Research into Post-Polio syndrome
and ME has made the astounding discovery that the virus that most often
triggers ME is closely related to the one that causes polio.|
Just a few
decades ago, hospital wards were full of children in iron lungs as a result of
polio. No longer.
The horrific spectacle appeared to abate with the advent of vaccination, but
nothing is without its price.
breathed a sigh of relief and even the medical profession believed, and still
seems to believe, that the dreaded scourge of polio was at last being
vanquished. We read predictions that it will be wiped out by the year 2000.
But a body
of evidence is growing linking myalgic encephalomyelitis (ME) to this terrible
disease largely caused by attempts to eradicate polio. An alternative polio
seems to be upon us.
proceedings of the first international scientific conference on the Post-Polio
Syndrome in the US have been collated in the Annals of the New York Academy of
Science. It includes 50 papers written by 118 contributors from a wide range
of specialties, including clinical neurology, neuroscience, electrophysiology,
brain imaging, histology, virology, immunology, epidemiology and
particular, papers by Dr Richard Bruno, assistant professor at the New Jersey
Medical School's department of physical medicine and rehabilitation and director
of Post-Polio Rehabilitation and Research Service at the Kessler Institute for
Rehabilitation in New Jersey, and four other specialists compare in graphic
detail ME - now often called Chronic Fatigue Syndrome and Post-Polio Syndrome (Dalakas,
et aI, ed. The Post Polio Syndrome: Advances in the Pathogenesis and
Treatment, Annals, NY Academy, Sciences, 1995:273:1409). Post-Polio is
developing in those who had polio 25-30 years previously. Clinically, it is
indistinguishable from ME.
'Of a dozen outbreaks of
ME, nine occurred during or right after outbreaks of, polio. '
Other researchers demonstrate
that ME is just another form of polio, which has increased with the advent of
polio vaccination. As one type of gut virus has been eradicated, so other forms
have had the space to proliferate.
To understand the link one
needs to understand the microbiological habits of both polio and other
enterovirus disease - that is, gut bugs.
A historical accident has led
to various names being given to viruses, all of which share physical, chemical
and epidemiological characteristics of what we consider the classic polio virus,
which science refers to as polio viruses 1, 2 and 3 (Dowsett: Journal of Hospital
Infection, 1988; 11: 103-15). In 1948 a polio-like illness in New York state
prompted scientists to culture the virus. But what grew looked to them at that
time like a new virus. They called it "Coxsackie" after the small town up the
Hudson River where it was found. And they called the disease "Atypical Polio"
because its symptoms identified it as a kind of polio, despite the virus being
This kind of polio, "Atypical
Polio", has since been renamed "ME" and even more recently, "Chronic Fatigue
Syndrome". But it remains a kind of polio despite the change of name, and newer
technology has shown up the generic similarities of the most frequent agent
that causes it.
These techniques place
Coxsackie, the virus most often implicated in ME, in the polio family tree,
along with so-called Echo viruses. Coxsackie has been further divided into
Coxsackie type A (with 24 viruses) and Coxsackie type B (six viruses). There are
34 Echo viruses. In total, there are at least 72 enteroviruses in all, with new
ones still being discovered.
All this has been unnecessarily confusing and complicated,
even for doctors. These days newly discovered enteroviruses are just given a
new number, not a new name, since their inter-relationship is recognized.
Had the techniques been available that we now have at our
disposal, all these viruses might simply have been called "Polio 1 through 72".
There are several angles from which to investigate the
hypothesis that ME is a type of polio. One is its clinical symptoms. Dr
Elizabeth Dowsett , consultant microbiologist of the Southeast Essex NHS Trust
who is in the forefront of ME research, explains that true ME (as opposed to
fatigue states with other aetiologies) strikes one clinically as being
polio-like, and it has often been diagnosed as a "non-paralytic polio".
patients have' weakness, pain down their spines and are systemically ill," she
She feels that it has been an
unfortunate mistake to turn to the label "Chronic Fatigue" because true ME is a
neurological condition that usually originates with a gut virus infection like
Apart from clinical
examination, in some cases of ME you can actually demonstrate the presence
of gut virus infection in the patient. The requirement to put off diagnosing ME for six months
after the patient falls ill has unwittingly militated against this. If tests are
not done very rapidly after the onset of infection, it is too late to identify
A blood screening test called
the IGM, which shows up recent infection, is an NHS procedure. This can be
positive up to three months after infection in adults. As the enteroviruses are
characterized by their relapsing nature (on average, three-week intervals), it
could also be identified on relapse.
Apart from modem techniques, a
research procedure called the acid elution test can remove antibody from
circulating virus and can be applied to viruses multiplying in the bowel. Years
ago it was difficult to diagnose polio, and it was this very test which was
A third way to compare ME with
polio is by looking at studies of actual
outbreaks which identified the viruses causing it. Here the evidence is
A recent paper by Richard T
Johnson, at the Department of Neurology, John Hopkins University School of
Medicine, in Baltimore, Maryland, published in the 1995 Annals of the New York
Academy of Sciences mentioned above, sets out evidence that has been available
since the 1950s.
|"In the spring of 1957, " he wrote,” we investigated an
epidemic of Poliomyelitis in Hawaii. . . of the 39 cases of non-paralytic
poliomyelitis, only four were related to type 1 poliovirus. There were 16
cases of echovirus 9, seven cases of Coxsackie, and four to five other
The very enteroviruses known to
be implicated in so-called ME were here identified as causing "non-paralytic
polio". ME has often been diagnosed as "non-paralytic polioAnd even more
interestingly, two of the 38 cases of paralytic disease were not caused by the
polio virus at all, but by one of the Coxsackie viruses.
