Talk:Polio

The intro...

Goes like this:

Poliomyelitis, often called polio or infantile paralysis, is an infectious disease caused by the poliovirus. Approximately 90% to 95% of infections cause no symptoms. Another 5 to 10% of people have minor symptoms such as: fever, headache, vomiting, diarrhea, neck stiffness and pains in the arms and legs.

That's not right. The fact that many people have minor symptoms or have no symptoms at all is not essential to the basic description of the illness. It is (or was) known and significant for its major debilitating effects and lethality. The intro should not begin with what is effectively a footnote. GregorB (talk) 12:12, 29 November 2015 (UTC)

You mean this is wrong "Poliomyelitis, often called polio or infantile paralysis, is an infectious disease caused by the poliovirus."?

Are you mean that this is wrong "Approximately 90% to 95% of infections cause no symptoms. Another 5 to 10% of people have minor symptoms such as: fever, headache, vomiting, diarrhea, neck stiffness and pains in the arms and legs."?

The latter is supported by the CDC http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/polio.pdf but I agree needs to be adjusted as the prior content was based on the 2009 rather than 2015 version of the Pink Book. Doc James (talk · contribs · email) 12:38, 29 November 2015 (UTC)

As I explained above, by saying "that's not right", I did not mean "that's untrue" - I meant "starting the intro with a red herring is not right". Still isn't, especially not in a featured article on a fairly important topic. GregorB (talk) 12:48, 29 November 2015 (UTC)

How is saying that most causes of infection do not result in symptoms not important? This explains why immunization is so important as one could catch it from one of the many potential asymptomatic carries. Doc James (talk · contribs · email) 12:50, 29 November 2015 (UTC)

As I already said, it is not what the illness is known or notable for, nor it is its defining characteristic. I'm not necessarily saying that this fact should be omitted from the intro entirely, but it's definitely not for the second sentence of the article. WP:INTRO says (emphasis mine):

The lead should stand on its own as a concise overview of the article's topic. It should define the topic, establish context, explain why the topic is notable, and summarize the most important points, including any prominent controversies. The notability of the article's subject is usually established in the first few sentences. The emphasis given to material in the lead should roughly reflect its importance to the topic, according to reliable, published sources.

Starting with rather ephemeral - if true - facts about the disease, before really major facts about the disease are listed, tends to confuse the readers, especially those who know why this illness is (or was) important and expect it right in the article's opening sentences. GregorB (talk) 13:07, 29 November 2015 (UTC)

We often write the lead in the same order as the body of the text. Thus definition followed by signs and symptoms of the disease. Second paragraph deals with cause and transmission and diagnosis. Third prevention and treatment. Fourth history, society and culture.

The symptoms of a disease is part of the major facts about it. Doc James (talk · contribs · email) 13:34, 29 November 2015 (UTC)

In fact, that was my impression too: that the article content was simply transplanted into the intro, in the original order. This sometimes works - and sometimes it doesn't. The intro is not simply a linear, condensed rehashing of the article's content, it has a different logic. What I'm saying is that its current organization violates WP:INTRO, as quoted above. GregorB (talk) 13:39, 29 November 2015 (UTC)

The lead is supposed to be a summary of the body of the text. I do not see it as violating WP:INTRO. I guess we disagree. Doc James (talk · contribs · email) 13:45, 29 November 2015 (UTC)

It would be fairly hard to argue, especially knowing what poliomyelitis is notable for (note IANAD!), that the intro does not violate the bolded sentence from WP:INTRO quoted above. Anyway, I leave it up to editors and readers to decide... GregorB (talk) 14:16, 29 November 2015 (UTC)

I don't disagree with the intro, but that's not to say we couldn't improve it. I think GregorB's point is that even though polio is now a mostly historical disease, lay people know about it because it caused hundreds of thousands of deaths in the twentieth century and was greatly feared by the general populace even in modern countries in pre-vaccine days. That is, a bit of historical context would be good before discussing the liklihood of specific manifestations if one is infected in 2015. Our current intro with information in the current order is "recentism", which may be expected in most medical articles but is perhaps misplaced here. - Nunh-huh 04:22, 30 November 2015 (UTC)

