Polio – a disease many have prematurely consigned to history – made headlines around the world in recent months when the virus was detected in relatively high-income country settings from New York, London, Montreal and Jerusalem. This apparent comeback in polio-free countries has left many questioning the feasibility of eradication. On the contrary, we have never been closer to achieving our goal of a polio-free world: this resurgence only underscores the urgent need for  eradication.

When the Global Polio Eradication Initiative (GPEI) was launched in 1988, nearly 1,000 children were being paralyzed with wild poliovirus (WPV) infection across 125 countries every single day. Since then, a concerted effort of health workers, communities, local governments, and global partners such as Rotary International have helped eradicate two of the three serotypes of wild poliovirus (WPV2 and WPV3) and cornered the remaining strain of WPV – type 1 (WPV1) – to small areas of Pakistan and Afghanistan – the last wild polio-endemic countries. The genetic diversity of the remaining chains of WPV1 is also on the decline, indicating the virus might very well be on the verge of being wiped out.

However, this incredible progress is in jeopardy. Due in part to the COVID-19 pandemic, the world has seen a worrying drop in immunization rates over the past few years, creating pockets of under-immunized communities at heightened risk of polio infection and paralysis. Children missing polio vaccinations creates opportunities for polio to re-emerge and spread – as seen in 2022 when WPV1 originating in Pakistan was detected in paralyzed children in Malawi and Mozambique. This episode served as a poignant reminder that as long as polio exists anywhere in the world, it remains a threat to people everywhere.”

Speaking of Medicine and Health (https://speakingofmedicine.plos.org/2023/03/17/why-is-polio-making-a-comeback-and-what-can-we-do-about-it/)

A virus is a small, infectious agent that is made up of a core of genetic material surrounded by a shell of protein. The genetic material (which is responsible for carrying forward hereditary traits from parent cells to offspring) may be either deoxyribonucleic acid (DNA) or ribonucleic acid (RNA). Viruses are at the borderline between living and nonliving matter. When they infect a host cell, they are able to carry on many life functions, such as metabolism and reproduction. But outside a host cell, they are as inactive as a grain of sand.

Viruses cause disease by infecting a host cell and taking over its biochemical functions. In order to produce new copies of itself, a virus must use the host cell’s reproductive “machinery.” The newly made viruses then leave the host cell, sometimes killing it in the process, and proceed to infect other cells within the organism.

Viruses can infect plants, bacteria, and animals. The tobacco mosaic virus, one of the most studied of all viruses, infects tobacco plants. Animal viruses cause a variety of diseases, including AIDS (acquired immuno deficiency syndrome), hepatitis, chicken pox, smallpox, polio, measles, rabies, the common cold, and some forms of cancer.

Viruses that affect bacteria are called bacteriophages, or simply phages (pronounced FAY-jez). Phages are of special importance due to the susceptibility of the viruse transmission. The disease Polio (poliomyelitis) in time will be transmitted throughout the bloodstream and the highly viral infectious disease is now spreading in the body.

Poliomyelitis (POLIO) is a viral disease. There are three types of poliovirus and many strains of each type. The virus enters through the mouth and multiplies in the throat and gastrointestinal tract, then moves into the bloodstream and is carried to the central nervous system where it replicates and destroys the motor neuron cells. Motor neurons control the muscles for swallowing, circulation, respiration, and the trunk, arms, and legs.

Human nerve cells have a protruding protein structure on their surface whose precise function is unknown. When poliovirus encounters the nerve cells, the protruding receptors attach to the virus particle, and infection begins. Once inside the cell, the virus hijacks the cell’s assembly process, and makes thousands of copies of itself in hours. The virus kills the cell and then spreads to infect other cells.

A virus is a small, infectious agent that is made up of a core of genetic material surrounded by a shell of protein. The genetic material (which is responsible for carrying forward hereditary traits from parent cells to offspring) may be either deoxyribonucleic acid (DNA) or ribonucleic acid (RNA). Viruses are at the borderline between living and nonliving matter. When they infect a host cell, they are able to carry on many life functions, such as metabolism and reproduction. But outside a host cell, they are as inactive as a grain of sand.

How polio is spread:

The virus enters through the mouth and multiplies in the throat and gastrointestinal tract, then moves into the bloodstream and is carried to the central nervous system where it replicates and destroys the motor neuron cells. Motor neurons control the muscles for swallowing, circulation, respiration, and the trunk, arms, and legs.