So we know that enteroviruses
in general can cause varying forms of the disease we call polio.
Other parallels between ME and polio concern neurological
In the November 1991 edition of
Orthopaedics, Dr Bruno says that "all the evidence available shows conclusively
that every case of poliomyelitis, human or experimental, exhibits lesions of
the brain. In the experimental animal this included non-paralytic and
abortive cases as well as paralytic cases." ME has been diagnosed by both
italicized names. In fact, brain abnormalities can now be demonstrated in the
brains of people with ME using SPECT and MRI scans.
One would expect there to be
differences in the diseases caused by different viruses, but if these viruses
are all of the same family and use the same receptor sites in the body, one
would also expect there to be similarities. This is just what we find.
Dr Bruno says: "Despite the
differences between poliomyelitis and ME, an association with the polio virus
was suggested by the fact that, of the more than one dozen ME outbreaks before
the introduction of the Salk vaccine, nine occurred during or immediately after
outbreaks of polio, and several involved hospital staff who cared for polio
patients" (Annals, NY Academy of Sciences, 1995).
There is also the case of a
woman who fell ill with classical ME/CFS while nursing a lady friend with acute
paralytic polio (Hyde et al: Epidemiological Aspects of ME/CFS, Nightingale
Research Foundation, Ottawa, Canada, 1994).
But if ME is a type of polio,
why doesn't everyone exposed to the relevant viruses develop ME just as they did
It has been forgotten that, as
Dr Thomas Stuttaford of The Times explains, ". . .only a small number of those
infected with the polio virus became paralyzed; about 90 per cent didn't even
realize that they had anything more threatening than a cold."
With polio and ME,
the state of your immune system governs whether you will be susceptible.
By altering the population's
resistance to a particular organism, we alter the balance of infectious agents
in the environment. The circulation of wild polio viruses 1-3 has declined
through vaccination. However, this has left us open to the other 69
polio-related viruses, which have thrived (see
A Guide to gut viruses
– How viruses “compete” with one another).
It is therefore not surprising
that since the late 1950s the incidence of ME has risen and risen, and experts
predict that it will be the neurological disease of the 21st
century. By suppressing the spread of three enteroviruses we have opened the
door to the rest.
The argument about whether
enterovirus infection persists over many years is still raging. In her
1995 review of the proceedings of the 1994 Post-Polio Conference, Dr Dowsett
draws attention to new evidence of persistent enterovirus infection in the
central nervous system of Post-Polio patients.
It is thought that the emergence of late-onset Post-Polio
fatigue may result from age-related changes in brain cells that survived the
original polio infection (Bruno, Annals, NY Academy of Sciences 1995).
|“Three separate groups of virologists from
USA, UK and France have found fragments enteroviral RNA in the spinal cord,
cerebrospinal fluid and blood of some patients with Post Polio syndrome. The
fragments are identified as polio virus by some and. as Coxsackie virus by
others," she said.
But it can be observed through case histories that just as
we see Post-Polio Syndrome 30 years after initial infection, so we are seeing
"Post-ME" as well. The Nightingale Research Foundation in Ottawa proposes that
in fact they are one and the same condition - others believe they may be
variations of each other.
What has arisen is "two new diseases with different names,
with different degrees of acceptance and exactly the same set of
symptoms at exactly the same time. It is unrealistic to believe that we are
dealing with two different disease processes and two different causes," the
A paper investigating the epidemiological aspects of ME/CFS
has revealed further convincing parallels between the behaviour of this disease
and polio. It describes the onset of ME as mainly being ushered in by a "minor
illness" which has "recently been described as a flu-like illness...". The
researchers continue: ". . .in reality it is identical to and has all of the
features and variability of the 'minor illness' of missed or abortive
In comparisons with epidemic
polio going back to 1916, they note that "we see the same two typical features"
in a typical year with an epidemic of ME : "a decreasing incidence from January
to reach a summer low; then. . . the strong late summer increased incidence,
peaking in the August to October period." (Hyde et al: Nightingale Research
Foundation, Ottawa, 1994).
ME, or Atypical Polio, is a serious and devastatingly
debilitating multi-system malfunction leading to such profound weakness in some
children that they are unable to speak and have to be tube-fed. But they can
breathe; enteroviruses have an affinity for certain tissues and many do not
attack the respiratory centre causing its paralysis, as in polio itself.
Children with polio were given intensive physiotherapy and
exercised. Now, up to a half of survivors have gone on to develop Post-Polio. It
has been predicted that this will eventually rise to 100 per cent.
What are we doing to our teenage ME sufferers when we force
them back to school, deny home tuition and tell them to exercise as a form of
The "treatment of choice" for
those with Post-Polio is "adequate rest, energy conservation, the pacing of
activities, and reducing physical and emotional stress" (Bruno: Annals NY
Academy of Sciences 1995).
What on earth will happen in 30
years' time to children now getting ME in a climate where they are disbelieved
and told to push themselves through the pain barrier? The condition "Post-ME",
which we are already seeing in adults, may well await them with a vengeance.
We have to ask ourselves the
disturbing question: if polio victims had been able to breathe, would we ever
have taken that disease seriously?
Jane Colby is author of ME:
The New Plague (First and Best in Education Ltd, 34 Nene Valley Business
Park, Oundle, Peterborough, PE8 4HL)
Republished with permission of What Doctors Don't Tell
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