Talk:Polio/Archive 4

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What was the first polio vaccine?

I'm confused. Don't the following contradict each other? :

Two polio vaccines are used throughout the world to combat poliomyelitis (or polio). The first was developed by Jonas Salk and first tested in 1952. It was announced to the world by Salk on April 12, 1955. http://en.wikipedia.org/wiki/Polio_vaccine

The first polio vaccine was developed in 1950 by Hilary Koprowski. The second one was developed by Salk also at the University of Pittsburgh, and announced to the world on April 12, 1955. http://en.wikipedia.org/wiki/Polio#Vaccine —Preceding unsigned comment added by Intelliot (talk • contribs) 00:15, 23 November 2008 (UTC)

In your prognosis paragraph, you should change the word abortive to an easier word to understand; such as, ineffective. I think it will help with understanding the paragraph better. —Preceding unsigned comment added by Paula bean7 (talk • contribs) 22:56, 11 February 2009 (UTC)

Due to the dates, the first one was the one of Koprowski (1950), the second one of Salk (1952) and the third one of Sabin (Sabin was basing on the materials given by Koprowski). The doubt might surge from the fact, that Koprowski's (and Sabin's) vaccine was a live one, and the Salk's was a killed one. So the first vaccine ever was developed by Koprowski, but the first vaccine based on killed viruses came from Salk.Lamignat(talk) 09:10, 15 December 2009 (UTC),

I've reverted the change that introduced the following paragraph:

The first effective polio vaccine, based on live but weakened (attenuated) virus, was invented by the Polish virologist and immunologist, Hilary Koprowski. Koprowski's vaccine was served for the first time on February 27th, 1950, but weren't commonly used until the 1958, when massive vaccinations in Kongo were performed.

The text is unsourced. All content added must meet our verifibiliy policy and use reliable sources. We need a reliable source that this vaccine saw clinical use (i.e. not just the large-scale experiments). It does appear to have been in-development earlier than the others but failed to complete development before the others. Has the efficacy of Koprowski's vaccine been proven? Note that we mention Koprowski in the lead so he deserves a mention in the body too, while keeping within WP:WEIGHT. Colin°^Talk 11:35, 16 December 2009 (UTC)

I reverted again, adding two sources - I guess the information is totally objective and correct now (?).

Why:

Let's distinguish an invention of a vaccine and a readiness for a massive production. As a date of developement of Salk's vaccine the year 1952 is given, while all the tests and experiments were finished by 1955, when this vaccine was "announced" to the world and went to the market. So in order to keep the consistency it should be mentioned, that the invention of vaccines starts with the live one of Koprowski (1950), followed by the dead one of Salk (1952) and then, modified live vaccine of Sabin. If we're talking about a massive usage, the order changes, as the Salk's vaccine was in common use since 1955, and the Koprowski's since 1958. But this is quite understandable, as the Koprowski's vaccine was based on a live virus and generated a fear against vaccination. Salk's one came soon after and, being based on dead viruses, generated no fear and immediately started to by used. This can be found in several sources, although the english ones are not so numerous. I find it in many polish publications - which is quite normal, although Salk was also born on a polish territory of today, in Białystok). I found it also in french, on Sanofi Pasteur page dedicated to Polio - what i linked in previous modification: http://www.polio-vaccine.com/fr/histoire/vaccins_oral.html

I see that DO11.10 found this source in english, so I now linked this one in the text. I also linked a bullettin of National Sanitary Inspection in Poland:

http://www.wsse.krakow.pl/Files/Attachments/phpIoa3ar_G_Historia%20odkryc%20szczepionek%20i%20rozwoju%20szczepien.doc

The rough translation is the following (supported by babelfish - sorry...):

"1950: Polish immunologist and microbiologist, Hilary Koprowski, working since world war II in USA, serves as first an effective vaccine against Polio disease.It was a vaccine with a live, but weakened virus.

[here some technical data on virus passages, rat's brains etc]

First massive vaccination with Koprowski's vaccine took placein Kongo in 1958 when within merely six weeks over 250 thousand child were vaccinated.

[here some historical data on vaccinations with Koprowski's vaccine (9 million doses) that took place in Poland, starting in 1959]

It has to be mentioned here an error committed in the majority of textbooks of the history of medicine. It's told there, that the discoverer of the vaccine was Salk, relatively Sabin. There is a falsehood, because first time Koprowski gave his vaccine to a child, Salk wass still performing experiments with monkeys, while Sabin was only starting his work."

By the way - I wonder why in the header, the names and dates are not following the chronological order (1952-1950-1962)? Lamignat (talk) 13:41, 16 December 2009 (UTC)

OK. I've read some more on the vaccine story. The source you used from Sanofi appears to be a reasonably balanced account. Having read some of the papers by those researchers I don't trust any of them to document their part in the history with any fairness. Was the single-strain "vaccine" that Koprowski tried in 1950 was effective (it produced antibodies but did it protect the community to a sufficient degree) or safe (lots of trouble with the live vaccine strains becoming more virulent). By the time of the large-scale trial in Congo and the use in Poland, it wasn't the same product at all (in 1950 it was PV2 but the later ones were PV1 and PV3). It would appear that Koprowski lost out on several points (some politics perhaps) but including the fact that Sabin's vaccine protected against three strains and met the requirements for safe attenuation (though Sabin had a hand in drafting those requirements:-). Ultimately, Koprowski's vaccine did not feature in the global fight against polio. The standards (ethical and clinical) of those early trials is rather shocking. Colin°^Talk 19:44, 16 December 2009 (UTC)

Collin - I do not agree.

By effective vaccine we mean the one that works - protects against the viruses in it.

Let's take for example Streptococcus pneumoniae or Neisseria meningitidis. Following your approach to Polio, we should agree theere is still no vaccine against it - 'cause none of the ones being currently in use protects against all of the types. The same with Hepatitis (there is a vaccine against A and B, but not against C).

The vaccine of Koprowski served in 1950 was based on PV2 and was totally effective:

"His results were excellent. The virus was found in the stools of everyone who received the vaccine, which indicated it had reproduced in their digestive systems and triggered the production of antibodies. When the immunized children received the vaccine a second time, they were not re-infected, evidence that they were protected. The findings were so spectacular that when Koprowski presented them to a meeting of the NFIP's Immunization Committee, the committee members greeted them with skepticism."

