Talk:Polio vaccine

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Contents 1 What each vaccine accomplished 2 Defective vaccine 3 Date of first vaccinations 4 Page bias 5 Number of triplets difference in vaccine from wild virus 6 Role of Koprowski 7 Who is Garbardy? 8 Addition of material from polio article 9 The two vaccines have eradicated polio ...

[edit] What each vaccine accomplished

It's important to explain what each vaccine accomplished. It's not an attack on Salk or his vaccine to say that the live vaccine is superior when wild poliovirus is still around. It's a fact that the live vaccine was necessary to completely eliminate the wild virus from the population; if only the killed vaccine were in use, people could be immunized against the effects of the virus, but the virus could still spread from person to person through the oral-fecal route and cause polio in those for whom the vaccine doesn't work.

The Salk vaccine was an expedient created from existing techniques designed to fight a major and immediate problem. The attenuation of the wild virus for use as a vaccine was a more novel and complicated approach. The live vaccine was a "magic bullet" that the killed vaccine wasn't. Yes, Sabin was a jerk to Salk, but that doesn't change history, and the relative merits of the vaccines don't detract from the fact that both men saved tens of thousands of lives through their work.--ArminTamzarian 00:11, 10 Mar 2005 (UTC)

Based on what you've said, it seems that that Salk vaccine would have eliminated polio (an illness) from the U.S. population, even if it wouldn't have eliminated the polio virus. Perhaps it wouldn't have eliminated polio completely, because you suggest that there are people for whom the vaccine doesn't work; but, by the same token, the Sabin vaccine didn't eliminate polio completely, because of the (admittedly rare) cases of vaccine-induced polio. I'll try a rewording that incorporates the explanation you've given above.

On another point, I assume the statistic you've given for vaccine-induced polio (one in 2.4 million) assumes proper preparation of the live-virus vaccine. Didn't at least one manufacturer perpetrate a major screw-up and ship some vaccine that was substantially more likely to cause polio? This is based on my recollection of something I read years ago, so I may have it garbled. If there was such an incident, it would be worth adding to the article, of course putting it in context as a one-time error by a manufacturer that was (according to my recollection) driven out of business as a result. JamesMLane 03:01, 10 Mar 2005 (UTC)

The initial trial of the killed vaccine, on several hundred thousand individuals, found effectiveness of about 90%. Cases of infantile poliomyelitis fell from about 15,000 in 1955 to 500 in 1962. I think most children had been vaccinated by then, so the killed vaccine was probably approaching the limit of its effectiveness. A few hundred deaths a year from wild polio still would have justified the use of the live vaccine. The 1:2,400,000 figure what the CDC says now, so I'm sure it does. I don't remember reading about defective live-virus vaccine, but the same thing happened with a large batch of adulterated killed-virus vaccine early in the distribution that caused a number of deaths. It was from defects in the manufacturing process, which were soon corrected. ArminTamzarian 14:57, 10 Mar 2005 (UTC)

Addendum -- another possible improvement to the article: The advantages of the Sabin vaccine certainly deserve mentioning, but the article now is somewhat imbalanced. We should probably add something between the first and second paragraphs about how polio was a dreaded disease, a terrible scourge, affecting many more people than AIDS does today, and Salk was hailed as a national hero. As it is, the article segues directly into the advantages of the Sabin vaccine. Salk's achievement is relegated to a subordinate clause buried deep in that paragraph. I admit that, for various reasons, I have a pro-Salk bias, but I think that elaborating on the pre-Sabin situation would improve the article. JamesMLane 03:14, 10 Mar 2005 (UTC)

What, do you have something against NYU doctors? I could add a lot more about the history of the disease and the development of the vaccine, but I have two reservations. First, this would become more of a "History of the polio vaccine" article than a "polio vaccine" article linked to a "polio" article and a "Jonas Salk" article. Maybe that's a good idea, since this is an important topic, but it would be a big change. Second, of the reading I've done on the topic, most of it was from secondary works, but a lot was from materials printed in the 1930s and 1940s. I don't consider this original research, which to me is something like an empirical study, or an examination of previously unknown historical sources and making new conclusions. These sources, however, like informational pamphlets and March of Dimes materials, are probably only available in major research libaries, so some might question whether parts of what I could write are original research. ArminTamzarian 14:57, 10 Mar 2005 (UTC)

