I Have Not Been a Consistent Blogger, Also Let’s Talk About Polio

I have been a very slack blogger lately. I’ve just realised that it’s actually been three months since I’ve blogged. Given that my blog is generally my soapbox, I was asking myself why I haven’t put fingertips to keyboard for three months.

The answer is that I have put fingertips to keyboard, just not in the context of my blog.

I have definitely felt the need to vent (this is where I usually do it), but have been quite ‘fatigued’ I think is the word. Perhaps it’s pandemic fatigue. Perhaps it’s Covid fatigue (which I had a month ago), and has been very slow to dissipate.

But here I am, back putting words together on my blog.

On May the 20th, Dark Days was released. It’s book 2 of my current fantasy series, The Chronicles of Albatar. We had a great, live, release, and a lovely function down at Double Picc, our favourite local cafe. You can find the release, here, on my facebook page. Thanks to all my readers!

Then I was scheduled to have toe surgery on the 15th of July, only to be foiled by testing positive to Covid on the 11th, despite our best efforts to stay Covid free. Fortunately, (thank you vaccines), both my husband and I were only mildly unwell, but it has taken the best part of a month to get past the next level fatigue. Toe surgery is now rescheduled for the 9th of September.

And what’s on my mind now? In the last few weeks, I’ve read articles about the sudden reappearance of polio in both London and New York, with some dismay.

In my day job, as a physiotherapist, I occasionally still see a polio victim, usually when I’m seeing them for something else. Due to vaccination, Australia has been free of polio for decades. The youngest polio victims are generally now in their seventies. Those I see, generally have weakness, or a smaller limb.

You can read about the polio threat here and here. Because I then read the social media comments from people who clearly either didn’t read, or understand, the articles I’ve referenced, I thought I’d take the time to demystify a few things.

  1. Polio is caused by any of three different strains of polio virus.
  2. It is an acute illness, which is a gastrointestinal infection, with a faecal/oral or occasionally oral/oral route of infection.
  3. It has an incubation period of 3-21 days, and people are most infectious from 7-10 days before symptoms start to 7-10 days after symptoms start.
  4. After infection in the gastrointestinal system, it migrates to the local lymphoid tissue, then enters the blood stream, and may then infect and replicate in the cells of the central nervous system.
  5. There are three main types of infection: asymptomatic (most common – possibly 1000:1 in children, and 75:1 in adults), systemic illness, and paralytic polio.
  6. Paralytic polio has three main types: spinal (79%), bulbar (2%), bulbospinal (19%) – this refers to the structures affected.
  7. Of paralytic polio infections, the case fatality rate in children is 2-5%, and in adults, 15-30%.
  8. Post-polio syndrome occurs in 25-40% of people who survive paralytic polio. It typically occurs 15 years or more after infection. It includes muscle weakness and pain.
  9. There are two main types of polio vaccine: Inactivated poliovirus (IPV), and oral poliovirus (OPV).
  10. Australia now uses IPV exclusively. (since 2005)
  11. OPV is a vaccine containing attenuated (weakened) virus.
  12. OPV can cause disease in people extremely occasionally – about 1 in 2.9 million people.

    You can find this information in more detail here.

In New York, and also in London, poliovirus has been found during routine sewage surveillance.

In New York, an unvaccinated young adult has suffered paralytic polio. Given the asymptomatic nature of the majority of polio infections, ongoing poliovirus in sewage suggests polio continues to spread. The sewage detections have mostly occurred in areas where there are very low rates of vaccination against polio. (About 60% vaccination rate). It is recommended that to stop polio infection, 95% vaccination rates are required.

I remember getting my polio vaccine as a child. It must have been OPV because it was given on a tiny spoon, on a sugar lump, at the town hall in Midland, Western Australia. Our children received OPV because they were born before 2005, when IPV replaced OPV.

My Mum still remembers when people lived in fear of polio during the epidemics of the 1950s, until polio vaccination became widely available.

Why are there cases in New York and London? Well, before the Covid-19 pandemic, we were well on the way to eradicating polio on a global scale. In many countries (wealthy ones) normal vaccinations continued on, but in those countries where wild-type polio was still occurring, Covid has meant some programs haven’t occurred or haven’t occurred as regularly. In addition, in those countries where polio has still been occurring, they are more likely to use the OPV, which in rare cases can cause actual polio (or vaccine derived polio). You can read about it here in The Lancet.

In somewhere like New York, or London, polio spread is really mostly likely only in unvaccinated populations. Both places have suboptimal levels of vaccine coverage in children. That means that if any type of polio arrives, it has the potential to gain a foothold.

Fortunately, here in Australia, we do have high levels of vaccination. You can find tables here that demonstrate that on a population basis, we generally sit at 96-97% of children vaccinated against polio. This is good. But there are still pockets where children are less vaccinated – Northern NSW is one such place. Vaccination rates there, drop below 90%, which means there are children and adults in those locations at much higher risk, should a traveller arrive bearing live polio. Remember those incubation periods above?

My personal concern is about the ongoing stream of conspiracy theories about Covid derailing parents from vaccinating their kids. Our Covid vaccines are a remarkable achievement considering the disease appeared only thirty months ago. But SARS-Cov-2 is a different, and much more mutatable (probably not a word, but oh well) beast than polio. Don’t be put off other vaccinations because you think every vaccine should be perfect, and Covid vaccines aren’t. Well, let’s face it, nothing’s perfect.

In Covid terms, I’m happy to have had an excellent chance at avoiding severe disease and death. (And I can now say that I’ve been there and done that.)

If it’s polio, I’m happy that I’m basically immune, and that the rest of my family is also immune. But if you or your loved ones haven’t been vaccinated, go and get it done. Don’t get sucked in by the conspiracy theorists who post loudly on every news article.

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