The disease still occurs. And yes we often do emphasis disease content rather than historical content. Many lay people know about it in the countries where it still occurs because of the campaigns that are working to eradicate the disease. We are a global encyclopedia and not just for people from the USA. I agree that when the disease is eradicated we should change the layout of the article and the lead. Doc James (talk · contribs · email) 09:38, 30 November 2015 (UTC)

I am well aware that the disease still occurs. And I am familiar with the ongoing effort to eliminate it. And I am aware as well that we are a global encyclopedia. For you to suggest otherwise seems disingenuous. Strawmen aside, the only difference between my position and yours is that you are downplaying the progress made thus far, and wish to continue to do so until actual elimination occurs. This seems to me to be unreasonable. Polio today is a far cry from polio in the past (and not only in the U.S., as you suggest), and not stating so at the outset is a textbook example of burying the lede. - Nunh-huh 10:07, 30 November 2015 (UTC)

The lead is written to reflect the body of the text. It also follows the ordering of the body of the text. There is nothing wrong with this. We do it for 100s of disease related articles.

I am not sure if you are trying to eliminate a discussion of symptoms from the lead or not? But if that is your goal I oppose it. The disease still occurrs in countries were 100s of millions of people live. Doc James (talk · contribs · email) 11:12, 30 November 2015 (UTC)

No, I am trying to suggest that a brief discussion of the historical importance of the disease precede the breakdown-of-symptoms-by-percentage-of-occurence within the lede. An edited version of the current fourth paragraph of the lede, moved up to follow the current first sentence, for example, would improve the introduction. - Nunh-huh 04:59, 3 December 2015 (UTC)

IMO it is useful to both readers and editors to have the lead in a consistent format for specific article types. Doc James (talk · contribs · email) 07:56, 3 December 2015 (UTC)

IMO it is useful to state the importance of a subject before delving into its minutiae. And it is also my opinion that articles should take the form needed logically rather than conform to an arbitrary format. This article should be for someone who wants to learn about polio, and written for him, not for someone who wants to compare various Wikipedia disease articles. I think it's quite odd that the thing we apparently feel will most enhance our readers' understanding of polio (after we've informed them it's a viral infectious disease) is that there are no symptoms (none of which we've named, at that point) in 70% of cases. - Nunh-huh 08:19, 3 December 2015 (UTC)

Yes we have presented the most common rather than the most serious symptoms first. I have switched it around so that the most serious are first which does get across the importance of the efforts to eliminate the disease better. Doc James (talk · contribs · email) 08:39, 3 December 2015 (UTC)

Much better IMO. GregorB (talk) 08:56, 3 December 2015 (UTC)

It is certainly less ridiculous. - Nunh-huh 09:06, 3 December 2015 (UTC)

Please correct typo in third sentence

"sore throat". Why does this article need protection?2604:2000:71E7:8D00:4D50:36DE:8FF6:7554 (talk) 00:28, 3 December 2015 (UTC)

Thanks and done. Doc James (talk · contribs · email) 07:56, 3 December 2015 (UTC)

Semi-protected edit request on 3 December 2015

I'm taking issue with the statement "Before the 20th century, polio infections were rarely seen in infants before six months of age", this requires more clarification and the statement itself is too vague. The paragraph cites as its informational source an article for the World Health Organisation authored by Dr. Susan Robertson (http://apps.who.int/iris/bitstream/10665/58891/3/WHO_EPI_GEN_93.16_mod6.pdf)

I have read the entire article and it does does not make any statements of this kind. Rather, Dr. Robertson draws distinctions between sub-clinical infection rates in infants and clinical infections, those being the cause of poliomyelitis paralysis, and describes OPV programs and their effectiveness in eradicating clinical poliomyelitis infections throughout populations. The article also mentions infection rates tracked from significant outbreaks in several countries:

"The majority of wild poliovirus infections are asymptomatic. A type 1 polio outbreak in 1948 allowed direct assessment of the number of subclinical infections for each paralytic case using results of serological tests and virus isolations from stools (Melnick & Ledinko 1953) (Table 1). In a total population of more than 80 000 persons aged 0 to 20 years, fewer than 1% developed paralysis. About one-quarter of children aged 0 to 14 years were infected subclinically, with somewhat higher rates in younger children. Among children aged 1 to 14 years, about 100 were subclinically infected for each paralytic case; among infants, about 200 were subclinitally infected for each paralytic case" -WHO/EPI/GEN/93.16, pp.1-2

There is no data from the article to suggest that "polio infections were rarely seen in infants before six months of age", and there certainly were infections of polio in infants and children before the 20th Century, but these infections were sporadic and did not constitute a "polio plague", the first of which occurred in 1894.

