Explaining polio -- vaccines, new cases and post-polio syndrome: Upstate Medical University's HealthLink on Air for Sunday, Sept. 25, 2022

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air": a neurologist discusses how polio can impact the body's nervous system.

Jenny Meyer, MD: ... Nervous tissues are one of the few tissues in the body that don't heal very well, which is why people can develop permanent neurologic side effects from just having the virus in the first place. And that could last their whole lives. ...

Host Amber Smith: And a pediatric infectious disease doctor shares what it was like taking care of patients with polio half a century ago.

Leonard Weiner, MD: ... The last major outbreak in the U.S. was in 1952. There were 20,000 cases of paralytic polio that year, the highest number ever. And by 1955 with the use of the inactivated vaccine, the killed vaccine, so-called Salk vaccine, polio was pretty much quickly eradicated. ...

Host Amber Smith: All that, and a visit from The Healing Muse, after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine, with the experts from Central New York's only academic medical center. I'm your host, Amber Smith. New York Gov. Kathy Hochul recently declared polio a state disaster emergency. In this week's show, we'll talk with a pediatric infectious disease doctor who cared for polio patients early in his career. But we start with information from a neurologist about the disease and its aftereffects.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." Polio can be a disabling and life-threatening disease, and it spreads easily from person to person. Many people who are infected don't have visible symptoms, but the virus can infect a person's spinal cord and cause paralysis. And some people deal with something called post-polio syndrome later on in their lives. Today, I'm speaking about the effects of polio with Dr. Jenny Meyer. She's an assistant professor of neurology at Upstate. Welcome back to "HealthLink on Air," Dr. Meyer.

Jenny Meyer, MD: Thanks for having me, Amber. It's really nice to see you guys again.

Host Amber Smith: Polio is back in the news because a case of polio left a person paralyzed in downstate New York and the discovery of poliovirus in the New York city wastewater. But the poliovirus has been around for centuries. Can you tell us when and how it was discovered or first identified?

Jenny Meyer, MD: So I recently was looking at some literature from the BBC, who did a news article about this, and actually, I did not know this, but apparently polio was even depicted in hieroglyphics in Egypt. There are drawings of humans with deformed limbs walking with canes in hieroglyphics. So apparently it's been around a very, very long time, but I believe it was first identified sometime in the early 1900s, and I believe it was found in the spinal fluid of humans that they had then injected into animals. And then the animals would get a polio-like syndrome, and that's how they determined it was an infectious material. But I believe it was after the electron microscope was invented that they actually saw polio, because it's a virus, so it's very small.

Host Amber Smith: It just hasn't been something we've been concerned about in recent years, or recent decades, even, in America. So it's back in the news, all of a sudden. Why is that?

Well, unfortunately, I think it's because of the movement to avoid vaccination in children. In some areas of the world, this remains an endemic illness, specifically Sub-Saharan Africa and in areas of Asia where they don't have adequate medical facilities to keep vaccination materials available for populations. And so, in many areas of the Second and Third World, this is still a virus that is very real and part of life. In the U.S., we've thankfully been all, mostly, vaccinated for the last 20 to 30 years, since about the 1950s, when the vaccine became mainstream. And therefore, many of us have never seen polio in our daily lives, and therefore, I think we've forgotten about it. Now later on in this program, I'm going to speak with Dr. Leonard Weiner. He's a pediatric infectious disease doctor from Upstate who has been practicing long enough that he recalls taking care of patients with polio, very early in his career. But from what I understand, a small portion of people with poliovirus infection will develop serious symptoms, either meningitis, where the brain or the spinal cord is infected, or paralysis, where their arms or legs become weak or immobile. For meningitis, it's up to five people out of 100. And for paralysis, it might be as many as one out of 200. So it's a fraction of those who are infected with polio who may develop more severe cases, is that right?

Jenny Meyer, MD: That is correct. Most people who experience polio would have had a GI (gastrointestinal) illness that probably resembled the common stomach bug. So it's one of those viruses that's very contagious because people don't get that sick. So they may not stay home very long. They may not realize they're still contagious and go out into the community and use a public bathroom or go to a restaurant and not adequately wash their hands for 30 seconds under hot water with soap. These are things that we all take for granted, and that's how many of the viruses are spread, you know.

Host Amber Smith: Are there simple tests like we have for COVID that tell whether a person is infected with poliovirus?