Human nerve cells have a protruding protein structure on their surface whose precise function is unknown. When poliovirus encounters the nerve cells, the protruding receptors attach to the virus particle, and infection begins. Once inside the cell, the virus hijacks the cell’s assembly process, and makes thousands of copies of itself in hours. The virus kills the cell and then spreads to infect other cells.

Polio is spread through person-to-person contact. When a child is infected with wild poliovirus, the virus enters the body through the mouth and multiplies in the intestine. It is then shed into the environment through the feces where it can spread rapidly through a community, especially in situations of poor hygiene and sanitation. If a sufficient number of children are fully immunized against polio, the virus is unable to find susceptible children to infect, and dies out. Young children who are not yet toilet-trained are a ready source of transmission, regardless of their environment. Polio can be spread when food or drink is contaminated by feces. There is also evidence that flies can passively transfer polio virus from feces to food. Most people infected with the poliovirus have no signs of illness and are never aware they have been infected. These people with no symptoms carry the virus in their intestines and can “silently” spread the infection to thousands of others before the first case of polio paralysis emerges. For this reason, WHO considers a single confirmed case of polio paralysis to be evidence of an epidemic – particularly in countries where very few cases occur.

The signs and symptoms of Polio:

Most people infected with the poliovirus have no signs of illness and are never aware they have been infected.

These symptomless people carry the virus in their intestines and can “silently” spread the infection to thousands of others before the first case of polio paralysis emerges. For this reason, WHO considers a single confirmed case of polio paralysis to be evidence of an epidemic – particularly in countries where very few cases occur.

Most infected people (90%) have no symptoms or very mild symptoms and usually go unrecognized. In others, initial symptoms include fever, headache, vomiting, stiffness in the neck and pain in the limbs.

Polio is a viral infection!!!

There are three types of poliovirus and many strains of each type.

There are three types of wild poliovirus (WPV):

Type 1, Type 2, and Type 3.

People must protect themselves against all three types of the virus to prevent polio disease.

Polio vaccination is the best protection.  There are two vaccines used to protect against polio disease: oral polio vaccine and inactivated poliovirus vaccine.

Type 2 wild poliovirus was declared eradicated in September 2015. The last detection was in India, 1999.

Type 3 wild poliovirus was declared eradicated in October 2019. It was last detected in November 2012. Only type 1 wild poliovirus remains.

Presently the CDC states “Type 2 wild poliovirus was declared eradicated in September 2015. The last detection was in India, 1999. Type 3 wild poliovirus was declared eradicated in October 2019. It was last detected in November 2012. Only type 1 wild poliovirus remains.”.

TYPES:

Acute flaccid paralysis (AFP): One in 200 infections leads to irreversible paralysis, usually in the legs. This is caused by the virus entering the blood stream and invading the central nervous system. As it multiplies, the virus destroys the nerve cells that activate muscles. The affected muscles are no longer functional and the limb becomes floppy and lifeless – a condition known AFP = Acute Flaccid Paralysis.

 Know all cases of AFP among children under fifteen years old are reported and tested for poliovirus within 48 hours of onset.

All cases of acute flaccid paralysis (AFP) among children under fifteen years of age are reported and tested for poliovirus within 48 hours of onset.

Bulbar polio:  More extensive paralysis, involving the trunk and muscles of the thorax and abdomen, can result in   quadriplegia. In the most severe cases (bulbar polio), poliovirus attacks the nerve cells of the brain stem, reducing breathing capacity and causing difficulty in swallowing and speaking. Among those paralysed, 5% to 10% die when their breathing muscles become immobilized.

Risk factors for paralysis

No one knows why only a small percentage of infections lead to paralysis. Several key risk factors have been identified as increasing the likelihood of paralysis in a person infected with polio. These include:

• immune deficiency

• pregnancy

• removal of the tonsils (tonsillectomy)

• intramuscular injections, e.g. medications

• strenuous exercise

• injury.

Treatment and prevention

There is no cure for polio, only treatment to alleviate the symptoms.  Heat and physical therapy is used to stimulate the muscles and antispasmodic drugs are given to relax the muscles. While this can improve mobility, it cannot unfortunately reverse permanent polio paralysis.

