7 ms·

Why smallpox is no more, but polio and other diseases persist

86 points by yarapavan 7y ago

esaym 7y ago
> has the potential to mutate and cause vaccine-derived polio Glad someone is at least admitting that now. Though sadly "vaccine derived" polio is usually of the paralytic type[0] [0]https://youtu.be/S8ixbGlHTTI?t=40m59s https://youtu.be/S8ixbGlHTTI?t=40m59s
- gumby 7y ago
  > Glad someone is at least admitting that now. Huh? It's never been any sort of secret, and has been a factor since the earliest vaccines. Doctors know this issue is always a possibility with live virus vaccines and only use them in specific restricted cases. I addition this was not an issue mentioned in the original, fraudulent Wakefield paper.
- makomk 7y ago
  They kind of had to stop downplaying the importance of vaccine-derived polio. Apparently it's now the main form of polio actually paralyzing kids at this point in the campaign to eradicate the disease, and no-one seems to have any workable end-game: https://www.npr.org/sections/goatsandsoda/2019/11/15/779865471/polio-vaccine-may-be-preventing-the-end-of-polio?t=1575755256060 https://www.npr.org/sections/goatsandsoda/2019/11/15/7798654... Western countries eradicated polio thanks to better sewage and water treatment limiting the spread of vaccine-derived strains and a switch to an injectable dead vaccine that's less effective but can't cause disease outbreaks, neither of which seem to be feasible in the affected countries at this time. Stopping the outbreaks is done using mass vaccinations which introduce more vaccine poliovirus into circulation, causing more outbreaks down the line. Also, it seems the claim in the article that type 2 poliovirus has been eliminated isn't quite the whole truth. Wild type 2 poliovirus has been eliminated, but vaccine-derived versions of it are still in circulation and causing paralysis.
  - ars 7y ago
    The good news there is that vaccine derived versions don't seem to circulate for very long. So if you can eradicate the wild type, stop immunizing with the vaccine type, within a year or two it should be gone.
    - makomk 7y ago
      Other way around, as I understand it: once the vaccine-derived strains have been circulating for a year or so, they become every bit as virulent and dangerous as the original wild polio and remain that way indefinitely unless they're stamped out using vaccination. The only way we can tell they're vaccine-derived rather than wild at that point is by using genetic sequencing to trace their heritage since they're otherwise exactly like wild polio. If we could somehow ensure that the vaccine strains didn't circulate for so long they wouldn't be able to regain their virulence and we wouldn't have this problem, but that's easier said than done.
  - selimthegrim 7y ago
    There is a big scandal right now in Pakistan where vaccine was improperly stored and given to kids causing VDP and the guy in charge of eradication tried to cover it up and was forced to resign.
    - gus_massa 7y ago
      Do you have a link for this? Preferably one with the technical info. The problem with a bad storage of the vaccine is that it makes it ineffective. I guess if the storage is very bad, some bacteria may grow in the vial (???), but it would not cause VDP. In the injectable version, the virus is totally "dead", so whatever you do, it would not cause VDP. In the oral version, the virus is "alive". If the storage is bad it may destroy the virus making the vaccine ineffective. But the virus can't reproduce and mutate inside the vial to become dangerous. The virus need approximately one year and a bunch of host to mutate and get dangerous. So, whatever crappy storage they used, the vaccine can't give the kid VDP. The problem may be that a bad storage may make all the vaccination campaign ineffective, you think that you have 99% of the population vaccinated, but the effective number is much smaller. In that case the virus from the vaccine can spread and mutate and cause problems later after a few hops in the unvaccinated kids.
3fe9a03ccd14ca5 7y ago
