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Geography in the News: Polio Returns with Tenacity

By Neal Lineback and Mandy Lineback Gritzner, Geography in the NewsTM

Polio’s Tenacity a Constant Battle

Just as the eradication of the crippling polio disease seemed within reach, it is advancing again and new questions are rising. Ignorance of science and medicine by the general public, migration from war-torn regions and possibly a new strain of the virus are to blame.

The recent discovery in California and elsewhere of a mystery virus, perhaps somehow related to the polio virus, is perplexing scientists, although the symptoms appear milder and perhaps of less duration in victims. The virus called EV68 is an enterovirus belonging to the family of polio viruses. According to Time magazine (Mar. 10, 2014), 20 children have suffered polio-like symptoms in California in the past 18 months, with a dozen paralyzed in one or more limbs. Heath officials don’t know whether the EV68 is to blame, as these are apparently not full-blown polio cases, but it is certainly cause for worry.

Until the real poliovirus is contained in every country where there is a single case, the threat of an outbreak spreading to other countries remains a distinct possibility. Today, polio is endemic in three countries, Afghanistan, Nigeria and Pakistan. The term endemic means that the disease is imbedded in the population and is currently uncontrolled. With international travel into and out of these countries, the virus is hitching rides to West Africa and the Horn of Africa. Particularly threatened are the Central African Republic, Cote d’Ivoire, Kenya, Liberia, Mali, Niger, Somalia and Uganda, according to the World Health Organization (WHO).

gitn_1204_polio
Map by Maps.com and Geography in the News. Permission granted to print by Maps.com.
Boundaries and names shown do not necessarily reflect the map policy of the National Geographic Society.

Polio is a terrible childhood disease that was on track to be eradicated by January 2005. The virus suddenly escaped from Northern Nigeria, where health organizations did their best to contain and eradicate the disease. The resulting analysis tells an interesting, but tragic story involving cultural dominance, religious fanaticism and geographic diffusion.

For Americans growing up in the 1940s and 1950s, just the word polio brought fear to entire communities. The disease was highly contagious, but mostly children under age 5 contracted it, tragically leaving many of those with symptoms crippled for life.

The scientific community in Europe first identified poliomyelitis in 1789, but the disease dates back to antiquity. It was described as a childhood disease that affected the spinal cord, leading to paralysis. Its origin is unknown, but a major outbreak occurred in Europe in the early 1800s, followed by the first outbreak in the United States in 1843. A 1916 U.S. epidemic killed an estimated 6,000 people and left 27,000 more paralyzed.

During the next century, cases of the disease increased worldwide. During the 1950s, there were more than 20,000 polio victims each year in the United States alone. The disease peaked in 1952 with 52,000 American children diagnosed with the disease. Immunologists had determined that the disease was transmitted through personal contact and contaminated water, entering the victim by mouth. Without an antidote or a preventative, the best the medical community could do was to quickly isolate infected individuals and provide assistance to those incapacitated by the disease.

Almost as soon as children were diagnosed with any polio-like symptoms, including gastrointestinal stress, sore throat, leg pain, equilibrium difficulties, difficulty breathing and general malaise, they were quickly separated from their families and placed in isolation. The most severe cases, those so paralyzed they could not breathe on their own, were placed in iron lungs. These bulky machines provided the mechanical chest compression rhythm necessary for paralyzed patients to live. Many were destined to spend the remainder of their lives lying on their backs in their iron lungs.

Finally, in 1955, Dr. Jonas Salk developed a polio vaccine that turned the tide on the disease. While the last polio case in the United States was in 1979, other countries continued to suffer the disease. As recently as 1988, wild polio viruses were prevalent in South and Central America, Africa, Southern Europe and Asia. By 1991, however, a polio eradication program led by the Pan American Health Organization had eliminated polio in the Western Hemisphere.

Two vaccines have been used around the world to try to eliminate polio. The oral polio vaccine (OPV) is no longer recommended because it contains a live virus and can occasionally result in the patient contracting polio (about one in 2.4 million). The second is the inactivated poliovirus (IPV) vaccination, which does not carry a risk and is recommended by the Centers of Disease Control. IPV can provide permanent immunity.

Thanks to epidemiologists, polio was nearly eliminated in Africa by early 2004. But the mainly Muslim region of Northern Nigeria refused to participate in the vaccination of its children, wrongly fearing that there was a Western plot to infect them with HIV, the virus that causes AIDS. Not only did the polio virus resurface, but an outbreak spread in Northern Nigeria, currently diffusing geographically across northern Africa and southern Asia.

Polio is a disease difficult to contain, given the reluctance of societies, particularly in developing countries, to accept proven science. The WHO’s international travel and health guidelines recommend that all travelers to and from polio-infected areas be fully vaccinated against the disease well before travel.

How medical professionals can overcome cultural bias is a constant battle. The discovery of the EV68 virus in the U.S. population, however, presents a new concern.

And that is Geography in the NewsTM.

Sources: GITN #1204, Polio Returns with a Vengeance, Maps.com, June 21, 3013; GITN #749, An Awful Scourge: The Revival of Polio, Oct. 8, 2004; Time magazine, “Polio’s Scary Specter,” Mar. 10, 2014;  http://www.polioeradication.org/Infectedcountries.aspx: http://www.tradearabia.com/news/HEAL_236471.html

Co-authors are Neal Lineback, Appalachian State University Professor Emeritus of Geography, and Geographer Mandy Lineback Gritzner. University News Director Jane Nicholson serves as technical editor. Geography in the NewsTM  is solely owned and operated by Neal Lineback for the purpose of providing geographic education to readers worldwide.

Nearly 900 of the 1200, full-length weekly articles Geography in the News (with Spanish translations) are available in the K-12 online education resource Maps101.com, including maps and other supporting materials and critical thinking questions.

 

Comments

  1. George Camp
    New York, USA
    April 23, 3:29 pm

    I concur with Mr. Ayoub in that the clergy have been an important partner in Worldwide Polio Eradication Program. As a Polio Eradication volunteer in countries like Nigeria, Bangladesh, India and Pakistan, I have the highest regard for their continued help.
    What I do think has inhibited the process is politics. Politics in the sense where someone or an organization will withhold vaccines as a way of holding populations hostage to your ideals.
    Those wishing to assist Rotary and it’s partners eradicate polio can either contribute or spread the word about the next great accomplishment by the world.
    END POLIO NOW!
    http://www.endpolio.org/

  2. Thomas J Setter MD.
    Anthem,Az,
    April 22, 4:19 pm

    I have been involved in Rotary’s program since 1985.
    We have made and continue to make GOOD progress in eliminating Polio.
    2014 has been good so far.
    We will complete the Job by 2018 with all of your help.
    Thank You. End Polio Now

    • Neal Lineback
      April 24, 12:07 pm

      Indeed, Rotary International has been a prime mover of efforts to eradicate polio. As a former member myself, I have long been aware of this organization’s efforts. Good work!

  3. Ayoub M Ayoub
    Cairo-Egypt
    April 21, 4:49 pm

    May I add that Rotary International has led global efforts to contain and eradicate polio since 1986. This cost Rotarians more than $1.2billions until now. Moreover, Moslem clergy were used in Kano, Kaduna in Northern Nigeria and in Baluchistan, Pakistan to spearhead efforts to allay misconceptions about polio vaccine. This helped vaccination teams although they were recently targeted by terrorist extremists in Pakistan. Teams are now vaccinating Pakistani children under army protection. Contributions to Rotary efforts will enhance prospects for speedy eradication of polio from the world.