Talk:Polio/Archive 2

Introduction
The person-to-person spread of polio is a rather modern occurence. Historically, the virus has been transmitted through water contaminated with fecal matter. Usually it would be picked up when an infant was nursing and protected by its mother's immunity, so that while the virus was endemic, the disease presentation was rare. It was only after the large scale water purification projects of the late 19th/early 20th century--which were intended to control cholera outbreaks--that the virus was no longer introduced in infancy. When introduced later, when the child is not longer protected, and poliomyelitis results.--TychaBrahe 20:39, 4 September 2007 (UTC)


 * History of poliomyelitis --DO11.10 22:20, 27 September 2007 (UTC)

Vaccine
There is no discussion of the disagreement over whether to use OPV (live, Sabin) or IPV (killed, Salk) vaccine. IPV is considered safer, as there is the slight but real possibility that OPV may revert to a more virulent form. IPV is more effective. It is also more expensive. The OPV, because it is administered orally, is much easier to give. Since the majority of poliomyelitis is in developing nations where vaccination is spotty, the OPV is preferred because attenuated virus is excreted in the feces. If the community does not or cannot maintain cleanliness and prevent the fecal-oral mode of transmission of wild poliovirus, they will also spread the vaccine via the same route in a process called secondary immunity. In the same manner, however, the OPV has resulted in cases of VAPP (Vaccine-Associated Paralytic Poliomyelitis) where a person contracts the disease through virus shed by someone who has recently been vaccinated.

In the late 1990's the US revised it's polio vaccination schedule, first to one dose of IPV and two of OPV, and then to all IPV. Other developed nations followed suit. Developing nations have not followed suit, primarily because VAPP is not considered consequential when there is a high number of wild poliovirus infections.--TychaBrahe 21:03, 4 September 2007 (UTC)


 * Polio vaccine --DO11.10 22:18, 27 September 2007 (UTC)

bad sentence
someone please rewrite this:
 * the use of weak muscles at an elevated capacity, substituting strong muscles with increased energy expenditure for tasks

I have no idea what it is saying. njaard 05:01, 27 September 2007 (UTC)


 * I tried to reword this, but I am not sure it that it is any better. This is a very difficult concept to summarize in one sentence, hopefully the added hyperlinked article helps explain it in more detail. --DO11.10 22:17, 27 September 2007 (UTC)

Bangladesh
You should add Bangladesh to the list... new cases reported after 7 years.. http://news.yahoo.com/s/afp/20071027/ts_afp/healthbangladeshpolio_071027065842 —Preceding unsigned comment added by 58.9.135.252 (talk) 08:50, 28 October 2007 (UTC)


 * The "list" (Nigeria, India, Pakistan, and Afghanistan) includes only countries with endemic polio. Polio is not endemic in Bangladesh.--DO11.10 23:17, 6 November 2007 (UTC)

Colin's review
This review by Colin is based on this version. Some items have been dealt with, some have not. Feel free to add or revise any aspect of this list or the article in general.--DO11.10 23:27, 6 November 2007 (UTC)


 * Thank you so much Colin. Your superb reviewing and copyediting skills have been absolutely invaluable here. I owe you a copyedits/reviews, if you ever need my help.--DO11.10 00:26, 12 November 2007 (UTC)

Lead

 * "primarily" Why? Is there another way? If not, drop the word. Later: I've spotted oral-oral in one source.
 * "more severe" More than what? Than asymptomatic? --removed
 * "(CNS)" Not sure the acronym is useful in the lead. It is given later in the body. --gone
 * "acute flaccid paralysis" Why is this in italics? WP:ITALIC
 * Technical terms and definitions- this is a technical term (?) Am reading this MOS page incorrectly?--DO11.10 03:36, 6 November 2007 (UTC)
 * I'm no expert here, and rarely use italic when perhaps I should. It isn't being defined at that point, nor are the individual words overly technical (i.e, a non-medical but well educated reader should know what all three words mean and then reasonably guess what the whole means). Compare: Lymphangioleiomyomatosis :-) Colin°Talk 18:26, 6 November 2007 (UTC)
 * oops, it's not anymore, I just removed it :-) Sandy Georgia  (Talk) 23:45, 6 November 2007 (UTC) ✅


 * "While polio...retrospectively, ..." The two halves of this are not as opposing as the "While" might imply. The retrospective identification is a detail that could be left to the History section. The main point is that medical historians believe polio is an ancient disease. It is far from unique in only being "singled out" relatively recently.
 * I've simply removed "retrospectively" for now, need to give this more thought.
 * Update: I have expanded out the lead a bit, and reworded. I think I have taken care of your concern above, but the passages might need another look.--DO11.10 02:29, 9 November 2007 (UTC)


 * "20th century". Comma afterwards.
 * "effective vaccine". We'd hardly aim to develop an ineffective one. Drop "effective"? --done
 * "today", "Recently" and "soon". See WP:DATED.
 * Removed "today" and "recently". IMO "soon" is an important modifier here and may qualify as a "time-sensitive statement that will need to be updated in the future." (As will the rest of the article, once polio is eliminated )--DO11.10 03:36, 6 November 2007 (UTC)✅

Cause

 * "which" That.
 * "A small..capsid. There are...protein." This contains too many unexplained technical terms too early on in the article. This is quite a short section. I know Summary-style moves much content to the daughter article but there is room for this to grow a little, perhaps by taking the lay reader gently through the description. For example, you could say "poliovirus is a member of the genus enterovirus, which are RNA viruses that preferentially inhabit the intestinal tract". The reader will not know what a capsid is, nor that some viruses have an envelope. One could explain what "serotype" means by referring to the "slightly different capsid protein" earlier in the sentence. I assume that having antibodies to one serotype doesn't confer (full) immunity to the others, hence the the vaccine must contain all three strains. You also mention later that there is a statistical difference in symptoms/severity between the serotypes. I wonder if both points could be briefly mentioned here. Don't drop any facts here, just add so text to help the lay reader.
 * Working on this....--DO11.10 03:36, 6 November 2007 (UTC) Update: I have added my attempts at a more lay-reader friendly description.--DO11.10 23:27, 6 November 2007 (UTC)
 * Good, though "paralytic progression" sounds like jargon and, coming so early in the article, might not be understood by a reader. Colin°Talk 19:42, 7 November 2007 (UTC)
 * Changed to "paralysis"--DO11.10 02:48, 8 November 2007 (UTC)✅

Transmission

 * I've corrected the 2-20 (which didn't make sense when compared to 3-35 outer-range) based on another web source saying 6. Please check this is OK.
 * I have also seen six on most pages.