Nothing against NYU Medical Center -- I was there yesterday! No, it's that, years ago, I worked on a case with Dr. Darrell Salk, the son of Jonas Salk (both of us donating our services, I as a lawyer and he as our scientific consultant). As for the article, I didn't see it as a big change in the nature of the article when you added information about the effect of the Sabin vaccine -- the sentence I've reworded that explains that the live-virus vaccine eradicated wild polio. It's also not a big change to add the information that the killed-virus vaccine effected such a dramatic reduction in the incidence of polio. If we develop lots and lots of information about the history of the vaccine, it might be appropriate to spin it off into a daughter article, but this one is still very short and I wouldn't see a need to do that anytime soon. I agree with you that this wouldn't be original research, but I also agree with you that some might raise that issue. There seem to be some people who think "original research" means "I couldn't provide a hyperlink to a website that says this is true." That view is plainly wrong, IMO. JamesMLane 18:59, 10 Mar 2005 (UTC)

Sorry, that was a small joke. Sabin got his degree there in 1931, Salk in 1939. I think I'll add little pieces here and there and see if anyone complains. ArminTamzarian 20:50, 10 Mar 2005 (UTC)

[edit] Defective vaccine

The incident referred to above by ArminTamzarian, in which there was a defective batch of killed-virus vaccine, is mentioned in this newspaper article: http://seattlepi.nwsource.com/health/170648_polio26.html and might be worth including in a "History" paragraph or section. JamesMLane 19:15, 10 Mar 2005 (UTC)

[edit] Date of first vaccinations

This article states that the polio vaccine was announced to the world in 1955. The polio article states that the first public vaccinations were in 1954. Can anyone clear this up? --Ptomato 21:56, July 25, 2005 (UTC)

I think that there was an extensive public trial. At one point, the article had the date of the first vaccination. Someone changed that to the 1955 date on which it was announced that the trial had shown the vaccine to be successful. You're right that it would be good if someone would track that down and augment the article with a little more detail about the chronology. JamesMLane 00:43, 26 July 2005 (UTC)

[edit] Page bias

The page is biased totally towards vaccination. It may have been OK if Jdwolf hadn't taken out the external links critical to the vaccine paradigm, eg Jim Wests pesticide research [1]. john 13:00, 1 January 2006 (UTC)

This page already has a link to Vaccine controversy, and complaints about the vaccination paradigm belong on that page, not here. --Arcadian 14:08, 1 January 2006 (UTC)

[edit] Number of triplets difference in vaccine from wild virus

I retain a memory that this is very small - only two - but at the same time there are three strains in the live vaccine (used in the UK until recently). Is there a virologist or biochemist to hand?Midgley 19:10, 25 January 2006 (UTC)

[edit] Role of Koprowski

An anon has made several edits here and elsewhere, inserting claims for the role of Dr. Hilary Koprowski but without providing any citations. The edits seem to me to overstate Koprowski's role.

One source states, "Hilary Koprowski developed the first polio vaccine tried on humans, but it failed...." [2] Another source contradicts even the claim that Koprowski was first to test a vaccine on humans, citing tests in 1935 by Park and Brodie and by Kolmer. [3] It's possible that Koprowski was the first to test an oral vaccine, but his 1950 test was on only 20 children, and in my initial research I've found nothing to indicate that the 1950 test showed the vaccine to be effective against polio.

It appears that one of Koprowski's problems was that weakening the live virus so that it wouldn't cause paralysis was a time-consuming procedure, compared to the Salk approach of using killed virus. According to one source, this factor meant that successful small-scale tests of live-virus vaccine couldn't lead very quickly to mass immunization: "All of these events took place four years before the Francis Field Trial of the Salk vaccine, but the oral polio vaccine would not be ready for use until five years after the injectable vaccine reached the market." [4] That article also alludes to some controversy as between Sabin and Koprowski as to the credit to be given for the oral live-virus vaccine.

It seems clear that Salk's vaccine was the first to be given a mass trial and was the first development to produce a major reduction in the incidence of polio. Also, although there were some mass immunizations using Koprowski's vaccine, the oral live-virus vaccine most widely used was one based on Sabin's work rather than Koprowski's:

• "In 1958, the National Institutes of Health created a special committee on live polio vaccines, in charge of testing the strains authorized for the oral vaccine. The Koprowski and Cox strains were eliminated, as were those of Yale University, while the Sabin strains were selected for the three viral types. They rapidly became the only strains to be used worldwide." [5]

• "Is Dr. Koprowski’s vaccine related to the polio vaccines now being used worldwide?