(I read somewhere that the one convincing the others, that the results are great and skepticism was stupid was... Salk)

Then, we got this information:

"In 1951, Koprowski tested a prototype of the vaccine containing attenuated strains of types 1 and 2 on a group of 61 children in Sonoma State Home, an institute for mentally retarded children."

So, summarizing the info gathered:

The first effective vaccine ever: Koprowski, 1950, live virus PV2, OPV.

The first vaccine against PV1: Koprowski, 1951, live virus, OPV.

The first trivalent vaccine: Salk, 1952, dead virus, IPV

The first one to have invented vaccines for all 3 types of virus: Koprowski (1950 PV2, 1951 PV1. I miss the date for PV3, but this one since 1958 was already in massive use in Congo, Germany and Poland. So he had to invent it before).

The first trivalent OPV vaccine: Sabin, 1962.

Each one of them invented sth for the first time, but it is obvious for me, that the expression "the first effective vaccine" should be linked with Koprowski.

I get, that Sabin is the most important for the "western world" (that's why, I guess, his "the face" of the first vaccine), as he invented sth safe and complete. But, on the other hand, for the 3rd world this vaccine was almost totally useless - imagine massive vaccinations with IPV in Africa (!). For the 3rd world far more important was the oral vaccine, and, even if it weren't covering the 3 serotypes, it was invented already in 1950 and it was the first one giving an immunity against Polio (represented by PV2).

Example: Although Koprowski's vaccine was not trivalent, it helped to reduce the nO of cases from 6k in 1958 to 30 in 1963.

I think you are mixing the words "invent" and "effective" with "prepare for a masive production" and "comprehensive"

Now - your comment to "Polio Vaccine" article:

"Sabin's vaccine contained several serotypes so it is an oversimplification to say that it came from Koprowski)"

It doesn't consider the fact, that already in 1951 Koprowski had at least 2 serotypes, including the most "popular" PV1. The fact that Sabin used the viruses from Koprowski is also not questionnable (?). Nobody says he just took viruses and did nothing with them later on. It was supposed to be an exchange of Scientific material in order to reach the common "target".

Lamignat (talk) 21:19, 16 December 2009 (UTC)

• I think the balance of the article on this topic is acceptable and probably close to the best that can be achieved with the available, reliable sources. The problem, as I see it, is that none of these scientists discovered vaccination or were the first to develop vaccines. The hepatitis example given above is not helpful at all; hepatitis A, B and C are caused by three completely different viruses. I cannot see the point of debating who was the first to develop the first effective polio vaccine. Effectiveness, or efficacy is impossible to determine without evidence from large scale clinical trials—antibody production alone is not a marker of efficacy, the antibodies have to be produced to levels that confer protection against all three serotypes and cell-mediated immunity is also important. Koprowski's first candidate vaccine was never tested for efficacy and safety. Without this data it remains that; a candidate vaccine. Koprowski's role is given due weight, let's leave it as it is, otherwise we will come close to contravening WP:NOR and WP:NPOV. Graham Colm ^Talk 21:48, 16 December 2009 (UTC)

• There are different ways of spinning this for sure. Note that your 1962 for Sabin is wrong for how could the 1958 NIH select his vaccine (all three serotypes) if it wasn't available then. Regardless, it doesn't really matter what your or my interpretation of the primary research facts is. What is needed is an independent published source of high quality to arbitrate on that. The Sanofi source repeatedly calls Koprowski's vaccine a "prototype". Ultimately, mass producing a vaccine to government standards of safety and consistency is part of the "development" process and the other guys got there first. At present, Koprowski gets about the same amount of article text as Salk, who arguably should have more.

I don't buy the "western world" argument. All the guys were working in the US, all were Jewish and two were from Poland. I think the current text is reasonable: Koprowski was first to research, first to small clinical trials but he was not first to actually produce a workable vaccine accepted for clinical use. Ultimately, for whatever reason, his vaccine wasn't considered as good as Sabin's and lost the beauty contest. Agree with Graham that we are in danger of original research here. Colin°^Talk 21:54, 16 December 2009 (UTC)

Ok, I won't argue much more. As to 1958/1962 of Sabin, I think it was not the vaccine that was chosen, but the virus (which was later on used in a final vaccine). "Western world" - you don't have to buy, it's just my interpretation ;) Neither I referred to the nationality and/or origin of the guys mentioned in the article - my deduction was taken looking from the point of view of the addressees of the vaccine.

I can agree the text in this section is acceptable as it is right now. Anyway, as the vaccines of Koprowski was in a massive usage by the time the Sabin's one went to market, I think the header should have a shape similar to the one before:

"The polio vaccines developed by Jonas Salk in 1952, Hilary Koprowski in 1950 and Albert Sabin in 1962 are credited with reducing the global number of polio cases per year from many hundreds of thousands to around a thousand"

I'd suggest a change to:

"The polio vaccines developed by Hilary Koprowski in 1950 and 1951, Jonas Salk in 1952, and Albert Sabin in 1962 are credited with reducing the global number of polio cases per year from many hundreds of thousands to around a thousand"

If you insist on distinguishing the Koprowski's one from the others due to its discontinuation or mono/duo(not tri-)valency, it can be written e.g. like this:

"The polio vaccines developed by Hilary Koprowski in 1950 and 1951, Jonas Salk in 1952, and Albert Sabin in 1962 (this one replaced Koprowski's vaccines), are credited with reducing the global number of polio cases per year from many hundreds of thousands to around a thousand"

Lamignat (talk) 23:52, 16 December 2009 (UTC)

• I offer, for discussion, a more neutral: "Developed in the 1950s, polio vaccines are credited with reducing the global number of polio cases per year from many hundreds of thousands to around a thousand". Subject to the citation supporting this. Graham Colm ^Talk 00:09, 17 December 2009 (UTC)

Fine with me - kinda compromise. Lamignat (talk) 00:18, 17 December 2009 (UTC)

I still have a major problem with including Koprowski here because, besides mentioning the developer and year of release, the vaccine section of this article is meant to be a very brief and pointed outline of the vaccines currently in use to prevent polio. Since Koprowski's vaccine is no longer used, and because specific information about the development of the other vaccines is not discussed here, it is confusing to the reader to have this information in this section. [Or rather, they were not initially included, although I suspect Colin's recent additions were meant to balance this point out]. I thought the best and most obvious place for the historical information about his vaccine was the polio vaccine article, which is why I moved it, corrected it and properly sourced it there. WRT the Polish article used as a reference there are two problems, it is in Polish and it is a Word document neither aspect lends the reference the verifiability these statements require. Surely English sources, whether web or texts, exist for this information. Finally, please keep in mind that the intention of Wikipedia is and should be to inform, not to "right the wrongs".

