This April 9, 2005, Children's Hospital Boston, the Spaulding Rehabilitation Hospital, and Harvard Medical School are holding a polio survivors' reunion and symposium in Boston. An expected 300-400 polio survivors, their families, and clinicians from around New England will gather from 2 to 5 p.m. to commemorate the vaccine and their own experience with the disease.
That experience still has resonance in today's era of emerging infectious diseases and bioterrorism fears. The medical community had to mobilize to cope with a sharp influx of polio patients. During Boston's worst epidemic, for example, Children's Hospital Boston dedicated virtually all wards to polio care. Emergency rooms overflowed, forcing doctors to triage patients in their cars, which lined up for blocks. Patients and beds sometimes waited outside until space could be cleared on the wards. Staff of all descriptions toiled overtime in record heat.
A vaccine was desperately needed, but before Salk could create one, there needed to be a practical way to grow poliovirus in quantity in the lab. In the late 1940s, the virus could only be grown in nerve tissue, which is difficult to maintain, or in live monkeys, a laborious and costly approach. Although Salk is famous for developing the polio vaccine, John Enders, Thomas Weller, and Frederick Robbins of Children's Hospital Boston were the first to culture poliovirus in a variety of tissues - under primitive lab conditions -- earning them a Nobel Prize in 1954.
Of note, soon after the Salk vaccine was announced, the U.S. government suspended mass immunization for several weeks when several bad vaccine batches were found to have caused more than 200 cases of polio. Because of the delay, Boston suffered the worst polio epidemic in its history that summer - one of the hottest on record -- despite the crucial virus research done there.
The April 9th event will recount the history of polio, give a survivor's perspective (that of Tenley Albright, MD, a Harvard surgeon and Olympic Gold Medalist), address polio's hidden aftermath, and look at virology then and now. Artifacts, photographs, news clips, a 1950s polio training film, and excerpts from Spaulding's Polio Oral History Project will be on view.
The event will be held from 2-5 p.m. at The Conference Center at Harvard Medical School, 77 Avenue Louis Pasteur, Boston. An RSVP is required to attend as space is limited.
BACKGROUND ON POLIO AND THE VACCINE
Polio vaccine: the story behind the story
Until the late 1940s, polioviruses could only be grown in nerve tissue, which is difficult to maintain, or in live monkeys. Researchers would have to infect monkeys with polio and try to deduce information about the virus, a laborious and expensive approach. In 1949, in the journal Science, John Enders, Thomas Weller, and Frederick Robbins of Children's Hospital Boston, reported the successful culture of poliovirus in quantity in a variety of tissues, earning them the 1954 Nobel Prize in Medicine.
This critical step, which enabled Salk to develop a vaccine, was accomplished on a shoestring budget in a makeshift lab. Enders and colleagues initially had no protective apparatus, had no sterile hoods for working with viruses, and had to book glassware for experiments in advance since there wasn't enough to go around. They made do by being creative: Weller purchased a $15,000 autoclave at auction for $25, and two craftsmen in the building built them some primitive equipment.
Virology then and now
For decades, no one knew what poliovirus looked like, since viruses cannot be seen under a microscope. In 1985, a team led by James Hogle of Harvard Medical School obtained high-resolution, 3-D images of poliovirus, and today, the newly formed Children's Hospital Boston - Harvard Medical School structural biology unit is heir to the Enders tradition. Led by Stephen Harrison, this group is using a variety of sophisticated tools like X-ray crystallography and molecular electron microscopy to obtain detailed, dynamic, 3-D views - accurate down to the atom -- of how viruses move, transfer information, and reconfigure themselves to attack their victims. These images are shedding light on many of today's viral scourges, such as HIV, dengue, and rotavirus, and providing new leads for treatment and vaccine development.
Polio: a product of good sanitation?
Polio was initially seen as a disease of immigrants in primitive, filthy living conditions. Public health officials enacted strict sanitation policies. But as the 20th century progressed, polio (once called "infantile paralysis") began striking older children and adults, and disproportionately hit the middle class. Scientists now believe that improved sanitation was to blame. When water supplies were consistently contaminated with the poliovirus, as they were in impoverished areas, people were typically infected during infancy -- but most suffered little more than diarrhea, and then had lifelong immunity against polio. In contrast, middle-class people with access to clean drinking water might not encounter the virus until later in childhood, when the virus was more likely to spread to brain and spinal cord and cause paralysis. This "sanitation hypothesis," now widely accepted, is similar to the popular "hygiene hypothesis" in asthma (which finds an increase in asthma as environments become cleaner).
The summer of '55: Boston
During the polio epidemics, hospitals had to mobilize to cope with a sudden onslaught of patients. A case in point: the very year the Salk vaccine was announced, Massachusetts suffered the worst polio epidemic in its history. The epicenter was Children's Hospital Boston, which took in adults and children alike and dedicated all but one ward to polio care. Hospitals around the city loaned cribs, and staff of all descriptions, as well as volunteers, toiled overtime in record heat (at one point hitting 104°) to keep up. Panicked families overwhelmed hospital emergency admission facilities, forcing doctors to triage people in their cars. If a child seemed to have polio, the family could bypass the line of autos, which stretched for blocks. Patients and beds sometimes had to wait outside until space opened up on the wards. Several staff members were stricken with polio, and two patients had babies while at Children's, one needing help with breathing throughout the birth.
Sadly, mass vaccination had begun in Massachusetts that May in first- and second-graders. But a CDC investigation by Dr. Alex Langmuir concluded some of the vaccine in distribution contained live polio virus and had caused some cases of polio. So the state of Massachusetts suspended its immunization program until the following January.
Inside the iron lung
The so-called iron lung was the first effective treatment for patients so severely paralyzed they couldn't breathe. First used in 1928 in an 8-year-old girl with polio at Children's Hospital Boston, it consisted of a tank made by a local tinsmith and a pair of vacuum cleaner blowers. As the machine breathed for her, the girl revived and later asked for ice cream. Later, as demand grew, hospitals moved to room-sized respirators. "I had space for four patients all sticking their heads out from this room with their bodies inside," wrote Children's physician James Wilson, "and we could get inside with them and care for them." Clinicians also gave care through portholes, initially purchased from a Boston shipyard; if a porthole was opened at the wrong moment, the patient would have his breath knocked out of him. Former patients can describe living in respirators for months on end, never leaving to be bathed or changed, eating flat on their backs, relying on nurses to feed them and mirrors to see around them. During power outages, hospital staff - even doctors - took turns pumping the respirators with a bellows.
Polio survivors who had been stable for 20 to 40 years might have thought the "worst was over." Unfortunately, some 70% now have postpolio syndrome -- weakness in previously unaffected muscles, often accompanied by fatigue, pain, and swallowing and breathing problems. Unfortunately, the medical system commonly attributes postpolio symptoms to other conditions or dismisses the symptoms as normal aging, according to Dr. Julie Silver of the Spaulding Rehabilitation Hospital network, an internationally known expert in postpolio syndrome.
An era not quite over
Polio was declared eradicated in the U.S. in 1979. Yet according to the World Health Organization, polio cases worldwide rose by a third in 2004, due in part to a vaccine boycott. Children's Hospital Boston and Spaulding Rehabilitation Hospital are still seeing new cases - the result of international adoptions from Third World countries and from Russia.
The public can obtain more information by calling 508-872-2200, ext. 241.
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