date with vaccinations, but also minimizing exposure to mosquitoes.

Additionally, you can use warm water and soap to avoid getting sick and spreading germs. 

‘It’s a one-in-million chance to get this so it’s extremely unlikely your child will get this,’ said Dr Acosta.  

‘Even if they have sudden onset of weakness, AFM is unlikely to have caused it. It’s more likely to be a stroke. However, if your child develops it, bring them in and this gives them the best chance of survival.’


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Papua New Guinea: Polio campaign winds down on positive note | Post Courier.

[November 23, 2018]

Natalie Cholohei writes:

The fourth round polio vaccination campaign in Morobe province is slowly winding down with positive results, says provincial program adviser Micah Yawing.

The vaccination coverage has reached 95 per cent as of yesterday, but the number is expected to increase over the weekend.

Mr Yawing said they are waiting for other districts to send in their data to have confirmed statistics.

He said so far the total number of children vaccinated in this round stands at 216, 911 children throughout the province.

“Data is still coming in so we are expecting to reach 100 per cent or more by Friday or Saturday because some districts started late,” he said.

He said the delay in updating data at the emergency centre was due to some districts starting off the round four campaigns late.

“Bulolo started late while Menyamya had difficulty in rounding up children from the village in terms of geographical situations but their data is slowly coming in where we will update our data system,” he said.

Health teams in Bulolo, Menyamya including Lae district are doing mop up program to ensure no one child is missed out.

While waiting for some more data to come in from the districts, Mr Yawing said Morobe has done well with its coverage since round one till the final round.

He said this was true with no reports of additional confirmed polio cases after the other two cases were confirmed in round one and two vaccination campaigns.

“We had only three cases since July, one was the first case on the outbreak while the other two were from 4 Mile area and Markham district but after that we did not report any suspicious case nor confirmed addition case,” he said.

The provincial emergency operations centre will be releasing the total number of vaccinated children in round one to round four oral polio vaccination campaigns by next week as they plan to go into the 2019 health programs.


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Polio this week as of 20 November 2018 | GPEI.

  • Summary of new viruses this week: Afghanistan –five wild poliovirus type 1 (WPV1) positive environmental samples. Pakistan –one WPV1 positive environmental sample. Papua New Guinea – three cases of circulating vaccine-derived poliovirus type 1 (cVDPV1). DRC- one case of circulating vaccine-derived poliovirus type 2 (cVDPV2). Nigeria – two cases of cVDPV2. Somalia- two cVDPV2 positive environmental samples. See country sections [in source article] for more details.
  • The Islamic Advisory Group (IAG) for Polio Eradication concluded its fifth annual meeting in Jeddah, Saudi Arabia on 14 November 2018, reaffirming a renewed commitment to continue supporting the Global Polio Eradication Initiative, protecting children against all vaccine-preventable diseases and expanding its mandate to support other health priorities. The full meeting statement is available here.
  • Featured on www.polioeradication.org: Coffee with Polio Experts – Dr. Zubair Wadood, Senior Epidemiologist and Technical Expert WHO, talks about the remaining operational challenges when it comes to reaching every last child with polio vaccine

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