 * "after eating or using the bathroom" The fecal-oral route only implies a fecal→oral direction, which explains the "after the bathroom" but not the "after eating". I've seen in another source that oral-oral may account for some cases, which would explain the "after eating" and also makes sense together with the later text in the paragraph that discusses the virus remaining in the throat. Perhaps mentioning the occasional oral-oral route would explain the bathroom/eating sentence better.
 * I think parts of this passage got lost somewhere, but I have reworded. Can you include your oral-oral source here?--DO11.10 03:36, 6 November 2007 (UTC)
 * It was the web FAQ below, but that isn't a reliable source. Colin°Talk 18:26, 6 November 2007 (UTC)
 * I've found and added a reliable source here. --DO11.10 23:39, 6 November 2007 (UTC)✅


 * " throat or feces" One is a body part, the other a bodily product. Would it be better to be consistent (e.g., saliva)? --done
 * "the risk of transmission is highest seven to 10 days before and after the onset of symptoms" this web FAQ mentions the 7–10 days before but not after. It doesn't use the word "highest", and I'm a little puzzled how they can be so precise about a peak if the incubation period can be as wide 3–35 days.
 * Several sources I found, , confirm the "before and after the onset of symptoms".--DO11.10 03:36, 6 November 2007 (UTC)
 * OK but what I read from the article text is there is a peak at 7-10 before and another peak at 7-10 after. The language you use matches the middle ref you give but not the other two. The third ref is clearest: "most infectious from 7-10 days before to 7-10 days after the appearance of symptoms." I think the middle ref text gives the wrong or ambiguous impression due to imprecise language. Colin°Talk 18:26, 6 November 2007 (UTC)
 * I have just incorporated the wording used in the third ref into the sentence. Seemed to be the best way to get around the ambiguity issues.--DO11.10 23:27, 6 November 2007 (UTC)✅

Classification

 * ""poliomyelitis"" I think this should be italics and not quotes per WP:ITALIC.
 * "During the ... categories of poliomyelitis were defined ... disease." I don't think we need the history here. I kept waiting for you to say that those categories were no longer used. If they are still valid, then we should just go ahead and define the categories. It avoids the passive "were defined" and makes the paragraph simpler. So I'd suggest this sentence is dropped and the following one begin with "There are two basic patterns of polio infection: ". -removed sentence
 * "In ..." There are too many sentences that begin with "In", both in this section and elsewhere. Need to add some variety. -- variety added
 * "either no– or minor symptoms" I'm not confident about the dash. Looks a little awkward but don't know what to suggest. --expanded out to "no symptoms or minor symptoms"
 * "(AFP)" Abbreviation not used elsewhere in the article so probably not worth mentioning.

Mechanism

 * "Poliovirus ..cell surface" Overlong sentence.
 * This section is often a difficult one in medicine since it starts using lots of medical terms. Specifically, the reader will not know "follicular dendritic cells"; "germinal centers"; "M cells"; "immunoglobulin"; "CD155"; "mesentery"; "lymphatic system"; "Peyer's patches"; "viremia"; "reticuloendothelial tissue". The term "viremia" is explained but the rest are just used, leaving the reader with only a vague idea of what/where you are talking about. It is probably too much to take the reader gently through all of this and I don't understand many of those words so probably am not the best person to attempt a definition. Perhaps it is worth searching some lay texts on polio and see how they attempt to explain, or Google for these terms to try to pick out supportive phrases to use.
 * Working on this... do you think just including some lay-descriptions in parenthesis would help, or are you looking for a more thorough re-write?--DO11.10 17:19, 7 November 2007 (UTC)
 * I have isolated the technical terms, so that hopefully the lay reader can read, for example, "in the throat and intestine" and the professional-level reader can read "the follicular..." Does this help?--DO11.10 19:05, 7 November 2007 (UTC)
 * Yes, improved. I like the "(specifically...)" to handle the technical bits for those who want to know. I still think the final sentence could be improved for the lay reader. Somehow reorder it so that it is clearer that the "mesentery and Peyer's patches" are parts of the intestine. Also, "penetrates" is active/aggressive, whereas "is absorbed" is passive. Thesaurus time? Colin°Talk 19:42, 7 November 2007 (UTC)
 * I rewrote the entire passage for clarity, and cleared up the active/passive issue. --DO11.10 02:48, 8 November 2007 (UTC)✅


 * "an "accidental" deviation" is this a quotation or are you unhappy to use the word in formal text? Either way, it doesn't work as it stands. The word implies the virus knows what it is doing and has made a mistake. Can you find another way of expressing this?--Colin°Talk 18:54, 6 November 2007 (UTC)
 * I have given this some thought. The reason it is in quotes is two fold, 1) that is the way the authors of the paper referenced expressed the idea and 2)because viruses don't "think" and can't really have "accidents". The important point here is that infecting the nervous system confers no reproductive advantage, and probably even limits transmission of the virus (sick people don't make for stealthy viruses). So infecting the CNS goes against the biological imperative of the virus. I think this is important and should be included in some manner, also it is current theory proposed by scientists to explain why a GI virus would even infect the CNS. I agree that "accident" might not be the best choice here, is inadvertent a better alternative? Unfortunately the English language lacks the appropriate words to non-anthropomorphically describe this concept (although I am sure there is a word in German). What do you think?--DO11.10 17:19, 7 November 2007 (UTC)
 * Perhaps maladaptive?--DO11.10 17:29, 7 November 2007 (UTC)
 * You've given it more thought than me! I just think scare quotes are unprofessional. I certainly agree this concept must be included. Don't think "maladaptive" or "inadvertent" are better. Anyone else like to offer a suggestion? Colin°Talk 19:42, 7 November 2007 (UTC)