Polio can be prevented through immunization. Polio vaccine, given multiple times, almost always protects a child for life.

“The first identified cases of Pontiac fever occurred in 1968 in Pontiac, Michigan, among people who worked at and visited the city’s health department.   The several workers at the county’s department of health came down with a fever and mild flu symptoms, but not pneumonia.  It wasn’t until Legionella was discovered after the 1976 Legionnaires’ disease outbreak in Philadelphia that public health officials were able to show that Legionella causes both diseases. The number of cases reported to CDC has been on the rise since 2000. Health departments reported nearly 10,000 cases of Legionnaires’ disease in the United States in 2018. However, because Legionnaires’ disease is likely underdiagnosed, this number may underestimate the true incidence. A recent study estimated that the true number of Legionnaires’ disease cases may be 1.8–2.7 times higher than what is reported.² More illness is usually found in the summer and early fall, but it can happen any time of year.”

Center for Disease Control and Prevention – CDC (https://www.cdc.gov/legionella/about/history.html)

Legionnaires’ disease and Pontiac fever outbreaks occur when two or more people are exposed to Legionella in the same place and get sick at about the same time!  Outbreaks are commonly associated with buildings or structures that have complex water systems, like hotels and resorts, long-term care facilities, hospitals, and cruise ships. These are high population environments

These structural places use water shared with other people from the main water line.  Examples apartment buildings, hospitals, cruise ships, etc…  The most likely sources of infection include water used for showering, hot tubs, decorative fountains, and cooling towers (structures that contain water and a fan as part of centralized air cooling systems for a building or industrial processes).

Legionnaires’ disease and Pontiac fever outbreaks can be difficult to identify. Sometimes people travel to a common location, are exposed to Legionella, and then return home before becoming sick. State, territorial, and local health departments take the lead in investigating outbreaks. They also identify control measures to remove Legionella from the water identified as the source of infection. CDC is only involved in outbreak investigations when a health department requests additional assistance. 

On July 17, 2015, the Bureau of Communicable Disease of the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) detected an abnormal number and distribution of Legionnaires’ disease (LD) cases in the South Bronx. This cluster of cases would eventually grow into the largest outbreak of LD in NYC history.

PBS.org states that “New York City is facing the largest outbreak of Legionnaires’ disease in its history.

The airborne respiratory disease has killed 10 people since early July, with 100 cases reported. So far, it’s been limited to the city’s South Bronx neighborhood.”  So it is in contained area.

NYC.gov documents the following “In 2017, most Legionnaires’ disease cases (26%) occurred in Queens; however, the Bronx had the highest rate (7.0 cases per 100,000 people).”  So remember this is not new and at least yearly checked upon situation to prevent epidemics.  No panic is needed.

The CDC states today regarding the most recent information about Legionnaires is the following:

Legionella can cause Legionnaires’ disease and Pontiac fever, collectively known as legionellosis.

Scientists named the bacteria after an outbreak in Philadelphia in 1976. During that outbreak, many people who went to an American Legion convention got sick with pneumonia (lung infection).

Health departments reported nearly 10,000 cases of Legionnaires’ disease in the United States in 2018.¹ However, because Legionnaires’ disease is likely underdiagnosed, this number may underestimate the true incidence. A recent study estimated that the true number of Legionnaires’ disease cases may be 1.8–2.7 times higher than what is reported.²

About one in 10 people who gets sick from Legionnaires’ disease will die.^2,3

People can get Legionnaires’ disease or Pontiac fever when they breathe in small droplets of water in the air that contain Legionella.

In general, people do not spread Legionnaires’ disease to other people. However, this may be possible under rare circumstances.^3,4

Legionella occurs naturally in freshwater environments, like lakes and streams. It can become a health concern when it grows and spreads in human-made building water systems.”

(https://www.cdc.gov/legionella/fastfacts.html)

updated 11/21/2023 by Strive for Good Health

“Legionnaires’ disease is a multisystem disease which causes pneumonia due to gram-negative bacteria (Legionella spp.) found in freshwater environments around the world. Humans are infected by inhalation of aerosols containing Legionella. The infection can be fatal and outbreaks from a common environmental source can occur. Cases of Legionnaires’ disease are mainly reported in persons in older age groups, especially in males.  Legionellosis is an uncommon form of pneumonia. The disease has no particular clinical features that clearly distinguish it from other types of pneumonia, and laboratory investigations must be carried out to confirm the diagnosis. It normally takes between two to ten days to develop symptoms (typically five to six days) but very rarely some cases may take two to three weeks to develop symptoms.”

