He con­tracted po­lio from a vac­cine, spurred change in U.S. health pol­icy

The Washington Post Sunday - - OBITUARIES - BY MATT SCHUDEL matt.schudel@wash­post.com

“We had a very healthy 8pound, 8-ounce baby boy, no prob­lems at all,” John Sala­m­one said in 1995, de­scrib­ing his then5-year-old son, David. The prob­lems started when David was 4 months old and re­ceived a rou­tine oral vac­ci­na­tion for po­lio.

He had a fever and a rash, but within weeks his par­ents no­ticed he could no longer crawl or turn over.

“I’d hold him up,” John Sala­m­one told USA To­day in 1995, “and his legs would just col­lapse.”

The doc­tors were as per­plexed as David’s par­ents. When his mother, Kathy, asked if her son might have po­liomyeli­tis — a once-dreaded com­mu­ni­ca­ble dis­ease that killed 3,000 Amer­i­cans a year in the early 1950s and par­a­lyzed thou­sands more — “the doc­tors pooh-poohed her,” John Sala­m­one said in 1999. “They said it wasn’t pos­si­ble.”

The threat of po­lio had been all but elim­i­nated in 1955 with the in­tro­duc­tion of a vac­cine de­vel­oped by Jonas Salk.

Salk’s vac­cine was ad­min­is­tered by nee­dle in­jec­tion, but by the early 1960s a dif­fer­ent kind of vac­cine, de­vel­oped by Al­bert Sabin, had come into gen­eral use. Sabin’s liq­uid vac­cine could be dropped onto a sugar cube or squirted into an in­fant’s mouth. It didn’t re­quire a sy­ringe and was cheaper to pro­duce than the Salk vac­cine.

In time, the Sabin vac­cine be­came the pre­dom­i­nant form of po­lio im­mu­niza­tion, and the Salk vac­cine was largely aban­doned.

By 1979, the con­ta­gious or “wild” form of po­lio had been erad­i­cated in the United States. Still, about eight to 10 peo­ple, mostly in­fants, con­tracted the dis­ease each year from the vac­cine it­self be­cause the Sabin oral po­lio vac­cine, or OPV, con­tained a weak­ened but still liv­ing form of the po­lio virus. In rare cases, it could de­velop into a more vir­u­lent strain of the dis­ease.

That is how David John Sala­m­one, who was born May 25, 1990, in Fair­fax, Va., be­came one of the last po­lio pa­tients in Amer­ica — and how his suf­fer­ing led to a change in fed­eral pol­icy that ban­ished the dis­ease al­to­gether.

It took two years be­fore doc­tors dis­cov­ered that David was born with a ge­netic im­mune de­fi­ciency called Bru­ton agam­ma­glob­u­line­mia, which left him sus­cep­ti­ble to many in­fec­tions and dis­or­ders, in­clud­ing po­lio. His par­ents were not told that a child with a com­pro­mised im­mune sys­tem could con­tract po­lio from the oral vac­cine.

“It was dev­as­tat­ing and frus­trat­ing and ul­ti­mately caused me a lot of anger,” John Sala­m­one told the Bal­ti­more Sun in 1999. “It was like a dirty lit­tle se­cret: No­body told you there were go­ing to be sac­ri­fi­cial lambs.”

David Sala­m­one wore a brace on his at­ro­phied right leg and had dif­fi­culty walk­ing. He had a rel­a­tively typ­i­cal child­hood in Oak­ton, Va., ex­cept for his fre­quent vis­its to hos­pi­tals around the coun­try.

His fa­ther — a lob­by­ist, fundraiser for char­i­ties and one­time top of­fi­cial with the Na­tional Ital­ian Amer­i­can Foun­da­tion — be­came his son’s ad­vo­cate, writ­ing let­ters to the Cen­ters for Dis­ease Con­trol and Pre­ven­tion, mem­bers of Congress and even the pres­i­dent. He or­ga­nized other fam­i­lies and be­gan to speak at med­i­cal con­fer­ences.

At first, the med­i­cal es­tab­lish­ment was un­moved. When eight to 10 chil­dren a year con­tracted po­lio, and mil­lions of oth­ers were pro­tected, “my feel­ing was it was a small price to pay,” Wal­ter A. Oren­stein, who was di­rec­tor of the U.S. im­mu­niza­tion pro­gram at the CDC from 1988 to 2004, re­called Fri­day in an in­ter­view. Then he heard David’s story. “Sud­denly, the eight to 10 peo­ple were not just tiny numbers but were real peo­ple,” Oren­stein said. “Just see­ing how th­ese peo­ple’s lives were ru­ined made a big dif­fer­ence. I went overnight from be­ing an OPV hawk to be­ing an IPV hawk.”

The CDC’s Ad­vi­sory Com­mit­tee on Im­mu­niza­tion Prac­tices, which in­cluded Oren­stein and Johns Hop­kins Univer­sity’s Neal Halsey, rec­om­mended that the coun­try switch from an OPV model of vac­cine to Salk’s IPV — or at least adopt a sched­ule in which the two vac­cines would be ad­min­is­tered in a se­quence that would pre­vent the virus from de­vel­op­ing into full-blown po­lio.

Af­ter re­sis­tance from man­u­fac­tur­ers and the CDC’s board, the com­mit­tee’s rec­om­men­da­tion was adopted in 1996. Since Jan. 1, 2000, the only po­lio vac­cine used in the United States has been the IPV, which Salk de­vel­oped al­most 50 years ear­lier.

“John [Sala­m­one]’s ad­vo­cacy on be­half of his son re­ally did change U.S. im­mu­niza­tion pol­icy,” Halsey said in an in­ter­view, “and changed it to­ward a safer vac­cine.”

The new stan­dard cost an ad­di­tional $3 mil­lion for ev­ery case of po­lio it pre­vented, but “the feel­ing was we had a moral duty and that it would re­in­force to the pub­lic that we put safety at a pre­mium,” Oren­stein said.

David Sala­m­one had rel­a­tively good health through his teen years and com­pleted high school in Rome. He en­joyed snow­board­ing and bi­cy­cling and even­tu­ally had an apart­ment in Ash­burn, Va. He worked as a com­puter troubleshooter and, as re­cently as a few months ago, pi­loted his fam­ily’s boat on the Po­tomac River.

He was 28 when he died Sept. 7 at a Wash­ing­ton hos­pi­tal. His cu­mu­la­tive ail­ments led to mul­ti­ple or­gan fail­ure, his fa­ther said.

Sur­vivors in­clude his par­ents, John and Kathy Sala­m­one of Mount Holly, Va.; a sis­ter, El­iz­a­beth Ve­nafro of Lees­burg, Va.; and a grand­mother, Anne Campbell of Colo­nial Beach, Va.

David Sala­m­one was a long­time pa­tient at the Na­tional In­sti­tutes of Health, where he be­came the sub­ject of a study on im­mune de­fi­ciency dis­ease.

Since 2000, when the CDC changed its pol­icy on vac­cines, not a sin­gle child in Amer­ica has con­tracted po­lio.

FAM­ILY PHOTO

David Sala­m­one, who worked as a com­puter troubleshooter, en­joyed snow­board­ing and bi­cy­cling.

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