Jenny Meyer, MD: I don't know how available the testing has been in the past, because it's been something that we haven't had to do very often. I do know that there are tests. They test stool, and they test blood for the PCR, which is where they look for the DNA of the virus. I know that in my practice, the time that we are looking for polio is usually when someone has an acute paralysis.

Host Amber Smith: But there's nothing over the counter. Someone can't go to the drugstore and get a test like they could for COVID?

Jenny Meyer, MD: No, no, it's nothing over the counter, as far as I know.

Host Amber Smith: Now, once poliovirus infects a person, how does it get -- because it's in the GI system, right? -- how does it get into the brain or the spinal cord?

Jenny Meyer, MD: Well, your GI system is highly connected to your bloodstream because that's where all your nutrients come into your body. So the blood-GI barrier is very weak. So the poliovirus can get into the bloodstream, and then it becomes a systemic infection. So it basically goes wherever blood goes. Polio tends to be a neurotropic virus, which means it likes nerves. So it goes into the blood-brain barrier and tries to penetrate that and enter the spinal cord and motor neurons, which are the nerves that control your muscles.

Host Amber Smith: So once it's in the spinal cord or the nervous system, are there symptoms that would tell a person that they've got a problem?

Jenny Meyer, MD: It's actually painless, from what I understand from people who've had it. However, it does cause weakness, and it can cause some mild headache because there is some irritation of the lining of the nervous system called the meninges, so meningitis. But the limbs, people don't experience painful limbs. It's more of just a slowly progressive weakness that can develop, or they can develop mild headache, a little bit of neck stiffness, symptoms that you might experience with flu. So you might not think that much about it. Any of us who've had the flu can say, "You know, I feel like I don't want to get off the couch. I feel like I got hit by a truck," that kind of body ache. Fever would be something that may or may not develop. And it's usually over a course of a few days to a week this paralysis would occur, or these symptoms would occur, and in the extreme case, cause paralysis.

Host Amber Smith: So is the body's immune system working to fight the poliovirus, even after it has invaded? If it does invade the nervous system, or is it inevitable that the person's going to develop paralysis?

Jenny Meyer, MD: The immune system kicks in as soon as it hits the bloodstream. Thankfully in your blood, you have immune cells that float around, and when they encounter these foreign viral particles, if they've seen them before, they can recognize them and start fighting right away. So if you've been vaccinated, it's very unlikely you would develop neurologic symptoms from it because your immune system is already in tune to "this is a foreign protein. It's not supposed to be here. Let me activate and get started on fighting this off." However, if you haven't been vaccinated, your immune system may not know what that protein is, and it may take longer for it to develop the mechanisms to start fighting off the infection, which is why people who are unvaccinated are more vulnerable to these severe side effects.

And certainly before the vaccine existed, that is why those, you quoted those numbers earlier about the statistics of the neurologic symptoms. Because if you didn't have immunity, some people's immune systems are better than others and may not recognize right away that the protein is foreign. By the time it kicks in, it's already spread to the nervous system, which is where it likes to live, and causes damage to those nervous tissues. And unfortunately, nervous tissues are one of the few tissues in the body that don't heal very well, which is why the post-polio syndrome and some of the aftereffects of having polio -- which is actually different than post-polio syndrome -- but people can develop permanent neurologic side effects from just having the virus in the first place. And that could last their whole lives.

Host Amber Smith: Some older adults who had polio as young children may develop muscle weakness and joint pain and fatigue decades later. How do you go about determining if that's caused by post-polio syndrome or something else?

Jenny Meyer, MD: So post-polio syndrome is essentially a disease that you have to rule out other causes. It's very scary because usually these are people who had polio as a child, recovered over the course of a year or two years, maybe has some permanent deficit to begin with, but for the most part feels back to normal. I'll put that in, like, air quotes, "back to normal," because they've recovered to the point where they're now living some sort of normal life, whether that's working or doing a sporting activity or something that makes them feel like they're at baseline. Then, sometime in their 40s, 50s, they might notice things are just slowing down, and it's very gradual. They just feel more tired. They have less energy. Things just seem a little harder. Walking up stairs takes a little longer. Maybe they feel a little unbalanced, and they have to hold onto the railing. Gradually, over the course of a couple of years, people notice some changes in their abilities, and usually it takes some time for them to find their doctor to ask about these, because most of my patients will say "I'm old," in air quotes, and that's why they feel this way.

