THE EPIDEMIOLOGY OF POLIOMYELITIS: ENIGMAS SURROUNDING ITS APPEARANCE, EPIDEMICITY, AND DISAPPEARANCE1
Abstract
The emergence of a debate in the US regarding poliomyelitis immunization practices makes it important to examine unresolved issues about the epidemiology of this disease. The literature suggests that poliomyelitis initially appears as a disease of preschool children, but then there is a trend toward increasing age of cases. Age differences in the case: infection ratio do not appear to have a consistent, predictable impact on overall incidence. The appearance of epidemic poliomyelitis is assumed to have resulted from a reduction in levels of maternal antibodies as booster reinfections became less common, a reduction in the frequency of antibody levels sufficient to produce cross-protection between virus types, and an increase in the average age of primary infections. The relative importance of virus virulence and of elevated infection rate in the production of epidemics remains unknown. The use of poliovirus vaccine in the US has reduced paralytic disease from an annual incidence of about 10,000 cases to 10 cases. The eradication of poliomyelitis in spite of the fact that no more than 90% of US children have been reached indicates that either vaccine virus has spread to the unimmunized or a herd immunity effect is operating and the resultant disappearance of wild poliovirus prevents exposure of the unimmunized. The unexpected eradication of natural poliomyelitis in the US has raised the problem of vaccine-associated disease when oral vaccine is used. Since oral poliovirus vaccine appears to have provided protection through herd immunity, any change in immunization practices that might increase the exposure of susceptibles should be undertaken with great caution. Evidence of repeated importations of wild poliovirus emphasizes this concern. If inactivated vaccine is seriously considered for primary immunization, it should be followed by reimmunization with oral vaccine.
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Nomoto and colleagues constructed chimeras with the capsid regions of Sabin 2 and Sabin 3 inserted into the genetic background of the more highly substituted and stable Sabin 1 strain.
“Nomoto and colleagues (97, 137) constructed chimeras with the capsid regions of Sabin 2 and Sabin 3 inserted into the genetic background of the more highly substituted and stable Sabin 1 strain.”
From VACCINE-DERIVED POLIOVIRUSES AND THE ENDGAME STRATEGY FOR GLOBAL POLIO ERADICATION (2005) · cites this paper as [137]
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Sioofy‐Khojine, A., Oikarinen, S., Honkanen, H., Huhtala, H., Lehtonen, J. P., Briese, T., Hyöty, H., & on behalf of the TEDDY Study Group (2018) · PLoS ONE · doi:10.1371/journal.pone.0201959 · Cited by 27 · see citing works
Green, M. S., Handsher, R., Cohen, D., Melnick, J. L., SLEPON, R., Mendelsohn, E., & Danon, Y. L. (1993) · Vaccine · doi:10.1016/0264-410x(93)90342-u · Cited by 27 · see citing works
Rahmandad, H., HU, K., Tebbens, R. J. D., & Thompson, K. M. (2010) · Epidemiology and Infection · doi:10.1017/s0950268810001676 · Cited by 26 · see citing works
Epidemiologic Aspects of Poliomyelitis Eradication
Nathanson, N. (1984) · Clinical Infectious Diseases · doi:10.1093/clinids/6.supplement_2.s308 · Cited by 26 · see citing works
“Issues considered herein have been discussed in more detail in previous publications [2-4].”
BackgroundSelf-citationMangal, T. D., Aylward, R. B., & Grassly, N. C. (2013) · American Journal of Epidemiology · doi:10.1093/aje/kwt203 · Cited by 26 · see citing works
“Probability of symptomatic infection 1 case in 200 Sutter, 2008 (61); Nathanson, 1979 (62); Fine, 2001 (63) 1 case in 1,000 Reflects variation in case:infection ratio among different serotypes”
Comorbidity profile of poliomyelitis survivors in a Chinese population: a population-based study
Kang, J., & Lin, H. (2011) · Journal of Neurology · doi:10.1007/s00415-010-5875-y · Cited by 25 · see citing works
“5% of infected patients develop paralytic poliomyelitis [4], which is characterized by flaccid and paralyzed muscles at diverse sites following acute infection with poliovirus.”
BackgroundWhat if protective immunity is antigen—driven and not due to so‐called “memory” B and T cells?
Zinkernagel, R. M. (2018) · Immunological Reviews · doi:10.1111/imr.12648 · Cited by 24 · see citing works
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“As a reference point for the historical emergence of poliomyelitis, the US epidemic of 1916 has been revisited by epidemiologists, historians of medicine and others on numerous occasions and from a variety of perspectives (Paul et al., 1932; Galishoff, 1976; Nathanson and Martin, 1979; Rogers, 1989; Risse, 1992).”
BackgroundInfluentialPolio and nobel prizes: Looking back 50 years
Norrby, E., & Prusiner, S. B. (2007) · Annals of Neurology · doi:10.1002/ana.21153 · Cited by 24 · see citing works
“These young people had not acquired immunity to polioviruses through inapparent enteric infections as infants when they were still protected by their mother’s anti-polio antibodies.(10) Gradually a nonimmune population of older children and young adults emerged, and when exposed to polioviruses, many of them experienc…”
BackgroundPoliomyelitis and Poliovirus Immunization
Modlin, J. F. (2014) · ASM Press eBooks · doi:10.1128/9781555818326.ch9 · Cited by 24 · see citing works
Kubli, D., Steffen, R. J., & Schär, M. (1987) · BMJ · doi:10.1136/bmj.295.6591.169 · Cited by 24 · see citing works
Quantifying the Impact of Expanded Age Group Campaigns for Polio Eradication
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“The task of estimating the poliovirus potential for transmission and prevalence from incidence of paralytic cases is complicated by a low case-to-infection ratio [14,23] and inconsistent case reporting rate.”