Trivalent OPV was "released" in 1962 and is the version of OPV that is currently used.

Per the introduction: I !vote for Graham's neutral version.--DO11.10 (talk) 00:41, 17 December 2009 (UTC)

• Bloody edit conflict (life is too short):-

Not really a compromise—it's an attempt to achieve consensus, which is not quite the same thing. It has been very thought provoking and interesting to discuss this and I thank you. I suggest not making the change until other involved editors have had the chance to read and comment on this discussion. Graham Colm ^Talk 00:47, 17 December 2009 (UTC)

PS, lets take a break and take time to reflect. Knowing Colin, he will probably be in the bathtub or in bed. It will do no harm to leave the article as it is for a few hours. Graham Colm ^Talk 01:03, 17 December 2009 (UTC)

At 1am? In bed, fast asleep. Colin°^Talk 10:02, 17 December 2009 (UTC)

If the vaccine section is intended to discuss only the current versions of the vaccines then it probably shouldn't mention people's names at all. We like mentioning names in history sections because it puts a face to the discoveries, but really these were team efforts and the vaccines are now manufactured by big drug companies, not labs headed by famous figures. According to that Sanofi article, the current OPV now contains a new strain of type 3 so OPV is not longer just Sabin's vaccine strains (a point that is currently missing from the polio vaccine article).

The problem with just discussing the vaccines from a technical rather than personal or historical POV is that I think it would leave this article failing to be "comprehensive". The names of the polio vaccine researchers, and the fact there was a race with winners and losers, are well known aspects of polio. I'm fully in agreement that we shouldn't be trying to "right the wrongs" here, which is why our sources on this should be articles/reviews that comprehensively and independently tell the story (not Koprowski or Sabin's own papers, which are biased). There is probably a better source than the Sanofi article but it tells me that if we mention Salk and Sabin then we should mention Koprowski too -- being first at something is a notable fact even if ultimately he lost the race.

I support Graham's suggestion for the lead. Colin°^Talk 10:02, 17 December 2009 (UTC)

I have edited the Lead accordingly. Graham Colm ^Talk 10:45, 17 December 2009 (UTC)

Well I guess can't argue with your comprehensiveness argument, and I think that what you've added is as neutral and properly weighted as can be. I totally agree about the bias issue, both of them make it seem like they worked in a bubble tirelessly researching (i.e. injecting their prototypes into scores or retarded children, without so much as a whisper of "consent") with no help or input from anyone else. I just didn't want that type of slanted POV ending up here, and especially without the proper context. In any event, I think you've done a great job keeping the cruft out, so to speak. I do now remember reading something in some book about the change of the type 3 vaccine, but I can't seem to find it again. I'll keep looking and update the vaccine article accordingly. --DO11.10 (talk) 22:44, 23 December 2009 (UTC)

1840 vs 1842

There was no basis for changing the year from 1840 to 1842 in revision 377333698 by 98.66.160.54 (talk). Although Citation 5 Paul JR (1971), A History of Poliomyelitis is not viewable online, other sources such as Merritt's Neurology Page 158 and The Founders of child neurology by Stephen Ashwal (1990) confirm that poliomyelitis was first recognized as a distinct condition by Jakob Heine in 1840. --Dan Dassow (talk) 18:09, 5 August 2010 (UTC)

Recent vandalism

I've reverted the article back to the last stable version on 13:59, December 10, 2010 by user:GrahamColm. IP users 41.209.88.67, 41.209.92.181, 41.209.90.217, and 41.209.93.27 vandalised article within a short period of time. --Dan Dassow (talk) 08:57, 12 December 2010 (UTC)

polio

how many people did poliomyelitis kill? --72.130.113.173 (talk) 05:32, 29 January 2011 (UTC)--72.130.113.173 (talk) 05:32, 29 January 2011 (UTC)--72.130.113.173 (talk) 05:32, 29 January 2011 (UTC)--72.130.113.173 (talk) 05:32, 29 January 2011 (UTC)

"Polio - Fact Sheet". Connecticut Department of Public Health. Retrieved January 29, 2011.

How common is polio in the United States?
Before a polio vaccine was developed, polio epidemics were common in the United States. For example, in the immediate pre-vaccine era (early 1950s), there were 13,000 – 20,000 paralytic cases and 1,000 polio-related deaths each year in the United States.

After the development of the inactivated (Salk) vaccine in 1955 and the live (Sabin) vaccine in 1961, the number of polio cases dropped dramatically. In 1960, there were 2,525 paralytic cases reported, but by 1965 this number had fallen to 61.

"Number of Inhabitants: Table 1 - Population of the United States, Territories, Possessions, 1790 to 1950". US Census Bureau. Retrieved January 29, 2011.

The US population in 1950 was approximately 154 million. This translates to a 0.00065% chance of dying from polio in 1950.

I will leave it to another editor to determine whether number of deaths should be included in the article.

--Dan Dassow (talk) 14:47, 29 January 2011 (UTC)

12th edition of Pink Book now available

The Pink Book (Citation 4) is cited extensively in this article. The 12th edition of the Pink Book is now available.

Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Atkinson W, Wolfe S, Hamborsky J, eds. 12th ed. Washington DC: Public Health Foundation, 2011.

http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/polio.pdf --Dan Dassow (talk) 13:27, 16 April 2011 (UTC)

Add video ?

http://www.youtube.com/watch?v=19KkFCQz8WQ It's up to you guys. 81.241.103.106 (talk) 10:41, 26 May 2011 (UTC)

The video would be more appropriate for Poliomyelitis eradication. A better link is bruce_aylward_how_we_ll_stop_polio.html.

Bruce Aylward: How we'll stop polio for good
About this talk

Polio is almost completely eradicated. But as Bruce Aylward says: Almost isn't good enough with a disease this terrifying. Aylward lays out the plan to continue the scientific miracle that ended polio in most of the world -- and to snuff it out everywhere, forever.

About Bruce Aylward

Bruce Aylward is a Canadian physician and epidemiologist who heads the polio eradication programme at WHO, the Global Polio Eradication Initiative (GPEI).

