With So Little Poliovirus Detected Around the World, What Is Causing Today’s Outbreaks of Acute Flaccid Paralysis?

Neenyah Ostrom -- 04/01/2001

The World Health Organization’s massive poliovirus eradication program recently declared Egypt on the threshold of  eradicating poliovirus. “We are now at the end of a polio era,” a UN Children’s Fund Project Officer told Reuter’s news service at the end of February 2001, with “not a single case of the crippling virus reported so far this year” or last (2000) in Egypt. Does this trend toward eradication of poliovirus mean an end to childhood paralysis around the world?

There is no obvious answer to that question. According to another set of statistics compiled by the World Health Organization (WHO), there were 54 cases of “acute flaccid paralysis” (abbreviated AFP) in Egypt in 2000, the most recent year for which statistics are available. In 1999, although 9 AFP cases were classified as due to poliovirus, Egypt had 276
more AFP cases that were classified as non-polio paralysis. These WHO statistics, kept back to 1996 for almost every country in the world, reveal a surprising fact: Most of the paralysis around the world today  is not caused by the poliovirus.

This fact raises new, disturbing questions, including: Was there ever an epidemic of poliovirus infection in the United States and Canada? These two countries experienced a great number of cases of AFP, to be sure, during which many children (and some adults) tragically were paralyzed or died. How many of these cases of paralysis, however, were caused by poliovirus? What did cause those not associated with poliovirus? And what continues to cause so much misery in areas of the world least-equipped to be able to deal with it?

Will mass vaccination campaigns and poliovirus eradication programs ensure that no child is ever again paralyzed? Or is it time—using new tools that didn’t exist in the mid-twentieth century when ground-breaking poliomyelitis research was first performed—to re-examine that basic research and the assumptions underlying it?