Polio and Silverberg family: Difference between pages

Revision as of 11:25, 19 December 2006

Revision as of 00:36, 11 June 2007

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{{Notability|fiction|date=May 2007}}

{{DiseaseDisorder infobox |

{{in-universe}}

Name = Polioliosis |

ICD10 = {{ICD10|A|80||a|80}}, {{ICD10|B|91||b|90}} |

ICD9 = {{ICD9|045}}, {{ICD9|138}} |

}}

{{Taxobox_begin | color = violet | name = ''Poliovirus''}}

{{Taxobox_image | image = [[Image:Polio.jpg|240px|]] | caption = }}

{{Taxobox_begin_placement_virus}}

{{Taxobox_group_iv_entry}}

{{Taxobox_familia_entry | taxon = ''[[Picornaviridae]]''}}

{{Taxobox_genus_entry | taxon = ''[[Enterovirus]]''}}

{{Taxobox_species_entry | taxon = '''''Poliovirus'''''}}

{{Taxobox_end_placement}}

{{Taxobox_end}}

The Silverberg family is a family of renoun military strategists from [[Konami]]'s [[Suikoden]] series of games. Among the characters listed are also those who have close ties to the Silverberg family.

'''Poliomyelitis''', often called '''polio''' or '''infantile paralysis''', is a [[virus (biology)|virally]] induced infectious disease which spreads via the [[fecal-oral route]]. It may proceed to the [[blood]] stream and into the [[central nervous system]] causing [[muscle]] weakness and often paralysis. An ancient disease, it was first recognized as a medical entity by [[Jakob Heine]] in 1840. [[Vaccination]] and eradication efforts led by the [[World Health Organization]] and [[The Rotary Foundation]] of [[Rotary International]] are credited with the reduction of the number of annual diagnosed cases from the hundreds of thousands to around a thousand.

In the ''Suikoden III'' manga, Caesar Silverberg attributes the countless successful strategists who have emerged from the Silverberg family as a result not only of the family passing down their teachings to a subsequent generation, but also because of each tactician's own personality traits. Throughout the course of history in Suikoden, the Silverberg family have been known to be heralds of change because of their involvement in nearly all the conflicts which have occurred.

==Infection==

Polio spreads through human-to-human contact, usually entering the body through the mouth due to fecally contaminated water or food (fecal-oral transmission).

Members of the Silverberg family frequently occupy the Tenki Star, the Star of Wisdom, amongst the [[108 Stars of Destiny (Suikoden)|108 Stars of Destiny]], which is the star assigned to the primary tactician of the hero or the Chikai Star, the Chief Star of Earth, which is assigned to the secondary tactician of the story.

The poliovirus itself is a small RNA ([[ribonucleic acid]]) virus related to [[Hepatitis A]]. There are three separate [[Viral quasispecies|quasispecies]] and all are extremely infectious. While polio can strike a person at any age, over fifty percent of the cases occur in children between the ages of three and five.

==Julian Silverberg==

The [[incubation]] period of polio, from the time of first exposure to first symptoms, ranges from three to 35 days. Most people infected with the poliovirus have no symptoms or outward signs of the illness and are thus never aware they have been infected. After initial infection with poliovirus, virus particles are excreted in the feces for several weeks. In all forms of polio, the early symptoms of infection are fatigue, fever, vomiting, headache and pain in the neck and extremities. Around 1% of unimmunized people develop paralytic complications, in some cases [[bulbar polio|bulbar]] paralysis.

A legendary strategist who helped Karnach Rugner, ancestor of [[Barbarossa Rugner]], become independent from [[Harmonia]] without any bloodshed, creating the Scarlet Moon Empire more than 200 years ago.

==Elenor Silverberg==

==Cause of the disease==

Elenor Silverberg is the earliest known Silverberg since Julian himself. She was originally tactician for the Scarlet Moon Empire, but she was banished due to the actions of her subordinate, Graham Cray.

Poliovirus enters the human body through infection of the intestinal lining. From there, it penetrates into the [[lymphatic system]] via the [[Peyer's patches]] and the bloodstream via the [[mesentery]] and becomes a [[viremia]].

After this she headed south into the Island Nations where she settled on Hermitage Isle with her new apprentice, Agnes. She was recruited by the Island Nation Forces after hearing of Graham Cray's involvement and she eventually lead the army to victory against the Kooluk Forces. After the final battle she confront Graham Cray at the top of Fort El-Eal to question his actions which lead to his flight from the Scarlet Moon Empire and her exile. Fort El-Eal was destroyed in a massive explosion shortly after and it is believed that it was here that Elenor lost her life.

In fit individuals with functioning immune systems polio infection is often [[subclinical]], which increases the risk of contagion inasmuch as they can spread the disease through their contaminated feces unawares. Others suffer only a mild flu-like syndrome. Together these two forms of presentation account for nearly 95% of all cases of polio.

Elenor appears in [[Suikoden IV]].