Here’s a more interesting dilemma, one which I could hardly believe once I heard it: > More Polio Cases Now Caused by Vaccine Than by Wild Virus If that’s true, at what point do we stop vaccinating for it? 1. https://www.nytimes.com/aponline/2019/11/25/health/ap-af-med-africa-polio.html https://www.nytimes.com/aponline/2019/11/25/health/ap-af-med... 2. https://www.npr.org/sections/goatsandsoda/2017/06/28/534403083/mutant-strains-of-polio-vaccine-now-cause-more-paralysis-than-wild-polio https://www.npr.org/sections/goatsandsoda/2017/06/28/5344030...
- tyingq 7y ago
  To be clear, it's the cheap, oral, live virus polio vaccine that's causing the problem. They don't use that in the US, at all, and we don't have the issue. We don't need to stop polio vaccination...we need to find a reasonable way to replace the low budget version.
  - EGreg 7y ago
    I don’t know why you are being downvoted, what you said is entirely correct AND cuts through the confusion. People need to realize that there are different Polio vaccines and the original Salk vaccine has zero chance of infecting people with Polio.
    - akamaka 7y ago
      I downvoted because it’s not correct to suggest that OPV is being used because it is a “low budget version”. In fact, both types of vaccines are being given to children in high-risk countries, as part of the transition away from the live vaccine. In countries with endemic polio or where there is a high risk of imported cases, the WHO recommends OPV vaccine at birth followed by a primary series of 3 OPV and at least one IPV doses starting at 6 weeks of age. https://en.m.wikipedia.org/wiki/Polio_vaccine https://en.m.wikipedia.org/wiki/Polio_vaccine
      - tyingq 7y ago
        "The IPV that has been used in the United States since 1987 is as effective as OPV for preventing polio" https://www.cdc.gov/vaccines/vpd/polio/public/index.html https://www.cdc.gov/vaccines/vpd/polio/public/index.html "Unfortunately, IPV costs considerably more than OPV per dose ($3-5 vs $0.12 on the subsidized world market). Because the WHO and most countries have plans to continue vaccination for at least 10 years after eradication, there will continue to be a market for the vaccine. Because of the high cost of the IPV, efforts are underway to derive improved and less expensive IPV vaccines." http://grantome.com/grant/NIH/R44-AI120260-02 http://grantome.com/grant/NIH/R44-AI120260-02 "One hundred twenty-six low- and middle Income countries will start to use IPV, which is injected, in a single dose, in addition to the oral polio vaccine (OPV). OPV will gradually be phased out, based on certain epidemiologic triggers. The previous price was a major barrier to making this shift. The shift is needed because, for eradication to occur, the polio virus needs to be gone from people, labs, sewage, etc. – i.e. the places in which vaccine-derived polio virus can survive, mutate and cause disease. IPV is ‘inactivated’, and does not carry risk of polio infection to people who are not vaccinated." https://blogs.unicef.org/blog/lowest-ever-prices-for-polio-vaccines/ https://blogs.unicef.org/blog/lowest-ever-prices-for-polio-v... The WHO only recommends OPV because of the low cost.
intuitionist 7y ago
Wild-type polio could very well be gone by now if the CIA hadn’t burned Western doctors’ goodwill in Pakistan by using fake polio vaccines to take DNA from children suspected to be related to Osama bin Laden. This isn’t close to the most evil thing the CIA has done, but it makes me the most unreasonably angry.
- Twixes 7y ago
  What the hell. This sounds comically villainous. On the other hand we _are_ talking about the CIA here. Got a link?
  - pgrote 7y ago
    https://www.scientificamerican.com/article/how-cia-fake-vaccination-campaign-endangers-us-all/ https://www.scientificamerican.com/article/how-cia-fake-vacc...
  - kick 7y ago
    The CIA have crafted a wonderful brand: with their actions, they've created a (truthful) universal public image that they'd stoop to the southern tip of Hell to get whatever they want, completely numbing the public to any possible action. If the CIA had a good reputation, hearing something like "They undermined public faith in vaccines, leading to multiple modern-day problems and epidemics" would lead to skepticism, and then riots. Instead, we all know the substance of the agency's actions, and of the character of its men. As a result, we're mildly surprised when we hear this, and don't feel it's a substantial deviation from the status quo.