Once they arrive to the doctor, the doctor would certainly interview them about their prior history. And once you've determined that they've had polio in the past, even if they weren't very sick from it, it is sometimes a clue that this is something that could have happened to them. Unfortunately it's a diagnosis where you have to rule out other things. So they often undergo MRIs, nerve conduction studies, electromyography. Sometimes they do physical therapy. And after everything they've done, if nothing seems like it's getting better, and we can't find the cause, this is the diagnosis that we give them.

It's primarily a motor disease. They don't often have much pain. Although I will say that the joint aches and pains are often something that people will complain about with this, because if your muscles are weaker, they don't support your joints as well. So your tendons undergo more stress, and things just don't feel quite as easy as before. The other thing that many patients with post-polio syndrome complain about is fatigue, which is a very hard thing to measure. I mean, my tired level versus your tired level on any given day might fluctuate. There's not really good scales to measure the subjective experience of being tired. But patients constantly tell me that if they could take one thing away, it would be their tiredness because it doesn't seem to matter how much they sleep. They just feel tired. And I think that's actually muscle fatigue that they feel. Their muscles don't want to move. They can't move them as easily. And everything is more effortful, so that overall experience of needing more energy to just do the most basic things is what they're expressing.

Host Amber Smith: So, this being a motor disease, what do you do to treat it? You mentioned the fatigue. Is there a medication that will give people a little more energy back?

Jenny Meyer, MD: Unfortunately, no. There's been many research studies in the past, trying to determine what we can do for these people. And there are two theories of why this disease happens, which I can get into a little later. But to specifically answer your question, the main area of treatment right now is supportive care, which means teaching people exercises to help them use their joints and limbs in a way that's safe so that they don't injure them further; helping people maintain their energy levels by taking time, whether that means stopping their job, whether that means taking breaks between activities so that they can have the energy to do what they want to do; providing equipment for them so that they can actually do the types of jobs or activities that they want to do, whether that's power mobility devices, handicapped stickers for their cars, canes, walkers. Orthotics are often used to help support, specifically like weak ankles or weak knees. Those types of things are really the areas that we use right now to manage post-polio syndrome.

So it's better to never get the disease than to get the disease.

Host Amber Smith: Please stay tuned. Upstate's "HealthLink on Air" has to take a short break, but I'll be back shortly with more information from neurologist Dr. Jenny Meyer.

Welcome back to Upstate's "HealthLink on Air". I'm your host, Amber Smith, and my guest is neurologist Jenny Meyer from Upstate Medical University. We've been talking about polio.

So If you're an adult who had polio as a child, are there things you can do to prevent the development of post-polio syndrome?

Jenny Meyer, MD: This is another area of research. We don't really know why the disease recurs or why it comes out in late aging. There's two different academic theories of why this is happening. One is that it's a decompensation of damaged neurons over time, due to aging, which certainly no one has control over how fast they age. Their body is aging at the same rate as everyone else. And whether you started out perfect, or you started out with some damaged neurons really depends on whether you got polio in the first place. As opposed to the other theory, which is that it's an immune response, and that it may be some type of autoimmune disease where polio gets reactivated and causes further damage, which is a target of some research studies to use medications for autoimmune diseases to try to suppress the immune system, to prevent the reactivation of polio.

Unfortunately, the research studies that I know about have not well elucidated these two theories. And so they remain theories at this time. And the treatments have not followed that because they have not elucidated the true cause.

Host Amber Smith: What are the late effects of this? If someone is determined to have it, what's likely to happen?

Jenny Meyer, MD: So usually they'll experience weakness in a new limb. So many people after polio may have one limb or maybe two limbs that were weaker to start with because they didn't 100 percent recover from polio. But it's really defined as weakness in a new limb. And there's actually specific criteria that we use in medical research for post-polio syndrome. It's part of the March of Dimes. It's called the March of Dimes criteria. And that is a definition saying that you don't have any other found cause for your weakness, it's involving a new limb that wasn't involved originally in your polio, and that it is a gradual onset of weakness over time. And those basically three main criteria are the foreground of designing who meets that.

