5 Cases of Polio in Amish Group Raise New Fears

"MN Agencies"

11/08/2005

By GARDINER HARRIS
NY Times
Published: November 8, 2005

LONG PRAIRIE, Minn. - Polio was pronounced dead in the Western Hemisphere years ago, after one of the most successful public health campaigns in history. But now it is stealing through a tiny Amish community here in central Minnesota, spreading from an 8-month-old girl to four children on two neighboring farms.

So far, no one has been crippled by the disease; only 1 in 200 cases of polio results in paralysis. But worried public health officials say it may be only a matter of time.

The story of how polio came to this dairy farming community of 24 families, with 19th-century ways that include a deep-rooted suspicion of vaccination, is both a medical whodunit and a cautionary tale, suggesting that eradicating polio may prove far harder than anyone thought, even in the developed world.

No one expects that the United States will be visited by the kind of outbreaks that recently flared up in Africa and Asia, frustrating the longstanding goal of eliminating polio for good by the end of this year. But the Long Prairie cases highlight a weakness in the worldwide campaign.

The 8-month-old Amish girl, whose name has been withheld by health officials, has an immune deficiency that makes her unable to rid her body of the virus.

How she contracted the virus remains a mystery. She may have been infected in a hospital by another immune-deficient patient who nursed it for years. A doctor or nurse may have served as a go-between. Or there may have been a chain of carriers in the Amish community. The virus is spread from stool to mouth, a surprisingly efficient form of transmission.

Regardless, the girl is now a wellspring for polio, a modern-day Typhoid Mary who can pass it along to others. Anyone who has not been vaccinated is vulnerable. And though vaccination rates in the United States are at historic highs, an increasing number of parents are resisting inoculations for their children, fearing that they may cause disorders like autism, a connection scientists have almost universally discounted.

So health authorities are keeping a watchful eye on the girl and her neighbors.

“If that child is a message in a bottle,” said Bruce Aylward, coordinator of the global polio eradication initiative at the World Health Organization, “it has just washed up on shore.”

The 24 families moved to this windswept stretch of prairie from Wisconsin about three years ago. An Amish community generally includes only as many families as can fit into one house for church services, and each community must come to a consensus on what to accept from modernity.

This one allows windshields for its horse buggies, kitchen cupboards that are attached to walls and some upholstered furniture - all somewhat unusual for the Amish, said Dr. Susan Rutten, a physician from nearby Sauk Centre who makes house calls in four Amish communities. Men can wear dark green shirts, not just navy blue and black.

The farms could have come straight out of children’s books. There are ducks and chickens, cattle and hogs. Fence posts are columns of stones enclosed by wire mesh. Lacking electricity, the farms are remarkably quiet. At one, the children rarely yelled or even spoke in the presence of a stranger. The air smelled of turned earth, manure and wood smoke.

The threat of polio seemed remote here - until this summer. That was when the baby was hospitalized with an immune-system disorder.

As her care became increasingly complex, she was shuttled through four hospitals. At the third, she developed diarrhea. On Aug. 27, doctors sent a stool sample to the hospital’s laboratory, which determined that the girl had an intestinal virus. In many states, nothing more would have been done.

But in Minnesota, hospitals send such samples to a sophisticated state laboratory. On Sept. 29, the tests matured. A laboratory supervisor called Dr. Harry Hull, the state epidemiologist, to say they had isolated a polio virus.

Dr. Hull was stunned. “I said, ‘You have made a mistake,’ “ he recalled.

Tall and thin, with glasses and bushy eyebrows, Dr. Hull is one of the world’s foremost polio experts. Before coming to Minnesota, he worked for 10 years in the World Health Organization’s global polio eradication effort. In an interview, he scrawled circles and arrows on a sheet of paper as he described the search for the virus.

The state laboratory redid the tests. The results were identical. Then it sequenced the virus’s genomic code. A supervisor plugged the code into a national genomic database, comparing it with the genes of a polio virus.

“Bingo,” said Dr. Norman Crouch, the laboratory’s director. “It was a 98 percent match. We knew we had nailed it.”

The Minnesota laboratory sent the sample to the Centers for Disease Control and Prevention in Atlanta, which confirmed the results. Officials were immediately concerned about where the virus originated and where it might have spread.

Confirming the presence of polio in a city with even one infected person is not impossible, said Dr. Mark D. Sobsey, a professor of environmental microbiology at the University of North Carolina. The stool of an infected person contains so many viral particles that tests at a sewage treatment plant can reveal it. Such tests helped track outbreaks in the Gaza Strip and Haiti in recent years.

Since many Amish use outhouses, however, state officials geared up to go door to door. They unearthed a public health form explaining how to collect stool samples. The form had pictures of a flush toilet and a garbage can with a plastic liner - things foreign to many Amish communities. Officials changed the form.