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February 5, 2015

Julius Youngner lecture: Honoring a polio pioneer

Polio pioneer Julius Younger received a very belated thank you for his work last week.

“This is actually a thank-you that’s long overdue to Julius, from me, because I’m of the generation that remembers polio and its devastating effects,” virologist Olen Kew told the guest of honor before delivering the Department of Microbiology and Molecular Genetics’ first annual Julius Youngner lecture on campus.

The new lecture series honors Youngner, distinguished service professor emeritus of molecular genetics and biochemistry.

Below: Julius Youngner. Above: Youngner with Jonas Salk, left, in lab.

Below: Julius Youngner. Above: Youngner with Jonas Salk, left, in lab.

In opening remarks, Arthur S. Levine, senior vice chancellor for the Health Sciences and dean of the School of Medicine, called Youngner “truly one of the world’s most influential virologists,” citing his work with Jonas Salk in developing a safe, effective polio vaccine, and later work with Pitt colleagues that included identifying what is now known as gamma interferon, and developing equine influenza vaccine.

Youngner_Julius“Julie’s infectious curiosity has fueled his own research and has influenced all who have had the privilege to work with him,” said Levine. “We should all wish for careers as productive and successful and lengthy as Julie’s. As a result there are countless numbers of people living longer and healthier lives.”

Levine said, “It’s appropriate that we honor Dr. Youngner with an annual lecture that reflects his unwavering commitment to scientific excellence.”

Kew told the audience, “There’s a giant that walks among you, and that’s Professor Youngner. … He did something that all of us as scientists dream about: To develop a vaccine, working in the laboratory side of that effort, that has saved countless lives. That’s what all of us in the sciences want to do: to have an impact on human health and have the aftereffect of what we’ve discovered actually making for a better world.

“In 1955 Julius had already done that and then went on to do many more things. …  He just kept on training generations of scientists, showing them how to do good science and inspiring them to do good science, and the joy and the benefits of discovery.”

Kew, of the Division of Viral Diseases/ Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention, spoke on “The Long Road to Global Polio Eradication: Progress, Challenges and Brightening Prospects,” in his Jan. 28 talk at Bridgeside Point II.


Scanning the audience of about 100, Kew said: “One of you — or maybe more than one of you —would have been paralyzed for life by this little virus that many of us think of now as a model for microbiology.

“I think it’s hard for a younger generation to appreciate just how devastating this disease was,” said Kew. “I remember children in my class disappearing — because they were now in iron lungs,” said Kew. “Deaths from poliomyelitis were terrible: children suffocating to death.

“There were no risk factors other than if you were born, you had a one-in-200 chance of getting lifelong paralytic disease. There was no way to prevent it. If you went to the movie theatres and the kid next to you coughed in your popcorn, you might be paralyzed, and in fact you might die. It was a great scourge in the mid-20th century,” Kew said.

“In my town, we didn’t get a public swimming pool until IPV (inactivated poliovirus vaccine) became available because there was just so much concern that the children would transmit polio amongst each other in the public swimming pool.”

Kew said he remembers church bells ringing when the announcement came in 1955 that the Salk team’s field trials a year before had proven IPV safe and effective. “My mother whisked us off to the physician’s office in April 1955 to make sure her three children were protected from this terrible disease.”

Where there had been nearly 14,000 cases of polio in the U.S. in 1955, six years after the vaccine was introduced, there were only 869 cases, Kew said. “So polio was on the way out by 1961, not only in the United States, but in a number of other developed countries.”

The introduction of Albert Sabin’s oral polio vaccine (OPV) continued that downward trend, “but the heavy lifting had already been done in the first six years,” Kew said.

By 1970 polio had virtually disappeared in developed nations, but in 1985 — 30 years after IPV — there still were nearly 400,000 cases of polio in the developing world, Kew said. Since the launch of the World Health Organization’s (WHO) global polio eradication initiative (GPEI) in 1988, nine million polio cases and 450,000 deaths have been prevented through global surveillance and mass immunizations.

Although GPEI’s target date of 2000 has passed, polio remains endemic in three countries: Nigeria, Pakistan and Afghanistan. Among the reasons the disease has never been eradicated in these areas is insecurity, Kew said. Attacks on young women vaccinators, antivaccine rumors and operational gaps all play a role.

And fighting polio is like pushing on a rubber wall, Kew said: Push in one place, it bulges out in another. Cases have spread from Pakistan into Egypt, Syria, Israel and Iraq, and also from Algeria into the horn of Africa.

“Countries will achieve polio-free status and then they’ll devote their very precious public health resources to other things — as well they should — and what you get then is the immunity gap widening, and then it gets introduced from the outside and it will blow up. This has happened over and over and over again. This is what we’re trying to prevent because the only way to finish this job is by eradication.”

Vaccine-derived polioviruses, a legacy from OPV strains, also are a challenge. While OPV has the advantage of being inexpensive and easily administered, use of OPV carries risks of 250-500 cases worldwide of vaccine-derived polio each year, he said. Health officials now are recommending adding at least one dose of IPV to the immunization schedule in countries where OPV is used. “That is not only to protect the children from polio but to protect them from vaccine-associated polio emergence,” Kew said, noting that IPV provides a rapid initial protection and primes the immune system for subsequent use of OPV.

“The to-do list for the global polio eradication initiative is to finish the job,” stopping circulation of both wild and vaccine-derived viruses, he said. Strengthening routine immunization, transitioning to IPV use and maintaining global polio surveillance is necessary.

The model for eradicating polio has ongoing applications for fighting other viral diseases including measles, rubella and rotaviruses. Public health efforts have raised expectations worldwide: “It’s no longer acceptable to have polio, no longer acceptable for your child to die of measles when it can be prevented. It’s no longer acceptable to have children with birth defects from rubella when there’s a vaccine available. It’s no longer acceptable for children to die of diarrheal disease from rotavirus infection when a vaccine is available. So the perception in the developing world has changed and they’re getting to be more like the developed world: The gap of the two-tier world is beginning to close,” Kew said.

“Professor Julius Youngner played a vital role in the eradication of polio. The long journey he helped set us on is now nearing completion: Polio immunization works where used as directed. The major current challenges are no longer technical. It’s basically insecurity, operational gaps and then backsliding,” Kew said.

Asked whether the Salk team’s efforts would be as successful today as in 1955, Kew said: “Sometimes I say that we are working on eradication of polio for the sake of the virus’s reputation. It’s doing its job. But it’s depending on human failure” — for example, low literacy, or general ignorance of the risk.

“Even the baby books waffle on the topic: ‘There are some concerns about vaccination.’ There aren’t any concerns when you compare with what the consequences are of nonvaccination,” Kew said.

“But this a problem. Even in Nigeria, it depends on how terrified people are. People are no longer terrified of polio because they haven’t seen it. It’s hard to scare people about something they haven’t seen — it’s just become an abstraction.”

If polio were to come back in the United States, Kew said there likely would be a panic greater than there was over Ebola. “I think people would be lining right up to get their kids immunized.

“It really is a measure of the perceived risks,” he said. For instance, in America, measles isn’t widely perceived as the dangerous disease that it is.

In Nigeria, “They queue right up for measles vaccine because they bury their kids every week from measles outbreaks … But polio, there’s only a few cases — in Nigeria, only six. When you have only six cases, people are no longer scared,” he said.

“That’s the perverse legacy of a successful public health program: People are no longer scared, they think they know more than the public health experts and they make their own decisions; sometimes those decisions are disastrous.”

—Kimberly K. Barlow