Polio may again threaten Amish, health officials say Alarm over refusal to vaccinate grows after outbreak in the Netherlands

November 07, 1992|By Knight-Ridder News Service

PHILADELPHIA -- It is with a growing sense of foreboding that Pennsylvania public health officials are watching events of the past two months in the Netherlands.

There, on Sept. 16, a 14-year-old boy who belongs to a fundamentalist Protestant sect that does not believe in immunization was paralyzed by polio. Since then, there have been 24 more cases of the crippling disease in the Netherlands. One victim, a 2-week-old baby, has died.

Why should this worry anyone in Pennsylvania?

Because in the spring of 1978 there was an epidemic of polio among members of the same religious sect in the Netherlands. By October, it had moved to Canadian members of that group. By January 1979, it showed up among the Amish in Pennsylvania, who also rarely take vaccines.

By the time the outbreak was over, 10 Americans, eight of them Amish Pennsylvanians, had been paralyzed, and the state Health Department had vaccinated thousands in Lancaster County, the center of the state's Amish community.

"Our concern is that we could see a possible repeat of what happened here in 1979," said Bruce Reimer, a spokesman for the Health Department. With anxiety apparent in his voice, Mr. Reimer added: "We're worried about it. The CDC [U.S. Centers for Disease Control and Prevention] is worried about it."

In 1979, the Health Department waited until polio was in the United States to begin immunizing the Amish. This time, it's already planning a mass immunization drive that will begin at the end of this month or the beginning of December, Mr. Reimer said.

Amish and Mennonites still are reluctant to be immunized, so the Health Department next week will send letters to 135 Amish bishops in Pennsylvania, advising them of the Netherlands epidemic and asking for their help in setting up immunization clinics where free vaccines will be offered. Similar letters to a smaller number of Mennonite bishops will follow later in the week.

Mr. Reimer said the state would abide by the bishops' wishes. "We respect their authority, and we don't press the issue," he said.

Thirteen years ago the Health Department managed to persuade about 4,000 people, about a third of the Amish residents then in Lancaster County, to take the vaccine, often in makeshift clinics set up in lantern-lighted barns. Thousands more non-Amish were vaccinated. But, as Mr. Reimer pointed out, "there's been a lot of babies born since 1979, obviously."

The Health Department estimates that 32,000 to 43,000 Amish people live in Pennsylvania, more than 20,000 of them in the Lancaster area. There is no religious prohibition against immunization among Amish and Mennonites. It is not part of family tradition, however. Many fear that the vaccines will make people sick, said David Abbott, a New Holland doctor who practices primarily among the two groups.

"It's a cultural thing," he said. "Their parents didn't [get immunizations], and they didn't."

The CDC is recommending measures like those planned in Pennsylvania for all states with large groups of Amish or other religious groups that oppose vaccination. Canadian authorities have taken similar steps.

The CDC has also written articles about the implications of the Netherlands epidemic for two major Amish newspapers, said Frederik van Loon, a CDC epidemiologist who is originally from the Netherlands.

This year's first polio victim in the Netherlands apparently came in contact with a polio virus, in this case a virus from India, while on a mountain trek in Germany. Polio most often is spread through poor hygiene. It also can be spread through the air. There is no known treatment.

The youth had received one dose of the three-dose polio vaccine series during the epidemic in 1978-1979. It was not enough to protect him from the strain now circulating, known as wild polio virus type 3.

A public health official said the teen-ager belongs to a Calvinist religious group. Dr. van Loon would not identify the group because health officials have had trouble getting members to cooperate. The group believes that immunization interferes with the will of God, he said.

That the infected youth brought home wild virus 3, instead of wild virus 1, which caused the last epidemic, is both good and bad news.

Wild virus 3 is much less likely to paralyze its victims than wild virus 1. Wild virus 1 causes symptoms -- paralysis or meningitis -- in one of every 100 people it infects. For wild virus 3, the rate is one for every 1,000.

The bad news is that wild virus 3 creates many more carriers: People can spread the virus for as long as two months but have no idea they are infected. The fact that 25 people have gotten sick means that more than 20,000 probably have the virus, Dr. van Loon said. "All those people live and work and travel," he said. "The risk of it going elsewhere as a result of this epidemic is even greater."

Health officials know it will be difficult to persuade the Amish, legendary for resisting the worldly ways of outsiders, to change their habits, especially during the busy harvest season.

Dr. Abbott, who began working in New Holland soon after the last outbreak, has been trying for years. Despite his frequent attempts to persuade parents to vaccinate their children, no more than 15 percent of his Amish patients actually do so.

They say, " 'Well, I'll ask dad,' and they never get around to it," he said.

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