--Dan Dassow (talk) 15:54, 26 May 2011 (UTC)

File:Womanonsideinlung.jpg Nominated for Deletion

An image used in this article, File:Womanonsideinlung.jpg, has been nominated for deletion at Wikimedia Commons in the following category: Deletion requests September 2011 What should I do? Don't panic; a discussion will now take place over on Commons about whether to remove the file. This gives you an opportunity to contest the deletion, although please review Commons guidelines before doing so. If the image is non-free then you may need to upload it to Wikipedia (Commons does not allow fair use) If the image isn't freely licensed and there is no fair use rationale then it cannot be uploaded or used. This notification is provided by a Bot --CommonsNotificationBot (talk) 13:00, 5 September 2011 (UTC)

Polio Outbreak in China

http://www.bbc.co.uk/news/world-asia-pacific-14997307 Not sure how this will factor into the broad picture, but being here in China made me curious about how often this happens crossing nearby countries. There is a bit under "Eradication" that could be updated or elaborated? Springfinger (talk) —Preceding undated comment added 06:27, 21 September 2011 (UTC).

Article is severely biased to biomedical ideology

There is no such thing as "polio infection". Polio is a disease, usually nonparalytic. The virus is poliovirus, and its infection is normal, usually bringing no disease. The statement Poliomyelitis is highly contagious is utterly false, as contagion is the spread of disease—not the spread of infection—and it is well understood in biology that poliovirus infection is far from sufficient cause of polio, let alone paralytic polio. It is well understood that polio did not become an epidemic disease—even then not following the contagion model—till spread of poliovirus infections became increasingly infrequent.

I plan a major revision in time, and I presume it might ruffle feathers of those who favor ideology of applied science (biomedicine), and its clinical application (medicine). I'll revise the article with pure science (biology), and discuss biomedicine, medicine, and epidemiology through the lens of scholarship—less through the lens of biomedicine, medicine, and international health themselves—sources mainly in history of medicine and sociology of medicine. The article is mostly medical ideology and sociological artifact. Kusername (talk) 05:59, 15 November 2011 (UTC)

Your comments are a bit puzzling. Biomedical sciences are not an ideology but a branch of science. Humanities methodology is generally not useful when dealing with disease entities. I think the current version is neutral, and your perspectives seem to be either your personal viewpoint or a viewpoint held by a very small group of people. I would advise caution before making sweeping edits. If you plan changes to particular claims or sections, perhaps you could first post a message on this talkpage, outlining your objections with the current version and the sources that you believe support your perspective. Good luck. JFW | T@lk 11:10, 15 November 2011 (UTC)

" There is no such thing as "polio infection".... The virus is poliovirus, and its infection is normal, usually bringing no disease. "

From Black's Medical Dictionary, "Infection" is "The process by which a disease is transmitted via micro-organisms from one person to another."

From Stedman's Medical Dictionary, "Infection" is "Multiplication of parasitic organisms within the body".

Kusername, I suspect that you may be using a different definition of "infection" from that generally used by health care professionals. Would you define "Infection" please, ideally with a source? Thanks. Axl ¤ [Talk] 22:38, 15 November 2011 (UTC)

Kusername, you'd better be able to support all of those assertions with medical reliable sources, as to me it looks like you're banging a drum for fringe theories that have no place in any article. Your desire to "ruffle feathers" also makes me think you need to carefully read WP:NPOV and Wikipedia:Advocacy. Fences&Windows 20:06, 8 December 2011 (UTC)

History

"The effects of polio have been known since prehistory; Egyptian paintings and carvings depict otherwise healthy people with withered limbs, and children walking with canes at a young age." Please separate these sentences. To put the first part with the second part gives the impression that Egyptian paintings and carvings aren't a historical record of any sort. Please understand the word prehistory means "before written records". Egyptian paintings and carvings need to be older than the first pictographs to necessitate association with "prehistory". Additionally, this whole sentence is conjecture at best. Also, I can't seem to find a readily viewable source for this information. I have found this same sentence in other works as well. http://www.billdoll.com/ref/ideas/health/dis/az/p/pol/pol.html Nikomaru (talk) 16:04, 1 December 2011 (UTC)

I agree that whole sentence seems suspect. Polio is far from the only malady to cause withered limbs or physical disabilities. thx1138 (talk) 20:39, 8 December 2011 (UTC)

What happened to the polio victims of the 1950s?

"... [16,000] polio survivors with varying degrees of paralysis live in in Australia ". OK, how would I recognize one if I saw one? We had a kid in primary school who had it, he was "severely handicapped" (the exact phrase that was used at the time), he could not walk nor talk properly, and we were forbidden from interacting with him without a teacher being present (remembering that this was a primary school and it was 1965).

Now in all of my years since primary school I have never seen anyone "like him". What has happened to children like him as they grew older? Did they improve with treatment? Did they die out relatively young? Are they still as challenged but isolated from the rest of the community, ie live in some kind of institution? I apologize in advance if the language is inappropriate but I don't know how else to ask what I wish to know. Old_Wombat (talk) 05:52, 18 December 2011 (UTC)

Summer Transmission

I was hoping to learn why it is transmitted mainly in the summer in temperate regions. The article makes this claim but never says why. Does anybody know? —MiguelMunoz (talk) 02:10, 9 June 2012 (UTC)

Incidence of entering central nervous system - 1% or 3%?

From paragraph 2 of the introduction: "In about 1% of cases, the virus enters the central nervous system, preferentially infecting and destroying motor neurons, leading to muscle weakness and acute flaccid paralysis." From papragraph 2 of the "Classification" section: "The virus enters the central nervous system in about 3% of infections." No source is cited in either case. I find this a bit confusing. Are "cases" different from "infections"? If not, is this not contradictory? If so, how? Pchisarik (talk) 11:58, 23 September 2012 (UTC)

Discovery of Poliovirus

In the Poliomyelitis article, it shows that the poliovirus was discovered in 1908 by Karl Landsteiner. However, in both the Poliovirus and Karl Landsteiner articles, the date is 1909. In the Poliomyelitis article, only Landsteiner is mentioned. In the Poliovirus article, Landsteiner is mentioned with Erwin Popper. In the Landsteiner article, Landsteiner and Popper are listed with Constantin Levaditi as discovering the poliovirus. Does anyone know which is correct?Jtyroler (talk) 16:34, 25 November 2012 (UTC)

