The first case of polio in the US since 2013 has rocked New York state, especially because it occurred in an area where many people have not been vaccinated against the disease.
Rockland County recently announced that a young adult living in the area was partially paralyzed by polio. Poliovirus has been eradicated in the US and most countries for decades; The infected person is believed to have caught the virus from an international traveller. Three weeks after the case was announced, the New York State Department of Health said the virus had been found in samples from New York City’s wastewater, after being detected in samples from Rockland and nearby Orange County since May. Only 60 percent of people in Rockland County and 59 percent of people in Orange County are vaccinated against polio, while about 80 percent of people nationwide are vaccinated against polio.
“It is relatively unexpected and unfortunate that we have a case of paralysis from a completely preventable disease like polio,” says Anand Bandyopadhyay, deputy director of polio at the Bill & Melinda Gates Foundation. Public health officials are particularly concerned because large Orthodox Jewish communities in Rockland County and other areas of New York experienced massive measles outbreaks in 2019. The outbreak was attributed to large numbers of unvaccinated people in the regions.
Polio outbreaks can be tricky compared to measles: Like COVID, many cases of polio are asymptomatic. Only one in four people who catch the virus develop symptoms of a cold — which would not be suspected of having polio — and only one in 200 infected people develop paralysis. London scientists, who regularly monitor the city’s wastewater for pathogens, also found polio in its sewage this year. This allowed public health officials to have a quick response, including offering booster shots to children aged one to nine. But in the US, where most jurisdictions do not comprehensively monitor wastewater, cases are usually found only after someone is paralyzed.
a terrible disease
Before the first vaccine for polio was developed in the 1950s, it was a dreadful disease. Although it can attack anyone, the ease with which the virus spread meant that most people encountered it as children and either developed immunity to it or were paralyzed. Those infected by the massive 1952 outbreak had to spend anywhere from weeks to decades in “iron lungs” – negative pressure ventilation machines that allowed them to breathe. Many of those who are still living today are in wheelchairs, and some are still in iron lungs.
As a result of widespread vaccination and public health awareness efforts, the World Health Organization (WHO) declared polio eradicated in the US in 1994. “Success in ending polio in the United States is one of the great American stories,” says Kimberly Thompson, a public health expert and president of the nonprofit Kid Risk in Orlando, Fla. Since then the wild virus has been wiped out in every country except Afghanistan and Pakistan. “A lot of people didn’t know it was still around,” she adds.
This means that if today’s parents are not afraid of polio, they may decide that it is not important to get their children vaccinated against it. “For each new set of parents, it’s a question of how they view it,” Thompson says. “But the choices people make for their children are lifelong” unless those children are vaccinated as adults.
Bandyopadhyay says that even polio-free countries need to realize that they are not risk-free. “We all know that a virus like polio is essentially an airplane ride away as long as it’s still in some corner of the world,” he says.
The unusual features of the oral polio vaccine (OPV) present another danger. If you were born in the US after 2000, you are most likely to receive the injectable inactivated polio vaccine (IPV). But before that year, the country had used OPV, which contains a weakened version of the virus. People who receive this vaccine excrete the weakened virus in their waste for several weeks, which means other people who come into contact with it can also get vaccinated. Because of this, almost everyone who was born before 2000 has some immunity to the virus.
However, there is a dark side to that secondary risk. In extremely rare cases, the weakened virus reactivates and infects either a vaccinated person or an uninfected person around them – which has happened in New York State. Such “vaccine derived” cases account for all modern cases of polio in countries where the disease has been eradicated.
In 2000 this exposure, resulting in about 1,000 polio cases worldwide each year, prompted the US to switch exclusively to IPV, which cannot be reactivated. But since IPV does not spread to others, there is no immunity among unvaccinated people in the countries that use it. Nevertheless, people who have received this injectable vaccine can still get and carry the polio virus and spread it to others without having any symptoms themselves.
OPV is easy to store and administer, so it is still used around the world. WHO has been encouraging countries to move away from this oral vaccine since 2016.
This effort has backfired somewhat because IPV rollout has been slow in many countries, meaning they continue to use OPV or do not vaccinate at all. Thompson says that when most people in a community are vaccinated, cases of vaccine-derived polio are extremely rare. But when relatively few people are vaccinated, the poliovirus in the oral vaccine has a chance to develop into a relatively common virus and spread like one.
As a result, the world has seen about 2,500 more cases of vaccine-derived polio since 2016 than public health experts expected. And in 2020 the WHO granted emergency authorization to a new oral polio vaccine (nOPV2), which does not reactivate because it is more resistant to mutations. In the past two years, millions of children in Africa have received the new vaccine.
But polio is unlikely to be completely eradicated anytime soon. The drop in child vaccination rates as a result of the COVID pandemic has not helped matters: for example, in 2021, tens of millions of children worldwide missed routine vaccinations for diseases including polio and measles. In July, WHO officials said that if these trends continued, there could be a widespread outbreak of these diseases.
And in a low-vaccinated community with a large Orthodox Jewish population like New York, a large number of children may be susceptible. Public health officials in New York have launched vaccination campaigns aimed at reaching these communities, including bulletins in Yiddish.
There is nothing in Orthodox Jewish law or tradition that prohibits vaccination, says Blima Marcus, an Orthodox Jewish nurse in Brooklyn, NY. In fact, rabbis and community leaders encourage it. She says the reason for the low vaccination rate is that anti-vaccination activists tend to target tight-knit communities, where their message will spread without much challenge at large. For example, activists descended on Rockland County amid the 2019 measles outbreak in an effort to counter the Provaccine public health message. Marcus says, “We have a group of passionate, fierce anti-vaccination activists who throw all their energy and passion behind their work, and this is met with silence because the rest of us are just doing our jobs. “
Without opposing arguments, messages from activists — including the discredited notion that vaccines cause autism — spread quickly among concerned parents. “People want to do what is right; it’s a community [of people that are] are very dependent on each other,” says Marcus. “These areas of deep mistrust and misinformation are widespread because of these close social ties.” She says rumors are now circulating in her community that a polio-infected man, now wheelchair-bound, did not actually have polio and was paralyzed from other causes, although doctors had confirmed the infection.
But Aaron Glatt, an infectious disease physician at Mount Sinai South Nassau on Long Island, who is also a rabbi, says a case of polio can wake people to the dangers of the disease and the importance of vaccination. “People have short memories. They don’t remember how dangerous it was in the 1950s,” he says.[People] Was scared of it. I hope we don’t have to go back to that stage of the disease.”
(This story has not been edited by seemayo staff and is published from a rss feed)