"No, the current oral polio vaccine was developed by Dr. Albert Sabin, uses Sabin strains and bears no relationship to the experimental vaccine." [6]

My preliminary conclusion is that our article on Polio vaccine should include some reference to Koprowski, but not as the very first sentence, where the anon put it, and not in the sweeping terms used by the anon, unless better evidence can be found. (The description at koprowski.net doesn't count!) The article on Poliomyelitis includes a summary of the information about the vaccine, and I'm undecided about whether there should be any reference to Koprowski there, as opposed to relying on the wikilink to Polio vaccine. I'm reverting the anon's edits to both articles.

The article on Hilary Koprowski might be the best place to get into the fullest detail about what Koprowski did how his work fit into the overall picture. JamesMLane t c 08:51, 24 April 2006 (UTC)

The anon has now reverted in this article and in Poliomyelitis, saying, "Check the facts before changing this back again." As demonstrated above, I've spent considerable time checking the facts. The anon has still provided zero evidence. I'm reverting again. Anon, if you want to help us get correct information about Koprowski into the articles, you're going to have to recognize that Wikipedia editing is collaborative. Discuss the issues here, please. JamesMLane t c 10:59, 26 April 2006 (UTC)

You mention "I've found nothing to indicate that the 1950 test showed the vaccine to be effective against polio." The link you provided as source,([7] ), seems to have a confusing structure. If you notice, the first four paragraphs are about Koprowski, then the name Albert Sabin appears and then a paragraph about Koprowski. The name may appear there because a picture of Sabin administering his vaccine appears at that point in the page. Confusion from this rogue line of text may be why we seem to be disagreeing. This fifth paragraph states that Koprowski's vaccine worked so well that NFIP's committe barely believed the results. Thus Koprowski's vaccine was the first to successfully immunize against Polio.

The source ([8])directly contradicts this by stating that Koprowski's vaccine failed. Seeing as this link doesn't even list its sources I am not sure how credible it is considering it contradicts the website www.polio.info .

If you read "Vaughan, Roger. Listen to the Music: The Life of Hilary Koprowski, Springer, New York, 2000." or "John Paul in A History of Poliomyelitis. NY and London: Yale University Press, 1971" you will see that Koprowski's vaccine was the first to successfully immunize against Polio.

If I did indeed claim that Koprowski's vaccine was the first tested on humans, I apologize. I meant to say that his was the first to successfully immunize humans. I also think we are disagreeing on the definition of a successful vaccination. While you seem to think they are only successful if tested in a mass trial, I believe just because it wasn't the first to be used in the mass trial doesn't mean it wasn't the first succesful vaccine. I think a similar misunderstanding occurs concerning production of the vaccine. As is clear in the definition of the word vaccine:

"A preparation of a weakened or killed pathogen, such as a bacterium or virus, or of a portion of the pathogen's structure that upon administration stimulates antibody production against the pathogen but is incapable of causing severe infection," [9]

the success of a vaccine is not dictated by how many people recieve it.

I want to appologize for my behaviour before. I am new to the methods of Wikipedia and did not mean to act so aggressively. Further, I certainly did not intend to put false information in the article. I worked for many years in biochemistry and know quite a bit about the Polio vaccine. I find it very misleading and unjust when Salk and Sabin are given credit for developing the only vaccines (I realize this may not have occured here). Anyway, I will not change this article again, but I highly suggest you mention that the first successful vaccine was developed by Koprowski for the sake of accuracy.

In the online source [10], the paragraph you cite says only that the subjects weren't re-infected by a later administration of the same vaccine. That indicates that the vaccine protected against itself, but not that it offered any protection against wild polio. Furthermore, my impression from Oshinsky's book is that the disbelief was caused not by the alleged effectiveness of the vaccine, but by Koprowski's administration of it to children, in particular to institutionalized children. I agree that the success of a vaccine doesn't depend on the number of administrations, but the statistical reliability of any conclusion about its effectiveness will normally depend on the number of trials. As I understand it, Koprowski gave his vaccine to 20 children, none of whom subsequently developed polio. That hardly demonstrates that his 1950 vaccine was effective, though, because in such a small sample it's quite possible that none of them would've gotten polio even without the vaccine. JamesMLane t c 17:36, 10 May 2006 (UTC)

[edit] Who is Garbardy?

The article doesn't seem to contain an antecedent for the name Gabardy. It appears in the sentence "When the live-virus Sabin oral vaccine was developed to cure Gabardy's crying problem, it gained in popularity for several reasons." If someone knows what this refers to, could he or she please add this to the article.--Ferrierd 11:55, 24 September 2006 (UTC)

Looks like vandalism to me - single, nonsense edit from an anonymous user (IP address) with no other history of contributions. JeffreyGA 19:23, 17 October 2006 (UTC)

[edit] Addition of material from polio article

The polio article was approaching a critical size, which promoted a move of approximately 12kb of material from that page to this one. I have incorporated the old and new material as best I could.--DO11.10 17:10, 27 February 2007 (UTC)

[edit] The two vaccines have eradicated polio ...