Dr Klenner's lost cure

(RFC was moved to a new title where question was summarized) I Added the following text about a cure on polio which was forgotten because of the lack of interrest in a time people were focussed on vaccine. It was removed because the refernces were more than 5 years. There is no point in needing for such recent sources when you're informing about history facts on which there is no recent research. Here is the text :

It is usually believed that there is no cure for polio, despite the fact that in 1948, after several years of personal experience on the use of vitamin C to cure viral illnesses, Doctor Fred R. Klenner designed and used a simple and efficient cure for polio, based on massive vitamin C injections (dozens of grams per day). During the epidemy of 1948 in North Carolina, he had around 60 patients who were all cured without consequences in 3-5 days. He publicized his cure at the annual session of American Medical Association and later published several articles about it, but lack of interrest from both scientific journals and scientific authorities when everybody was focussed on developing vaccinal technique, made him quite ignored and his cure was forgotten.

and here are the references :

• Klenner Fred R. (1951). "Massive Doses of Vitamin C and the Virus Diseases" (PDF). Journal of Southern Medicine and Surgery. 113 (4): 101–107.
• Klenner Fred R. (1949). "The Treatment of Poliomyelitis and Other Virus Diseases with Vitamin C" (PDF). Journal of Southern Medicine and Surgery. 111 (7): 209–214. {{cite journal}}: Unknown parameter |month= ignored (help)
• JAMA, September 3, 1949, pages 1-8, volume 141, no. 1
• Klenner Fred R. (1952). "The Vitamin and Massage Treatment for Acute Poliomyelitis" (PDF). Journal of Southern Medicine and Surgery. 114 (8): 194–197. {{cite journal}}: Unknown parameter |month= ignored (help)
• Klenner Fred R. (1971). "Observations on the Dose and Administration of Ascorbic Acid When Employed Beyond the Range of a Vitamin in Human Pathology" (PDF). Journal of Southern Medicine and Surgery. 23 (3 & 4): 61–87.
• The Origin of the 42-Year Stonewall of Vitamin C by Robert Landwehr

Here is the start of the discussion (please continue hereafter): (-- 213.189.160.119 (talk) 10:38, 27 December 2012 (UTC))

Per WP:MEDRS secondary sources from the last 5 years are needed. Cheers Doc James (talk · contribs · email) (if I write on your page reply on mine) 09:39, 27 December 2012 (UTC)

I understand you want recent researchs on current medical topics, but you shouldn't reject old references when it's about comparing history and now and there is clearly no point in asking for recent sources when it's about history on which there is no recent research.

(sorry for not having an loggin, but mine is already used on the english wikipedia (it even might be one I created years ago and lost the password before all wiki IDs were centralized). - 213.189.160.119 (talk) 09:59, 27 December 2012 (UTC)

Now it's Dodger67 (talk) who removed the topic, not caring for coming to discussion page, but claiming on publication comment that this is fringe theory and self published sources. Both claims are false. Succesfully healing people is no theory but a fact. Fact which might be largely ignored like many history facts but is still a fact, and scientific publications should not be considered as self published since they are peer reviewed. -- 213.189.160.119 (talk) 11:05, 27 December 2012 (UTC)

The site www.injectablevitaminc.com is clearly an SPS - a highly promotional one with a large axe to grind and it's main purpose is selling a book. The simple fact that the treatment is not widely used in mainstream medicine is per se proof that it is a WP:Fringe theory. BTW I resent the implication that I have to answer to you for my edits of this article. Please read WP:OWN and WP:PROMO.Roger (talk) 11:45, 27 December 2012 (UTC)

Who cares about the website !? It's nothing more than a repository from where the PDF is available. You don't address the scientific reference at all !!! I'm quite sure you didn't even have a look at the articles just because it was stored on the wrong website. That's not this repository which is important, but the publishing journal. If you don't want to read the PDF from this website, please feel free to find another copy or to consult the articles from the scientific library of your choice !!! There is nothing about promo in this. And by the way, if the treatment is not widely used, it's because medecine prefered preventive vaccine to curative treatment and no one was interrested in this. This is no valid reason to pretend there is no treatment when someone did it. Particularly when there are countries were polio still cripples people. -- 213.189.160.119 (talk) 20:09, 27 December 2012 (UTC)

Request for comments on a cure for Polio

previous discussion Here

It is usually thought that there is no cure for polio and it has nasty consequences in countries where this illness is still active. It was discovered that, in 1948 a cure has been disovered and used, but at that time everybody was focused on vaccine and this raised no interest and was nearly lost. I wanted to mention it in the article but my edit were reverted on the motive that :

• References were too old (this is about history and since the cure was nearly forgotten and developped countries rely on vaccine, there has been no recent research on this.)
• Since nobody uses this cure, it must be fringe theory (ignoring the fact that people were actually healed)
• The available copies of the articles were stored on a site who sells a book on vitaminC (focussing on the pdf repository and ignoring the actual scientific reference)

Do you believe information on this cure should or shouldn't be provided in the article on polio ? -- 213.189.160.119 (talk) 11:08, 28 December 2012 (UTC)

• No Reliable sources are required. We are not here to bring the "truth" back to life. If you wish to do that please publish a review article on this topic in a well respected peer reviewed journal. We will than quote you. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:33, 28 December 2012 (UTC)

Those are perfectly valid source on an historical point of view, and rejecting a source just because it is too old while there are no more recent sources contesting nor adding anything to the claims, is just wrong. Btw, there is no WE will quote you. -- 213.189.160.119 (talk) 14:34, 28 December 2012 (UTC)

Map

The map of polio case rates highlights Turkmenistan as a place of high infection rate, when the data states that Afghanistan has significantly high case rates and doesn't mention Turkmenistan at all. 98.164.92.246 (talk) 08:01, 9 January 2013 (UTC)

250 cases of polio worldwide last year

Here's the source: [1]. It also talks of a new needle free vaccination that could be used in the future thereby eliminating the need to refrigerate the vaccine. I'll let the people who worked on the FA decide how to incorporate the information. Cheers, Jack (talk) 09:11, 8 February 2013 (UTC)

Yes should see if we can find a proper source.Doc James (talk · contribs · email) (if I write on your page reply on mine) 09:18, 8 February 2013 (UTC)

Okay found one [2] Doc James (talk · contribs · email) (if I write on your page reply on mine) 09:23, 8 February 2013 (UTC)