This version

Paralytic polio

 * "The destruction ... deep cerebellar nuclei." Why are there two parts to this: the spine and the brain? Is the brain less commonly affected (if so, say so)? Otherwise I think the sentence should just list all the areas were lesions occur. The lay reader will not know what the "spinal ganglia" are but can at least guess they are part of the spine, which is fine. The other areas are less clear to a lay reader; the first two give no clue as to their location, and the latter two only if you know what cerebellar means (most well educated readers should). How about "found in regions of the brain known as the ...". I don't think it our job to explain where/what each of those brain areas are, it is enough detail for this article that the reader at least knows they are in the brain, and the wikilinks will help if they want to know more.
 * I **think** I have taken care of this.--DO11.10 19:05, 7 November 2007 (UTC)✅


 * "Other changes.." Again, some clue as to where the hypothalamus and thalamus are would help (use "cerebral" or some other adjective for brain, just for variety?). This sentence teases the reader without satisfying. What changes and what is the consequence?
 * Clarified and added forebrain (assuming that the reader might not know what that is technically but it has the word brain in it.)--DO11.10 19:05, 7 November 2007 (UTC)✅


 * "Early symptoms.." It is great that you've used lay words for these medical symptoms... except "paresthesia". Can we replace this with "pins and needles"?
 * "extensive paralysis of the trunk and muscles of the chest and abdomen and affecting all four limbs—quadriplegia—" This text is a bit awkward, with lots of "and"s. Isn't the trunk the same thing (more or less) as the "chest and abdomen". This list is essentially the whole body below the neck. Are the hands/feet (fingers/toes) affected to the same extent/likelihood as the rest of the limbs? Could this text be simplified to just "extensive paralysis below the neck (quadriplegia)"?
 * Fingertips and toes are less affected than the limbs. I've reworded a bit, seems simpler and with fewer "ands" now.--DO11.10 19:05, 7 November 2007 (UTC)✅

Colin°Talk 13:41, 7 November 2007 (UTC)

Prognosis

 * "patients that develop aseptic meningitis" Should this be "patients that only develop.."?
 * Not sure... what is you reasoning here?--DO11.10 18:50, 8 November 2007 (UTC)
 * Do patients who develop the paralytic form also sometimes develop aseptic meningitis? If so, they may not recover so quickly. Colin°Talk 19:06, 8 November 2007 (UTC)
 * Good point, I don't know if those with the paralytic form also develop aseptic meningitis. Best to err on the side of caution here.--DO11.10 23:05, 8 November 2007 (UTC) ✅


 * "respiratory support" vs "mechanical ventilation" These seem to be being used interchangeably or perhaps the former includes the latter.
 * Yes I think it does. According to Mechanical ventilation- "respiratory support" includes 1)Hand-controlled ventilation and 2)A mechanical ventilator. Do you think it makes sense/is appropriate to use these two terms as they are in the article? We can't be sure what type of ventilation was provided. Thoughts? --DO11.10 18:50, 8 November 2007 (UTC)
 * The last two sentences seem to describe two exclusive/opposite groups of patients, yet use different terms for the support. Colin°Talk 19:06, 8 November 2007 (UTC)
 * I've changed mechanical → respiratory, so they are all the same.--DO11.10 23:05, 8 November 2007 (UTC)✅

Colin°Talk 13:46, 8 November 2007 (UTC)

Post-polio syndrome

 * "PPS is observed in 28.5% of patients who had recovered from an acute polio infection." I can't read the first ref, but can read the second, which refers to the first. It says "approximately 25 to 28% of patients". I think that quoting a figure accurate to one decimal place is over-precision considering that the denominator cannot be precisely determined. The phrase "acute polio infection" is being wrongly used as though it is a diagnostic entity. The source says "many years after their acute poliomyelitis paralysis". This contains two key factors: the polio case involved paralysis and that we call that phase the "acute" illness. To be honest, I think the first sentence in this paragraph says it all, to the precision required, so suggest this sentence is dropped. The refs could be moved if required. Colin°Talk 12:11, 10 November 2007 (UTC)
 * I removed the sentence, and the refs attached to it actually better supported the preceding sentence anyway.--DO11.10 18:16, 11 November 2007 (UTC) ✅

Diagnosis

 * "recovery of poliovirus from the stool or pharynx". "the stool" sounds overformal to me. How about "a stool sample"? The "pharynx" is a body part, would it be better to indicate what was actually examined (a swab?).
 * "Neutralizing antibodies to poliovirus can be diagnostic" can be misread, as though "neutralizing" was an action to be taken in the diagnostic test. How about just dropping the first word?
 * This section doesn't mention diagnostic signs that could be used by a physician to diagnose polio without a lab test. Surely this would have been common during the epidemics, where there wouldn't be the ability or resources to do this. Is it worth briefly mentioning what these signs might be? What would alert a physician that she may have a case of polio on her hands, and therefore request the lab tests?
 * So the sign here would be AFP, plain and simple. I have been having a hard time figuring out where this information belongs though. Ideas?--DO11.10 18:16, 11 November 2007 (UTC)
 * ✅ Added the formal (read: wordy) clinical description as given by the CDC.--DO11.10 00:26, 12 November 2007 (UTC)

Vaccine

 * "Eight years after Salk's success". Is this eight years after the development (1952) or announcement (1955)? Regardless, it doesn't tie up with the trial (1957) or the licence (1962).
 * Regarding IPV/OPV (see Fvasconcellos' review), the BNF states that IPV is recommended for routine immunisation (though it is generally given combined with other vaccines, and the individual vaccine is discouraged). OPV is available only for outbreaks. It appears that the UK and the US have changed from OPV to IPV (OPV was certainly used when I was a child). I think the last sentence, while technically correct, doesn't indicate this shift and may mislead the reader into thinking industrialised countries have always used IPV.
 * ✅ I modified this sentence to include "switched to", not sure this is the best wording here, though?--DO11.10 18:16, 11 November 2007 (UTC)