I have reviewed both of the references supplied by Marco Tolo and neither of them substantiate or even address the claim that "The two vaccines have eradicated polio from most of the countries in the world and reduced early cases from hundreds of thousands per year to less than 2000 cases worldwide in 2006." FWIW, I believe the claim to be valid but I would like to see suitable, encyclopedic references provided.--DieWeibeRose 06:11, 13 March 2007 (UTC)

Okay, I'm not sure I follow. The Aylward ref (PubMed) notes:

"...well over 350,000 children were paralysed by poliovirus in 1988 — the year that the goal of global eradication was adopted"

supporting the "hundreds of thousands per year" benchmark, and

"As a result of the strategies, partnerships and activities outlined above, by the end of 2002 polio appeared to be on the brink of eradication, with only six countries still harbouring indigenous wild virus and just 1918 virologically confirmed cases of polio reported world-wide that year (www.polioeradication.org/casecount.asp)"

supporting the "where we are now" statement.

This reference points out the 2006 tally of polio cases (1997 cases worldwide) and is provided as a means to look-up the updated cases; since it is the same source used in the Aylward article, using the updated figure seemed appropriate.

Does this clarification help or am I missing your concern? -- MarcoTolo 08:25, 13 March 2007 (UTC)

I appreciate your efforts. I think what is lacking in this article is the inclusion of clear references to causality between the use of the vaccines and the reduction of polio mortality and morbidity in populations rather than merely individuals. Such a causal mechanism is implied throughout the article and esp. in the "Efficacy Section" but none of the references support the assertion that "The two vaccines have eradicated polio from most of the countries in the world and reduced early cases from hundreds of thousands per year to less than 2000 cases worldwide in 2006." Although I presume that the actual Aylward article, as opposed to the abstract, would include such references. The current references may support a correlation in populations but correlation does not imply causation. I don't think it is too much to require that an article on the "polio vaccine" ought to actually cite epidemiological and other evidence for causality that also rules out competing alternative causal mechanisms for the reduction of polio in human populations. Surely, such references exist. --DieWeibeRose 03:56, 24 March 2007 (UTC)

Okay, I cannot access the Aylward article mentioned in the article either, and I don't have any idea which "competing alternative causal mechanisms for the reduction of polio in human populations" you are referring to, but here is a paper that I think clearly states the assertion made in this article: Aylward R, Maher C (2006). "Interrupting poliovirus transmission -- new solutions to an old problem". Biologicals 34 (2): 133-9. PMID 16682220. 

I am not sure if you are able to access this article so I will include the salient points here:

...the success of polio control activities in Cuba, where by 1962 indigenous transmission had been interrupted using OPV during annual mass vaccination campaigns [2]. In the 1980s, the sustained implementation of OPV campaigns in Brazil, coupled with intensified surveillance, had a striking effect in rapidly reducing the high burden of paralytic polio to its lowest levels in history [2].

And the most compelling statement:

By January 2006, the systematic application of the polio eradication strategies originally developed in PAHO and then refined through experience in other WHO Regions had reduced the number of countries with ongoing transmission of indigenous wild polioviruses to just four (Nigeria, India, Pakistan, and Afghanistan), the lowest ever in history. (NOTE: according to the article) The PAHO strategy involved: strengthening routine immunization services to optimize population immunity, the use of annual National Immunization Days (NIDs), reporting and virologic investigation, large-scale house-to-house mop-up immunization campaigns.

Here is another citation: Kew O, Sutter R, de Gourville E, Dowdle W, Pallansch M. "Vaccine-derived polioviruses and the endgame strategy for global polio eradication". Annu Rev Microbiol 59: 587-635. PMID 16153180.  The supporting statement here is:

The year 2005 marks the fiftieth anniversary of the introduction of the IPV of Salk and Youngner (149, 173), and the promise of a world free of poliomyelitis (polio). Within 15 years that promise had been realized in most developed countries, through widespread immunization with IPV and then with the live, attenuated OPV of Albert Sabin (170), introduced in the early 1960s.

These statements clearly support the assertion that the polio vaccines were directly responsible for the worldwide decline in polio cases.--DO11.10 00:14, 25 March 2007 (UTC)