LEBANON — Dartmouth-Hitchcock researchers are asking Upper Valley residents for help in eradicating polio once and for all.
It’s a goal that public health officials have been working toward — and had great success — for more than half a century, but breakthrough cases remain. Now, Dartmouth-Hitchcock researchers are joining others at two universities to test a vaccine that researchers have high hopes will lead to complete eradication.
“I think the salient aspect of polio today is that it no longer exists in the U.S.,” said Sirey Zhang, a student at Dartmouth College’s Geisel School of Medicine who is working on the study. “For the last several decades we’ve been on the verge of eradicating polio worldwide. Every year public health scientists are really hopeful that this is the year that polio will be fully eradicated.”
Researchers are is testing an improved version of the oral polio vaccine that will help reduce the spread in areas of the world where the virus is still prevalent, and is recruiting subjects from the Upper Valley.
The widely used oral polio vaccine, called Sabin, which is commonly used in developing countries, contains the virus itself and has been shown to spread through the feces of vaccinated people.
“Since it’s a live virus and it has the chance of reverting back there’s always a few cases each year where they report vaccine-derived polio,” Zhang explained. “Normally, this wouldn’t be a big problem because if enough of the population is vaccinated, especially with the oral vaccine, if someone who’s vaccinated gets the wild-type virus that came from the vaccine, they would be able to neutralize it and it wouldn’t be transmitted any further.”
Dr. Peter Wright, an infectious diseases and international medicine provider at D-H, said there has been talk of developing a new vaccine for more than 20 years.
“We were making progress with polio eradication, a bit slow and with some persistent polio in a very limited number of areas of the world, then this increasing emergence of the idea that the Sabin vaccine, the traditional vaccines could under very rare conditions and mostly after having been given to young children in a developing country setting, could spread in the community,” Wright said. “They were not going to be the ultimate solution to the target which is the eradication of polio.”
“The difference now is that they’ve altered it so it’s a little more genetically stable so it doesn’t have as much tendency to revert back and become a wild type,” Zhang said. “Our main goal is to make sure that it’s better and it doesn’t have as much viral shed.”
Wright said a vaccine for one type of polio has been given to 100 million young children in West Africa aiming to block post-vaccination spread.
Most people in the United States who were vaccinated prior to the year 2000 received the oral Sabin polio vaccine, which contained a version of the live virus. After that, the Centers for Disease Control and Prevention made the switch to an injectable version of the vaccine that contains a dead or inactive version of polio.
The study is recruiting people who received either type of the vaccine. D-H researchers plan to recruit around 80 subjects; participants will be compensated financially.
The University of Vermont and University of North Carolina are also recruiting people for the study, which is being funded by the Bill and Melinda Gates Foundation and sponsored by Path, a nonprofit organization that advocates for health equity.
“For this study which really involves adults, all of whom we make sure have antibodies to polio before we give them vaccines, there really is no risk of any adverse reactions. It’s the first time that this particular virus for these particular types of polio has been given to man so we’re being very careful in terms of recording any reactions that they have,” Wright said. “The study both from the perspective of the individual volunteers and from their contacts of the community is really very, very safe.”
There are some limitations: Study participants, who must be between the ages of 18 and 45, cannot work in food service or a health care setting. They also cannot be immune-suppressed, or live with someone who is immune-suppressed, pregnant or younger than 2 years old. They also must live in a place that uses a sewer system instead of septic system, which can be challenging in a rural area like the Upper Valley.
“The college students are a good target population, if you will, because they’re all living either on campus or in housing around Hanover or Lebanon that is very likely to have a municipal septic system,” Wright said.
Participants spend 57 days enrolled in the study and will undergo a health screening to make sure they are eligible. Then, they will be given a dose of the new oral vaccine and collect their own stool samples, which will be picked up by Green Mountain Messenger. They will also have some follow-up visits at Dartmouth-Hitchcock Medical Center.
“We do pretty rigorous patient training on good hand hygiene, keeping the area clean when you’re gathering your stool samples,” Zhang said.
The efforts to eradicate polio speak to the power of public health systems when resources are available and people are able to unite around a common goal.
“I still think this has been, will be, one of the major public health triumphs … in the last 100 years,” Wright said. “I think it’s an interesting example of the kind of research both that Dartmouth and Dartmouth-Hitchcock are doing and the ability of people in the Upper Valley to come together and help solve problems that really are global in scope.”
Editor’s note:
Liz Sauchelli can be reached at esauchelli@vnews.com or 603-727-3221.
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