This thesis is a study of a post-World War II polio epidemic in one small Southwest Virginian town before widespread application of the vaccine. While others have explored urban public health responses to polio and national efforts to promote prevention and treatment efforts, in this history I look at reactions to the disease at the local level in this rural community particularly hard-hit by an acute medical event. The central question addressed in the research is how the polio epidemic changed the nature of community. Prior to the polio epidemic in this rural Southwest Virginian town, community meant creating and strengthening social ties throughout town—most visibly through large social functions and leisure gatherings such as church or baseball. Through identifying and analyzing reactions to the epidemic among families/individuals, the public health, and business, a transition emerged. Being a part of community during the summer polio epidemic meant protecting the public health while simultaneously protecting economic health as a backbone and lifeline of the family. / Master of Arts

Objetivos: Descrever aspectos clínicos e epidemiológicos da síndrome pós-poliomielite (SPP) e fatores associados, bem como suas repercussões na capacidade funcional e à sua gravidade. Métodos: Estudo descritivo de série de casos e fatores prognósticos da SPP, em população de pacientes com diagnóstico de SPP acompanhados no Ambulatório de Doenças Neuromusculares da Universidade Federal de São Paulo. A definição de caso utilizada foi história prévia de poliomielite, período de estabilidade funcional maior ou igual a 15 anos, presença de nova fraqueza muscular por período maior de 1 ano e a exclusão de outras enfermidades que pudessem afetar a força muscular. A descrição da doença foi efetuada segundo aspectos relativos ao tempo, espaço e pessoa. A associação entre formas graves e exposições de interesse foi investigada pelas estimativas não ajustadas e ajustadas da odds ratio, com os respectivos intervalos de confiança de 95%, usando regressão logística não condicional. Resultados: Dos 132 casos de SPP estudados, 63,6% eram do sexo feminino; a mediana da idade foi de 45,5 anos. A mediana da idade da poliomielite aguda foi de 17 meses, do período de recuperação funcional foi de 3,0 anos e do período de estabilidade funcional 33,7 anos; 50,4% foram considerados graves. Mostraram-se independentemente associados à gravidade: período de recuperação neurológica e funcional máximo menor e igual a 4 anos (OR= 2,8;IC95%:1,2-6,7), seqüela crônica de dois membros (OR=3,6;IC95%:1,5-8,7) e ter residido na época da poliomielite aguda em município com acesso a assistência médica de maior complexidade (OR=2,5;IC95%:1,15,6).Conclusões: A alta proporção de casos graves e as perdas funcionais dos pacientes com SPP no Brasil indicam a necessidade de políticas públicas focalizando o problema. / Objectives: To describe the clinical and epidemiological aspects of post-poliomyelitis syndrome (PPS) and associated factors, and repercussions on functional capacity and severity. Methods: A descriptive study of cases series and prognostic factors was undertaken, including PPS patients from Neuromuscular Diseases Outpatients Clinic of the Federal University of São Paulo. The case definition used was a previous history of poliomyelitis with a period of functional stability more than or equal 15 years and presence of new muscle weakness lasting greater than 1 year, after ruling out other diseases that affect the muscle strength. The disease was described in terms of time, space and personal characteristics. Associations between severe forms and exposures of interest were investigated by calculating unadjusted and adjusted odds ratios, with respective 95% confidence intervals, using unconditional logistic regression. Results: The median age of the 132 PPS cases studied was 45.5 years and 63.6% were women. The median age when poliomyelitis was contracted was 17 months, median time taken to achieve maximum functional recovery was 3.0 years and median length of time with functional stability was 33.7 years; 50.4% were considered severe. Factors independently associated with severity: neurological and maximum functional recovery period less than or equal 4 years (OR= 2.8; 95%CI:1.26.7), permanent sequelae in two limbs (OR=3,6;95%CI:1,5-8,7) and having lived at the time of acute poliomyelitis in a municipality with access to higher-complexity medical care (OR=2,5;95%CI:1,15,6). Conclusions: The high proportion of severe cases and losses of functional capacity among PPS patients in Brazil indicate the need for public policies focusing on this problem.

Thesis (D.P.H.)--University of Michigan.

Dissertation (D.P.H.)--University of Michigan.

