Polio Epidemic (Historical Epidemiology)

Background and History

What is Polio?

Background

• Polio is caused by the poliovirus (CDC, 2017)
• Polio is strictly a human virus that is spread through direct transmission (CDC, 2017)
• The virus lives in infected patient intestines and throat and is spread via the fecal oral route (CDC, 2017)
• Symptoms include nausea, tiredness, fever, sore throat, headache and stomach pain (CDC, 2017)
• Some patients develop neurological symptoms including meningitis, paralysis, and paresthesia (CDC, 2017)
• Diagnosis is made through blood testing (CDC, 2017)
• The best prevention of the polio virus is vaccination (CDC, 2017)

Epidemiological problem

Epidemiological Problem

• Merrill (2017) states "epidemiology is commonly referred to as the basic science or foundation of public health" (p. 2)
• Polio is no longer an epidemic in the US but is was in the 1900s
• From 1937-1997 polio infected more than 457,000 people in the U.S (Weeks, 2015)
• The summer time was considered polio season (Beaubien, 2012)
• "In 1952 alone, nearly 60,000 children were infected with the virus; thousands were paralyzed, and more than 3,000 died" (Beaubien 2012).
• Polio effected every socioeconomic group both rich and poor (Beaubien, 2012).
• The first polio epidemic started in Vermont in 1894 with 132 cases (Beaubien, 2012)
• The worst epidemic was in New York City in 1916 with more than 27,000 cases and 6,000 deaths (Beaubien, 2012)

Descriptive Statics

• Polio was a crippling disease in the US in the 1900s
• "During five US epidemics in the time period 1907-1912, most reported cases occurred in one- to five-year-olds, whereas during the 1950s the average age of contraction was 6 years" (Ochmann & Roser, 2017).
• The following graphs show polio deaths and statics on Polio in the US

Descriptive Statistics

Descriptive Analytic Stats

Descriptive Analytic Stats

• Polio during the 1900s was non-discriminate
• Our president Franklin D. Roosevelt fell victim to the virus 12 years before he became president (Beaubien, 2012)
• Children who were under the age of 10 were most likely to die from the disease (Hitchcock & Stuart, 2017).
• This presentation focuses on the US cases but the following will also show cases of Polio in the world

Causality

• Polio is strictly a human disease and spreads by the fecal-oral route (Ochmann & Roser, 2017)
• It is commonly found in areas of poor sanitation and areas with poor water filtration (Ochmann & Roser, 2017)
• It is also common in areas where people are living in close proximity which can explain why there was such a large outbreak of polio in New York City in 1916 (Ochmann & Roser, 2017)
• Before there was a sewage system, polio was rampant because people were more exposed to feces (Ochmann & Roser, 2017)
• It was also more common for polio to be contracted in the summer because children were out of school playing in open water and with other children causing the surge (Ochmann & Roser, 2017)
• The summer was also a time when uncooked food was prepared like watermelon that increased the risk of using unclean water (Ochmann & Roser, 2017)
• "For a while it was believed that cats or mosquitoes were spreading the virus which lead to the killing of more than 72,000 cats and the extensive spraying of the insecticide DDT, in a futile attempt to interrupt the transmission of the virus" (Ochmann & Roser, 2017)

Health Goals

• Polio was deemed eradicated in the Americas in 1994
• According to the World Health Organization (WHO) (2018) "polio does still exist, although polio cases have decreased by over 99% since 1988, from an estimated more than 350 000 cases to 22 reported cases in 2017. This reduction is the result of the global effort to eradicate the disease. Today, only 3 countries in the world have never stopped transmission of polio (Pakistan, Afghanistan and Nigeria)."
• "Economic modeling has found that the eradication of polio would save at least US$ 40–50 billion, mostly in low-income countries" (WHO, 2018)
• "Failure to eradicate polio from these last remaining strongholds could result in as many as 200 000 new cases every year, within 10 years, all over the world" (WHO, 2018).
• The goal of the CDC and WHO is to make the last few countries polio-free by increasing the number of vaccinations

Ethics

Anti-vaccination Movement

• The first is the anti-vaccination movement
• Some people choose not to vaccinate their children because they feel vaccines cause autism even though it is not scientifically insignificant
• These people place everyone at risk for the return of polio in the US