Going forward from that, the rate of decline is variable. So some patients who maintain a low-impact, frequent exercise program can often maintain their strength, despite having post-polio syndrome in those weak limbs. But it's really key to work with a therapist that knows about post-polio syndrome because certainly you wouldn't want to do, like, a marathon-level training if you've had polio in the past, because you don't want to create any additional damage to the muscle tissue. Because those neurons are already struggling. And those muscles are dependent on those struggling neurons. So we want to make sure that we maintain what we have as long as we can, and we support the joints that are involved so that they don't deteriorate further. Because another big thing is rotator cuff tears, knee injuries, falls. These are things that certainly greatly impact someone's quality of life and their longevity. Hip fractures, for example, we know in the elderly can cause a major cause of mortality. So the big thing is preventing the injuries that can occur because of the weakness.

Host Amber Smith: You mentioned the March of Dimes. Can you tell us a little about that organization?

Jenny Meyer, MD: From what I know, the March of Dimes was founded during FDR's presidency. And it was a nonprofit group that was created to raise money to support mothers and children. Their main goal at that time was to support vaccination for polio because it was at that time endemic. And there was a significant amount of disability associated with having a child that had had polio. And also, there was a big push for the public health to support vaccination. So I believe that the name March of Dimes came about because there was a campaign where they asked people to donate 10 cents, or a dime, toward polio research. Just as you might see a bucket in your barbershop raising money for St. Jude (Children's Research Hospital,) this was how they raised money for polio research. The March of Dimes criteria is a criteria created because of the funding from the March of Dimes used for research for polio, and that's where the name comes from.

Host Amber Smith: So beyond maybe being a little more susceptible to injury, does post-polio syndrome put a person at higher risk for other medical conditions?

Jenny Meyer, MD: As far as I know, no. I might be proven wrong if they determine that it's an autoimmune disease, which may later on impact their immune system's ability to fight off other viruses. But I think as of right now, we haven't elucidated that fact yet that it necessarily increases your risk of heart disease, GI illnesses, other infections. I think at this point it does increase your risk of orthopedic injuries. It certainly increases your risk of disability from being unable to maintain your activities of daily living -- brushing your teeth, toileting, showering. These are things that most people don't think about as challenging, but if you can't lift your leg up more than two inches, getting over that tub rail is pretty hard.

Host Amber Smith: So we talked about how it's just a small fraction of people who are infected with polio that develop paralysis or meningitis. If a person had a mild case as a child, or maybe they even had it without knowing it, are they still at risk for developing post-polio syndrome?

Jenny Meyer, MD: Yes, they are. Anybody can develop post-polio syndrome, even if their polio was mild. Unfortunately, because of the fact that this is a lesser-known illness now, because of the fact that we have almost essentially eradicated it in the U.S., I would say many providers are probably unaware of this possibility. And certainly it's only been in my experience, people who lived prior to vaccinations. So my post-polio population is largely in their 70s or grew up in a country where there were no vaccinations available, if they're under that age.

Host Amber Smith: So that means maybe we should pay really good attention to the polio threat that is emerging today. What can people do now to protect themselves from possibly becoming exposed to this polio virus that's been recently detected?

Jenny Meyer, MD: First of all, I would say, talk to your doctor. Certainly if you are not sure about your vaccination status, whether or not you were vaccinated, asking them to check you for titers (evidence of infection) to see if you have the immunoglobulin against polio. And if your vaccination status has waned, getting a booster would certainly be the first step. Areas where I would say probably require more attention would be pregnant women, because certainly if you're carrying a new person, you want to make sure that you're giving them those immune globulins through your milk when they're first born, so they can be protected, because they're not going to be able to wash their hands or deal with the spread from other humans. Certainly I would say if you live in an area where you are very closely affiliated, so college students, military personnel, anywhere where you're going to be living very close quarters with other people and using shared bathrooms, I would say checking your vaccination status and getting boosted is a reasonable place to start.

And then children, if the children have been unvaccinated because of whatever reason, certainly you can always change your mind as a parent. If you made a decision when your child was young and said, "You know, I didn't want to get my kid vaccinated, but now that I realize this is something that maybe is a real threat again," you know, you can change your mind, and your pediatrician will understand.

Host Amber Smith: Well, Dr. Meyer, thank you so much for making time for this interview.

Jenny Meyer, MD: Thank you for having me. It's been a pleasure.

Host Amber Smith: My guest has been Dr. Jenny Meyer. She's an assistant professor of neurology at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air:" polio from an historical perspective.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Dr. Leonard Weiner is the senior member of the pediatric infectious disease team at Upstate. And while his colleagues have been taught to care for someone with polio, Dr. Weiner is the only one who can tell stories about actually taking care of patients with polio in the early years of his career, when it was much more common. Dr. Weiner is a professor of pediatrics and pathology, and he specializes in pediatric infectious disease.