Objetivos: Descrever aspectos clínicos e epidemiológicos da síndrome pós-poliomielite (SPP) e fatores associados, bem como suas repercussões na capacidade funcional e à sua gravidade. Métodos: Estudo descritivo de série de casos e fatores prognósticos da SPP, em população de pacientes com diagnóstico de SPP acompanhados no Ambulatório de Doenças Neuromusculares da Universidade Federal de São Paulo. A definição de caso utilizada foi história prévia de poliomielite, período de estabilidade funcional maior ou igual a 15 anos, presença de nova fraqueza muscular por período maior de 1 ano e a exclusão de outras enfermidades que pudessem afetar a força muscular. A descrição da doença foi efetuada segundo aspectos relativos ao tempo, espaço e pessoa. A associação entre formas graves e exposições de interesse foi investigada pelas estimativas não ajustadas e ajustadas da odds ratio, com os respectivos intervalos de confiança de 95%, usando regressão logística não condicional. Resultados: Dos 132 casos de SPP estudados, 63,6% eram do sexo feminino; a mediana da idade foi de 45,5 anos. A mediana da idade da poliomielite aguda foi de 17 meses, do período de recuperação funcional foi de 3,0 anos e do período de estabilidade funcional 33,7 anos; 50,4% foram considerados graves. Mostraram-se independentemente associados à gravidade: período de recuperação neurológica e funcional máximo menor e igual a 4 anos (OR= 2,8;IC95%:1,2-6,7), seqüela crônica de dois membros (OR=3,6;IC95%:1,5-8,7) e ter residido na época da poliomielite aguda em município com acesso a assistência médica de maior complexidade (OR=2,5;IC95%:1,15,6).Conclusões: A alta proporção de casos graves e as perdas funcionais dos pacientes com SPP no Brasil indicam a necessidade de políticas públicas focalizando o problema. / Objectives: To describe the clinical and epidemiological aspects of post-poliomyelitis syndrome (PPS) and associated factors, and repercussions on functional capacity and severity. Methods: A descriptive study of cases series and prognostic factors was undertaken, including PPS patients from Neuromuscular Diseases Outpatients Clinic of the Federal University of São Paulo. The case definition used was a previous history of poliomyelitis with a period of functional stability more than or equal 15 years and presence of new muscle weakness lasting greater than 1 year, after ruling out other diseases that affect the muscle strength. The disease was described in terms of time, space and personal characteristics. Associations between severe forms and exposures of interest were investigated by calculating unadjusted and adjusted odds ratios, with respective 95% confidence intervals, using unconditional logistic regression. Results: The median age of the 132 PPS cases studied was 45.5 years and 63.6% were women. The median age when poliomyelitis was contracted was 17 months, median time taken to achieve maximum functional recovery was 3.0 years and median length of time with functional stability was 33.7 years; 50.4% were considered severe. Factors independently associated with severity: neurological and maximum functional recovery period less than or equal 4 years (OR= 2.8; 95%CI:1.26.7), permanent sequelae in two limbs (OR=3,6;95%CI:1,5-8,7) and having lived at the time of acute poliomyelitis in a municipality with access to higher-complexity medical care (OR=2,5;95%CI:1,15,6). Conclusions: The high proportion of severe cases and losses of functional capacity among PPS patients in Brazil indicate the need for public policies focusing on this problem.

Thesis--University of Chicago. / Bibliography: leaves 53-56.

Thesis (M.S.)--Miami University, Dept. of Family Studies and Social Work, 2005. / Title from first page of PDF document. Document formatted into pages; contains [1], viii, 88 p. Includes bibliographical references (p. 83-88).