A short breakdown of the remaining cases follows:

==Leon Silverberg==

* 4-5% develop non-paralytic polio

The current head of the Silverberg family, the uncle of Odessa and Mathiu Silverberg, whom he took care of after the death of their parents, and grandfather of Albert and Caesar Silverberg. He appears in [[Suikoden I]] and [[Suikoden II]].

* 0.1% (children) 1.3% (adults) develop paralytic (spinal or bulbar) polio, of which:

: 10% die

: 50% recover fully

: 40% are left with only partial recovery (25%) or permanent paralysis (15%)

Leon is well-known throughout the world as a genius strategist and was involved in many wars, including the Succession War, the Toran Liberation Wars, and Dunan Unification Wars. He lives by his strategic maxim of "ending war as fast as possible with the fewest casualties", using whatever means necessary, regardless of the morality of it, and regardless of who will win the war. His philosophy is shared by his grandson, Albert.

Of those 0.4% of polio patients who are left with partial recovery or permanent paralysis, the most affected locations are either one or both lower limbs. While up to 0.2% of all polio patients (1 in 500, 20% of paralytic polio cases) may require mechanical resipiration in the acute stage, permanent quadriplegia or resipiratory paralysis occur in only 0.01% (1 in 10,000) of all polio patients.

As a strategist, he is responsible for the Kalekka Incident which legitimized Scarlet Moon Empire's act of war against Jowston. During the Gate Rune Wars, Leon acted as tactical advisor for the Toran Liberation Army and aids them in ending the war. During Suikoden II, he is requested to become the strategist of the Highlands by [[Jowy Atreides]] (Jowy Blight). He aids the Highland until its defeat at the end of the Dunan Unification War.

===Non-paralytic polio===

Non-paralytic polio may result in fever, vomiting, abdominal pain, lethargy, and irritability, and some muscles tender to the touch. In some cases there may be no significant symptoms whatsoever.

==Mathiu Silverberg==

===Paralytic polio===

Mathiu Silverberg is the brother of Odessa and nephew of Leon, and is a well known strategist. He is also the mentor of strategists Shu and Apple. Mathiu's tactical philosophy contrasts with his uncle's, where upon Mathiu believes that the method is more important that achieving the end goal as quickly as possible. He appears in [[Suikoden I]].

[[Image:Iron Lung ward-Rancho Los Amigos Hospital.gif|thumb|An [[iron lung]] ward.]]

The virus affects the anterior horn cells in the spinal column which control movement of the trunk and limb muscles including the intercostal muscles. An affected limb becomes floppy and poorly controlled — the condition of acute flaccid paralysis (AFP). This presentation can lead to permanent paralysis of the body yet it only occurs in around 1% of cases. The classic later appearance (as seen in ancient Egyptian illustrations) is of muscle wasting in a leg. Destroyed motor neurons do not regenerate and the affected motor units of muscles will not be able to contract. However, some sprouting from nearby surviving neurons may reinnervate the denervated muscle. This additional load on surviving motor neurons may precipitate the later developing symptoms of post-polio syndrome.

He became a member of the Scarlet Moon military during his youth and participated in the Succession War as a strategist for Kasim Hazil, then served as a vice-strategist for Barbarossa Rugner under his uncle Leon. When Leon devised the plan to slaughter the town of Kalekka, Mathiu reluctantly carried out his duty, but retired from his position soon after, having realized that war inevitably causes innocents to suffer.

The degree of paralysis is proportional to the extent of infection of the motor nuclei, which is likely to be proportional to the degree of viraemia, and inversely proportional to the degree of immunity. Extensive paralysis of the trunk and muscles of the thorax and abdomen ([[quadriplegia]]) may occur.

Over a decade later, Mathiu became the head strategist for the Toran Liberation Army during the Gate Rune Wars following the death of Odessa. Near the end of the war, he was fatally wounded during the attack on the floating fortress by a spy. He dies shortly thereafter, just after the fall of Barbarossa.

Of all paralytic polio cases, 79% are spinal and 19% spinal with bulbar symptoms. If it affects the upper part of the cervical spinal cord (C3-4-5) then diaphragm paralysis requires ventilator support. Without respiratory support, polio affecting respiration is likely to result in death from failure of breathing, or aspiration of secretions and resulting [[pneumonia]]. The critical nerves are the phrenic nerve (the nerve driving the diaphragm to inflate the lungs) and the innervation to the muscles needed for swallowing. Skilled clearing of the airway with suction and [[tracheostomy]] are part of the care of such a patient, but they can expect to need mechanical ventilation. The tank respirator - [[iron lung]] - has some advantages over positive pressure applied through a tracheostomy and is still in use by a few people. In Europe, the usual treatment is either mask ventilator or tracheal ventilator. Some patients use [[cuirass]] type mechanical ventilators worn over thorax and abdomen.