Welcome back to "HealthLink on Air," Dr. Weiner.

Leonard Weiner, MD: Glad to be here.

Host Amber Smith: Did you ever think polio would make a comeback in America?

Leonard Weiner, MD: Well, I hate to use the term "comeback," but it's not totally surprising that we do see cases pop up, including the most recent case that's garnered so much attention in the press and in New York state.

Polio still occurs around the world, and it has been imported into the United States from time to time. And this unfortunate patient in Rockland County is not the first time. I took care of a patient with polio from what's called a vaccine-derived strain in the year 2000.

And as I mentioned, there have been cases, around the country, in subsequent years. The important thing to remember is that those cases occur in under-immunized communities. They would not occur in a community where the immunization rate is at a level which is effective in preventing polio.

Polio vaccine, given in its full course, is 99-plus percent effective in preventing polio.

Host Amber Smith: So, we've seen sporadic cases here and there in the United States in the recent past. But this seems a little bit different, with the governor declaring a public health emergency. It seems like people are getting really worried about this.

Leonard Weiner, MD: Well, I think they should be worried about it, but again, it represents the difficulty of controlling what is normally fully vaccine-preventable disease when you have low rates of vaccination. The counties in question downstate, particularly Rockland County and Orange County, have some of the lowest rates of polio immunization in the United States.

Host Amber Smith: So, when did you start practicing medicine? And what can you tell us about the patients that you took care of with polio way back then?

Leonard Weiner, MD: Well, I've been at this a long time, but let me just give you some background. The last wild case, when I say "wild" polio, I'm talking about a virus that is not derived from a vaccine. And I guess that requires some clarification.

The vaccine (used in) the United States now is inactivated vaccine. It has no potential whatsoever of causing disease in anybody, but it is, as I mentioned, almost a hundred percent protective when administered properly. Oral polio vaccine, the so-called Sabin vaccine, which has not been used in the United States since the year 2000 or so, but is used in other parts of the world, has the potential since it's live and it replicates, that means it grows in people to produce the protection. Rarely, that virus reverts back to a disease-causing strain. That reversion is usually in the so-called Type 2, which is what's happened in this particular case. And it's happened before and does happen in other parts of the world as well.

So with that background, what we have is a scenario where somebody comes in contact with somebody who had oral polio vaccine somewhere other than in the U.S. and picks up the virus and either gets sick directly because the virus is the so-called reverted virus, or it passes through people. It's infectious from one person to the next.

And by the way, that's why oral polio (vaccine) is used in other parts of the world, because it does spread and protect. In the United States, we don't need that, but in other parts of the world we do, because we don't reach out with the vaccine to everybody. So it's kind of a yin and yang; we have a great vaccine for all scenarios, but occasionally the Type 2 strain in the oral polio vaccine can revert and cause real disease.

And that's what happened here somehow. And nobody knows for sure how yet. This person who developed it was an adult who developed polio, paralytic polio, was exposed to somebody who got oral polio outside of the U.S. or brought it back, and that strain has caused disease. And that's what people are identifying in wastewater and in specimens from other individuals. And that's why the governor, I think appropriately, has said we've got to get this under control. This is an emergency.

Host Amber Smith: There are stories of parents in the 1940s that were afraid to let their kids play with other children or go where there might be crowds -- movie theaters or swimming pools. What do you recall about the mood of the country at that time?

Leonard Weiner, MD: So, I recall not in the '40s because it's before my time, but I do recall my parents not letting me go to the community pool because they were afraid of polio. So the last major outbreak in the U.S. was in 1952, there were 20,000 cases of paralytic polio that year, the highest number ever, and by 1955 with the use of the inactivated vaccine, the killed vaccine, so-called Salk vaccine, polio was pretty much quickly eradicated in anyone, in any community where vaccine, was utilized.

And that's the scenario of where schools and clinics were set up, and everybody went and got their shot, and then they would get the remaining shots. Polio vaccine requires four doses in children, at 2 months, 4 months, 6 to 18 months and then another last dose at between 4 to 8 years of age. If you do that, you never need anything else later in life, and you're protected against polio.

Host Amber Smith: So is the polio vaccine in use today the same one from back in the 1950s?