Additionally, there was no way of detecting the presence of poliomyelitis viral material prior to the 20thC. Perhaps the paragraph could be restructured into a more appropriate synopsis of Dr. Robertson's source material which is entitled "The Immunological Basis for Immunization" not "The History of Polio".

From a source on the History of Polio (http://www.historyofvaccines.org/content/timelines/polio), this statement is a more accurate description of the content this paragraph outlines:

"Indeed, many scientists think that advances in hygiene paradoxically led to an increased incidence of polio. The theory is that in the past, infants were exposed to polio, mainly through contaminated water supplies, at a very young age. Infants’ immune systems, aided by maternal antibodies still circulating in their blood, could quickly defeat poliovirus and then develop lasting immunity to it. However, better sanitary conditions meant that exposure to polio was delayed until later in life, on average, when a child had lost maternal protection and was also more vulnerable to the most severe form of the disease."

It is my belief that this first sentence of the article requires editing and expansion for greater clarity and precision. The opening sentence of the paragraph probably ought to read something like this:

"Before the 20th Century, clinical infections of poliomyelitis virus causing paralysis were uncommonly seen in infants under six months of age. Prior to the 20th Century, lower standards of sanitation meant infants suffered constant exposure to the virus through contaminated water supplies, but maternal antibodies (provided largely through breastfeeding) allowed natural immunities to overcome infection in the vast majority of population. At the turn of the 20th Century, the prevailing theory holds that the overall purification of water supplies led to a lack of viral exposure until much later ages for the majority of the population, leading to epidemic outbreaks of the most severe form of the virus, which causes clinical poliomyelitis paralysis. The first of these outbreaks is recorded as beginning in 6/17/1894 (in the United States, Rutland County, Vermont)."

And probably ought to reference as its source the "History of Polio" from www.historyofvaccines.org as above. Qwiddity (talk) 03:58, 3 December 2015 (UTC)

That there were apparently less cases of the paralytic polio in the XIX-th century may be explained by many causes:

1. The cases of paralytic polio were never specifically looked for to begin with. Even now this is a problem and there even exists a target for the flaccid paralysis detection among children during polio surveillance (I think around 10 per 100,000 children per year)
2. The flaccid paralysis is harder to detect in babies and they recover better than adults.
3. The child mortality was very high and susceptible children may have died from other causes before developing of any polio symptoms.

Concluding, the so called sanitation hypothesis, though popular, is unproven. Ruslik_Zero 04:54, 3 December 2015 (UTC)

Not done: please establish a consensus for this alteration before using the {{edit protected}} template. Eteethan(talk) 21:25, 7 December 2015 (UTC)

Obvious contradiction requiring correction

The following cannot be right:

"These efforts have reduced the number of annual diagnosed cases by 99.9%; from an estimated 350,000 cases in 1988 to a low of 483 cases in 2001, after which it has remained at a level of about 1,000 - 2000 cases per year.[80][81] In 2015, cases decreased to 94.[77][82] "

It could not have remained at a level of about 1,000 - 2000 cases per year and have decreased to 94.

The number 94 is not about 1,000 to 2,000.

If it decreased to 94, then it has not remained at about 1,000 to 2,000.

71.109.145.178 (talk) 23:25, 9 January 2016 (UTC)

Thanks and adjusted. Doc James (talk · contribs · email) 00:45, 10 January 2016 (UTC)

Edit request

Please make the following gramatical correction to the last sentence of the first paragraph in the lede.

Please change:

"Years after recovery post-polio syndrome may occur, with a slow development of muscle weakness similar to what the person had during the initial infection."

to the gramatically correct

"Years after recovery post-polio syndrome may occur, with a slow development of muscle weakness similar to that which the person had during the initial infection.

86.153.133.193 (talk) 16:09, 27 February 2016 (UTC)

Done EvergreenFir (talk) Please {{re}} 23:56, 27 February 2016 (UTC)

Semi-protected edit request on 27 February 2016

Please change

it has remained at a level of about 1,000 - 2000 cases per year for a number of years

to

it remained at a level of about 1,000 - 2000 cases per year for a number of years

(delete the word "has")

because

"has remained" means that it still remains there, which is false, because the level 2015 was below 100.