==Odessa Silverberg==

Hovewer, even gravely paralyzed (quadriplegic or resipiratory paralysis) patients may recover within time. Nerves can tolerate more than 25% neurons being destroyed and maintain full muscular functionality. Only when damage exceeds to 50% neurons being destroyed, a paralysis will occur. If there are any neurons left, the remaining neurons will grow "superclustered" axons and replace those which have died. The usual recovery period is three months. Any paralysis which remain after one year is likely to be permanent, but recoveries even after a decade have been known.

Odessa Silverberg is the sister of Mathiu and niece to Leon. She appears in [[Suikoden I]].

As an aristocrat, Odessa had lived most of her life in relative comfort and was unaware of the suffering of the common people. When she came to see the corruption within the Scarlet Moon Empire, she became one of the original founders of the Toran Liberation Army, an anti-imperial movement started by her late fiancé, Achilles.

===Bulbar polio===

{{main|Bulbar polio}}

The brainstem is homologous to the spinal cord, but the motor neurons arising from there and passing in the various [[cranial nerves]] control the various muscles of eyeball movements; the trigeminal nerve and facial nerve which innervate cheeks, tears, gums, and muscles of the face, etc; the [[glossopharyngeal nerve]] which in part controls swallowing and functions in the throat, tongue movement and taste; the nerve that sends signals to the heart, intestines, and lungs; and the accessory nerve that controls upper neck movement. In bulbar polio, the virus infiltrates and destroys these nerves.

As the leader of the Toran Liberation Army, Odessa also acted as the group's chief strategist, using her knowledge of military strategy as taught by Mathiu. She welcomes a young [[Tir McDohl]] into the army and begins to see him as a potential successor as he gained her respect. When the Imperial Army attacked the rebels' base, taking advantage of the absence of a considerable number of their forces, Odessa is assassinated while attempting to save a child.

The Copenhagen epidemic has been described as the start of intensive care, when large numbers of patients were ventilated by hand ("bagged") by medical students and anyone else to hand. In modern medicine, electronic ventilators have replaced bagging in long-term care situations.

The surviving members of the Liberation Army seek out Mathiu to take up Odessa's place as chief tactician and nominate Tir as their new leader. Thanks to Odessa's foresight and advanced planning, the Toran Liberation Army is ultimately victorious in the war.

The mortality rate of bulbar polio ranges from 25% to 75%,<ref>http://www.cdc.gov/nip/publications/pink/polio.pdf</ref> according to the age of the person. If positive pressure ventilators are available, the mortality rate can be reduced to 15% [http://www.fdcw.unimaas.nl/personal/WebSitesMWT/Wackers/proefschrift.html#h4]. In 2006 there are still polio survivors who must use a [[Medical ventilator|ventilator]], spend their entire day or most of their day in an [[iron lung]] or attached to an assistive respiratory machine to stay alive. Bulbar polio and spinal polio are part of a continuum of anatomy and disease (paralytic polio). Bulbar polio occurs in 2% of cases of paralytic polio. Approximately one in 1000 people who have had paralytic polio have permanent resipiratory paralysis.

==??? Silverberg==

In extremely rare cases usually resulting from [[immunocompromise]] an uncontrolled infection of the entire brain called fulminating [[encephalitis]] can develop. Even with intravenous antiviral therapy and intensive care the mortality rate for these cases is extremely high.

Mathiu and Odessa had a younger brother, but his name is unknown as is his current whereabouts. It is certain that he is still alive.

==Shu==

==Polio and children==

Shu is the chief tactician of the Allied Forces during the Dunan Unification War. As a child, he studied military strategy under Mathiu Silverberg and alongside Apple, whom he views as a surrogate sister. He appears in [[Suikoden II]].

Young children who contract polio may sometimes suffer mild symptoms, and as a result they may become permanently immune to the disease. Hence inhabitants of areas with better sanitation may actually be more susceptible to polio because fewer people have the disease as young children.

Under Mathiu, he learned everything about military strategy. Mathiu saw great potential in this young pupil. However, Shu used his knowledge for personal gain and was cast out from Mathiu's school. Since then, Shu has become a trader in Radat. With his uncanny grasp of the movements in the world, he quickly became rich through trade.

People who have survived polio sometimes develop additional symptoms, notably muscle weakness and extreme fatigue, decades later; these symptoms are called [[post-polio syndrome]]. Since it's possible to have a polio infection without having significant paralysis, many people who are unaware they ever had polio may now be suffering from post-polio syndrome.

During the Dunan Unification War, the Allied Forces asked Shu to join them. He initially refused, but with persistent begging by Apple and Riou, he agreed and quickly whipped the Allied Forces into shape by scoring an initial victory against the Highland Army, resulting in the execution of Solon Jhee. He quickly devised cunning strategies to rally support from other city-states and established an alliance with the Toran Republic.

==History==

The effects of a polio infection have been known since [[prehistory]]. [[Ancient Egypt|Egyptian]] paintings and carvings depict otherwise healthy people with withered limbs, walking with canes at a young age, etc. It has been theorized that the [[Roman Emperor]] [[Claudius]] was stricken as a child, and this caused him to walk with a limp for the rest of his life. The first medical report on poliomyelitis was by Jakob Heine in 1840. [[Karl Oskar Medin]] was the first to empirically study a poliomyelitis epidemic in [[1890]]. The work of these two physicians has led to the disease being known as the Heine-Medin disease.