History

 * "The polio epidemics...disability rights movement." is overlong and complex. Why not expand all three cultural changes into three full sentences.
 * Working on this.--DO11.10 18:16, 11 November 2007 (UTC)
 * I split out the disability rights, which I think simplifies the sentence a lot. (?)--DO11.10 00:26, 12 November 2007 (UTC)

Other
There are two dead links:


 * http://www.cdc.gov/nip/publications/surv-manual/chpt10_polio.pdf
 * http://www.post-polio.org/educa/August2004_HistoricalPerspective_Neumann.pdf

This link is unresponsive:


 * http://www.euro.who.int/mediacentre/PR/2002/20020620_1

Colin°Talk 21:41, 7 November 2007 (UTC)

Fixed now! Wow did you check all the links? I am kind of surprised that only three went bad. --DO11.10 23:49, 7 November 2007 (UTC)

Try this :-) Colin°Talk 00:14, 8 November 2007 (UTC)


 * Ahh, I should have known, nifty tool.--DO11.10 02:48, 8 November 2007 (UTC)


 * The word "result" (and variations) is overused. "leading to" and "causing" are alternatives but it would be best to have a wider variety of such phrases to describe a process, or reword the sentences to avoid their use. There's nothing wrong with them, it just gets a bit tedious when the same word is overused. Colin°Talk 17:41, 8 November 2007 (UTC)
 * I'll see what I can do here.--DO11.10 18:54, 8 November 2007 (UTC)
 * Variety achieved.--DO11.10 19:08, 8 November 2007 (UTC)

SG Review
Colin asked me to lend a hand here. So far it looks good. I'll start a section here to add my comments as I work (feel free to revert anything stupid I do and to remove inline queries I may add as you address them—no need to check with me):
 * Curious why all of the WP:MEDMOS recommended sections (e.g.; Signs and symptoms) aren't included, and why the order is altered? (Perhaps as I begin reading that will become clear?)
 * The "signs and symptoms" are essentially incorporated into the "mechanism" and "classification" sections. I did this because each incarnation of polio has it's own unique symptoms, almost like separate diseases. Should I pull the "signs and symptoms" out into it's own section? Is the section order okay? Seems to flow logically to me but I am not opposed to changing them around. --DO11.10 04:22, 7 November 2007 (UTC)


 * Does the WP:LEAD provide a stand-alone summary of all of the important content areas? It looks brief and doesn't seem to cover all the bases.  Perhaps have a look at WP:LEAD again and see what can be added.
 * Expanded the lead a bit, and reworded based also on Colin's comments above.--DO11.10 01:19, 12 November 2007 (UTC)


 * The Cohen JI book: is that content cited both times found on page 1144, or does the book have 1144 pages?  Chamberlin book cite needs a page number.  Page number needed on Paul book citation.  In general, cite page numbers for all book sources.
 * both Cohen refs are on page 1144, can this be made more clear? All others done now.--DO11.10 01:19, 12 November 2007 (UTC)


 * I fixed a number of WP:DASHes in the cite templates. Diberri has corrected the journal cite template tool so that it now returns endashes on page ranges, but previously, it returned hyphens.  You can ask  to run a script that will fix all of the endashes.
 * I fixed some usage of WP:ITALICs.
 * Removed 95%, the remaining six seem to be correct, but I could be wrong?--DO11.10 03:13, 7 November 2007 (UTC)


 * Why is Polio capitalized in the table in classification? (— Spinal Polio — Bulbospinal Polio — Bulbar Polio )
 * I did some WP:MOS adjustments, but there are more (see punctuation on sentence fragments vs. full sentences).
 * Bulbar polio section, more use of WP:ITALICS I don't agree with; terms being defined don't need to be italicized here. Complications, more.  The overuse of italics is distracting.
 * Per WP:OVERLINK and WP:CONTEXT, do all of those countries need to be linked? Is there anything in those country articles that is relevant to Polio?
 * The date parameter in the cite templates needs to be wikified when it's a full date (accessdate is automatically wikified because it's always a full date).
 * Please review External links per WP:EL, WP:RS, WP:NOT; any link that is already in dmoz may not need to be there.
 * See WP:MOSNUM, I fixed a few but there may be more (don't repeat the % on ranges. I don't see any more.
 * Forgot one: I'd really like to see the Mayo Clinic sources replaced with peer-reviewed sources if possible.  I don't consider them reliable enough for FA status.  --Replaced all but the "complications" reference, which I've supplemented with another, less accessible, reference. The Mayo clinic page is really the most simple and comprehensive source here.

I'm done. Besides the minor MOS issues (mentioned above) that need adjustment still, I'm concerned about the overuse of italics throughout, and I'm still not sure why there is no Signs and symptoms section. VERY nice job; the careful effort that has gone into this article shows. Sandy Georgia (Talk) 00:39, 7 November 2007 (UTC)

Antibody serum
This an excellent article - well done indeed! But, (why is there always a but), I don't like the wording of this section which is about immunoprophylactic antisera. An antibody serum is simply an antiserum. You can't isolate a serum, but you can prepare an antiserum and this is what was done. An antiserum was prepared, (or even developed?) that was shown to be 80% effective, would be a better wording. GrahamColm 13:29, 7 November 2007 (UTC)
 * Good point, thank you for clarifying that.--DO11.10 16:55, 7 November 2007 (UTC)

FV's review
OK, here we go. This is just a start:


 * General suggestions
 * Ask to run his dash-fixing script on the article for WP:DASH compliance. -- Request submitted
 * hmmm, Brighterorange hasn't been online all week; we may have to dig in and do these fixes manually if he doesn't show up. Yuk.  Sandy Georgia  (Talk) 21:06, 7 November 2007 (UTC)
 * Will do. Fvasconcellos (t·c) 14:23, 8 November 2007 (UTC)
 * Done. Dr pda's new ref editing script is really helpful. Fvasconcellos (t·c) 00:59, 9 November 2007 (UTC)


