A Distinguished Physician’s Newly Funded Research Will Draw on the History and Continuing Challenges of Polio

In the United States, polio is an old story that has been largely forgotten. The Salk vaccine, made available to children and families starting in 1955, led to the elimination of the disease in this country. But “it’s still out there in the world,” says Dr. Hannah Wunsch, Distinguished Professor of Anesthesiology Research and Vice Chair for Research in the Department of Anesthesiology. In her view, historical amnesia and complacency are unacceptable and even dangerous.

Her passion for that history and its present-day implications is rooted in her experience as an anesthesiologist and intensive care doctor; one who puts patients on a ventilator in the ICU when they’re having trouble breathing.

It turns out that the modern ventilator originated in Denmark, spurred by the polio epidemic in that country’s capital, Copenhagen, in 1952. That innovation led to modern intensive care.

Through her research, writing and advocacy, Dr. Wunsch aims to share her knowledge and foster awareness, thus helping to prevent the re-emergence on our shores of a horrific, entirely preventable disease.

A physician of many parts

Dr. Wunsch’s journey has involved a number of fascinating twists and turns. An author, speaker, ICU doctor, anesthesiologist and researcher, she has many impressive achievements under her belt, including the following:

• She has authored more than 200 peer-reviewed articles, published in leading medical journals over the years.
• She’s also the author of a book titled “The Autumn Ghost: How the Battle Against a Polio Epidemic Revolutionized Modern Medical Care.”
• And she just received funding from the National Institute on Aging for her current research efforts related to polio.

Research with a human face

It’s about a neglected group of polio survivors: older adults, many now in their 70s and 80s, who are living with disabilities, often caused by their earlier encounter with the disease.

When slated for surgery, some of these patients expressed concern that exposure to different types of anesthesia could lead to a recurrence or worsening of polio symptoms, such as weakness in their limbs or breathing issues. “They were right to be concerned, but we didn’t have answers for them, as there was very little research to guide anesthesia care. Clearly, more research was needed.”

Deeply engaged in that research now, and supported by an R03 grant from the National Institute on Aging, she is using data from the Multicenter Perioperative Outcomes Group (MPOG), a consortium of academic medical centers that includes Weill Cornell Medicine, to see how often polio survivors appear in its anesthesia records. Are these patients’ outcomes different from those of other patients? If so, what might be contributing to these differences? What do anesthesiologists and patients with a history of polio need to know to ensure safe and effective care? These are among the questions Dr. Wunsch and her colleagues seek to answer.

“When I was writing the book, many polio survivors shared their stories with me. My new research is all about giving back to this community.”

What is polio?

Polio, short for poliomyelitis, is a potentially disabling disease. For the majority of those infected, it can be asymptomatic or cause mild, non-specific symptoms. But for a small minority, the virus attacks nerves in the spinal cord—mainly, those controlling muscles, and can include those that control swallowing, coughing and breathing—resulting in paralysis.

Polio, formerly known as infantile paralysis, often struck children. As Dr. Wunsch explains, that’s because it’s transmitted via the oral-fecal route, a common mode of infection. By ingesting infected fecal matter, one child could pass the virus to another. Older people were either exposed earlier in life and immune, or more recently, vaccinated.

Remembering the American polio epidemics

The polio epidemics peaked during the 1940s and early 1950s, disabling roughly 35,000 people each year in the U.S.—many of them children. However, Franklin Delano Roosevelt (FDR) contracted it as an adult. Unable to walk unassisted, he lived with the disability and governed the country with skill and dignity from 1933 to 1945. 

Just ten years later, the Salk vaccine was introduced. Parents broke down in tears as they welcomed the good news. The vaccine also proved hugely effective.

If you’ve ever seen a photo of a child in an iron lung—the predecessor of the modern ventilator—you’ll get a sense of how fearsome a virus polio was, and still is in certain small areas of Pakistan and Afghanistan.

“It’s an interconnected world,” Dr. Wunsch says. “All it takes to reverse our polio elimination status is one person with wildtype polio getting on a plane to the U.S. and passing the infection to someone here who isn’t vaccinated.”

A tale of two vaccines

The Salk vaccine sharply curbed the polio epidemic in America. Then, in 1961, Albert Sabin created a second vaccine, an oral formulation administered in a child-friendly sugar cube. Both vaccines are thought to confer lifelong immunity to polio.

Absent effective treatments for the disease, prevention is key, and vaccination is the centerpiece of prevention.

Salk’s injectable vaccine uses inactivated (dead) virus to stimulate a powerful immune response in individual patients. However, the oral vaccine is more effective in curbing transmission.

But the oral vaccine has an important downside. It contains weakened but live virus, which can be shed in the stool. Vaccine-derived polio virus has been found in New York’s wastewater, both in the city and the surrounding metropolitan area. The oral vaccine doesn’t typically cause infection, but the viral shedding tells us people are being exposed to the virus. If it mutates enough, it can infect an unvaccinated person.

That’s exactly what happened in July 2022. A single case of paralytic polio appeared in Rockland County, where there are communities of unvaccinated people. Given that polio causes paralysis in 1 in 200 of those infected, that one case may have been the tip of the iceberg in that outbreak.

But if everyone gets vaccinated, that vaccine-derived virus can’t cause problems. “A vaccine works because everybody buys into it,” Dr. Wunsch says—but nowadays, that scenario can’t be taken for granted.

The public good

A growing group of parents say they don’t understand why they should have their children vaccinated against a disease they’ve never seen.

Of course, parents want to do right by their children. But vaccination is also about the good of the community. In today’s vaccine-skeptical environment, that’s the piece that can get lost.

“We’re victims of our own success,” Dr. Wunsch says. “Because of vaccines, we live in a society where children can be protected from measles, mumps, RSV and polio, among other infectious diseases,” Dr. Wunsch says. Through her medical practice, writing, research and advocacy, she hopes to help keep it that way.

The good news is that it’s never too late to get vaccinated. All of Weill Cornell’s primary care sites routinely vaccinate children for polio via the inactivated, injectable vaccine during their 2-month, 4-month, 6-month and 4-year-old wellness visits.

Make an appointment with your Weill Cornell Medicine family practice physician or pediatrician through Connect, or find a doctor here.