New Polio Outbreak Raises Questions, Shatters Complacency

Sandy Torres sits in a wheelchair in the front of his sixth-grade class, learning anatomy, although his own body is forever damaged by a disease that has scientists scrambling for answers.

Sandy, 13, contracted polio in September, nine years after scientists believed it had been eliminated from the Western Hemisphere. His mother said he was never vaccinated because she didn’t know he needed to be.

“It’s not easy watching your child, who ran and played like all the other children, and now he can’t walk,” Sylvia Altagracia Nunez said.

Sandy is one of six confirmed cases in the Dominican Republic. There is a seventh in Haiti, which shares the island of Hispaniola, and 15 suspected cases are being investigated by local health workers, the U.S. Centers for Disease Control and Prevention and the Pan American Health Organization based in Washington, D.C.

The outbreak indicated that the health care systems failed to follow through on a basic vaccination program, and it also raised larger concerns about the worldwide effort to eradicate the disease.

For the victims, the questions are simpler--and harder to face.

Will 3-year-old Erika Pimentel, who now drags herself across the floor with her hands, ever be able to run around the neighborhood, tiring her mother out as she used to do? How will 6-year-old Alejandrina Arismendy, now unable to stand on her own, make it down the steep hill outside her home to school?

Polio is a highly infectious disease that usually strikes children under 5. It damages the spinal cord and brain, causing paralysis and sometimes death. It is transmitted by ingesting food or water contaminated by fecal matter of an infected person.

So far, investigators have determined that the outbreak occurred because thousands of children were not vaccinated, making both countries a prime breeding ground for a vaccine-derived mutation, like the one that infected Sandy.

In Constanza, a remote mountain town where the first cases appeared, officials estimate that only 20% of children had received all three doses of the vaccine, said Socorro Gross, Pan American’s representative here.

“All of the people involved either weren’t vaccinated or were only vaccinated once,” Gross said. And the government wasn’t pushing the vaccine or even making it available to all clinics.

“I had the vaccine here in a refrigerator, but it was old. I couldn’t use it,” said Dr. Antonio Santos, director of Constanza’s public hospital.

In an immunization drive in recent weeks, about 25,000 children--more than 95%--in Constanza and the surrounding region have been vaccinated, Gross said. A nationwide vaccination campaign was scheduled the weekend of Dec. 15 to 17. Haiti plans a vaccination blitz in January.

The outbreak raises larger questions about the campaign to eliminate polio: whether vaccinations can ever be stopped, and the type of vaccine being used in most countries. The World Health Organization hopes by 2002 to eliminate wild polio from the few countries in Africa and Asia where it still exists.

But after that, polio would still exist in the children who received the oral vaccine, a relatively safe version of the live virus. If the vaccinations stopped, those children might pass the disease on to unvaccinated children. And if the vaccine version of the disease circulated long enough in the population, it could mutate back into the deadly version, as apparently happened here.

The only other such case occurred in Egypt in the 1980s, infecting more than 30 people.

“This is a real problem because it highlights the point that we cannot predict what polio virus will do,” said Dr. Vincent Racaniello, a professor of microbiology at Columbia University. Racaniello long has argued that the effort to eradicate polio cannot end when the wild virus has been eliminated.

He is among those who say health workers will have to switch from the oral vaccine, called Sabin, to the older, costlier Salk vaccine which must be injected but uses a killed strain of the virus and cannot mutate.

Pan American officials are resistant, saying Salk is not only too costly but too difficult to use in developing countries because it has to be administered by a professional.

In addition, the immunity from the oral Sabin vaccine is contagious, spreading from child to child and giving what experts call “herd immunity.” As long as a high enough percentage of children are vaccinated directly, the few who are not can get the vaccine from the rest.

“Nearly four decades of experience with oral polio vaccine has shown that it is very safe and effective in preventing poliomyelitis,” said Ciro de Quadros, Pan American’s director of the vaccination program.

But the United States changed the protocol for polio vaccinations in 1997 to include the Salk vaccine, in order to prevent mutations. The Hispaniola outbreak does not threaten countries like the United States, where almost all children are vaccinated and are therefore immune to the wild disease and the mutation.

For Sandy Torres, the real question is simple: “I ask God when I will be able to walk again, and if I can continue playing baseball.”

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Centers for Disease Control and Prevention: https://www.cdc.gov/health/diseases.htm

Pan American Health Organization:

https://www.paho.org/English/HVP/HVI/tag_14.htm

World Health Organization: https://www.who.int/health-topics/poliomyelitis.htm