 * "Further reading" should precede "Notes and references", per WP:GTL. --done
 * I like to link notable journals (NEJM, Lancet, Archives etc.) at first occurrence, when an article is available. This can be somewhat boring work, so if you'd like me to do it let me know :)
 * I am not sure what you mean here, perhaps you could do this?
 * Like this, in the references. I'll do it, if you don't mind—it's a good way to keep journal articles from being orphaned, and helps clarify some of the abbreviations. Feel free to strike through my comments, by the way. Fvasconcellos (t·c) 18:46, 7 November 2007 (UTC)


 * Cause
 * The lead looks good. Vaccine, polio vaccine and vaccination looks like overlinking, although each is important; I don't mind, but someone may complain.
 * "Poliovirus is a member of the genus enterovirus, which are [...]"—which comprises sounds better. --yep, you are right, changed
 * "Poliovirus is structurally very simple:" link structurally to Virus. --done
 * Transmission
 * "The disease is transmitted [...] occasionally via the oral-oral route." Is this known to be rare enough to warrant stronger wording, such as rarely or far less commonly, or is there no real data on this?
 * I couldn't really find more specific information here, but I included a context where oral-oral might be more common.--DO11.10 23:48, 7 November 2007 (UTC)


 * Classification
 * "The virus enters the central nervous system in about 3% of infections. In 1–2% of infections [...]" 1–2% of all infections, or of the 3% in which the virus enters the CNS? The latter sounds unlikely, but the current wording leaves room for confusion.
 * The 1-2% is much clearer in the table form above, so I have clarified that the "majority" of CNS involvement manifests as menengitis.


 * Mechanism
 * "Once the virus enters the bloodstream it becomes a viremia". That sentence is very clumsy. The virus doesn't become viremia; what you mean is something like "the presence of virus in the bloodstream is known as viremia", right? --indeed, clarified
 * I really like that you're citing landmark work such as . I don't know why, but I love seeing seminal/landmark papers being mentioned in Wikipedia.
 * And I actually read it too, like went to the library and dug out the microfiche, made the librarian very happy, too.


 * "Poliovirus can survive and multiply within the blood and lymphatics [...]"—blood is a fluid, lymphatics are structures. Not really a problem; just sounds a little bit awkward, even if accurate.
 * The cousin to blood would be lymph, but I understand that the virus lives in both the lymph and in the lymph nodes, thus the "lymphatics".--DO11.10 19:27, 7 November 2007 (UTC)


 * "This sustained replication causes a secondary major viremia [...]"—that's a little too much jargon in such a short sentence :) And isn't secondary major viremia redundant? Don't secondary and major viremia mean the same?
 * "Rarely [...] the virus invades the central nervous system (CNS) [...]"—no need to redefine the acronym here. You can go with central nervous system or CNS, but both are not necessary.
 * "The mechanisms by which poliovirus spreads to the CNS [...]"—why would socioeconomic position be related to more/less frequent CNS infection? Am I missing something? (This would be a good time to note I am not a physician.)
 * This relates to sanitation. Essentially it doesn't matter if you live in a slum (lower socioeconomically, poorer sanitation) or a suburban environment (higher socioeconomically, better sanitation), polio might spread to your CNS either way.--DO11.10 19:27, 7 November 2007 (UTC)


 * "Paralysis [...] is usually complete when the fever breaks."—when the fever breaks or by the time the fever breaks? Not that there's a causal relationship or anything, just wondering. -- this is probably a chicken/egg thing.
 * "[...] more often the paralysis is asymmetric and affects unbalanced parts of the body." Unbalanced doesn't sound right here.
 * Changed to "uneven"(?) this is really just clarifying what is meant by asymmetrical. --DO11.10 23:48, 7 November 2007 (UTC)
 * I'm not sure clarification is necessary; "uneven" is still not really accurate. Fvasconcellos (t·c) 14:23, 8 November 2007 (UTC)
 * I didn't like "unbalanced" either and judged the text after "and" to be redundant. I think asymmetric is understandable to most folk. Colin°Talk 16:48, 8 November 2007 (UTC)


 * "The critical nerves affected are the phrenic nerve (the nerve driving the diaphragm to inflate the lungs) and the innervation of muscles needed for swallowing." And the innervation also sounds a bit strange.
 * The diagrams in this section would look great as SVGs.
 * Yes they would. I bow to the unnecessarily humble SVG god (if you have time:).--DO11.10 19:27, 7 November 2007 (UTC)
 * Come on now, there's no need to bow :) Seriously, here's one—have a look and tell me what you think. Fvasconcellos (t·c) 23:35, 7 November 2007 (UTC)

Looks much better, as you predicted. The text is so much clearer. Thank you. --DO11.10 23:48, 7 November 2007 (UTC)

More to come later. Fvasconcellos (t·c) 17:27, 7 November 2007 (UTC)

OK, here's some more:
 * Diagnosis
 * "Detection of virus from the CSF is diagnostic of paralytic polio, but rarely occurs."—detection of virus in the CSF? -yes
 * Vaccine
 * It might be worth mentioning that IPV is injected.
 * "IPV is currently the vaccine of choice in most countries." A couple of examples, maybe? I know the U.S. is one, but actually that's it (Brazil still exclusively uses oral polio vaccine IIRC).
 * I expanded this out a bit to describe who uses which vaccine. FYI: The word "industrialized" came straight from the WHO, because I couldn't find a list of countries that use IPV vs. OPV, and some use both.--DO11.10 00:14, 9 November 2007 (UTC)


 * Eradication
 * "These efforts have reduced 99% of annual diagnosed cases [...]" Strictly speaking, cases aren't reduced; their number is. Perhaps reduced by...'? --reworded for clarity
 * Thanks for your edits :) Fvasconcellos (t·c) 00:59, 9 November 2007 (UTC)