However, Leon Silverberg suddenly sides with the Highland Army and causes disruption to Shu's plans. After the Dunan Army's retreat against Luca Blight, Leon helped Shu defeat Luca Blight by informing him of a planned night raid and Shu did not let that chance go by. Throughout the war, Shu's attitude towards military strategy had transformed. Originally, his philosophy was identical to Leon Silverberg's philosophy, where soldiers were pawns and strategists were never supposed to risk themselves.

[[Image:Rooseveltinwheelchair.jpg|thumb|[[Franklin D. Roosevelt]] may have contracted polio in 1921]]

However, with the influence of Apple and Nanami, he started to see that it is sometimes necessary to put himself on the line in order to truly win. In the end, he leads the Allied Forces to victory after he defeats Leon Silverberg. After the war, he became the Chancellor for the new Allied Nation while awaiting the return of the hero to his rightful post. He later retires, but then is brought out of retirement by the Higheast Rebellion, in which he secretly planned a plot to cause internal discord within Harmonia, which caused them to withdraw from the Highland territory.

[[Franklin Delano Roosevelt|Franklin D. Roosevelt]] may have contracted polio in 1921. The unquestioned diagnosis at the time and thereafter in countless references was paralytic poliomyelitis. Yet his age (39 years) and many features of his illness are more consistent with a diagnosis of [[Guillain-Barré syndrome]] (an [[autoimmune]] [[peripheral neuropathy]]). A peer-reviewed study published in 2003,<ref>Goldman, AS ''et al'', [http://www.rsmpress.co.uk/jmb_2003_v11_p232-240.pdf ''What was the cause of Franklin Delano Roosevelt's paralytic illness?'']. J Med Biogr. 11: 232-240 (2003)</ref> using [[Bayesian analysis]], found that six of eight [[posterior probabilities]] favored a diagnosis of Guillain-Barré syndrome over poliomyelitis. See [[Franklin D. Roosevelt's paralytic illness]] article.

==Apple==

Regardless of the cause, the result was that Roosevelt was totally and permanently paralyzed from the waist down. Although the paralysis (whether from poliomyelitis or [[Guillain-Barré syndrome]]) had no cure at the time, for the rest of his life Roosevelt refused to accept that he was permanently paralyzed. He tried a wide range of therapies, but none had any effect. Nevertheless, he became convinced of the benefits of hydrotherapy, and in 1926 he bought a resort at [[Warm Springs, Georgia]], where he founded a hydrotherapy center for the treatment of polio patients which still operates as the [[Roosevelt Warm Springs Institute for Rehabilitation]] (with an expanded mission). Furthermore, after he became President, he helped to found the [[National Foundation for Infantile Paralysis]] (now known as the [[March of Dimes]]), that supported the rehabilitation of victims of paralytic polio and the discovery of the [[polio vaccines]].

Like Shu, Apple is not a member of the Silverberg family, but was actually a student of Mathiu Silverberg. She appears in [[Suikoden I]], [[Suikoden II]] and [[Suikoden III]].

Apple deeply respects her mentor and aids him during the Toran Liberation Wars (Suikoden I). She becomes tactician to Viktor's mercenaries early in the Dunan Unification War (Suikoden II). After the fall of Muse, she successfully recruits Shu for the Allied Forces and helps him as a secondary strategist.

The first [[iron lung]] was invented by [[Philip Drinker]] and demonstrated dramatic results on its first case on October 12, [[1928]] at Children's Hospital, Boston. The design was subsequently improved by [[John Haven Emerson]] in [[1931]], and the Emerson Iron Lung remains the standard to this day. The positive pressure [[ventilator]] was first time used in Blegdamshospital, [[Copenhagen]], [[Denmark]] during a polio outbreak in 1952 [http://www.fdcw.unimaas.nl/personal/WebSitesMWT/Wackers/proefschrift.html#h4]. It proved a success and soon superceded the tank resipirator (iron lung) all over Europe. Positive pressure ventilators reduced mortality in [[bulbar polio]] to 15%.

During Suikoden III, Apple works as a historian gathering information to compile a biography on Mathiu. She travels with a student of her own, Caesar Silverberg, and assists the young tactician as he acts as strategist for the Flame Champion during the Second Fire Bringer War. According to Apple, Caesar's tactical mindset is likely the closest to that of her master's.

===Vaccine history===

==George Silverberg==

During the late 1940's and early 1950's, a research group headed by Dr. John Enders at Boston's Children's Hospital successfuly cultivated the polio virus in human tissue. This highly significant breakthrough ultimately allowed for the development of vaccines against polio. Enders and his colleagues, Dr. Thomas H. Weller and Dr. Frederick C. Robbins, were recognized for their labors with a Nobel Prize<ref>http://nobelprize.org/nobel_prizes/medicine/laureates/1954/</ref> in 1954.