Somalia outbreak

Sadly, I think this may merit some mention: [3].
86.130.63.47 (talk) 13:54, 17 August 2013 (UTC)

• This looks like it would be appropriate to reference in Poliomyelitis eradication. --Dan Dassow (talk) 18:03, 18 August 2013 (UTC)

Poliomyelitis in chimpanzees? (from WT:MED)

Does anyone here have access to Ryan KJ, Ray CG (eds.) (2004). "Enteroviruses". Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 535–7? This is cited in our article on poliomyelitis for a statement that the poliovirus "infects and causes disease in humans alone", but as a posting on our help desk points out [4], primateologist Jane Goodall reported an outbreak of what may have been poliomyelitis amongst her wild Chimpanzee study group (see [5] page 152: "poliovirus (or a similar virus)") - possibly as a result of human contact. It would be nice to confirm one way or another. AndyTheGrump (talk) 15:57, 25 August 2013 (UTC)

The PDF you link cites several papers about poliovirus infection in non human primates. Such references seem widespread in the literature. Here on the Journal of Neuroscience, 2013, one can read: "Old World primates can also be infected by PV, with a symptomatology not too different from that seen in humans; experimental primate PV infections were a great asset in our initial understanding of PV infections leading to flaccid paralysis and in developing immunization strategies to combat the virus (Bodian, 1954, 1955; Nathanson, 2008).", for example. I would remove the sentence from the article, since it seems to be contradicted by a lot of old and recent literature.--cyclopia^speak! 16:20, 25 August 2013 (UTC)

Also here, a study on poliovirus infection on non-human primate tissues. Right from the abstract: "Humans and some Old World monkeys, chimpanzees, and cynomolgus macaques, are susceptible to oral poliovirus (PV) infection."--cyclopia^speak! 16:26, 25 August 2013 (UTC)

From the first link you provide: "Because PV primarily infects human cells, there is no latent reservoir of virus in animals, a key feature in the potential for the global eradication of the virus." The issue seems to be not whether other primates can be infected with PV, but whether PV is found in non-human primates other than as a result of human contact, or deliberate infection for experimental purposes. AndyTheGrump (talk) 16:31, 25 August 2013 (UTC)

Well, our article now says simply "PV infects and causes disease in humans alone.", which is clearly falsified by sources above. We can say "PV is a natural pathogen only for humans, albeit a number of non-human primates can be infected with PV in laboratory conditions", perhaps. It would be also nice to have a sentence about the fact that such studies on animals have been useful scientifically and medically, as the J.Neurosci. ref above states. --cyclopia^speak! 16:35, 25 August 2013 (UTC)

The chimps studied by Goodall weren't "infected with PV in laboratory conditions". AndyTheGrump (talk) 16:47, 25 August 2013 (UTC)

Correct -I sinned of synthesis, and wrong one too. This is the full relevant section from your source:

Accidental exposure to infected laboratory workers has led to poliovirus infections of chimpanzees and gorillas since the 1940s (1). Poliovirus can infect not only our closest living relatives, chimpanzees, gorillas (Gorilla gorilla), and orangutans (Pongo pygmaeus) (2), but also more distantly related anthropoids like the colobus monkeys (e.g., Colobus abyssinicus kikuyuensis [=guereza]) (42). Antibodies and shed virus have also been found in recently imported animals (8), and some chimpanzees may act as symptomless carriers (2). Long-term research by Jane Goodall on wild Tanzanian chimpanzees documented the potential for transmission of poliovirus (or a similar virus) in free-ranging chimpanzee populations (43). Since no samples were collected, it is impossible to determine if the epidemic described by Goodall was part of a natural chimpanzee cycle or the result of introduction from local human populations or researchers.

Therefore it seems safe to state that, given the sources we have so far, it is not known if there are natural reservoirs of PV in non-human primates. However it certainly can infect non human primates, it causes disease in them, it can be transmitted from humans to non human primates, and infection of non human primates with PV has been an integral part of research in poliomyelitis.--cyclopia^speak! 17:07, 25 August 2013 (UTC)

Per the above, Humans are the only known natural host for the virus. ([6] PMID 22128250) Although that statement isn't specifically sourced in the article, it seems to be carefully (and cautiously) worded.

• From the same article, Polio was first shown to be caused by a virus by Landsteiner & Popper (1909) when they transmitted the disease successfully from the spinal cord of a fatal human case to a monkey.
• From [7] PMID 10233910: Landsteiner and Popper (14) injected intraperitoneally into two Old World monkeys (Cynocephalus hamadryas and Macacus rhesus) a suspension of spinal cord from a 9-year-old boy who had succumbed to severe poliomyelitis after four days of illness. The two monkeys, in good condition, had been available from previous experiments with syphilis. The inoculated material, which was bacteriologically sterile, yielded negative results when injected into rabbits, guinea pigs, and mice. The two monkeys, however, exhibited lesions in the spinal cord, medulla, pons, and brain stem that were indistinguishable from those observed in cases of human poliomyelitis. One of the monkeys, the rhesus monkey, developed complete flaccid paralysis of both legs. Landsteiner and Popper were unable to passage the agent, but this was achieved soon afterward and independently in 1909 by Römer (22), Flexner and Lewis (8), Leiner and von Wiesner (15), and Landsteiner and Levaditi (13). ... As early as 1910, Flexner and Lewis (9) had cautiously suggested that poliovirus gained access to the central nervous system via the nasal mucosa, a hypothesis supported by experiments with monkeys performed by Flexner’s group and by Leiner and von Wiesner: swabs containing poliovirus were introduced into the nose and rubbed vigorously over the upper nasal mucous membrane, with ensuing clinical poliomyelitis. Poor monkeys... 86.130.63.47 (talk) 18:26, 25 August 2013 (UTC)

Error in transmission section

The section "Transmission" under "Causes" lists tonsillectomy as a risk factor for contracting poliovirus. The reference cited to support this (https://www.ncbi.nlm.nih.gov/pubmed/12978882) in fact states the opposite: that tonsillectomy (and adenoidectomy) did not alter the rate of infection, either positively or negatively. Tonsillectomy should be removed as a risk factor. Planx constant (talk) 02:42, 28 September 2013 (UTC)

Removed, thanks for pointing it out - something as obvious as that you can usually just fix yourself and then discuss as needed if someone reverts. Tobus2 (talk) 10:23, 28 September 2013 (UTC)