- dominotw 7y ago
  couldn't they have done both at the same time though? take DNA and give them vaccine.
  - mantap 7y ago
    The point is that now people in that part of the world think doctors are CIA agents and try to kill them.
vo2maxer 7y ago
Several articles in the news including the one in Quanta [1,2,3] appear to have caused some misunderstanding. What is clear so far is that “circulating vaccine-derived polioviruses (cVDPVs) can emerge in settings with low population immunity...,” therefore, “all countries must maintain high population immunity.” [4] It was found that “compared with January 2017–June 2018, the number of reported cVDPV outbreaks more than tripled, from nine to 29,” in the most recent survey. [4] As a result, the Global Polio Eradication Initiative” is planning future use of a novel type 2 OPV, stabilized to decrease the likelihood of reversion to neurovirulence.” One of the most significant barriers to polio eradication is “reaching every child – including inconsistent campaign quality, insecurity, conflict, massive mobile populations, and, in some instances, parental refusal to the vaccine.”[5] It is false to say that somehow cVDPVs had been kept a secret or their importance downplayed. [6] There are critical reasons to remain vigilant of any adverse consequences but keep in mind that every year “hundreds of thousands of cases due to wild polio virus are prevented. Well over 10 million cases have been averted since large-scale administration of OPV began 20 years ago.” [7] [1] https://www.quantamagazine.org/why-smallpox-is-no-more-but-polio-and-other-diseases-persist-20191203/ https://www.quantamagazine.org/why-smallpox-is-no-more-but-p... [2] https://www.nytimes.com/aponline/2019/11/25/health/ap-af-med-africa-polio.html https://www.nytimes.com/aponline/2019/11/25/health/ap-af-med... [3] https://www.washingtonpost.com/world/africa/more-polio-cases-now-caused-by-vaccine-than-by-wild-virus/2019/11/25/1a4d087e-0f76-11ea-924c-b34d09bbc948_story.html https://www.washingtonpost.com/world/africa/more-polio-cases... [4] https://www.cdc.gov/mmwr/volumes/68/wr/mm6845a4.htm https://www.cdc.gov/mmwr/volumes/68/wr/mm6845a4.htm [5] http://polioeradication.org/news-post/global-leaders-pledge-us2-6-billion-to-eradicate-polio-at-the-reaching-the-last-mile-forum-in-abu-dhabi/ http://polioeradication.org/news-post/global-leaders-pledge-... [6] https://www.ncbi.nlm.nih.gov/books/NBK236293/ https://www.ncbi.nlm.nih.gov/books/NBK236293/ [7] https://www.who.int/features/qa/64/en/ https://www.who.int/features/qa/64/en/
basicplus2 7y ago
<the laboratory-weakened virus used in the oral polio vaccine can very rapidly regain its strength if it starts spreading on its own. After a child is vaccinated with live polio virus, the virus replicates inside the child's intestine and eventually is excreted. In places with poor sanitation, fecal matter can enter the drinking water supply and the virus is able to start spreading from person to person. "We discovered there's only a few [mutations] that have to happen and they happen rather quickly in the first month or two post-vaccination," Andino says. "As the virus starts circulating in the community, it acquires further mutations that make it basically indistinguishable from the wild-type virus. It's polio in terms of virulence and in terms of how the virus spreads." In June, the World Health Organization reported 15 cases of children paralyzed in Syria by vaccine-derived forms of polio. These cases come on top of two other vaccine-derived polio cases earlier this year in Syria and four in the Democratic Republic of the Congo.> https://www.npr.org/sections/goatsandsoda/2017/06/28/534403083/mutant-strains-of-polio-vaccine-now-cause-more-paralysis-than-wild-polio https://www.npr.org/sections/goatsandsoda/2017/06/28/5344030...
Liquidity 7y ago
Small pox is still available in highly secure laboratories of Both US and Russia. Also, FDA approves small pox vaccine. https://www.fda.gov/news-events/press-announcements/fda-approves-first-live-non-replicating-vaccine-prevent-smallpox-and-monkeypox https://www.fda.gov/news-events/press-announcements/fda-appr... https://www.cdc.gov/smallpox/vaccine-basics/who-gets-vaccination.html https://www.cdc.gov/smallpox/vaccine-basics/who-gets-vaccina...