BackgroundVaccine-Associated Paralytic Poliomyelitis
Querfurth, H. W. (1990) · Archives of Neurology · doi:10.1001/archneur.1990.00530050061013 · Cited by 23 · see citing works
Long‐lasting immunity by early infection of maternal‐antibody‐protected infants
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Vaccine-Preventable Disease and Immunization in the Developing World
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100 years poliovirus: from discovery to eradication. A meeting report
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“Landsteiner’s seminal discovery occurred in an era when there was a tremendous increase in the number of cases of poliomyelitis in the first decades of the twentieth century [23, 32].”
BackgroundGregory, C. J., Ndiaye, S. M., Patel, M. K., et al. (2012) · Clinical Infectious Diseases · doi:10.1093/cid/cis715 · Cited by 20 · see citing works
“This outbreak is one of an increasing number involving older aged patients in developing countries; similar to the pattern seen in the middle of the 20th century in developed countries [18].”
Sutter, R. W., Kew, O. M., Cochi, S. L., & Aylward, R. B. (2017) · Elsevier eBooks · doi:10.1016/b978-0-323-35761-6.00048-1 · Cited by 22 · see citing works
Sabin and wild polioviruses from apparently healthy primary school children in northeastern Nigeria
Baba, M. M., Oderinde, B. S., Patrick, P. Z., & Jarmai, M. M. (2011) · Journal of Medical Virology · doi:10.1002/jmv.23184 · Cited by 20 · see citing works
“This implies that most of poliovirus infections are asymptomatic and are recognized rarely [Debre and Thieffery, 1955; Nathanson and Martin, 1979].”
BackgroundFrancis Field Trial of Inactivated Poliomyelitis Vaccine: Background and Lessons for Today
Monto, A. S. (1999) · Epidemiologic Reviews · doi:10.1093/oxfordjournals.epirev.a017989 · Cited by 20 · see citing works
“We now know that this phenomenon was a result of an increased likelihood of infection being asymptomatic in young individuals, and maternal antibodies attenuating the infection, both factors contributing in debatable proportion (5).”
BackgroundValenti, W. M., Hruska, J. F., Menegus, M. A., et al. (1981) · Infection Control · doi:10.1017/s0195941700053728 · Cited by 20 · see citing works
The Effect of Potential Climate Change on Infectious Disease Presentation
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Poliomyelitis in the United States
Modlin, J. F. (2004) · JAMA · doi:10.1001/jama.292.14.1749 · Cited by 19 · see citing works
Punsoni, M., Lakis, N. S., Mellion, M. L., et al. (2023) · Neurology International · doi:10.3390/neurolint15020035 · Cited by 18 · see citing works
“In the United States, the use of poliovirus vaccination drastically reduced the annual incidence rate from over 10,000 cases to about 10, and virtually eradicated wild poliovirus [1].”
Optimal Timing of Disease Transmission in an Age-Structured Population
Reluga, T. C., Medlock, J., Poolman, E. M., et al. (2007) · Bulletin of Mathematical Biology · doi:10.1007/s11538-007-9238-5 · Cited by 18 · see citing works
“Similarly, prior to its control through vaccination, poliomyelitis may have exhibited a higher case fatality rate in older age groups (Weinstein et al., 1952; Paul, 1971), although trends in age-specific incidence are more difficult to interpret (Nathanson and Martin, 1979).”
BackgroundNathanson, N., & Horn, S. D. (1992) · Vaccine · doi:10.1016/0264-410x(92)90396-2 · Cited by 18 · see citing works
Self-citationJubelt, B., Salazar‐Grueso, E. F., Roos, R. P., et al. (1995) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.1995.tb27546.x · Cited by 18 · see citing works
- Authors
- NATHANSON, N., & MARTIN, J. R.
- ORCID
- NATHANSON, NEAL
- Venue
- American Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 1979-12
- Volume
- 110
- Issue
- 6
- Pages
- 672-692
- ISSN
- 0002-9262 (ISSN-L)
- 1476-6256
- OpenAlex
- W2163845414
- Cited by
- 214
- References
- 0
- Citations by year
- 2025: 3 · 2024: 1 · 2023: 3 · 2022: 3 · 2021: 4 · 2020: 4 · 2019: 9 · 2018: 5 · 2017: 5 · 2016: 6 · 2015: 7 · 2014: 15 · 2013: 9 · 2012: 13
- FWCI
- 2.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Viral Infections and Immunology Research
- Health Sciences › Medicine › Epidemiology › Virology and Viral Diseases
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Keywords
- poliomyelitis, polio vaccination, polio vaccine, oral polio vaccine, inactivated poliovirus vaccine, herd immunity, vaccine-associated disease, polio eradication, maternal antibodies, cross-protection, age at infection
- MeSH terms
- Adolescent, Adult, Age Factors, Child, Child, Preschool, Disease Outbreaks, Humans, Infant, Infant, Newborn, Poliomyelitis, Poliovirus Vaccine, Inactivated, Risk, Seasons, Time Factors, United States
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