Polio virus found in London waste water persistently for the first time since1984. what does this all mean welcome to another med cram lecture where we’re going to break this down and show you step by step what it is that’s going on so what you have to understand is that there are a number of waste water plants that are checking for either of viruses in waste water and so.
This is popping up all around the world they’re looking at ways of monitoring for infections because they don’t have to actually test people to do this you can actually see it in the waste water so. You’re going to see this more and more and it’s actually kind of a cool way of figuring out when infections are increasing so what’s happened.
There is that since february from february to may of this year in london in a waste water plant that services the north and eastern portion of london which is about 4 million people they’ve been seeing the polio polio virus persistently being elevated in that waste water and they are looking at the of the polio virus and they’re seeing that these sam plesare some what genetically related to each other and so because of that.
They’re either saying that this is coming from one individual that may beimmuno compromised and is shedding continuously. It’s being passed around to many different people and so i want to take this opportunity to go over what is going on with polio virus a little bit under standing about the virus itself the vaccines for the virus where we’ve come from where.
We’re going this blog is not meant to raise anxiety levels actually quite the opposite is to sort of look at this and get understanding about what it is that’s going on because knowledge is power but in order to understand what’s going on we’ve got to go back to the basics so you understand the virus itself and where we’ve come from so the polio virus is a single stranded virus so in this case.
It’s actually similar to covet 19 and stars cov 2 but instead of binding to the ace 2 receptorit binds to cd 155 it’s on human cells and particularly it likes to attach in the gi tract so this is what’s known asan entero type of virus in other words it is transmitted by fecal oral type of transmission it goes into your mouth you swallow it it goes into your stomach and actually survive very acidic situations ph of less than two it infects those gi cells the single stranded.
Which is the genome inside of the polio virus goes into those enterocytes hijacks the cell machinery tells. The ribosomes to make an dependent poly merase and what that means is those proteins in the gi tract are basically being made by ribosomes in the cells and of course once that gets made the gi tract makes more virus and of course it spreads as you can see here the polio virus goes into the gi tract and then once.
These cells become infected they go into the interstitium and the lymphatics pick it up the lymphatics of course dump into the blood and now you have something called viremia this is what makes you feel pretty bad so you’ll have a sore throat tiredness fever nausea headache that lasts for about 10 days now in very rare situations there is something called the blood brain barrier and a very rare situations.
The virus will actually penetrate that and infect where it likes to go and that’s the motor nerves of your central nervous system now the motor nerves of course cause you to actually move and so when the virus infects those it can cause inflammation which you might get some weakness or it might damage it so much so that you will occasionally get permanent weakness or even require aventilator and that’s the reason why when we had an epidemic of this in the united states people were placed on iron lungs we even had a president.
Who was wheel chair-bound as a result of polio that was franklin delano roosevelt so this happens rarely fortunately only about 1 in 200 cases will actually penetrate that blood-brain barrier and get into the motor neurons and cause that type of diseaseand that’s known as paralysis and of course.
That paralysis can last for very long it causes a trophy of the muscle and this has been infecting human beings fora very very long time this is not a new thing so we have some good data that shows that this has been around for a period of time here we see a 15th century bcsteely of an egyptian and clearly.
It shows a shriveled up leg here that you can see and that’s highly suggestive that polio has been going on for a very very long time so the reason why we don’t see this much anymore is because of vaccines and it’s really important to understand the types of vaccines and what’s going on because what we’re seeing today in london ironically is actually very likely related to a virus that has escaped from a vaccine in fact it’s possibly mutated and we’ll talk more about that and.
If you want to learn more about that for over 60 hours of continuing education credits and medical topics what we’re looking at here are the polio virus infects the gi tract the gi tract then goes to the lymphatics into the blood causing the viremi a and then finally.
The motor nerves and then paralysis let’s take a look at these vaccines and see what’s going on there’s the first type of vaccine known as the ipv ipv stands for inactivated polio vaccine this is the inactivated so this is basically a polio virus that’s been treated in formalin and killed it’s not alive.
It’s simply the proteins on the surface and this was invented by salk is introduced back in 1955 and it covers all three types of the polio virus it’s usually given as three shots and they typically get a booster later on in child hood now because it’s injected it will get into the human body byby passing the gi tract and causing animmune response in the lymphatics in the blood and so what you see here is you see antibodies primarily in the blood there’s less intestinal immunity.