George is the son of Leon Silverberg and the father of Albert and Caesar Silverberg. Nothing else is known about him.

In the manga, Caesar describes his father as a "true tactician", a strategist who was capable of knowing when to choose between winning more battles or watching out for the soldiers under his command, which is what Caesar himself strives to become.

There were other proposed vaccines introduced before Jonas Salk's [[vaccine]] in 1953. In 1935 W. H. Park and Maurice Brody, a research assistant at New York University, claimed to have discovered a vaccine procured from ground up monkey spinal cords. Brodie tested the vaccine on himself and several of his assistants. He gave the vaccine to three thousand children and many developed allergic reactions, but no immunity to polio. Other researchers could not replicate his experiment. Philadelphia pathologist John Kolmer also claimed to have developed a vaccine that same year, and not only was that false, but it proved to be fatal to a number of children.<ref>http://www.utexas.edu/features/2005/polio/</ref>

==Caesar Silverberg==

In the [[1950s]], amid a U.S. polio epidemic, millions of dollars were invested in finding and marketing a [[polio vaccine]] by commercial interests, including Lederle Laboratories in New York under the direction of [[H. R. Cox]]. Polish-born virologist and immunologist [[Hilary Koprowski]], who also worked at Lederle, claims to have created the first successful polio vaccine (in [[1950]]) but his vaccine, a live attenuated virus taken orally, was still in the research stage and would not be ready for use until five years after Jonas Salk's polio vaccine (a dead injectable vaccine) reached the market. From a normal level of around 20,000 cases a year, the U.S. experienced an outbreak of 58,000 cases in 1952 and 35,000 in 1953. Salk's vaccine was used in a test involving 623,972 schoolchildren who received either a placebo or the vaccine. Results were announced in 1955 with the vaccine showing 80-90% efficiency. Immediate vaccination campaigns in the U.S. reduced the number of cases of polio to only 5,600 in 1957. With the addition of Sabin's vaccine after 1961, only 161 cases were recorded in the U.S. in 1964. (The last wild virus case of polio in the U.S. occurred in 1979.)

Caesar Silverberg is the son of George and the younger brother of Albert Silverberg. He travels with his mentor, Apple. Caesar appears in [[Suikoden III]].

Caesar is the youngest and most inexperienced of the strategists, though still possessing the talent his family is known for. Initially appearing to be a lazy and disinterested teenager, he possesses a keen and watchful mind and while he never demonstrates the elaborate plans of his predecessors his cunning misdirections and ability to see the situation stripped of emotional attachment serve the Flame Champion well.

[[Albert Sabin]] used samples of difficult-to-manufacture attenuated virus given to him by Hilary Koprowski to make his own vaccine. "Koprowski would later complain that the polio vaccine he had discovered became known as the Sabin vaccine."<ref>http://www.polio.info/polio-eradication/front/templates/index.jsp?codeRubrique=34&lang=EN</ref><ref>http://www.dimes.on.ca/events/iabs.asp?sect=curr</ref> Koprowski's own vaccine was ultimately tested, but the outcome was a failure. After the attenuated live virus entered the body, it sometimes reverted to a virulent state.<ref>http://www.tufts.edu/as/wright_center/lessons/pdf/docs/activities/polio.pdf</ref> Nevertheless, from 1957 to 1960, large scale tests were carried out in the [[Zaire|Congo]]. The results have been controversial.<ref>http://www.koprowski.net/Polio%20Article.htm</ref>

His motivation to pursue the life of a tactician comes from his sibling rivalry with Albert, hoping to best his older brother. Caesar believes in Mathiu's ideology, where reducing the amount of casualties on both sides involved holds priority to the goal in mind so that neither opposing forces loses their strongest human resources such that they will be able to rebuild and manage a peaceful resolution because each side remains able to empathize with the other.

The Simian Virus known as [[SV40]] was also present in many polio vaccines from 1954 to 1962. The U.S. [[Food and Drug Administration]] and the [[Centers for Disease Control and Prevention]] have taken the lead in responding to questions on SV40 and polio vaccine. CDC states that SV40 markers have been found in certain types of human cancers, but it has not been determined if SV40 plays any role in these cancers. A recent report published by the Institute of Medicine of the National Academy of Sciences concluded that "the evidence is inadequate to accept or reject a causal relationship between SV40 containing polio vaccines and cancer." There is a need for further research to answer questions that have been raised concerning this possible relationship. More detailed information on SV40 and the polio vaccine can be found at the [http://www.cdc.gov/nip/vacsafe/concerns/cancer/default.htm CDC Web site].

Caesar is initially dismissed by the Grasslanders, despite how his tactics saved the Chisha clan from Harmonia forces, and becomes discouraged, though Apple assures him that as a strategist, he must find generals to guide in battle. He eventually earns his place as their strategist when he reveals that he is familiar with the tactical advisor of the Harmonian forces: Albert Silverberg. Karaya clan chief Lucia convinces the other chiefs to accept Caesar as their tactician since she knows of Caesar's grandfather, Leon Silverberg, and the value of having Silverberg tactician on their side.