Leonard Weiner, MD: How should we say this? It's been spoofed up, it's better than it was then. It's been modified. But in the early '60s, we went to the so-called Sabin vaccine, I mentioned that before, which was the live vaccine. And we used that in the U.S. through 2000. And then in 2000, it became clear that the complications of that vaccine, the rare, less than one in a million chance of getting actual polio from that vaccine was still greater than the risk of going back to the newer inactivated vaccine that we use now. And so, since approximately 2000, we've used only inactivated, but it's a newer inactivated, and it's more effective.

Host Amber Smith: When it was first made available, was it just for children, or was it for everyone? Did the whole population need to get vaccinated at first?

Leonard Weiner, MD: No, because most polio occurs in children, and we can go into that quickly. That's because, as I said, most people who get polio have no other symptoms other than maybe flu-like or nothing, and yet they're protected. So, in the '50s and '40s, most adults who didn't get sick already had some protection. So this was a childhood vaccine.

Host Amber Smith: Were people receptive to getting vaccinated, or was there skepticism when it first rolled out?

Leonard Weiner, MD: Again, I wasn't there, but I can tell you from the pictures that they lined up for blocks and blocks, and then when it became, in the early '60s, the live vaccine on the sugar cube, schools were doing it every day until everyone was fully vaccinated. This was a very, very safe vaccine, even safer today, and highly, highly effective. And if you've been fully vaccinated as a child, you do not ever need a booster -- unless you maybe are going to parts of the world as a health care provider where polio is still seen.

Host Amber Smith: You're listening to Upstate's "HealthLink on Air." This is your host, Amber Smith. And my guest is Dr. Leonard Weiner. He's a pediatric infectious disease specialist and professor of pathology at Upstate. And we've been talking about polio.

With the polio virus being discovered in the wastewater in New York City and a case of the adult being paralyzed by a polio infection, how big of a threat is this disease to the general population?

Leonard Weiner, MD: Well, that's the key question, isn't it? And I would just point out what we touched on earlier, which is that in the scenario that we're seeing now, it's only a threat for communities where vaccination rates are low. If you were vaccinated as a child, it doesn't matter that it's in the wastewater, or somebody else might potentially transmit it to you. It's not a threat to you. However, if you're talking about communities with low vaccination rates, then the virus is able to spread and cause disease. So the answer, clearly, is we have an effective and safe vaccine, very effective, very safe. We just need to get it out there.

And, as a marker of what can be done, back a few weeks ago in Rockland County, they administered 2,000 doses of polio vaccine in one afternoon.

Host Amber Smith: Just from people who suddenly recognized the importance?

Leonard Weiner, MD: They recognized they were under vaccinated and they showed up.

Host Amber Smith: Now, if someone was vaccinated as a child, as an infant, or if they can't remember whether they were vaccinated or not, is it worthwhile to get a booster at this point?

Leonard Weiner, MD: Since the '70s in the United States, it's been a school requirement to be fully vaccinated against polio. So if you went to school -- not home school, but if you went to a public school -- you'd be vaccinated. If anybody has any question, since records going back that far are hard to find, it's perfectly safe to get polio vaccine additional doses. However, it's usually not recommended, even in the scenario we're talking about for adults, because they were adequately vaccinated as youngsters.

Host Amber Smith: We've heard about viruses that mutate, such as with COVID, the SARS CoV-2 virus, so I wonder if that could happen with polio. Is the disease that we're seeing today the same as it was in the '40s, or has it changed?

Leonard Weiner, MD: I'm going to answer that in two ways. The virus that is derived from the vaccine -- which is what we're seeing now, and what's in the wastewater and what caused disease in Rockland County, in Israel and other parts of Europe -- that is a mutated virus from the oral polio vaccine strain Type 2. So it is a mutation. I commented earlier, this was sort of a reversion back to a disease-causing virus from the attenuated form that's usually in the oral vaccine.

However, the second part of your question really relates to, if you get polio now with one of these mutated strains, is it really any different than what polio used to be? Or if you're unlucky enough to be in Afghanistan and you get polio, is that a different disease now? And the answer is no. The disease is the same, and in some cases tragically the same, but we're not dealing with the same kind of mutation that we associate with, for example, COVID or even influenza virus each year, when we have to change the vaccine to match the virus, because it changes each year.

Host Amber Smith: So let's go over, if you don't mind, what are the symptoms, and how is this diagnosed today?