On the first day of August in 1961, the Health Ministry of the German Democratic Republic (GDR) announced the closure of the German-German border permanently, accusing the Federal Republic of Germany (FRG) of neglecting its citizens and failing to properly administer vaccinations against poliomyelitis.1 This accusation sparked the ire of the West German and United States media, and the Federal Republic denied that there were outbreaks. The episode raises questions about common perceptions of healthcare in East Germany. The thought that East Germany might have an epidemic disease under control, which still caused problems in West Germany, contradicts the perception that East Germany lagged behind its western neighbor in every realm. While recent histories of international relations and healthcare emphasize collaboration between the US and the USSR, and their Cold War allies in this period, this dissertation presents a less constructive relationship. Despite the shared goal of polio control and eradication, East and West Germany used epidemic control as evidence of the successes of one system of healthcare governance, or the faults of the opponent’s system. The Berlin Wall announcement was the culmination of almost 15 years of government competition, speckled with individual collaboration, in the field of healthcare. This dissertation contributes to literature on healthcare in divided Germany, narratives which present the history of polio as an “American story,” and scholarship on healthcare and international relations. It shows how two separate healthcare systems were 1 “East Germany Curbs Travel: Blames Polio,” Chicago Tribune, 1 August 1961, 11. v constructed by Soviet and American occupiers with German collaborators between 1945 and 1947. These separate systems, established before the official division of Germany, laid the foundation for two separate states. During the first postwar polio epidemic in 1947, the United States showed its affluence and experience with polio through a robust response centered on technological solutions. The USSR, conversely, could not match the United States’ response due to inexperience with polio and lack of economic resources, garnering criticism from German citizens and US occupiers. In 1955, the introduction of Jonas Salk’s injected polio vaccine gave doctors and civilians in the US hope that polio would soon be a memory, but European responses were much more ambiguous. Albert Sabin’s forthcoming oral polio vaccine appeared to be a much more promising option to many physicians due to its ease of administration and cost-effectiveness. When Sabin chose to field test his vaccine in the USSR, his decision to collaborate with the US’s Cold War opponent demonstrated significant potential for collaboration. Nonetheless, the Soviet connections of Sabin OPV led to a crisis in divided Berlin. The history of polio is not an American story and recognizing the ways in which the fight against this disease went beyond the national, complicated by political boundaries but involving recognizable collaboration across those boundaries, helps expand the historical narrative of poliomyelitis. While vaccine diplomacy was indeed a form of soft power used in the context of the Cold War, promises of vaccines were not always received without question, and incorporating a deeper examination of recipient countries’ discourses helps complicate our understandings of diplomacy and hesitancy. / Thesis / Candidate in Philosophy / This thesis outlines the ways in which an infectious disease, poliomyelitis, was treated and prevented in divided Germany between 1945 and 1965, contextualizing medical history with the political context of the Cold War. The first two chapters examine the period from 1945 to 1953, when no vaccines against polio were available and Germany was occupied by the Allied powers. The German healthcare system was reconstructed differently in the Soviet and American zones. The political beliefs of each occupying power shaped the resulting systems: socialized and centralized medicine was a hallmark of the Soviet zone’s healthcare, while the American zone pursued a free market approach. Chapters three and four explain the introduction of two different vaccines, both developed in the United States: an injected vaccine created by Jonas Salk, and an oral vaccine developed by Albert Sabin. The United States championed the Salk vaccine, while the USSR was an early adopter of the Sabin vaccine. These chapters explain how a vaccine created in the US became known as a Soviet vaccine, and how this reputation affected western countries’ adoption of the medical innovation. The thesis concludes that doctors are not separate from the political contexts in which they live and shows how political ideology and cross-border rivalry affect healthcare provision.

Since diffusion models of social network are widely used in studying epidemiology, in this thesis, we apply diffusion models to study the contact immunity generated by attenuated vaccines.Oral polio vaccine (OPV) is a typical attenuated vaccine for polio that can produce contact immunity and therefore help protect more individuals than vaccinees. / To better capture the utilization of OPV’s contact immunity, we model the community as a social network, and formulate the task of maximizing the contact immunity effect as an optimization problem on graphs, which is to find a sequence of vertices to be “vaccinated” to maximize the total number of vertices “infected” by the attenuated virus. Furthermore, as immune defiicient patients may suffer from the live attenuated virus in the vaccine, we develop models in consideration of this restriction, and study related problems. / We present polynomial-time algorithms for these problems on trees, and show the intractability of problems on general graphs. / 社交網絡的擴散模型被廣泛運用于對流行病學的研究，在本文中，我們使用擴散模型對減毒活疫苗產生的接觸性免疫進行研究。口服脊髓灰質炎疫苗（OPV）是一種典型的減毒活疫苗，它可以在人群中產生接觸性免疫，使得更多未接種疫苗的人獲得免疫力。 / 爲了更好的刻畫OPV 產生的接觸性免疫，我們將社區模型化為社交網絡，從而將接觸性免疫效應最大化的任務轉化爲圖優化問題，即通過發現頂點的一個「接種」序列來最大化被減活病毒「感染」的頂點數量。此外，因爲減毒疫苗中的活病毒會使患有免疫缺陷的病人患病，我們考慮在此因素限制下的模型，并研究相關的問題。 / 我們給出這些問題在樹上的多項式時間算法，并證明其在一般圖上的複雜性。 / Ma, Chenglong. / Thesis M.Phil. Chinese University of Hong Kong 2015. / Includes bibliographical references (leaves 40-47). / Abstracts also in Chinese. / Title from PDF title page (viewed on 12, September, 2016). / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only.

This thesis offers a detailed account of early polio epidemics (between 1918 and 1945) in Johannesburg, where the disease was particularly severe. At this time, little was known about the poliovirus, and such limited understanding affected the public health and medical initiatives taken during this period. These actions are highlighted in the thesis, along with the responses of the media and lay public to the disease. The effect of war on the management of the disease is also examined, as it siphoned off vital medical personnel and jeopardised disease control. It also lent an emotional overlay to the way the disease was perceived, as `battle' rhetoric became the parlance used against polio, which was personified as the `enemy' of innocent children who were disabled at the whim of the virus. The epidemic of 1944-1945 was the first to be systematically investigated, by Dr James Gear as part of his groundbreaking polio research; he later became part of an international team of researchers who contributed to the development of a prophylactic vaccine within a decade of this epidemic. / History / M.A. (History)