Ethics

Social Norms/Economics

• People in countries where polio is still prevalent do not accept vaccinations and are suspicious of healthcare workers (Global Eradication Initiative, 2018)
• Education is key to help people trust the healthcare team members
• People in the countries with polio have poor access to healthcare so may not be able to get the vaccine

Clinical Implications in Nursing

Nursing

• Nursing had a critical role during the polio epidemic in the US because they were the ones who were vaccinating the children
• After the epidemic of polio in New York City (NYC) in 1916, Lilian Wald a public health nurses turned her attention to the poor children that were affected by polio (Hitchcock & Stuart, 2017)
• Wald developed one of the first home-based care models for people with polio (Hitchcock & Stuart, 2017)
• Nurses were leaders in caring for the children after the diagnosed with polio
• Today it is important for nurses to continue to education the public on vaccination
• Nurses are the ones who are left in the room after the doctor leaves to explain the importance of vaccination

Problem Solving

• The focus of this Prezi was the historical polio epidemic but it is still present today
• The major goal of healthcare works should be to promote vaccination of all children against polio
• Education is also a key component to preventing the spread of polio to areas where it has been eradicated
• Increase in the amount of funding given to those who are working on the ground to prevent polio is also important
• The goal of the world should be to end polio by 2025
• There is such a small percentage of people who have polio still alive; therefore, we may seen it eradicated in our lifetime

American Museum of National History. (2018). Polio. Retrieved from https://www.amnh.org/explore/science-topics/disease-and-eradication/countdown-to-zero/polio.

Beaubien, J. (2012). Wiping Out Polio: How The U.S. Snuffed Out A Killer. National Public Radio. Retrieved from https://www.npr.org/sections/health-shots/2012/10/16/162670836/wiping-out-polio-how-the-u-s-snuffed-out-a-killer

Blue Horizon. (2016). Immunity Blood Tests. Retrieved from https://bloodtestslondon.com/test-categories/immunity-blood-testing-in-london

Centers for Disease Control and Prevention. (2017). Polio. Retrieved from https://www.cdc.gov/polio/

Centers for Disease Control and Prevention. (2017). Polio Elimination in the United States. Retrieved from https://www.cdc.gov/polio/

Collins, B. (2018). The Man in the Iron Lung. Minnesota Public Radio. Retrieved from https://blogs.mprnews.org/newscut/2018/05/the-man-in-the-iron-lung/

Global Eradication Initiative. (2018). Polio. Retrieved from http://polioeradication.org/news-post/the-journey-of-a-stool-sample-understanding-polio-surveillance/

Hitchcock, L. I., & Stuart, P. H. (2017). Pioneering Health Care for Children with Disabilities: Untold Legacy of the 1916 Polio Epidemic in the United States. Journal of Community Practice, 25(1), 90–111. https://doi-org.ezproxy.neu.edu/10.1080/10705422.2016.1269249

International Centre for Polio Education. (2009). Polio Vaccination. Retrieved from http://www.postpolioinfo.com/vaccination.php

Kling, M. (2014). IN MEMORIAM: DONALD ANDERSON, FIRST POSTER CHILD, 1940-2014. March of Dimes. Retireved from https://www.marchofdimes.org/news/in-memoriam-donald-anderson-first-poster-child-1940-2014.aspx

Merrill, R. M. (2017). Introduction to epidemiology (7th ed.). Burlington, MA: Jones & Bartlett Learning.

Ochmann, S. & Roser, M. (2017). Polio. Our World in Data. Retrieved from https://ourworldindata.org/polio

ProCon. (2017) Polio Cases, Deaths, and Vaccination Rates. Retrieved from https://vaccines.procon.org/view.additional-resource.php?resourceID=005964

The History of Vaccines. (2018). NYC Polio Epidemic. Retrieved from https://www.historyofvaccines.org/content/new-york-city-polio-epidemic

VacciNews. (2013). The antivaccine movement. Retrieved from http://www.vaccinews.net/2013/04/the-anti-vaxxers/

Weeks, L. (2015). Defeating Polio, The Disease That Paralyzed America. National Public Radio. Retrieved from https://www.npr.org/sections/npr-history-dept/2015/04/10/398515228/defeating-the-disease-that-paralyzed-america

World Health Organization. (2018). Poliomyelitis. Retrieved from http://www.who.int/en/news-room/fact-sheets/detail/poliomyelitis

References