Leonard Weiner, MD: Again, the most important thing to remember is that most individuals with polio, and most of them are children, almost all are children,will have little or no symptoms. If they have symptoms, about one in four or one in five, of those that are infected -- the others being truly asymptomatic -- the one in four or one in five have a little low grade fever, may have some headache, could start with the runny nose and end up with a little bit of diarrheal illness, loss of appetite. And the incubation for period for that from one person to the next is somewhere around three to six days.

So it gets transmitted pretty quickly by the fecal-oral route. If you're going to develop paralysis --and, as I said, that's quite rare -- somebody who's infected may be one in 100 or even less than that. Around seven to 21 days, you begin to show signs of, usually, upper arm or upper leg weakness, and that can progress over the next days and can be severe, and in a small percentage affect the breathing muscles. And those are the individuals who are at greatest risk and have to go on a respirator, and sometimes, in the past, those people did not survive. And in other parts of the world, they don't survive.

Host Amber Smith: Since this mainly affects children, if you're an adult here in New York and you were not vaccinated as a child, is there a reason to be,or not?

Leonard Weiner, MD: Oh, absolutely. I mean, I think that's partly what the Health Department and the governor is trying to get people to do, if you were not vaccinated as an adult. Remember the case that alerted us to all this was an adult. That was not a child. The individual in Rockland County was an adult who was not vaccinated. It was part of a community with a very low vaccination rate, and that individual, even though we don't know who that is, we do know that that individual was not vaccinated. So if you're not vaccinated, or you think you're not vaccinated, that's a real trigger to go get vaccinated.

Host Amber Smith: Can you tell me about how the disease is treated today and compare it with how it was treated when you were coming up?

Leonard Weiner, MD: So, there is no antiviral agent for the class of viruses that polio... so polio is an enterovirus. There are other enteroviruses that cause a wide range of disease from just minimal illness. There are even some that can cause a polio-like illness called acute flaccid myelitis. And we do see that from time to time. So that quite closely mimics polio, though it's not the same strain. It's a cousin, so to speak. It's part of the enterovirus family. We do not have drugs that can inactivate the enterovirus group of viruses.

So polio treatment and treatment for the other paralytic diseases that come from the other types of enteroviruses is always supportive treatment. And it was supportive treatment back in the '50s and before. And the main support in those days was, if you had trouble breathing, was the iron lung, and we don't do that anymore. We use respirators. But it's supportive treatment. There is no magic medicine. And, that's why vaccination is so important, because you have to prevent.

Host Amber Smith: Earlier in this program, we spoke to a colleague of yours from neurology about the late-term effects of polio that she sees in older people with post-polio syndrome. So even if you are exposed or you get polio and you survive it just fine, for some people, at least, it comes back to haunt them later in life.

Leonard Weiner, MD: It certainly does, because it damages the nerves, and I'm sure Dr. (Jenny) Meyer talked about that. And as you get older, loss of function becomes quite significant.

The real point to remember is that we do have an almost 100% perfect prevention for this disease, and that is polio vaccination, which is one of the safest and longest standing vaccines. Remember, we're talking about Jonas Salk, who discovered the inactivated vaccine and first gave it to patients in the early '50s. By 1955, even though 1952 was the year with the largest paralytic polio outbreak -- 20,000 cases -- by 1955, that number was down to hundreds, just due to vaccinating children in schools and at houses of worship and community centers. It was miraculous..

Host Amber Smith: And since then, pediatricians' offices have been giving out the vaccine to the children. If you're an adult, would you be able to get the vaccine from your primary care provider?

Some, and also from the health departments. County health departments are now, as part of the emergency, are now being geared up to help give the polio vaccine. And, you can look online at the New York State Department of Health site, and you can see what the polio vaccine rate for children is in the various counties. And if you're in a county with a low rate -- remember, this disease is spread usually by children to other children, but also, potentially, to adults, as occurred in Rockland County -- then if you're in a community at risk or you know you are in a population group that has a low rate, you want to seek out vaccine.

Host Amber Smith: Well, I appreciate you making time for this interview, Dr. Weiner.

Leonard Weiner, MD: My pleasure.

Host Amber Smith: My guest has been Dr. Leonard Weiner, a professor of pediatrics and pathology at Upstate who specializes in pediatric infectious disease.

I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from audiologist Erin Bagley from Upstate Medical University. What's important to know about over-the-counter hearing aids?