An analysis presented at the Vaccine Cell Substrate Conference in 2004<ref>http://www.newscientist.com/news/news.jsp?id=ns99996116</ref> suggested that vaccines used in the former [[Soviet bloc]] countries, China, Japan, and Africa, could have been contaminated up to 1980, meaning that hundreds of millions more could have been exposed to the SV40 virus.

He proves himself to be a skillful tactician (though assisted by Apple and Salome Haras of the Zexen Confederacy) and intends to test his skills against Albert by pledging his support to the new Flame Champion. While the Grasslanders and the Zexen Confederacy defeat the Harmonians and the Destroyer forces, Caesar realizes that Albert remains the superior tactician and decides to return to his studies in hopes of surpassing his brother some day.

===Vaccine-derived polio===

==Albert Silverberg==

The oral polio vaccine (Sabin or OPV) can revert to a virulent form. This is believed to be a rare event, but outbreaks of vaccine-derived poliovirus (VDPV) have been reported, and tends to occur in areas of low coverage by OPV.<ref>{{cite journal | author=Kew OM, Morris-Glasgow V, Landaverde M, ''et al.'' | title=Outbreak of poliomyelitis in Hispaniola associated with circulating type 1 vaccine-derived poliovirus | journal=Science | year=2002 | volume=296 | pages=356&ndash;9}}</ref><ref>{{cite journal | author=Yang C-F, Naguib T, Yang S-J, ''et al.'' | title=Circulation of endemic type 2 vaccine-derived poliovirus in Egypt, 1983 to 1993 | journal=J Virol | year=2003 | volume=77 | pages=8366&ndash;77}}</ref><ref>{{cite journal | author=Shimizu H, Thorley B, Paladin FJ, ''et al.'' | title=Circulation of type 1 vaccine-derived poliovirus in the Philippines in 2001 | journal=J Virol | year=2004 | volume=78 | pages=13512&ndash;21}}</ref> There is currently (14 Aug 2006) an outbreak of vaccine-derived poliovirus in China.<ref>{{cite journal | author=Liang X, Zhang Y, Xu W, ''et al.'' | title=An outbreak of poliomyelitis caused by type 1 vaccine-derived poliovirus in China | journal=J Infect Dis | year=2006 | volume=194 | pages=545&ndash;51 }}</ref> This sort of polio outbreak only occurs in areas of low vaccine coverage, presumably because the OPV is itself protective against the related outbreak strain.

Albert Silverberg is the son of George and the older brother of Caesar Silverberg. He appears in [[Suikoden III]].

Albert excelled in his studies and is an excellent strategist, eventually gaining the role of Harmonia's chief tactical advisor during Harmonia's invasion of the Grasslands. His ideals are largely similar to that of his grandfather, Leon, where bringing about the end goal as quickly as possible to spare lives takes priority over the methods used, no matter how amoral the methods may be or how much suffering must be caused as a result. He and Caesar, as a result of their differing ideologies, is a sore point between the brothers along with their contrasting personalities, especially since Albert is much more serious in comparision to his younger brother.

===First effective vaccine===

He initially works alongside [[Sasarai]], a bishop of Harmonia and the commander of the Harmonian invaders searching for the [[27 True Runes|True Fire Rune]], but reveals that he is actually working for Luc, the Masked Bishop. Albert's motives are unclear, but it appears that he believes supporting Luc will allow him to gain power within the Harmonian bureaucracy. It is revealed that he chose to follow Luc in hopes of lessening the amount of casualties in Luc's war through strategic means.

The first effective [[polio vaccine]] was developed by [[Jonas Salk]] at the [[University of Pittsburgh]], although it was the oral vaccine developed by [[Albert Sabin]] eight years later that was used for modern mass inoculation. The Salk vaccine is based on formalin-inactivated poliovirus. The Sabin vaccine is a live-attenuated vaccine, produced by the passage of the virus through non-human cells at a subphysiological temperature. <!-- - the resulting mutants have alterations in the virus' IRES. an--> The first [[immunization]] of children against polio began at Arsenal Elementary School and the [[D.T. Watson Home for Crippled Children|Watson Home for Children]] in [[Pittsburgh, Pennsylvania]] in [[1954]]. Through mass immunization, the disease was wiped out in [[the Americas]], although a small outbreak of vaccine-related polio occurred in [[Haiti]] in 2002, where political strife and poverty have interfered with vaccination efforts.<ref>http://www.vaccinationnews.com/DailyNews/March2002/PolioHaitiLinkedIncompleteVax.htm</ref>

He eventually disappears at the end of the Second Fire Bringer War, intending leave the continent and start again under an assumed name. Caesar finds him before he leaves and informs his older brother that he will surpass him some day.