86 points by yarapavan 7y ago

> has the potential to mutate and cause vaccine-derived polio Glad someone is at least admitting that now. Though sadly "vaccine derived" polio is usually of the paralytic type[0] [0]https://youtu.be/S8ixbGlHTTI?t=40m59s https://youtu.be/S8ixbGlHTTI?t=40m59s

gumby 7y ago
> Glad someone is at least admitting that now. Huh? It's never been any sort of secret, and has been a factor since the earliest vaccines. Doctors know this issue is always a possibility with live virus vaccines and only use them in specific restricted cases. I addition this was not an issue mentioned in the original, fraudulent Wakefield paper.
makomk 7y ago
They kind of had to stop downplaying the importance of vaccine-derived polio. Apparently it's now the main form of polio actually paralyzing kids at this point in the campaign to eradicate the disease, and no-one seems to have any workable end-game: https://www.npr.org/sections/goatsandsoda/2019/11/15/779865471/polio-vaccine-may-be-preventing-the-end-of-polio?t=1575755256060 https://www.npr.org/sections/goatsandsoda/2019/11/15/7798654... Western countries eradicated polio thanks to better sewage and water treatment limiting the spread of vaccine-derived strains and a switch to an injectable dead vaccine that's less effective but can't cause disease outbreaks, neither of which seem to be feasible in the affected countries at this time. Stopping the outbreaks is done using mass vaccinations which introduce more vaccine poliovirus into circulation, causing more outbreaks down the line. Also, it seems the claim in the article that type 2 poliovirus has been eliminated isn't quite the whole truth. Wild type 2 poliovirus has been eliminated, but vaccine-derived versions of it are still in circulation and causing paralysis.
- ars 7y ago
  The good news there is that vaccine derived versions don't seem to circulate for very long. So if you can eradicate the wild type, stop immunizing with the vaccine type, within a year or two it should be gone.
  - makomk 7y ago
    Other way around, as I understand it: once the vaccine-derived strains have been circulating for a year or so, they become every bit as virulent and dangerous as the original wild polio and remain that way indefinitely unless they're stamped out using vaccination. The only way we can tell they're vaccine-derived rather than wild at that point is by using genetic sequencing to trace their heritage since they're otherwise exactly like wild polio. If we could somehow ensure that the vaccine strains didn't circulate for so long they wouldn't be able to regain their virulence and we wouldn't have this problem, but that's easier said than done.
- selimthegrim 7y ago
  There is a big scandal right now in Pakistan where vaccine was improperly stored and given to kids causing VDP and the guy in charge of eradication tried to cover it up and was forced to resign.
  - gus_massa 7y ago
    Do you have a link for this? Preferably one with the technical info. The problem with a bad storage of the vaccine is that it makes it ineffective. I guess if the storage is very bad, some bacteria may grow in the vial (???), but it would not cause VDP. In the injectable version, the virus is totally "dead", so whatever you do, it would not cause VDP. In the oral version, the virus is "alive". If the storage is bad it may destroy the virus making the vaccine ineffective. But the virus can't reproduce and mutate inside the vial to become dangerous. The virus need approximately one year and a bunch of host to mutate and get dangerous. So, whatever crappy storage they used, the vaccine can't give the kid VDP. The problem may be that a bad storage may make all the vaccination campaign ineffective, you think that you have 99% of the population vaccinated, but the effective number is much smaller. In that case the virus from the vaccine can spread and mutate and cause problems later after a few hops in the unvaccinated kids.