That's basically it. Overall, the article is excellent, and if you're concerned about it being lay-accessible, don't worry too much; in my view, medical jargon is used only when necessary and is very well explained. Great work. Fvasconcellos (t·c) 21:58, 8 November 2007 (UTC)

History
Would the very interesting History section not be better placed at the top of the article? What do you think? GrahamColm 19:16, 7 November 2007 (UTC)
 * Discussed several times at WP:MEDMOS. Sandy Georgia  (Talk) 21:03, 7 November 2007 (UTC)

Possible contradiction between Poliomyelitis and History_of_poliomyelitis
In Poliomyelitis it states: "Approximately 1 in 200 to 1 in 1000 cases progress to paralytic disease, in which the muscles become weak, floppy and poorly-controlled, and finally completely paralyzed; this condition is known as acute flaccid paralysis" citing the source Frauenthal HWA, Manning JVV (1914). Manual of infantile paralysis, with modern methods of treatment.. Philadelphia Davis, 79–101. OCLC 2078290. (Poliomyelitis)

In History_of_poliomyelitis it states: "In children, paralysis due to polio occurs in 1/1000 cases, while in adults, paralysis occurs in 1/75 cases." citing the source Gawne AC, Halstead LS (1995). "Post-polio syndrome: pathophysiology and clinical management". Critical Reviews in Physical Medicine and Rehabilitation 7: 147–88. (History_of_poliomyelitis)

This appears to be a contradiction.

--Dan Dassow 12:45, 14 November 2007 (UTC)


 * This has to do with the intricacies of statistics, and the fact that these are estimates. The 1/200 estimate refers to overall chance of developing polio regardless of age. The 1/75 refers to a very specific population, adults. Since children, even with only a 1/1000 chance, make up a greater proportion of cases (more than 2/3 of cases in the 1950s for instance) their numbers will contribute more to the overall chance than the cases in adults will (less than 1/3 in the 50s). In a sense this "drags down" the overall chance of paralysis. Does this make sense?--DO11.10 18:17, 15 November 2007 (UTC)


 * Yes, your explanation makes sense. I did not consider conditional probability when I first compared these statements. This is usually a difficult concept in epidemiology to communicate to the public as a whole. I consider this issue closed. --Dan Dassow 20:16, 15 November 2007 (UTC)

Jargon
The lay reader is being asked to learn a lot of terminology in this article. I think we have to be sensitive to that. I have taken two paragraphs from "Mechanism" and xxxx-ed out the words that will be unfamiliar (in my opinion) to most readers. As you can tell, it is quite a few. It is for this reason that I am concerned about the technical level of the article. While the article does explain many of these terms, it continually introduces new ones. A reader can only sustain such prose for so long before they are overloaded. They cannot use all of the new words.


 * Poliovirus enters the body through the mouth, infecting the first cells it comes in contact with—the pharynx (throat) and intestinal XXXXX. It gains entry by binding to a XXXXX XXXX, known as the poliovirus receptor or XXXXX, on the cell surface.[26] The virus then hijacks the host cell's own machinery, and begins to replicate. Poliovirus divides within gastrointestinal cells for about a week, from where it spreads to the tonsils (specifically the XXXXX XXXXX cells residing within the XXXXX XXXXX centers), the intestinal XXXXX XXXXX including the XXXXX XXXXX of XXXXX XXXXX, and the deep XXXXX and XXXXX XXXXX XXXXX, where it multiplies abundantly. The virus is subsequently absorbed into the bloodstream.[27]


 * Known as XXXXX, the presence of virus in the bloodstream enables it to be widely distributed throughout the body. Poliovirus can survive and multiply within the blood and XXXXX for long periods of time, sometimes as long as 17 weeks.[28] In a small percentage of cases, it can spread and replicate in other sites such as XXXXX, the XXXXX tissues, and muscle.[29] This sustained replication causes a major XXXXX, and leads to the development of minor influenza-like symptoms. Rarely, this may progress and the virus may invade the central nervous system, provoking a local inflammatory response. In most cases this causes a XXXXX inflammation of the XXXXX, the layers of tissue surrounding the brain, which is known as XXXXX XXXXX XXXXX.[2] Penetration of the CNS provides no known benefit to the virus, and is quite possibly an incidental deviation of a normal gastrointestinal infection.[30] The mechanisms by which poliovirus spreads to the CNS are poorly understood, but it appears to be primarily a chance event—largely independent of the age, gender, or socioeconomic position of the individual.

Reading such prose is easy for someone familiar with it, but not for the rest of us! Awadewit | talk  10:44, 16 November 2007 (UTC)

I agree completely that this is a challenging problem here and with most medical articles that are encyclopaedic in depth (rather than just at patient fact sheet level). The Mechanism section is usually the worst. Some parts of medicine are just hard to understand/explain. Be grateful the section wasn't called Pathophysiology! There are several options and techniques:
 * Replace technical terms with friendly ones. A recent edit replaced "asymptomatic" with "no symptoms at all", but maintained the wikilink. This isn't always possible. There is no lay equivalent of "follicular dendritic cells". The "symptoms of paralytic polio" area is a good example where lay words have been used rather than the usual medical terms.
 * There may be no lay equivalent of "follicular dendritic cells" but that doesn't mean there isn't a descriptive phrase that can replace that term. If you wanted to explain that phrase to my undergraduates, for example, what would you use? :) Awadewit | talk  22:16, 16 November 2007 (UTC)


 * If knowing the technical term is important to readers of the article, then it must be used and explained. "acute flaccid paralysis" is an example here.
 * I agree with this in principle, but I wonder just how many terms are important to know. What vocabulary list, in other words, must the reader learn in order to understand polio? Maybe we could list the ten most important words? Ten is already a lot...Awadewit | talk  22:16, 16 November 2007 (UTC)


 * Avoid over-technical detail altogether. Sometimes, WP articles do contain information that is pretty esoteric and should be excised. My preference is that in sections such as this, it should stretch the educated reader a little bit. The uneducated reader will struggle with this section regardless (which is one argument for placing the difficult sections later on).
 * I felt that the later sections were easier to understand, but I also felt that they were less important. I am torn here. Awadewit | talk  22:16, 16 November 2007 (UTC)