==Recent eradication efforts==

{| class="wikitable" style="text-align:center"

|+Polio Case Counts

|-

! Year !! Estimated !! Recorded

|-

| 1975 || - || 49,293

|-

| 1980 || 400,000 || 52,552

|-

| 1985 || - || 38,637

|-

| 1988 || 350,000 || 35,251

|-

| 1990 || - || 23,484

|-

| 1993 || 100,000 || 10,487

|-

| 1995 || - || 7,035

|-

|2000 || - ||2,971

|-

|2001 || - ||498

|-

|2002 || - ||1,922

|-

|2003 || - ||784

|-

|2004 || - ||1,258

|-

|2005 || - ||1,998

|-

|2006 || - || 1,763*

|-

|colspan="3" |References:<ref>http://www.rotary.org/foundation/polioplus/news/eradication.html</ref><ref>http://www.rotary.org/foundation/polioplus/news/milestones/index.html</ref><ref>http://www.polioeradication.org/casecount.asp</ref><ref>http://www.who.int/vaccines/immunization_monitoring/en/diseases/poliomyelitis/afpextract.cfm</ref><ref>http://www.unicef.org/pon95/heal0002.html</ref><ref>http://www.worldwatch.org/node/1644</ref>

|-

|}

*<nowiki>*</nowiki>To [[5 December]] [[2006]]

Due to the large increase in the number of vaccinators and field workers since 1998, the number of estimated cases is thought to be reasonably close to the actual reported number of cases in recent years.<ref>http://www.who.int/bulletin/volumes/83/4/268.pdf#search=%222005%20%22%20estimated%20polio%20cases%22%22</ref>

===1988===

In 1988, the [[World Health Organization]] passed a resolution to eradicate polio by 2000, a measure which was inspired by [[Rotary International]]'s 1985 pledge to raise $120 million toward immunising all of the world's children against the disease. The next plan called for a stop of spreading the virus by 2005. Most remaining polio infections are located in two areas: the Indian sub-continent and [[Nigeria]]. Eradication efforts in the Indian sub-continent have met with a large measure of success. The Indian Government started the [[Pulse Polio]] Campaign to get rid of polio. Most families allowed their children to take the vaccine.

===1994===

On 20 August the Americas region was certified as polio-free.

*[http://www.cdc.gov/mmwr/preview/mmwrhtml/00032760.htm Read about the certification]

===1995===

Operation Mecacar (Mediterranean, Caucasus, Central Asian Republics and Russia) is launched: from now on, National Imunnization Days are coordinated in 19 adjacent countries of the European and Mediterraenean regions of [[WHO]].

===2001===

575 million children (almost one-tenth the world's population) received polio vaccine (some 2 billion doses of oral polio vaccine).

===2002===

The World Health Organization announces that Europe is polio-free.<ref>http://www.europaworld.org/week88/unhealthbody28602.htm</ref> Certification took place on [[June 21]] in the [[Copenhagen]] [[Ny Carlsberg Glyptotek|Glyptotek]].<ref>http://www.euro.who.int/mediacentre/PR/2002/20020620_1</ref>

===2003===

In the [[Kano]] province in Northern Nigeria, which operates under [[Sharia]] (Muslim religious law), the immunisation campaign was suspended in September [[2003]] when prominent Muslim leaders said they suspected that vaccines supplied by Western donors were adulterated to reduce fertility and spread [[HIV]] as part of a [[United States|U.S.-led]] drive against [[Islam]].<ref>http://allafrica.com/stories/200407020367.html</ref> On [[June 30]], [[2004]], the WHO announced that Kano had pledged to restart the campaign in early July, after a 10-month ban during which the virus spread across Nigeria and into 10 other African countries that were previously polio-free. By 2006, this ban would be blamed for 1,500 children being paralyzed and having caused $450 million for emergency activities.<ref>http://news.yahoo.com/s/ap/20061012/ap_on_he_me/un_polio_who;_ylt=ApbHVMLfLg1C8MIDSa80lxIR.3QA;_ylu=X3oDMTA3czJjNGZoBHNlYwM3NTE-</ref>

In addition to the rumors of sterility and the ban by Nigeria's Kano state, civil war and internal strife in the countries of Sudan and Ivory Coast have complicated WHO's polio eradication goal.

*[[Uttar Pradesh]] state in India accounted for two-thirds of the worldwide total cases reported this year.

===2004===

Almost two-thirds all the polio cases in the world occur in Nigeria (760 out of 1170 total).