3fe9a03ccd14ca5 7y ago

Here’s a more interesting dilemma, one which I could hardly believe once I heard it: > More Polio Cases Now Caused by Vaccine Than by Wild Virus If that’s true, at what point do we stop vaccinating for it? 1. https://www.nytimes.com/aponline/2019/11/25/health/ap-af-med-africa-polio.html https://www.nytimes.com/aponline/2019/11/25/health/ap-af-med... 2. https://www.npr.org/sections/goatsandsoda/2017/06/28/534403083/mutant-strains-of-polio-vaccine-now-cause-more-paralysis-than-wild-polio https://www.npr.org/sections/goatsandsoda/2017/06/28/5344030...

tyingq 7y ago
To be clear, it's the cheap, oral, live virus polio vaccine that's causing the problem. They don't use that in the US, at all, and we don't have the issue. We don't need to stop polio vaccination...we need to find a reasonable way to replace the low budget version.
- EGreg 7y ago
  I don’t know why you are being downvoted, what you said is entirely correct AND cuts through the confusion. People need to realize that there are different Polio vaccines and the original Salk vaccine has zero chance of infecting people with Polio.
  - akamaka 7y ago
    I downvoted because it’s not correct to suggest that OPV is being used because it is a “low budget version”. In fact, both types of vaccines are being given to children in high-risk countries, as part of the transition away from the live vaccine. In countries with endemic polio or where there is a high risk of imported cases, the WHO recommends OPV vaccine at birth followed by a primary series of 3 OPV and at least one IPV doses starting at 6 weeks of age. https://en.m.wikipedia.org/wiki/Polio_vaccine https://en.m.wikipedia.org/wiki/Polio_vaccine
    - tyingq 7y ago
      "The IPV that has been used in the United States since 1987 is as effective as OPV for preventing polio" https://www.cdc.gov/vaccines/vpd/polio/public/index.html https://www.cdc.gov/vaccines/vpd/polio/public/index.html "Unfortunately, IPV costs considerably more than OPV per dose ($3-5 vs $0.12 on the subsidized world market). Because the WHO and most countries have plans to continue vaccination for at least 10 years after eradication, there will continue to be a market for the vaccine. Because of the high cost of the IPV, efforts are underway to derive improved and less expensive IPV vaccines." http://grantome.com/grant/NIH/R44-AI120260-02 http://grantome.com/grant/NIH/R44-AI120260-02 "One hundred twenty-six low- and middle Income countries will start to use IPV, which is injected, in a single dose, in addition to the oral polio vaccine (OPV). OPV will gradually be phased out, based on certain epidemiologic triggers. The previous price was a major barrier to making this shift. The shift is needed because, for eradication to occur, the polio virus needs to be gone from people, labs, sewage, etc. – i.e. the places in which vaccine-derived polio virus can survive, mutate and cause disease. IPV is ‘inactivated’, and does not carry risk of polio infection to people who are not vaccinated." https://blogs.unicef.org/blog/lowest-ever-prices-for-polio-vaccines/ https://blogs.unicef.org/blog/lowest-ever-prices-for-polio-v... The WHO only recommends OPV because of the low cost.

intuitionist 7y ago

Wild-type polio could very well be gone by now if the CIA hadn’t burned Western doctors’ goodwill in Pakistan by using fake polio vaccines to take DNA from children suspected to be related to Osama bin Laden. This isn’t close to the most evil thing the CIA has done, but it makes me the most unreasonably angry.

Twixes 7y ago
What the hell. This sounds comically villainous. On the other hand we _are_ talking about the CIA here. Got a link?
- pgrote 7y ago
  https://www.scientificamerican.com/article/how-cia-fake-vaccination-campaign-endangers-us-all/ https://www.scientificamerican.com/article/how-cia-fake-vacc...
- kick 7y ago
  The CIA have crafted a wonderful brand: with their actions, they've created a (truthful) universal public image that they'd stoop to the southern tip of Hell to get whatever they want, completely numbing the public to any possible action. If the CIA had a good reputation, hearing something like "They undermined public faith in vaccines, leading to multiple modern-day problems and epidemics" would lead to skepticism, and then riots. Instead, we all know the substance of the agency's actions, and of the character of its men. As a result, we're mildly surprised when we hear this, and don't feel it's a substantial deviation from the status quo.
dominotw 7y ago
couldn't they have done both at the same time though? take DNA and give them vaccine.
- mantap 7y ago
  The point is that now people in that part of the world think doctors are CIA agents and try to kill them.

