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Three more cases of polio infection found in Minnesota

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State Health Commissioner Diane Mandernach says the general public is not at risk of being exposed to the polio virus. (MPR file photo)

St. Paul, Minn. — (AP) - More polio cases will probably turn up in a conservative, closed Amish community in central Minnesota, state health officials said Thursday.

Three more children - all siblings under age 16 - tested positive for polio, after an initial case was found two weeks ago in an infant hospitalized for immune problems. The siblings weren't related by blood to the infant, but their families had direct links, officials said. None of the children have symptoms of paralytic polio.

The cases are the first known occurrence of polio in the United States in five years.

State epidemiologist Harry Hull said the general public isn't at risk because most people have been vaccinated against polio. He declined to identify the Amish community, which has between 100 and 200 people, most of whom are not immunized for religious reasons.

"In this community, we believe that it's an urgent matter to get these unimmunized children and adults vaccinated as quickly as possible," Hull said at a news conference. "We're doing our best to convince people to accept it."

Hull said some parents in the community were declining to have their children immunized. The state cannot force the immunizations, he said. Because of that, he said it's possible the virus would spread to other Amish communities.

The situation points to the possibility of an outbreak similar to what happened in 1979 in Amish communities in Iowa, Wisconsin, Missouri and Pennsylvania. Ten people were paralyzed from the disease, three suffered temporary paralysis and two had polio without symptoms of paralysis, according to the U.S. Centers for Disease Control and Prevention.

The outbreak lasted about six months, and many cases probably went undetected, said Dr. Jane Seward, chief of the CDC's viral vaccine-preventable diseases branch.

"Everybody who's unvaccinated needs to be aware of the risk, especially any communities in contact with this community, and protect themselves through vaccination," she said. "Every state has unvaccinated populations. It's not only Amish people."

Everybody who's unvaccinated needs to be aware of the risk. Every state has unvaccinated populations. It's not only Amish people.
- Dr. Jane Seward, Center for Disease Control and Prevention

The polio strain found in Minnesota's Amish community appears to be a mutated version of a live polio vaccine still used in some countries, Hull said. State and federal health officials were still investigating how the child became infected. Stool or saliva from an infected person can transmit the virus.

Use of the live virus vaccine stopped in the United States in 2000. It caused about eight cases of paralytic polio a year.

Because of an immune deficiency, the infant has been infected for at least several months and is having trouble getting rid of the virus, Hull said. The polio diagnosis turned up when the baby was tested for gastrointestinal viruses at the end of August.

Polio infections typically are over in two weeks to two months.

Hull described the Amish community as a tight-knit society that shuns modern technology. He said he met with the community's leader, who was receptive but said community members would have to make individual decisions about whether to be immunized.

"Essentially we have been going house to house talking with them about the risk, offering the vaccine and attempting to collect specimens to see if the virus has been spreading," Hull said. "Some families have said, `No, thank you, we do not want to interact with you at all.' Other families have said, `Sure, we'll get vaccinated. We'll provide specimens."'

Dr. Paul Van Gorp, a family physician in Long Prairie, said he didn't know which Amish community had the polio cases. But the area around Long Prairie in central Minnesota has seen an influx of Amish in the past 10 years, drawn by inexpensive farmland.

"Amish people live the life that non-Amish family farmers lived 30 to 100 years ago," Van Gorp said. "They come in when they're injured or they're seriously ill. But they usually don't come in for well child visits or annual physicals or any of that."

Van Gorp estimated that Amish make up 10 percent of the population in his clinic's area, but only 1 percent of the patients at his clinic.

Hospitals, clinics and doctors in Minnesota, as well as health officials in Canada and surrounding states, are being alerted to watch for polio symptoms, particularly among unimmunized populations.

Health officials consider polio eliminated in the Western Hemisphere. It persists in other parts of the world, with the vast majority of cases concentrated in India, Nigeria and Pakistan, according to the World Health Organization.

Minnesota's last case of polio - related to the live-virus vaccine - occurred in 1992.

At least 98 percent of Minnesota children are immunized against polio and aren't at risk of contracting the disease, Hull said.

(Copyright 2005 by The Associated Press. All Rights Reserved.)