===2005===

{{main|Poliomyelitis in 2005}}

1,831 cases of wild poliovirus (excludes [[vaccine]] derived polio [[virus]]es) were confirmed worldwide<ref>http://www.polioeradication.org/content/fixed/casemap.shtml</ref> with almost 40% of those occurring in Nigeria.<ref>http://www.polioeradication.org/casecount.asp</ref>

*[[India]] has used the [[Pulse Polio]] campaign to increase polio immunisation rates. India recorded 4,791 cases of polio in [[1994]], 1,600 in [[2002]], 225 in [[2003]], and 135 in [[2004]].<ref>http://onlypunjab.com/fullstory2k5-insight--status-22-newsID-25278.html</ref>

*In the United States, "On [[September 29]] [[2005]], the Minnesota Department of Health (MDH) identified poliovirus type 1 in an unvaccinated, immunocompromised infant girl aged 7 months (the index patient) in an [[Amish]] community whose members predominantly were unvaccinated for polio. The patient has no paralysis; the source of the patient's infection is unknown. Subsequently, poliovirus infections in three other children within the index patient's community have been documented." [http://www.cdc.gov/mmwr/preview/mmwrhtml/mm54d1014a1.htm CDC]

*[[Yemen]] and [[Indonesia]], neither of which had reported cases since before 2000, each had hundreds of cases - all derived from importation, probably from Nigeria.

===2006===

1763 cases reported by December 5, an increase from the previous year.

Only four countries in the world (Nigeria, India, Pakistan, and Afghanistan) are reported to have endemic polio. Cases in other countries are attributed to importation. Nigeria accounts for the majority of cases this year (to date) but India has reported more than ten times the number of cases this year as it had last year (30% of worldwide cases this year). Pakistan has reported 8 cases this year in children despite being given the polio medication.

==Famous polio survivors==

* [[Alan Alda]], actor

* Sir [[Arthur C. Clarke]], scientist and [[science fiction]] author

* [[Francis Ford Coppola]], film director

* [[Bill Cullen]], game show host

* [[Donovan]], musician

* [[Ian Dury]], rock musician

* [[Mia Farrow]], actress

* [[Michael Flanders]], British actor, broadcaster, and writer

* [[Arthur Guyton]], physiologist

* [[Frida Kahlo]], artist

* [[Dorothea Lange]], photographer

* [[Alan Marshall]], Australian author

* [[Mitch McConnell]], Senate Minority Leader

* [[Joni Mitchell]], musician

* [[Jack Nicklaus]], golfer

* [[Kerry Packer]], Australian media proprietor

* [[Yitzhak Perlman]], violinist

* [[Franklin Delano Roosevelt|Franklin D. Roosevelt]], US president, commonly thought to have had polio, probably had [[Guillain-Barré syndrome]]

* [[Wilma Rudolph]], athlete, later Olympic gold medalist

* [[David Sanborn]], American Jazz Musician

* [[John Thaw]], British actor

* [[Robert Anton Wilson]], author

* [[Milton Erickson]], psychiatrist

* [[Neil Young]], musician

* Sir [[Walter Scott]], author

==References==

<references/>

==External links==

* [http://www.suikosource.com '''Suikosource''']

{{commonscat|Polio}}

[[Category:Suikoden characters]]

*[http://citizenxpress.com/blog.php?sub_section=view&id=104 Indian Polio Eradication Mission reached, but not achieved ?

*[http://www.polioeradication.org/ Global Polio Eradication]

*[http://www.rotary.org/foundation/polioplus/ Rotary International: PolioPlus]

*[http://www.polio.pitt.edu/ University of Pittsburgh's Jonas Salk and Polio information]

*[http://www.post-polio.org/ Post-Polio Health International]

*[http://www.post-gazette.com/pg/05094/482468.stm Pittsburgh Post-Gazette on 50 years of Polio]

*[http://www.cgdev.org/publications/MillionsSaved/studies/case_4.cfm Elimination of Polio in Latin America and the Caribbean]

*[http://www.radionewssource.com/Scripts/salkvaccineanniversary.htm Audio and text about Franklin D. Roosevelt's granddaughter expressing hope for rapid eradication of polio.]

*[http://www.johnprestwich.btinternet.co.uk Longest surviving polio iron lung patient dies at 67.]

*[http://www.scq.ubc.ca/?p=45 Polio: A Virus' Struggle] - an amusing yet educational graphic novella from the Science Creative Quarterly

*[http://archives.cbc.ca/IDD-1-75-363/science_technology/polio/ CBC Digital Archives - Polio: Combating the Crippler]

==Further reading==

*{{cite book | author = Maus, Richard A. | title = Lucky One: Making it Past Polio and Despair | edition = | publisher = Anterior Publishing | year = 2006 | id = ISBN 0-9776205-0-6}} (A memoir by a childhood survivor of polio.)

*{{cite book | author = Oshinsky, David M. | title = [[Polio: An American Story]] | edition = | publisher = Oxford University Press | year = 2005|id = ISBN 0-19-515294-8 }} (Awarded the 2006 [[Pulitzer Prize]] for history.)

*{{cite book | author = Paul, John R. | title = A History of Poliomyelitis | edition = | publisher = Yale University Press | year = 1971 | id = }} (Classic history.)

*{{cite book | author = Wilson, Daniel J. | title = Living with Polio: The Epidemic and Its Survivors | edition = | publisher = University of Chicago Press | year = 2005 | id = }} (History of polio from accounts written by survivors.)

[[Category:Infectious diseases]]

[[Category:Picornaviruses]]

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