Could West Nile Virus be the New Polio?

A Bruno Byte
From Richard L. Bruno, HD, PhD 
Director, International Centre for Polio Education

Question: 

A NYC health commissioner reported that two-thirds of New Yorkers who got the West Nile virus in 1999 still complain of fatigue, difficulty walking, muscle weakness and memory loss. More than one-third are depressed. She said, "Many people don't realize that this is not an infection that you always get over." Why are people who had West Nile Virus believed when they complain of these symptoms, while doctors still don't “believe” in PPS?

Dr. Bruno’s Response: 

I don't know what causes doctors not to "believe" in Post-Polio Sequelae. Young doctors may know too little about polio to even be interested in PPS. Older doctors, especially those who remember the polio epidemics, want to believe that polio is a thing of the past. All doctors may be so squeezed by HMOs that they turn their backs on polio survivors' need for more than the eight-minute average visit allowed by insurance companies. And no doctor will say he has time to read the 35 years of published research on PPS.

But autopsies done in the 1940s proved that poliovirus-caused encephalitis was far more common (actually every polio survivor had some degree of encephalitis whether they had paralysis or not) and brain damage was commonly far more severe than in West Nile patients. Although doctors get away with ignoring PPS today, 65 years ago polio encephalitis could not be ignored, since it produced a coma, paralysis of breathing and swallowing muscles and death in about 5 percent of all polio patients.

The remarkable similarities between the symptoms and damage done by the West Nile virus and polioviruses should be a wake-up call for doctors who don’t believe in PPS:

• The peak of West Nile cases occurs in late summer, as was true with polio.

• West Nile virus affected younger and stronger individuals and caused polio-like muscle paralysis, even putting several people on ventilators. This could be evidence that the WNV is becoming more virulent over time, just as the poliovirus did in the 1950s.

• Nearly 1% percent of those infected with WNV develop encephalitis that can cause death or paralysis, almost the same percentage as those infected with poliovirus who developed paralysis.

• Up to 15% of those who are severely affected by WNV die; about 15% of polio survivors died after having severe brain stem encephalitis called "bulbar" polio.

• About 20 percent of those infected with WNV develop mild flu-like symptoms. Twenty-two percent of those infected with poliovirus developed flu-like symptoms and either didn't know they had polio or were diagnosed with "non-paralytic" polio.

• We just now know that those with West Nile encephalitis have lasting symptoms -- two-thirds have chronic fatigue, half report difficulty with walking and 44% have muscle weakness – albeit symptom percentages lower than in polio survivors.

In spite of these similarities and the fact that PPS was first reported in 1875 -- versus 1999 for the first US WNV case -- the question remains: Why are fatigue and muscle weakness still not "believed" when they occur in polio survivors?

And there is another question: Will the 20% of West Nile patients who had flu-like symptoms and were not diagnosed with WNV go the way of the polio survivor? Will WNV patients in 2030 join polio survivors, those with chronic fatigue syndrome, fibromyalgia -- plus millions more with cerebral palsy, spina bifida, Guillain-Barre Syndrome and spinal cord injury who report new, midlife fatigue and muscle weakness -- also be told that they are malingering or that their symptoms are "all in their heads?"