European Centre for Disease and Control (https://www.ecdc.europa.eu/en/legionnaires-disease/facts)

Who to Test for Legionnaires’ Disease:

·Patients who have failed outpatient antibiotic therapy

·Patients with severe pneumonia, in particular those requiring intensive care

·Immuno-compromised host with pneumonia

·Patients with pneumonia in the setting of a legionellosis outbreak

·Patients with a travel history [Patients that have traveled away from their home within two weeks before the onset of illness.]

·Patients suspected of healthcare-associated pneumonia

Diagnostic Tests done in checking for illness or infection of the lungs, in general:

Legionnaires’ disease is similar to other types of pneumonia. To help identify the presence of legionella bacteria quickly, your doctor may use a test that checks your urine for legionella antigens — foreign substances that trigger an immune system response. You may also have one or more of the following:

·Blood tests

·Chest X-ray, which doesn’t confirm Legionnaires’ disease but can show the extent of infection in your lungs

·Tests on a sample of your sputum or lung tissue

·A CT scan of your brain or a spinal tap (lumbar puncture) if you have neurological symptoms such as confusion or trouble concentrating.

How to test in particular for Legionnaires’ Disease Only:

·Urinary antigen assay & culture of respiratory secretions on selective media are the preferred diagnostic tests for Legionnaires’ disease

·Sensitivity varies depending on the quality and timing of specimen collection as well as technical skill of the laboratory performing the test.

TREATMENT:

·Legionnaires’ disease is treated with antibiotics. The sooner therapy is started, the less likely the chance of serious complications or death. In many cases, treatment requires hospitalization. Pontiac fever goes away on its own without treatment and causes no lingering problems.

LASTLY about “outbreaks of Legionnaire’s disease” are preventable, but prevention requires meticulous cleaning and disinfection of water systems, pools and spas.

Avoiding smoking is the single most important thing you can do to lower your risk of infection. Smoking increases the chances that you’ll develop Legionnaires’ disease if you’re exposed to legionella bacteria.

“Few people have heard of Pontiac fever, and yet most are aware of Legionnaires’ disease. It is intriguing therefore to discover that both illnesses are triggered by the same bacterium… called legionella. Pontiac fever is far milder and much less serious than Legionnaires’ disease. Indeed it may be possible for someone to contract Pontiac fever and assume they simply have the flu, since both present with very similar symptoms.  The main difference is pneumonia. Sufferers of Legionnaires’ disease will probably contract pneumonia and are therefore likely to require hospital treatment in order to make a successful recovery. This is why Legionnaires’ is more serious than Pontiac fever, which doesn’t present with this additional illness.  It is good to know that Pontiac fever is not as serious as Legionnaires’ disease. However it is still wise to identify it if at all possible. It may point to an outbreak of Legionnaires’ that could help others get more urgent treatment as a result.”

Legionella Control (https://legionellacontrol.com/legionella/pontiac-fever-legionnaires-disease/)

“Refrigerate perishable items within two hours of coming out of the oven or refrigerator. After two hours, perishable food enters the “Danger Zone” (between 40 F and 140 F), where bacteria can multiply quickly and cause food to become unsafe. Perishable food should be discarded if left out for longer than two hours, so refrigerate or freeze items to prevent food waste  .Use the Monday after Thanksgiving as a reminder that it is the last day you can safely eat leftovers. If you want to keep leftovers longer, freeze them within that four-day period. Frozen food stays safe indefinitely, though the quality may decrease over time (best quality if eaten within six months.  Make sure your reheated leftovers reach 165 F as measured with a food thermometer. Reheat sauces, soups and gravies safely by bringing them to a rolling boil.  When reheating in the microwave, cover and rotate the food for even heating. Arrange food items evenly in a covered microwave safe glass or ceramic dish and add some liquid, if needed. Because microwaves have cold spots, check the internal temperature of the food in several places with a food thermometer after allowing a resting time.”

The U.S. Department of Agriculture (https://www.usda.gov/media/blog/2021/11/22/leftovers-lets-keep-best-part-thanksgiving-safe)