Erin Bagley: My biggest concerns are some of the marketing has been, "now available without needing a hearing test." I do think it's still really important if you have concerns about your hearing to get a hearing test. Hearing loss is one of those things that can come on very gradually over time. So, it's not always clear what degree of hearing loss you may have. Over-the-counter hearing aids are really intended for people with a mild to moderate hearing loss. But if you haven't had a hearing test, you may not know if you fall in that category.

Also, I think it's very important to make sure that we're ruling out other causes of hearing loss that might be treatable in another way. We want to make sure that it's not something like wax in their ears, or fluid, things like that that could be treated differently. So, I still think it's really important to at least get a baseline hearing test where you put on headphones, and let the audiologist know when you hear the beeps. We also measure word understanding as well, so some recordings of speech and have the patient repeat the words to see how clear speech is for them, too.

Ears come in all different shapes and sizes. And that's where, as a professional, it's important to make sure that our patients' hearing aids fit well. So that is a concern that we have with over-the-counter hearing aids, is just making sure people are able to get something that fits well for them. You know, I'm anticipating they're going to come with some different-size tips that go on the part that goes into the ear, and finding a size that is a good fit for the ear so that it stays in place well is going to be important.

Currently we don't know exactly how the labeling is going to work on over-the-counter hearing aids. Our professional organizations, the American Speech Hearing Association, and the American Academy of Audiology have been working with the FDA, to give suggestions on labeling.

Hearing aids purchased through an audiologist in New York state, have a 45-day trial period. So the patient can return the hearing aids within 45 days to get a refund. We don't know yet exactly how return policies will work with over-the-counter hearing aids, so one thing I would caution people about is to make sure anything you do buy over the counter does have some sort of clearly stated return policy in case it doesn't work out for you.

Also, I'm a big believer in things like online reviews. Get as much information as you can about the product you're buying because we don't know yet which manufacturers or which companies may be starting to produce their own devices and enter the market. So even audiologists, we're not sure yet what kind of devices we might be seeing in the stores.

You know, I'm anticipating some will look kind of more like a Bluetooth headset kind of device, and some are going to look more like a traditional hearing aid, so I think we're going to see a range of sizes and styles. A lot of prescription hearing aids have the ability to answer the phone, to stream music. Most of them have an app where you can make some adjustments to settings or volume.

Prescription hearing aids through an audiologist are fit, like a prescription. So they are fit to the person's hearing loss. There's measurements that can be taken with a small microphone in the ear while the patient's wearing the hearing aid to make sure that the output of the hearing aid is doing what we think it's doing and meeting their needs.

In my experience, the longer someone has been struggling with their hearing, sometimes the longer it takes for them to get used to hearing differently through the hearing aids and hearing sounds around them again, and kind of relearn what all those different little noises in their home environment are. But every person is different and has a different experience. I find people that are really motivated and wear their hearing aids consistently do adapt more quickly than people who are not quite ready to wear them all the time.

Host Amber Smith: You've been listening to audiologist Erin Bagley from Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: KB Ballentine's sixth poetry collection, "The Light Tears Loose," can be found at Blue Light Press. The poem she gave us, "After Surgery," is a meditation on all we see and feel as we recover. Here is "After Surgery":

A pair of swans preen, slide

swiftly across the blue cool

of lake -- soon they will taste

the frost before it comes and rise

together finding a thermal draft

that guides them to warmer climes.

The lamps on each bedside table beckon,

downy softness sandwiched

between them where letters turn to words

that take dreams to flight:

promise of light before the final dark.

Following the trail as sure as scent,

the wolf of smoky fur and tender heart

nuzzles his mate. She licks his ear

while they pause beneath an evergreen

leaning with the weight of snow.

Branches bristle, spear the feathery mounds.

Toes seek solace in fuzzy comfort ,

left and right slippers waiting by the door.

Twelve hours constricted in stiff leather

pressing concrete pleads a soothing escape

to stretch and wiggle.

Seahorses couple, anchor themselves

in the reeds, the grass. Undulating

they wrap around each other

and daily dance invisible currents --

nodding to blennies and gobies, to kelp

clinging across the rock and sand.

I didn't know I was grateful,

with my eyes and ears and lungs,

to watch the moon twin the sun: two flawed

globes that balance night and day --

lead the seasons, reel against the dizziness

that unbalances my new walk, my new life.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York. Next week on "HealthLink on Air": comprehensive multiple sclerosis care. If you missed any of today's show or for more information on a variety of health, science and medical topics, visit our website at HealthLinkonAir.org. Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Stephen Shaw. This is your host, Amber Smith, thanking you for listening.