Mysterious polio-like illness striking down California children sounds like a scenario reminiscent of Hollywood medical disaster epic. This real-life medical mystery involves a polio-like malady that is definitely not polio but has been identified in a group of 25 diverse children, all in California, since the unknown illness first appeared in 2012. Preliminary reports are inconclusive but, since the children do not live in close proximity, doctors are at a loss to explain why these particular children have fallen prey to the condition.
This polio-like illness causes muscle weakness or outright paralysis of one or more limbs after a mild respiratory episode, along with other symptoms that indicate that the children have been exposed to something unusual, suggesting that a viral infection might be involved. So far, none of the children who have been infected with the disease have recovered from the paralysis.
Doctors are concerned about the polio-like illness demonstrated by the children who have the disorder because polio has been eradicated in the United States through a universal vaccination program against the dreaded childhood disease. The last known case of the disease in the United States was reported in 2005, when four children in a Minnesota Amish community were diagnosed with Poliomyelitis, none of whom became symptomatic. Doctors believe that group was infected by exposure to an oral polio vaccine from another country. This followed a previous outbreak in ‘recorded in 1979, affecting members of Amish communities in several different states who do not vaccinate their children.
The most troubling aspect of the recent cases is that the children don’t know each other and do not know people in common, making it very difficult for researchers to identify the disease vectors that are transmitting the illness. Unlike the earlier cases in the Amish community, the new cases do not involve overseas travel, nor did the children involved have any exposure to oral polio vaccines that were not manufactured in the United States
Poliomyelitis was once considered an urban scourge in the United States and around the world, with many families in the temperate zones leaving large urban areas each summer to avoid infection. Although it usually strikes children, adults are not immune to the condition. Franklin Delano Roosevelt was stricken with the disease as an adult and lost the use of his legs before becoming president. The four-term Democrat took great pains to conceal his disability during public appearances, to the point where news photographers honored an unwritten rule never to publish photographs of the president in his wheelchair. Everyone in a America knew that Roosevelt had polio, but Americans never saw visual evidence of the disease during his lifetime.
In warmer climates, the disease remains active year round and that may be a hint about what’s going on in California. The disease is primarily transmitted through the fecal-oral route, most commonly resulting when infected carriers fail to wash their hands properly after touching fecal matter….but the condition can also be transmitted by insects who pick up the infection from human fecal matter, or by oral contact with an infected person.
In recent years, increasingly negative attitudes toward vaccination have caused some parents to forego them entirely for their children, raising questions about whether the polio virus was ever actually eradicated rather than merely dormant. The current California drought, with its hot, dry, dusty weather, is a perfect environment for the incubation and transmission of the polio virus. In rare cases, the “attenuated” virus in the oral polio vaccine has been known to cause similar paralysis, but this occurs once in 750,000 cases, so it is extremely unlikely that the new illness will be traced back to the vaccines themselves. The wide age spread among the victims, who range from two to 16, also argues against vaccination as the source of the infection.
As dire as the disease’s reputation is, 90 percent of the patients who contract polio remain asymptomatic, and only 1 percent develop the characteristic symptoms of permanent muscle weakness and paralysis that are associated with the disease. Still endemic in tropical regions, it was eradicated in temperate zones such as the United States after the introduction of the Salk vaccine in 1952 and Sabin vaccine in 1962.
On Jan 13, 2014, India was declared polio-free by an international consortium that included the Indian government, Rotary Club International, the Global Polio Initiative and the Bill and Melinda Gates Foundation. However, persistent reports in the fringe media going back to 2012 claim that 47,500 cases of Acute Flaccid Paralysis (AFP) had appeared in India following the distribution the oral vaccine to more than 170 million Indian children by the consortium. The two statements are not mutually exclusive, because AFP is a different condition from poliomyelitis…but AFP bears a distinct resemblance to the unnamed illness in California.
The “patient zero” with this still unnamed illness is four year-old Sophia Jarvisk, who was admitted to Oakland’s Children’s Hospital in 2012 for respiratory problems that doctors initially identified as asthma. In Jarvisk’s case, the acute phase of the disease has run its course, but the nerve damage appears to be permanent, leaving the four year-old with paralytic arm and leg.
The fact that the infection has so far been confined to California is good news according to epidemiologists involved in the case, because the condition does not appear to be spreading. The bad news is that, since the children have not had direct contact with either other, doctors have no idea yet where it is coming from.
The publicity generated by the announcement of the condition will most likely result in the discovery of new cases, both in California and across the country but this is a case in which misery does not want company. The doctors involved in the case are hoping that they won’t see it spreading from California, but it is seems unlikely that the polio like illness, whatever it is, will remain confined to the Golden State.
By Alan M. Milner