There’s not zero intestinal immunity but it’s significantly less and again the reason is is because ipv is injected into the body and so what we see here are antibodies primarily in the blood now because you need large quantities of the polio virus to generate the ipv vaccine that needs to be dealt with in fairly high level laboratories so bsl3 and that’s on a scale of one to four so.
It’s not the highest level but it’s a significantly high level and so the polio ipv vaccine does have sort of a supply issue there in that sense now let’s go on to the opv because the opv is very differentand opv stands for oral polio vaccineit’s a live attenuated in other words.
This virus is alive as much as you could say a virus is alive it actually can infect and replicate but it’s genetically modified so that it doesn’t cause the problem of motor nerves paralysis and i say that delicately because if it mutates it sometimes can and we’ll talk about that in a little bit so this was invented by saban it was first used in 1961 it also covers types one two and three it’s usually given in three oral doses and because it’s given the same way that the virus infects it actually does cause antibodies not only in the blood but also in the gi tract now.
That’s important to understand because when you have protection here in the gi tract remember how this spreads it spreads in the gi tract and then it goes back and infects another person in this way so this is an important distinction here because this is how it spreads person to person by going from somebody’s gi tract to another person’s mouth basically even as gross as that might be but the benefit of having opv is that you get antibodies in the gi tract and you can actually potentially stop person to person spread with ipv your antibodies.
Are primarily only in the blood and it may not stop this type of person-to-person infection here’s the issue that we need to talk about to understand vaccine-derived polio virus basically what happens here and we’ll talk a little bit more about this is with vaccine-derived polio virus the opv because it’s live goes inside the person and because of mutation rates which is very common for single-stranded because there’s no proof reading mechanism and etc.
It can mutate back into a virulent form and actually cause polio that way that is something that is a concern and it can cause vaccine-associated paralytic polio myelitis where the person actually develops paralysis as a result of getting the opv vaccine this opv vaccine is often used in countries where there are high rates of polio and that could be the issue because it reduc estrans mission person to person once there is not a lot of polio in that country and you don’t have to worry about person-to-person spread it’s advised to go to the ipv.
You lose the person-to-person prevention but that’s okay what we want to make sure is that we don’t get these spora diccases of vaccine-derived polio virus and as a result of that the united states has not used the opv vaccine since 2000 okay let’s talk about how successful these vaccines are in doing just that this is looking specifically not at the world but at the united states and we’re looking from 1910 to 2019 just recently and in blue we have polio cases and in red we have polio death so you can kind of see how many people get the case and.
How many people would die of it it’s not one percent it’s actually significantly higher than one percent in this case but you can see here with the introduction of the ipv vaccine right here there wasa dramatic reduction in the number of cases so it seems as though ipv can reduce the cases we did say that there was gi tract antibodies but not as many as opv with opv introduction you can see here that we had essentially eliminated polio in the united states so i wanted to define a couple of terms.
We’ve already talked about opv not ipv but opv when opv goes into a human being there is a rare situation that can happen in that person where the virus mutates and it becomes virulent and it can actually cause an infection in that person that causes paralysis and that’s known as vapp or vaccine associated paralytic polio myelitis so that’s in the person who got opv but what we’re talking about today is something more than that what we’re talking about today is something called vaccine derived polio polio virus that’s when the person who got the opv now has a virus that’s virulent.
Polio Virus vaccine
It is now replicating it is spreading and it can actually go to another individual now this individual typically has not gotten a vaccine either opv or ipv and what can happen because they’re not immune to polio is they can actually pick up a vaccine-derived polio virus from somebody who did get the vaccine so the question is is there any difference interms of disease that some body could get from a wild type or normal polio and vaccine-derived polio virus and the answer is is there’s really no difference between these two types of virus both are just as likely to cause disease so.
You can see here that in countries that don’t have high rates of polio it probably would not be a good idea to use opv in that population because you could actually create more disease from the vaccine than you would from the natural virus itself and this is a statemen there from the cdc they say vd pvs or this vaccine-derived polio virus can cause outbreaks in countries.
