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Childhood Polio Infection May Cause Chronic Fatigue Syndrome in Baby-Boomers

A childhood poliovirus infection may cause chronic fatigue in baby-boomers concludes a paper published in the January, 11, 2000, issue of the American Journal of Physical Medicine and Rehabilitation "Paralytic Versus 'Non-Paralytic' Polio: A Distinction without a Difference," by Dr. Richard L. Bruno, director of The Post-Polio Institute at New Jersey's Englewood Hospital and Medical Center and chairperson of the International Post-Polio Task Force.

Bruno reviewed the personal laboratory notebooks, publications and private correspondence of Dr. Albert Sabin, developer of the oral polio vaccine, regarding a 1947, Cincinnati, Ohio outbreak of the "summer Grippe," a flu-like disease that affected more than 10,000 children. Because Summer Grippe was associated with a stiff neck a hallmark symptom of polio Sabin hospitalized and studied a dozen children. "Sabin concluded that Summer Grippe was caused by a mild form of the Type 2 poliovirus which caused a flu-like illness even though it did not cause paralysis," said Dr. Bruno. However, when Sabin infected monkeys with poliovirus from the Summer Grippe children, spinal cord and brain stem neurons were killed just as they would have been by a paralytic poliovirus. "Both the Summer Grippe and paralytic polioviruses damage the brain stem," Dr. Bruno continued. "Sabin showed us that even a 'mild' poliovirus infection could cause neuron damage that, although not apparent in terms of causing polio-like symptoms, was very real."

However, Dr. Bruno reports that another "mild" poliovirus outbreak did cause symptoms. In the very next year, 1948, over 1,000 Icelanders became ill with a flu-like illness causing stiff neck, some muscle weakness, and fatigue. While many of those with "Iceland Disease" recovered, some who became ill in 1948 still have fatigue today. "Iceland Disease was also apparently caused by a relatively mild Type 2 poliovirus," said Dr. Bruno, "but one that did more severe and therefore more apparent damage to the brain stem damage that caused chronic fatigue." Fifteen years of research at The Post-Polio Institute has found evidence of brain stem damage in polio survivors who have fatigue associated with Post-Polio Syndrome, including lesions on MRI of the brain, attention deficits on neuropsychologic testing, reduced levels of brain activating hormones, and brain wave slowing. "These abnormalities are evidence of damage to the brain stem neurons that activate the brain the brain activating system that keeps the brain awake and focuses attention and they are identical to abnormalities seen in patients with Chronic Fatigue Syndrome (CFS)," said Dr. Bruno. "We believe that brain activating system damage causes fatigue in both polio survivors and those with CFS."

Between 1934 and 1954, the year the polio vaccine was developed, nine outbreaks of CFS occurred either at the same time as polio epidemics or affected the staff at polio hospitals. "In fact, the first CFS outbreak was in 1934, sickening the staff at the Los Angeles County polio hospital," said Dr. Bruno. And, just as in Iceland, some who became fatigued in L.A. in 1934 remained fatigued for decades. "The symptoms of polio and CFS were so similar," said Dr. Bruno, "that 48% of the patients in the CFS outbreaks between 1934 and 1954 were thought initially to have had non-paralytic polio."
Sabin's Summer Grippe, Iceland Disease and the long association between polio and CFS have important implications for those diagnosed with Post-Polio Syndrome and CFS today," according to Bruno. Englewood Hospital and Medical Center's The Post-Polio Institute treats many middle-aged adults with fatigue who had non-paralytic polio as children. "Albert Sabin showed us that even a mild poliovirus infection can damage the brain activating system setting the stage for fatigue to develop later in life," said Dr. Bruno. The Post-Polio Institute's experience is supported by the 1987 U.S. National Health Interview Survey which found that 21\% of those who had had non-paralytic polio report fatigue in mid-life. "The one million North Americans who had non-paralytic polio must be assertive," said Bruno, "telling their doctors that both paralytic and non-paralytic polio survivors develop late-onset fatigue."

An epidemiological study by Dr. Leonard Jason, published in the October 11, 1999, issue of the Archives of Internal Medicine, found that half of the estimated 836,000 Americans with CFS are at least 40 years old. Jason concluded that baby-boomers may be at greater risk for CFS. "Potentially half of those diagnosed today with CFS may in fact have had Summer Grippe or undiagnosed non-paralytic polio as children in the years before the polio vaccine became available," said Dr. Bruno. "They may also have brain activating system damage that causes chronic fatigue."

"There is no question that neither the naturally-occurring poliovirus nor the Sabin oral polio vaccine causes CFS today," said Dr. Bruno. "But the possibility of a non-paralytic poliovirus infection in childhood causing chronic fatigue in middle-aged baby-boomers is a reason for hope." The Post-Polio Institute's research has found that conserving energy, daytime rests breaks, stopping activities before fatigue starts, and a higher-protein diet significantly reduce symptoms of fatigue."

The Post-Polio Institute, Englewood Hospital and Medical Center. Contact Claudie Benjamin (201) 894-3486.

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