71.109.147.203 (talk) 18:47, 27 February 2016 (UTC)

Done EvergreenFir (talk) Please {{re}} 21:03, 27 February 2016 (UTC)

Hello,

We are a group of students working on the sociocultural aspects of disease. These are a few of our suggested additions for the page. We do not have authorized permission to edit ourselves because this is a protected page. -University of Kansas students.

The Global Polio Eradication Initiative:

       	The Global Polio Eradication Initiative is a program funded by international governments, the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevents, and UNICEF with the goal of eliminating polio worldwide. The program was launched in 1988 (Callaway 2012).  In 2012, the program was revitalized to eradicate polio in the last three major strongholds: Nigeria, Afghanistan, and Pakistan. 

Global spending was increased by $2.2 billion (Callaway 2012). The GPEI and specifically WHO have been accused of false optimism and rhetoric regarding the time frame of total eradication of polio. It has always been known that door-to-door campaigns in countries with political unrest would be difficult, but WHO continued to make light of the situation, at one point stating “ Global eradication could be achieved as early as 1995” (Closser 2012). The GPEI is still working towards their goal of eliminating polio worldwide (Callaway 2012). Total eradication of polio will provide immense economic benefits; it has been estimated that the eradication of polio will save countries roughly 40 to 50 billion dollars (WHO).

Eradication of Polio in India:

India was one of the last stronghold countries when it came to eradicating polio. In 2000 there were media reports in India that the vaccine used in the earliest round of vaccinations had killed three children (Ember 2003). This lead to a cultural resistance toward vaccination, as parents were afraid that immunization would cause the death of their child (Ember 2003), increasing the eradication difficulty already caused by India’s immense population and widespread poverty.

To combat these difficulties, the Indian government and WHO combined efforts to create the National Polio Surveillance Project (NPSP) (Chaturvedi 2008). By deploying specially trained officers in mobile units, the NPSP actively monitored and reported polio symptoms, collected data, and analyzed the otherwise passive or skeptical population. With help from additional initiatives such as National Immunization Days (NID), held twice a year by a reported 2 million local and outside volunteers India was able to claim full eradication in January of 2011 (Krishna 2014). To ensure there are no longer re-emerging cases of polio in India, the government created the Pulse Polio program, which provides immunization to all citizens under the age of five years old by utilizing social mobilization in local areas (Sharma 2015).

Though successful in eradicating polio, India continues to struggle with a cultural stigma towards those debilitated by the poliovirus, often in defects related to paralysis. Culturally embedded religious views regarding karma and the Hindu caste system cause mass discrimination and marginalization of those with disabilities (Chaturvedi, 2008). As the polio virus was once so widespread in India, disabilities and the resulting stigma are unfortunately common, with experts estimating four million people are currently living in India with the effects of polio (Krishnan 2014).

Similarities Between Countries Still Affected by Polio:

Despite the global aim of eradication, three countries are still affected by polio and recognized by WHO as such – Nigeria, Pakistan, and Afghanistan. These countries all possess weak health infrastructure and public education. More specific causes, most of them cultural in nature, can be pinpointed as well. The current occurrence of polio in Pakistan and Afghanistan can be explained by the ban on vaccination (Peckham, 2016) placed by the Taliban in 2012. This ban was enforced due to both the Islamic condemnation of immunization and as backlash against the CIA capture of Osama bin Laden in 2011, a Western operation hidden under the cover of a door-to- door Polio vaccination campaign in Pakistan (Peckham, 2016). Communities were already wary of vaccination campaigns due to lack of public health education, and bin Laden’s assassination only increased community distrust and sometimes violent non-cooperation. Eradication efforts in Nigeria continue to suffer due to rumors that have circulated about the vaccination process. In 2003, a WHO polio vaccination program was halted when various Nigerian doctors and politicians publicly claimed that the vaccine carried the risk of AIDS contraction, cancer, and infertility. This reinforced the community rumors caused by lack of education and understanding regarding the disease, often combined with religious opposition (Reinsvold 2010).

Polio cases have also been reported in Syria, beginning in 2013 and directly coinciding with the Syrian Civil War. Conflict zones are especially vulnerable to the spread of disease, but the eradication of Polio in other conflict areas (such as Sudan and the Democratic Republic of Congo) provides a hopeful future outlook (Peckham, 2016).