3 more polio cases found among Amish

CLARISSA, MINN. - State health officials have tracked four cases of polio infection to a Todd County Amish community, where a long-standing mistrust of vaccines could dampen efforts to contain the outbreak.

State epidemiologist Dr. Harry Hull announced Thursday that three more cases have been confirmed, though none of the children has polio symptoms. Hull said the new cases were linked to a baby whose polio infection was made public two weeks ago.

State officials also revealed that all of the cases occurred in an Amish community in central Minnesota.

Because many Amish do not get vaccinated, their communities are susceptible to disease outbreaks, including a 1979 polio outbreak that sickened 15 unvaccinated people in four states.

In an effort to limit the spread of the polio virus among the Minnesota Amish, Hull two weeks ago visited the affected community, located near the towns of Browerville and Clarissa, according to a community member who asked to be identified only as Eli.

Eli said that vaccines were just as scary as polio. He's not sure if he will allow his 10 children to receive the vaccine, which he fears could itself cause polio infection.

"We are leaving it with God, and we are watching it very carefully," said Eli, who did not know Thursday that the polio virus had been diagnosed in three more community members until a reporter told him.

It is common for people with polio infections not to have symptoms. Hull said that only 1 out of 200 infected people progresses to the disease, which can cause total paralysis.

Health Commissioner Dianne Mandernach emphasized Thursday that the only people at risk are those who have not been vaccinated.

Eli said the community has rallied around the family whose baby has been infected with polio. That child remains hospitalized in the Twin Cities for conditions other than polio.

Officials knocking on doors

State public health officials are visiting and talking with Amish community leaders, asking them to spread the word at Sunday church meetings and living room gatherings.

"We are welcome," Hull said. "We are not shut out of the community."

Hull said he met with the leader of the affected Amish community 10 days ago: "He was receptive," Hull said. "He had a lot of good questions about the vaccine and the disease."

Some, but not all families, have agreed to be vaccinated or to provide stool samples for the tests to determine if they have been infected. The three new cases were found through those tests, Hull said.

Yet the word has not spread widely among the Amish in Todd County. Noah Slabaugh, 38, who lives near Staples, about 30 miles from Eli, said that despite knowing Eli, he was not aware of the polio infection in the community.

"I haven't heard about any polio in Minnesota, but if it is so it could be pretty serious," said Slabaugh, who lives in one of the five Amish communities in the area.

Slabaugh said he was vaccinated when he was an older child, but he had concerns about giving vaccines to the younger of his seven children, who range in age from 4 to 14.

Even in the Clarissa area where all of the cases have occurred, there has been little discussion about polio in the Sunday church gatherings, Eli said.

More kids probably infected

Hull said it is likely that the three new confirmed cases caught the virus from the first confirmed case and that there are probably more infected children. "These three are the ones that we have found to be infected. We may find others," he said.

So far, investigators have collected samples from about 20 percent of the community, which he described as 100 to 200 people in dozens of families.

State officials, who did not disclose the location of the affected Amish community for privacy reasons, also did not reveal how extensive their outreach has been among the Amish residents.

The 1979 polio outbreak, which struck unvaccinated members of the Amish and Mennonite communities, demonstrated that the disease can pass among people who don't travel over wide geographic areas because they typically shun modern forms of transportation. Amish communities generally do not have a specific prohibition against vaccination, but attitudes vary from one place to another. In the 1979 outbreak, officials had some success in vaccinating the Amish, including some in Minnesota.

Public health officials still face the challenge of getting the word out to a group that generally does not listen to television or radio.

A spokesman for the U.S. Centers for Disease Control in Atlanta said a national alert about the Minnesota outbreak will be issued shortly.

Wisconsin, which has substantial Amish populations, is monitoring developments in Minnesota. Local public health officials will visit Amish communities to see if any residents have been in contact with the Minnesota community, said Carla Vigue, spokeswoman for the Wisconsin Department of Health and Family Services.

Still looking for the source

Hull said that investigators have not determined how the first infection had passed to the Amish baby, who appears to have had the virus for four months. Researchers still believe that the source originated from a foreign country because the baby has a form of virus that is related to polio vaccines that use a live form of the virus.

The use of the live-form polio virus was discontinued five years ago in the United States because people who receive the vaccine can pass the virus on to someone with a weak immune system.

It is possible, but not confirmed, that the baby caught the polio virus while she was hospitalized. The virus was unexpectedly discovered in the baby as part of a battery of tests that were taken to help doctors diagnose her medical problems, which have weakened her immune system.

Posted by Becca

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