Where vaccine coverage is lowlong-term excretion can also occur in people with certain immuno deficiency disorders because opv has not been used in the united states since 2000 so notice that the live attenuated has not been used in the united states for over 20 years and vaccine with ipv is high itis unlikely that any vaccine-derived polio virus would become wide spread inthe united states also polio vaccination protects people against naturally occurring polio viruses and vaccine-derived polio viruses if this person here is vaccinated it doesn’t matter.
If it’s wild-type polio or vaccine-derived polio virus they’re going to be immune to that so what exactly is it that’s going on in london now let’s take a look at an article so again what’s happened here recently is they’ve been detecting polio virus in waste water in an area of london.
That covers about four million people in the north and the east portion of the city at the bech ten sewage treatment plantand fortunately there have been no cases of polio actually detected in the medical infrastructure and certainly no cases of paralysis.
Here they mentioned in this new york times article that because of this health authoritiesin britain have declared a national incident after finding evidence suggesting local spread of polio virus in london and again to reiterate no cases of polio have actually been identified we’re just picking this up here in the waste water and because we discussed before that people who are vaccinated really don’t need to worry about this type of issue they are urging any body in that area.
Particularly young children to immediately seek vaccines now it should be noted that they are saying that maybe once or twice a year it’s normal to pick up polio virus in the waste water because occasionally some body travels from a country where the opv vaccine is being used and they come back to the uk and they detect the virus in the stool but it usually goes away after.
The vaccination what’s different here is that between february and may the officials have identified the virus in several samples collected in london and while the genetics of the various samples are different they seem to be genetically linked to one another importantly.
In this article dr hayman an infectious disease expert at the london school of hygiene and tropical medicine says the ratio of those that become infected and who actually get paralyzed is actually one in 500 and once again they confirm what we’ve just talked about in britain as well as the united states immunization for polio is carried out with an injected inactivated polio viru.
Which cannot be shed through feces but in some countries of the world that use the polio vaccine that contains a live weakened version of the virus immunized people can briefly shed thisvirus in their feces.
Which can then turn up in the sewage so where would this have come from well in recent months the opv vaccine has only been used in afghanistan pakistan and some countries in the middle east and africa and it should be noted that wild type polio virus or the natural.
Polio virus has been eliminated from every country in the world except for afghanistan and pakistan but vaccine-derived polio continues to cause small out breaks particularly in communities with low vaccination coverage and.
What we don’t know right now is whether or not this is a single individual perhaps that is continuously shedding it because of immuno compromised state or whether or not this is spreading in the community they say here quote the big issue here is whether it’s been continuously circulating in the ukor whether it’s an immunod eficient person so in terms of vaccines we can see here that at some point here in just the united states there was over 40 000 cases per year as those cases were going up currently world wide.
What we’re seeing interms of wild polio is 176 maybe 140 cases what is here in red is concerning and this again is this vaccine-derivedpolio virus which actually is higherthan the wild type and this is thereas on why the who has urged countries that do not have out breaks to switch from the opv live attenuated virus to the ipv inactivated virus because this vaccine-derived polio virus does not come from ipv so for those of you who are interested in finding out.
Why is it that the virus that’s used in the opv the live attenuated vaccine why does it revert to a more virulent factor i would turn you to this article in the journal of virology it’s an excellent review and it talks about how the sabin like virus type 1 type 2 and type 3 actually mutate and causes a mutation in the vp1 which is a capsid protein and potentially is the reason why these opv vaccines are causing this small sporadic vaccine-derived polio virus and of course.
We’ll put a link to this article in the description below there’s another paper that i found here that also shed some light on it saying that the vp1 protein in the polio virus may actually not only affect binding which is what you would expect it to do if it was on the outside of the viral capsid.
but also the release of viral and that may be one of the reasons why we’re seeing revision back to a more virulent virus so the bottom line here is what we’re seeing the reason why we’re seeing polio virus in the waste water in the uk may be the result of an immuno compromised individual.
Who received the opv vaccine or it could be that and it’s spreading to other individuals who are not vaccinated according to the information presented here the risk of a global pandemic from polio virus is pretty small but continued evaluation and monitoring is definitely indicated.
Poliomyelitis or polio, Causes, Signs and Symptoms, Diagnosis and Treatment.
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