Global Polio Eradication and World Polio Day

How about adding a section describing the on-going eradication efforts? http://www.polioeradication.org/

In addition, every year, 24th october is World Polio Day. World Polio Day was established by Rotary International over a decade ago to commemorate the birth of Jonas Salk, who led the first team to develop a vaccine against poliomyelitis. Use of this inactivated poliovirus vaccine and subsequent widespread use of the oral poliovirus, developed by Albert Sabin, led to the establishment of the Global Polio Eradication Initiative (GPEI) in 1988. Since then, GPEI has reduced polio worldwide by 99%. On that day, various events take place all over the world to raise awareness and collect funds. http://www.who.int/pmnch/media/events/2013/polioday/en/ — Preceding unsigned comment added by Rcth1130 (talk • contribs) 13:56, 1 December 2013 (UTC)

Section on India

Why is India mentioned as one of four countries in which polio is endemic? There have been news reports (I believe on Feb 20 2012) stating that for about a year, India had had no cases of polio, if the same reports did mention that there were still cases in Pakistan. ACEOREVIVED (talk) 17:02, 21 February 2012 (UTC)

How long must there be no cases before a country is officialy removed from the "endemic list"? Roger (talk) 17:13, 21 February 2012 (UTC)

India is now declared polio free by WHO 1.186.5.115 (talk) 15:36, 14 January 2014 (UTC) (http://www.searo.who.int/mediacentre/features/2014/sea-polio/en/index.html).

Not quite, as your link says: "A commission of experts will meet at the World Health Organization offices at the end of March to analyze the data and determine the polio status for the Region." Tobus (talk) 00:17, 15 January 2014 (UTC)

Wrong Congo?

In your map for cases of polio in 2012 [[8]] you've got the Republic of the Congo shaded blue, but the table says the cases were in the neighboring DR Congo --Killing Vector (talk) 12:25, 18 January 2014 (UTC)

Fixed, thanks for the heads up. Tobus (talk) 14:11, 23 January 2014 (UTC)

all Afghan cases imported?

When the Afghan count stood at 11, PolioEradication.org reported that all were imports from Pakistan. The final count for the year looks to be 13, 12 near the border and one near Kandahar. Any idea if that case is related to the importation from Pk, or is it a resurgence from the old center of transmission? Afghanistan would still be considered "endemic", of course, until 2 yrs have passed, but still, it would be worthwhile noting if there were no known indigenous cases in 2013. — kwami (talk) 04:43, 26 January 2014 (UTC)

No, PolioEradication.org said that "All WPV1 cases in 2013 are reported from Eastern Region, close to the Pakistan border."[9] - that's not the same as saying they are all imports from Pakistan. Both PE and WHO still consider polio endemic to Afghanistan so I think it's a bit premature for us to be calling it imported. The 12th case was in Nad-e-Ali in Helmand province, a long way from the border. I haven't see anything saying where it came from, but it's only been a few weeks and more info might come to light when/if they do genetic sequencing on it. Tobus (talk) 07:08, 26 January 2014 (UTC)

No, they said all were imported from Pakistan. That was before the 12th case. News outlets are now reporting WHO saying 12 of the 13 are from Pakistan, but I haven't found the WHO report. Added one of the news refs anyway. — kwami (talk) 10:26, 26 January 2014 (UTC)

No worries, I couldn't find the original either but that news report will do - I've put it up the top with other ref to keep the table clean. Tobus (talk) 11:16, 26 January 2014 (UTC)

WP:COMMONNAME

In accordance with WP:COMMONNAME, should this article be re-named to "Polio"? JDiala (talk) 17:25, 28 March 2014 (UTC)

Poliomyelitis is a good name. Do not see a reason to change. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:46, 28 March 2014 (UTC)

Semi-protected edit request on 16 April 2014

The last line, "Doctors and international public health agencies report more than 90 cases of polio in Syria, with fears of contagion in rebel areas from lack of sanitation and safe-water services" is incorrect. The source, Annie Sparrow, does not work for polio and based this assumption upon false reading of the data. The line that should replace this is as follows:

The World Health Organization has reported at least 40 confirmed cases of polio in Syria. The poliovirus was able find pockets of children who had not been immunized due to the civil unrest and establish itself initially among these vulnerable populations. The virus reached Syria from Pakistan via Egypt where polio was found in sewage samples in 2013. How exactly the virus got to Egypt from Pakistan, or to Syria from Egypt is unknown, but the virus is highly contagious and was likely carried by people travelling between these areas. In March 2014 Iraq reported its first case of polio in over 14 years after virus moved from Syria into areas just north of Baghdad. All countries in the middle east bordering Syria and Iraq are engaging in intensive polio immunization campaigns to stop the virus.

Further information can be found at http://www.polioeradication.org/

signed, Jeffrey Bates, Chief of Communications and Polio Lead for UNICEF Iraq (formerly UNICEF HQ in NY)

Jemiba (talk) 13:50, 16 April 2014 (UTC)

Not done for now: This seems out of scope for a simple edit request, may require some discussion. I'm not quite sure about the New York Review of Books, but a little searching for the author, Annie Sparrow, makes her look quite credible (see here). From her article, it looks like she personally combined the data reported by the ACU and the official data from Syria (which the WHO is using), to get her figure of 93. The WHO figures, most recently from 3/21/14, give a much lower figure of 37. I think we can go in two directions here - either change things to the WHO figure, or, if we find Sparrow to meet RS, then perhaps include both figures, as Sparrow raises questions about the reliability of the WHO figures as they are primarily using data reported by the Syrian Ministry of Health, the reliability which she questions at the bottom of the first page of her article, and notes that the ASU figures were tested by the Turkish Ministry of Health "with the help of the CDC". Cannolis (talk) 00:56, 17 April 2014 (UTC)

Which ref supports this? Doc James (talk · contribs · email) (if I write on your page reply on mine) 08:30, 17 April 2014 (UTC)

Vaccine-Derived Cases

I don't think the article did a good job in explaining the difference between the "wild" virus and the "vaccine-derived" virus. There is only a short reference to the distinction in the "Diagnosis" section, as well as numbers of vaccine-derived cases in a table. I had to go elsewhere to get a good understand of what the "vaccine-derived" virus was, which particular vaccine causes it, how it is caused, etc. Thank you. ThomasSchroeder (talk) 15:25, 13 May 2014 (UTC)