 * Ensure the main text is accessible but still have some highly technical parts. For example, this section has "(specifically the follicular dendritic cells residing within the tonsilar germinal centers)". I hope it is clear to the reader that this information in parenthesis is optional and can be skipped. Another option is to have a very accessible opening paragraph, that explains things with no technical langauge, which is then followed by highly technical paragraphs that may be skipped.
 * I hate to burst your bubble on the parenthetical, but I don't think that the average reader will understand that the information is unnecessary. Perhaps the most depressing thing I have learned from teaching composition courses for about seven years now is that the students (in the United States, anyway) are not taught to read very well in high school. They cannot summarize a straight-forward text and they cannot pick out the important information. Clues such as parentheses fly right past them. Awadewit | talk  22:16, 16 November 2007 (UTC)


 * Subtly teach the reader. For example, the term "viremia" is introduced and "meninges, the layers of tissue surrounding the brain" explains the technical term. I would be upset if an encyclopaedia replaced "meninges" with "layers of tissue surrounding the brain" as you've lost an educational opportunity. Clearly, as Awadewit says, we can't try to teach too much as the brain will overload, the eyes glaze and we've lost.
 * I guess I would ask "what is it we are trying teach?" The words or the concepts? If more readers understand generally how polio works is that better than fewer readers understanding at a more technical level? This is a real dilemma and not easily decided. I waffle on this all of the time. For an article like polio, however, which one might anticipate would get a lot of hits, I would hope it would be quite accessible at some point. Awadewit | talk  22:16, 16 November 2007 (UTC)


 * Ensure the reader will still get the gist of the text, even if they don't follow all the words. For example, later on the words "hypothalamus and thalamus" are used. The reader doesn't need to know exactly what these are, but they can tell from the text they are parts of the brain.


 * Rely on wikilinks. I've never heard of Peyer's patches but learning about them is a click away (or a mouse-hover if you've got Popups).
 * I really am pessimistic, aren't I? I guess that I don't believe that readers will click on every term they don't know, particularly if it starts to be in the dozens. Awadewit | talk  22:16, 16 November 2007 (UTC)

My point in mentioning these is that effort has already been made to help the lay reader. IMO, this article has a more accessible Mechanism section than most medical articles (including other FAs). There is room for improvement but I don't think there's much here I'd like to excise (I speak as a lay reader who doesn't follow it all). What might help is for there to be a lay-friendly overview paragraph at the start of this section. As for other sections, there may be less excuse for over-technical words. Colin°Talk 11:50, 16 November 2007 (UTC)


 * I had originally proposed an "Overview" of the entire article for just this reason and to avoid having to rip apart the beautifully written sections that already exist. I understand it will introduce repetition, but I think that the benefits outweigh the costs. I suggest this only because I feel this article will invite quite a few non-specialist and curious readers, such as high school students who find out Franklin Delano Roosevelt had polio. Does this page speak to them? Awadewit | talk  22:16, 16 November 2007 (UTC)


 * I don't disagree with anything you've said, though we have slightly different viewpoints. Wikipedia has set itself an impossible task. This isn't the Oxford Encyclopaedia for Teenagers (I wouldn't buy it, would you?) and yet I agree it would be unfair to write prose that effectively excluded most high school students. The Patient Information Factsheets that government health bodies issue are an excellent example of prose designed to inform the (largely uneducated) lay reader about the disease and teach them nothing else. They are immensely accessible but not encyclopaedic (a comprehensive and well rounded source of knowledge). In an encyclopaedic article of 5000 words on a single infectious disease, I'd hope to learn a few words that aren't specific to polio. How else are the high school students going to learn what pathogen, lymph nodes, quadriplegia, ... are other that by reading text that stretches them a little? Sure, readers won't click on every wikilink, and text that is too dense just hurts the brain. Another comparison might be a magazine like New Scientist. If it had an article on polio, it would be more accessible than this. However, they haven't set themselves the task of comprehensively discussing everything about polio. If a paragraph on the mechanism is too difficult, the editor can just cut it out.
 * I'm glad you don't want to rip apart the text or dumb it all down. Let's see if someone can propose an overview that fits and doesn't irritate through repetition. BTW: Roosevelt might not have had polio. -- Colin°Talk 23:05, 16 November 2007 (UTC)


 * Although I am not a medical doctor, I have spent a lot of time researching this article, so the jargon is pretty familiar to me. But I also understand that some sections are quite advanced. While I think that the mechanism section will inherently require a certain amount of technical jargon, a few of these words might be better explained. I'll make an attempt, based upon your XXXX paragraph above. --DO11.10 (talk) 00:36, 17 November 2007 (UTC)

Confused sentence
"The disease is transmitted primarily via the fecal-oral route, by ingesting contaminated food or water, and occasionally via the oral-oral route,[10] especially in areas with good sanitation and hygiene.[11] "

The latter clause was added here. I don't understand it. Why would good sanitation and hygiene help transmission, and it is somewhat ambiguous as to whether this helps oral-oral or both transmission types. Colin°Talk 13:40, 16 November 2007 (UTC)
 * I presume in places with good sanitation, fecal-oral transmission of polio (as with pretty much any disease spread in this manner) is rarer, thus making the oral-oral route more likely? Fvasconcellos (t·c) 14:27, 16 November 2007 (UTC)
 * Indeed. I have split the sentence to help make the point that good sanitation helps the oral-oral route. You could tack on "...where fecal contamination is less likely" or some such explanation, but that might be redundant.--DO11.10 (talk) 23:15, 16 November 2007 (UTC)

Simple English version of this article
There was one major concern expressed while this article was under consideration for becoming a featured article: the article was too technical for the general reader. I personally believe that the article strikes the correct balance between technical correctness and readability. However, there are still readers who would find the article too difficult to comprehend. One possibility that I have been pondering would be to translate this article into Simple English. This would allow a larger readership while retaining the integrity of the current feature article. A good example of a Simple English article is the Simple English translation of the article on Water(http://simple.wikipedia.org/wiki/Water).

