Our guest speaker tonight was introduced by Nancy Morris. A very timely presentation as Thursday, October 24th is World Polio Day. We are very fortunate to have her come out and make a presentation tonight. Dr. Crockett is an Associate Professor of Pediatrics and Child Health, Medical Microbiology and Community Health Sciences and Section Head for Pediatric Infectious Diseases at the University of Manitoba. Although she grew up in rural Nova Scotia, she has traveled extensively during her studies and subsequent work completing her BA (Psychology) and MD at Queen’s University and her Pediatric Residency at Dalhousie University followed by a Master of Public Health in International Health at the Johns Hopkins School of Public Health. Dr. Crockett completed a Diploma in Tropical Medicine and Hygiene at the Gorgas Course in Peru during her clinical fellowship in Pediatric Infectious Diseases at SickKids Hospital followed by a malaria immunology fellowship in Toronto. She moved to Winnipeg from Kenya in 2007 and now combines her clinical pediatric infectious diseases focus in Manitoba with her work on global maternal, newborn and child health projects in India, Kenya and Pakistan as the child health lead at the University of Manitoba’s Centre for Global Public Health. Last year, Dr. Crockett was included on the inaugural list of Canadian Women in Global Health.

Dr. Crockett opened her presentation with a comment on the
U.N. Convention On The Rights Of The Child
Article 24: Children have the right to good quality health care, clean water, nutritious food and a clean environment so that they will stay healthy. Richer countries should help poorer countries achieve this.
Of note is that the United States is the only U.N. member country that has not signed on to the Convention.
When one looks at child mortality under 5 years of age, polio is not near the top. Polio does not often kill its victims. They tend to develop mobility issues which can have massive impacts on their lives, especially if the child does not have access to physical aids to assist with walking.
The polio virus is identified as an Enterovirus. There are 3 serotypes (1, 2, 3). The virus has no envelop, these types of viruses tend to be very sturdy and can be around in the water and sewers for a very long time. The virus will survive for 3 - 6 weeks in feces as well as 1 - 2 weeks in respiratory secretions. Humans are the polio viruses only reservoir. The incubation period for the non-paralytic polio type is 3 – 6 days. The patient feels unwell as if they have the flu. The paralytic polio type has an incubation period of 7 – 21 days. The patient will present with a history of feeling ill then getting better followed by a sudden worsening and numbness developing.
Type 2 Wild Polio Virus has been eradicated. [VAPP is the only type of Polio Type 2 seen]. Vaccine-associated paralytic poliomyelitis (VAPP) is an adverse event following exposure to Oral Polio Vaccine [OPV]. OPV is made with live attenuated (weakened) polioviruses that can result in a case of VAPP. ... There is very little evidence that the vaccine virus circulates from VAPP cases, and there are no outbreaks associated with VAPP.
Type 3 Polio Virus has not been seen since 2012 (likely eradicated).
Type 1 Wild Polio Virus is the only virus seen circulating. Also, vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus (cVDPV – circulating vaccine-derived polioviruses). This cVDPV gets into the water and sewers and causes exposure.
When exposed to the live vaccine there are a few outcomes possible:
- 70% no symptoms
- 25% minor symptoms / flu like symptoms
- 1% – 5% viral meningitis with or without sensory changes.
- <1% is paralytic polio. 2/3 have residual weakness.
Post Polio Syndrome (25% - 40%). This is non-infectious. Patients have worsening weakness and pain.
Polio in Canada:
- 11,000 Canadians were paralyzed by polio between 1949 – 1954.
- Salk vaccine developed in 1955 (injected, killed virus) Canada uses this now.
- Sabin vaccine developed in 1966 (attenuated live virus vaccine / sugar cube drop).
Canada was certified polio free in 1994.
Dr. Crockett worked in India – Uttar Pradesh, population 232 million in 2019. Until 2009 India had 68% of the global cases of polio. India has a total population of 1.2 billion people. Due to a massive coordinated effort, in 2014 India was declared polio free. This was possible due to the following 5 prong attack strategy.
- Government ownership and commitment in India:
- Financial support
- India Expert Advisory Group for Polio Eradication
- Chief Ministers in key endemic states
- District task forces
- Private Sector: Rotary International
- Financial support
- Social mobilization campaigns
- Religious Leaders: All religions were involved and supported the immunizations
- Academic bodies
- Bollywood: Actors advocated on behalf of immunizations
There has been a growing effort to supply fresh clean water to all villages in India. Sanitation is of great importance as well.
Challenges remain in 3 Countries. Nigeria, Pakistan & Afghanistan (WPV1 cases in 2017 – 2018).
There has also been a new outbreak in Philippines. One 3-year-old girl as well as virus found in the sewers of Manila.
Vaccine hesitancy is also an issue for some parents. You need everyone to be vaccinated to protect those that can not be vaccinated due to true medical issues.
Equity; a chart was shown indicating that if you are rich, you are much more likely to be vaccinated. (Bhutta et al – Countdown 2015 / Lancet 2010).
Sustainable development goals: (17 of them now)
No poverty, zero hunger, good health & well being, quality education, gender equality, clean water & sanitation, affordable & clean energy, decent work & economic growth, industry, innovation & infrastructure, reduced inequalities, sustainable cities & communities, responsible consumption & production, climate action, life below water, life on land, peace, justice & strong institutions, partnerships for the goals.
Check out these online publications for current polio information:
Q/A
1.- Janet Spence, any thoughts or actions to convert anti-vaxxers?
A.- Tricky situation. They have not necessarily seen vaccines prevent diseases. Tend to not engage in that conversation at the initial visit, enough stress with a sick child already. A longer-term relationship can work for some people to begin to come around to understand the importance of vaccination.
2.-Nancy Morris. These anti-vaxxers were most likely vaccinated by their parents and have not seen the terrible diseases caused by these viruses.
A.- They don’t understand “herd immunity’. Vaccinating a 95% of a given population so that almost all in that population are protected.
3.- Darvin Jasper advised that his oldest brother had polio as a child in the 1940’s. His feet and legs were involved. Any idea as to the virus type?
A.- no way to tell the type just by the physical symptoms. All types can cause the same illness. The ‘Iron Lung’ was needed when the muscles of the diaphragm and intercostals (group of muscles running between the ribs) were involved.
4.- Dan Sutton wondered if the data presented regarding Nigeria was current?
A.- Yes, did up the presentation this morning. Info from ProMed….produces data weekly.
5.-Elaine Thompson wanted to confirm that the polio virus can be transmitted through saliva. She had an uncle that died in the 1950’s due to polio. Family did not get sick.
A.- Yes it is. Possible they did get sick, just not paralytic. Perhaps flu like symptoms, or not sick/ exposed at all.
6.- Glenn Campbell asked why the oral vaccine is used in poor countries.
A.- Can result in broader coverage, no needles required. When polio is eliminated in a country, they switch to the killed virus vaccine injection (Salk). This helps to decrease the vaccine derived outbreaks.
7.- Iain Scott advised that he remembers getting the sugar cube polio vaccine.
A.- Live virus vaccine droplet (Sabin) was placed on the sugar cube.
Acting President Jim Forestell thanked Dr. Maryanne Crockett for her presentation. Jim remembers back when he was a child, a young girl next door taken away in the middle of the night due to polio, never seeing her again. Jim was terrified of polio as a child and rightfully so!
Dr. Crockett was advised that the club raises funds for Polio Plus all the time. The club will be making an extra $500 donation to Polio Plus in appreciation of her visit / presentation tonight.