Better Sanitation

The following is from the third paragraph of the article: "The epidemics are attributed to better sanitation which reduced the prevalence of the disease among young children who were more likely to be asymptomatic. Survivors then develop immunity." At first I thought that it was a mistake to site "better sanitation" as an attributing factor to polio epidemics. As I read more, I discovered that this is correct and better understood the reason why. However, I don't think these two sentences give a descent early understanding of the reason. First, I'd suggest using the a term like "counter intuitive" or "irony" somewhere in the sentence to make clear that "good sanitation" is indeed a contributing factor. Two, nowhere else in the article does it claim children are more likely to be asymptomatic, but rather, the infection itself is usually asymptomatic. Finally, nothing is offered to directly suggest (at this early point) why poor sanitation helped reduce epidemics. I don't believe I have a complete understanding yet, but as I read the full article this is the sense I got rather the than the two sentences above: "The epidemics are, ironically, attributed to better sanitation which significantly reduced regular exposure to the virus and so eliminated an opportunity for a large population to slowly build a natural immunity." Again, thank you for considering my comments. ThomasSchroeder (talk) 15:57, 13 May 2014 (UTC)

Missing Citation?

From the entry:

"Paralytic polio"Paralytic polio" "Denervation of skeletal muscle tissue secondary to poliovirus infection can lead to paralysis."

"In around 1% of infections, poliovirus spreads along certain nerve fiber pathways, preferentially replicating in and destroying motor neurons within the spinal cord, brain stem, or motor cortex. This leads to the development of paralytic poliomyelitis, the various forms of which (spinal, bulbar, and bulbospinal) vary only with the amount of neuronal damage and inflammation that occurs, and the region of the CNS affected."

This paragraph has no citations -- shouldn't it have at least one? Rissa, copy editor (talk) 21:54, 10 September 2014 (UTC)

Updates

Updated the eradication section, also rearranged what was there and eliminated some duplications; further improvements welcome. This file could be used to update the image, too. HLHJ (talk) 21:24, 4 August 2015 (UTC)

Updated "Epidemiology" with 2014 chartAumnamahashiva (talk) 21:55, 2 September 2015 (UTC)

What is "wild poliomyelitis"?

The term "wild poliomyelitis" is used throughout the article, but without any explanation. Does this term imply that the virus can exist outside of human bodies, e.g. in animals? If so, how can eradication ever be successful, since we don't vaccinate animals? If every single human being would be polio-free, could there still be new infections? If yes, where from? Is polio inside of humans somehow "domesticated"? I'm not competent to answer these questions, but I believe answering them would further improve an already very good article. 92.231.219.248 (talk) 12:33, 28 October 2014 (UTC)

I think this is already in the article, at the end of the Poliomyelitis#Diagnosis section Cannolis (talk) 07:29, 29 October 2014 (UTC)

To spell it out, the term is used to distinguish between strains of the polio virus found in the wild, as opposed to those found in the laboratory: that is, the strains that cause human disease, and the strains found in the vaccine (attenuated or otherwise altered in the lab). The RNA of poliovirus is about 7441 nucleotides long; out of this there are, for example, about 57 nucleotide differences between the wild type and the Sabin 1 strain. - Nunh-huh 15:28, 29 October 2014 (UTC)

I always seem to see this in the context of "wild" vs "vaccine-derived" poliomyelites. — kwami (talk) 01:55, 3 September 2015 (UTC)

Seriously out of date information -- Extremely urgent, life-threatening errors

As of September 7, 2015, polio had been recently found in Guinea, Mali, and Ukraine.

http://www.reuters.com/article/2015/09/07/health-polio-idUSL5N11D1X220150907

The article does not reflect this and incorrectly implies that a person could travel safely to those countries without fear of infection and without needing to get the vaccine first. It is imperative to fix this immediately.

In the Africa section, the sentence "Africa has had no confirmed cases polio since Aug. 11, 2014" is false.

In the lead, the sentence "In 2014 the disease was only spreading between people in Afghanistan, Nigeria, and Pakistan" may be a technically true statement about the situation in 2014, but it needs to be followed with information about the current information in Guinea and Mali.

In the Europe section, the sentence "Europe was declared polio-free in 2002." may be a technically true statement about the situation in 2012, but it needs to be followed with information about the current information in Ukraine. 71.109.146.123 (talk) 03:26, 8 September 2015 (UTC)

Semi-protected edit request on 26 September 2015 - Polio no longer endemic in Nigeria

In the table that shows where polio is endemic, importation, vaccine-derived, etc., please either change status for Nigeria or remove Nigeria from the list. On 25 September 2015, the World Health Organization announced that polio was no longer endemic in Nigeria. Also, update the Africa section to indicate that, for the first time in history, polio is not endemic anywhere in Africa. http://www.nbcnews.com/health/health-news/who-removes-nigeria-list-countries-polio-n433986 http://www.nation.co.ke/news/africa/WHO-takes-Nigeria-off-global-list-of-polio-endemic-countries/-/1066/2887194/-/oi981hz/-/index.html http://www.usnews.com/news/world/articles/2015/09/26/un-strikes-nigeria-from-list-of-polio-endemic-countries http://www.bbc.com/news/health-34328447 71.109.145.114 (talk) 23:28, 26 September 2015 (UTC) 71.109.145.114 (talk) 23:28, 26 September 2015 (UTC)
 No. All I see are a bunch of links, please organize and explain the edit detail and I will reconsider. Krett12 (talk) 04:18, 28 September 2015 (UTC)

The table that shows where polio is endemic, importation, vaccine-derived, is out of date

On 25 September 2015, the World Health Organization announced that polio was no longer endemic in Nigeria.

The table that shows where polio is endemic, importation, vaccine-derived, etc., still indicates that it is endemic in Nigeria, which is no longer correct.

(Sources to cite: http://www.nbcnews.com/health/health-news/who-removes-nigeria-list-countries-polio-n433986 http://www.nation.co.ke/news/africa/WHO-takes-Nigeria-off-global-list-of-polio-endemic-countries/-/1066/2887194/-/oi981hz/-/index.html http://www.usnews.com/news/world/articles/2015/09/26/un-strikes-nigeria-from-list-of-polio-endemic-countries http://www.bbc.com/news/health-34328447 )

71.109.145.113 (talk) 04:49, 6 October 2015 (UTC)