This would a huge task that I would be interested in performing over the next few months if there is sufficient interest. In order to test out the feasibility of translating this article, I plan to translate a much simpler article into Simple English.--Dan Dassow (talk) 12:43, 20 December 2007 (UTC)

Undid removal of sentence
I undid the edit (http://en.wikipedia.org/w/index.php?title=Poliomyelitis&diff=183928464&oldid=183782194) by Undid revision 183928464 by 66.32.194.254 (talk). The following sentence should not have been removed: "Bulbar polio leads to weakness of muscles innervated by cranial nerves."

The sentence is supported by the article http://www.health.ri.gov/chew/refugee/Alerts/InfoRefugeesExposedPoliovirusSHD%5B1%5D.pdf.

Note: this is the first and only edit by 66.32.194.254

--Dan Dassow (talk) 02:11, 13 January 2008 (UTC) what is up y feb1 —Preceding unsigned comment added by 69.28.2.216 (talk) 23:31, 1 February 2008 (UTC)

Crop pic?
Does anyone think it would be good to crop the upper right picture to remove some of the background and have a more close-up view of the subject? I can do it if people want. delldot on a public computer  talk  06:35, 24 February 2008 (UTC)


 * I prefer the picture (Image:Polio_lores134.jpg) as it is without being cropped. The picture in its current state tells a story beyond the atrophied right leg and club foot; it gives a context of where the man lives, how he fits within society and his abilities beyond the aftermath of polio. There already is a picture of a young girl that focuses on her atrophied right leg. We do not need another picture that focuses on a person's disability. In addition, the composition of the picture would suffer, the resolution would be degraded, and the intent of the original photographer, Barbara Rice, would be violated, if it were to be cropped.--Dan Dassow (talk) 07:33, 24 February 2008 (UTC)


 * Cool, good thing I asked first then.  delldot on a public computer   talk  08:52, 24 February 2008 (UTC)

Origin of the disease
Where did the poliovirus come from? Has it been endemic to hominids for millions of years, or did it recently migrate to us from an animal we domesticated? 129.215.48.112 (talk) 06:32, 9 March 2008 (UTC)

Humans alone?
"PV infects and causes disease in humans alone." Jane Goodall says that the chimpanzee communities in the Gombe were affected by an outbreak of polio in November 1966 to January 1967. http://www.janegoodall.org/jane/study-corner/chimpanzees/gombe-timeline.asp —Preceding unsigned comment added by 209.204.181.123 (talk) 06:11, 29 May 2008 (UTC)


 * While chimps are often experimentally infected with poliovirus. Natural polio infection is thought to occur in humans alone. --DO11.10 (talk) 03:04, 30 May 2008 (UTC)

The original Mission statement promoted if not necessarily written by Franklin Roosevelt included a search for a cure. I have contacted the March of Dimes and see that no effort is being made toward finding a "cure" for polio. A survivor myself who had to be removed from a hospital due to conditions that horrified my parents at Herman Kieffer Hospital in Detroit which was allied with the March of Dimes. At that hospital, parents were not allowed to visit their patients in the wards. They were permitted to visit for thirty minutes every other week.They weren't allowed to see the ward.That was when I had to go to an iron lung.Dad finally brroke in and took pictures of the ward and me and general conditions.Those pictures were dated and indicated location and still exist. My parents signed all sorts of releases and were forced under duress to state they would seek no further treatment for me. I have copies of some of it. All of this happened in late 1950 and early 1951.

I went to Children's Hospital in Detroit where parents were permitted to see the conditions in which their children lived. We had clothing and were not kept nude in our own filth as children of fifteen months there. I survived despite the March of Dimes and contribute nothing to them as they have deserted the some 400-500,000 polio survivors alive in the US. They have undertaken a new worthy cause. Birth defects are a worthy cause.I won't deny that but they have left a job undone. They also basically spit upon us who brought them to prominence.

This article almost totally neglects hypothalamus and thalamic damage to polio survivors, no matter the degree of infection (even people who had no paralytic polio have problems of the thalamus and hypothalamus as polio may infect not only the spinal cord but the brain) or paralysis. I still have trouble breathing though that is not surprising after months in an iron lung. Damage is done to the lower brain and has been recognized by disability standards in the US. I will be happy to cite references to these assertions.

I can also retrieve the reference in Science Magazine about pilio virus and virus fragments being found post mortem in polio survivors who have since died from infections many years ago. The article is from the 1990s but I have seen no refutation. It would be informative to take spinal fluid froma polio survivor and inject it into a monkey and see if symptoms develop. This would clear matters up. I confess I am a scientist and prefer verifiable experiments with appropriate controls. That created some conflicts between me and many federal and state government microbiologists who chose to use no controls, either positive or negative in their testing for salmonella or varieties of Listeria.That attitude has grown since I left federal service and I believe is unfortunate.

It is not clear from my reading if the virus is potentially infective or even active but it is a rather simple virus as my education and work in microbiology, chemistry and virology indicate. It has even been reconstructed in the laboratory as can be seen is Internet searchable sites. The fact that the virus was found over fifty years after my initial infection in a spinal fluid sample from me is something I find suggestive of a tough virus.(I have had spinal surgery since then.) From my observations, viruses tend to be tougher than bacteria. The best a bacterium can do is form a spore and wait for an opportunity. Viruses are rather tough.Much more work is needed to make this article truly informative. —Preceding unsigned comment added by Petitjean1 (talk • contribs) 21:47, 22 July 2008 (UTC)

New cases down to 1,310
The number of new cases in 2007 was 1,310. Just though the figures could be updated.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5718a4.htm

Comrinec (talk) 18:40, 31 July 2008 (UTC)
 * Thanks for the updated information. I have updated the page and referenced the CDC article provided.  Cheers. —Fudoreaper (talk) 05:40, 23 August 2008 (UTC)