vo2maxer 7y ago

Several articles in the news including the one in Quanta [1,2,3] appear to have caused some misunderstanding. What is clear so far is that “circulating vaccine-derived polioviruses (cVDPVs) can emerge in settings with low population immunity...,” therefore, “all countries must maintain high population immunity.” [4] It was found that “compared with January 2017–June 2018, the number of reported cVDPV outbreaks more than tripled, from nine to 29,” in the most recent survey. [4] As a result, the Global Polio Eradication Initiative” is planning future use of a novel type 2 OPV, stabilized to decrease the likelihood of reversion to neurovirulence.” One of the most significant barriers to polio eradication is “reaching every child – including inconsistent campaign quality, insecurity, conflict, massive mobile populations, and, in some instances, parental refusal to the vaccine.”[5] It is false to say that somehow cVDPVs had been kept a secret or their importance downplayed. [6] There are critical reasons to remain vigilant of any adverse consequences but keep in mind that every year “hundreds of thousands of cases due to wild polio virus are prevented. Well over 10 million cases have been averted since large-scale administration of OPV began 20 years ago.” [7] [1] https://www.quantamagazine.org/why-smallpox-is-no-more-but-polio-and-other-diseases-persist-20191203/ https://www.quantamagazine.org/why-smallpox-is-no-more-but-p... [2] https://www.nytimes.com/aponline/2019/11/25/health/ap-af-med-africa-polio.html https://www.nytimes.com/aponline/2019/11/25/health/ap-af-med... [3] https://www.washingtonpost.com/world/africa/more-polio-cases-now-caused-by-vaccine-than-by-wild-virus/2019/11/25/1a4d087e-0f76-11ea-924c-b34d09bbc948_story.html https://www.washingtonpost.com/world/africa/more-polio-cases... [4] https://www.cdc.gov/mmwr/volumes/68/wr/mm6845a4.htm https://www.cdc.gov/mmwr/volumes/68/wr/mm6845a4.htm [5] http://polioeradication.org/news-post/global-leaders-pledge-us2-6-billion-to-eradicate-polio-at-the-reaching-the-last-mile-forum-in-abu-dhabi/ http://polioeradication.org/news-post/global-leaders-pledge-... [6] https://www.ncbi.nlm.nih.gov/books/NBK236293/ https://www.ncbi.nlm.nih.gov/books/NBK236293/ [7] https://www.who.int/features/qa/64/en/ https://www.who.int/features/qa/64/en/

basicplus2 7y ago

<the laboratory-weakened virus used in the oral polio vaccine can very rapidly regain its strength if it starts spreading on its own. After a child is vaccinated with live polio virus, the virus replicates inside the child's intestine and eventually is excreted. In places with poor sanitation, fecal matter can enter the drinking water supply and the virus is able to start spreading from person to person. "We discovered there's only a few [mutations] that have to happen and they happen rather quickly in the first month or two post-vaccination," Andino says. "As the virus starts circulating in the community, it acquires further mutations that make it basically indistinguishable from the wild-type virus. It's polio in terms of virulence and in terms of how the virus spreads." In June, the World Health Organization reported 15 cases of children paralyzed in Syria by vaccine-derived forms of polio. These cases come on top of two other vaccine-derived polio cases earlier this year in Syria and four in the Democratic Republic of the Congo.> https://www.npr.org/sections/goatsandsoda/2017/06/28/534403083/mutant-strains-of-polio-vaccine-now-cause-more-paralysis-than-wild-polio https://www.npr.org/sections/goatsandsoda/2017/06/28/5344030...

Liquidity 7y ago

Small pox is still available in highly secure laboratories of Both US and Russia. Also, FDA approves small pox vaccine. https://www.fda.gov/news-events/press-announcements/fda-approves-first-live-non-replicating-vaccine-prevent-smallpox-and-monkeypox https://www.fda.gov/news-events/press-announcements/fda-appr... https://www.cdc.gov/smallpox/vaccine-basics/who-gets-vaccination.html https://www.cdc.gov/smallpox/vaccine-basics/who-gets-vaccina...