Delays in vaccinating children during the COVID-19 pandemic and general anti-vaccination sentiment could be fueling the most serious polio threat to the United States in years, raising alarm from New York to California.
In recent weeks, health officials in New York have identified the first person in nearly a decade in the United States to be diagnosed with polio. The person suffered from paralysis. Since then, the polio virus has been found in sewage not only from two counties in the region where the patient lives but also, since Friday, from New York City.
Now experts and health officials in California are expressing concern.
Los Angeles County Public Health Director Barbara Ferrer said there are discussions about tracking polio in sewage, especially in areas with low vaccination rates. That makes sense, experts said, given the high number of travelers between Los Angeles and New York and because people can be contagious with polio without showing symptoms.
“The detection of poliovirus in sewage samples in New York is alarming,” said Dr. Mary T. Bassett, New York State Commissioner of Health, said in a report. “For every paralytic polio case identified, hundreds more may go undetected.”
Health officials in New York are “treating the single case of polio as the tip of the iceberg of a much larger potential spread. As we learn more, what we know is clear: the danger of polio is present in New York City today,” Bassett said. said.
There is no cure for paralysis caused by polio, said Dr. Peter Chin-Hong, an infectious disease expert at UC San Francisco. But poliomyelitis can be prevented by vaccination, which is more than 90% effective. Babies should be given three doses; a fourth is given to children from 4 to 6 years old.
About 75% of people infected with poliomyelitis have no symptoms; others may have flu-like symptoms. It may take three to six days after exposure to the polio virus to symptoms appear. Paralysis can occur seven to 21 days after infection.
Patients are usually infected through the mouth, usually from hands contaminated with feces from an infected person, but the virus can also spread by sneezing or coughing from an infected person.
Paralysis or weakness in the arms or legs can occur in 1 in 1,000 people infected with polio, Chin-Hong said. The disease can cause paralysis because the virus can infect the spinal cord.
Between 2 and 10 out of every 100 people infected with poliomyelitis die because the virus can damage the muscles that help them breathe.
“Even children who appear to fully recover may develop new muscle pain, weakness or paralysis as adults, 15 to 40 years later,” the United States Centers for Disease Control and Prevention said. This is called post-polio syndrome.
Chin-Hong said the emergence of polio in New York is concerning enough that clinicians are familiarizing themselves with the disease.
“We are concerned because this is the first case identified in the United States in almost 10 years,” Chin-Hong said at a recent town hall.
The paralytic polio case occurred in Rockland County, a suburb just north of New York City. Rockland County is notable to have a large population of Orthodox Jews, among whom there are low vaccination rates.
Infectious disease outbreaks have hit Rockland County before. At the end of 2018, the county was the epicenter of a major measles epidemic in Orthodox Jewish communities after it was first detected in an unvaccinated teenager. Seven-month outbreak was longest in US since 2000, CDC says report.
Additionally, large outbreaks of COVID-19 have been seen in Orthodox Jewish communities in Rockland County and Brooklyn, related at low vaccination rates.
The polio patient is an unvaccinated 20-year-old man who traveled to Hungary and Poland earlier this year and was hospitalized in June, according to the Washington Post reported, citing a public health official who spoke on condition of anonymity. The New York Times reported that the patient is a member of the Orthodox Jewish community.
Genetic analysis of a sample of the patient’s polio virus indicates that it was taken from a person who had received the oral polio vaccinewhich has not been used in the United States since 2000, health officials said.
The oral vaccine contains live, weakened poliomyelitis virus. “If allowed to circulate in underimmunized or non-immune populations for long enough…the virus can revert to a form that can cause illness and paralysis in other people,” said the CDC said.
The oral polio vaccine is used in some parts of the world because it is easy to administer, given as drops.
Since 2000, the United States has used only inactivated polio vaccine, which cannot cause disease.
Following the public disclosure of the polio case, New York officials began testing sewage for signs of the virus in stool samples. This month, officials confirmed the presence of the poliomyelitis virus in Waste samples collected in June and July in Rockland County and neighboring Orange County; they said it was evidence of local polio transmission.
Wastewater samples detected in both counties were found to be genetically related in the index case of poliomyelitis.
“If you are an unvaccinated or incompletely vaccinated adult, please elect now to get vaccinated,” said Dr. Ashwin Vasan, commissioner of the New York City Department of Health and Mental Hygiene, said in a report. “Polio is completely preventable, and its reappearance should be a call to action for all of us.”
The case in New York is genetically related to polio samples identified in Israel and Britain, health officials said.
The outbreak in the Jerusalem area began after a not vaccinated According to the World Health Organization, a 3-year-old child developed paralysis in February and was later publicly revealed to have polio. The last case of poliomyelitis in Israel dates back to 1988.
Eight other children have since tested positive for polio, all asymptomatic. Of the nine children in the outbreak, eight were not fully vaccinated for their age group, according at the Israeli Ministry of Health.
According to Jerusalem Post, Israeli health officials responded to the outbreak — which occurred in Orthodox Jewish areas — with a campaign to encourage parents to catch up on vaccinations for their children. By early July, the outbreak was considered under control, with no polio virus having been found in sewage in the previous month.
In New York, Rockland and Orange counties have some of the lowest rates of childhood polio vaccination, with only about 60% of 2-year-olds having received three doses. The statewide polio vaccination rate for 2-year-olds is approximately 79%.
In New York City, approximately 86% of children between 6 months and 5 years of age received three doses. Vaccination rates are approaching 60% in some Brooklyn neighborhoods, such as Williamsburg and Bedford-Stuyvesant.
About 80% of a population needs to be vaccinated against polio to prevent the virus from spreading, Chin-Hong said.
The spread of polio could end up becoming “a phenomenon we are seeing as vaccination rates decline in communities,” Chin-Hong said.
“I’m really worried because, as we saw in 2015, vaccination rates were low in many communities,” he added, referring to the 2014-2015 measles outbreak that started at Disneyland and has spread to eight states, Canada and Mexico, transmitted mainly by unvaccinated people. “We know that the COVID-19 pandemic has fueled the largest continuous decline in vaccinations in three decades.”
A study published in October in the journal JAMA Pediatrics found that weekly pediatric vaccination rates in eight U.S. health systems were significantly lower. lower during an early phase of the COVID-19 pandemic.
“Interventions are needed to promote catch-up vaccination,” the report said.
In response to the 2014-2015 measles outbreak, California passed legislation except vaccine exemptions, including for polioamong schoolchildren based on a parent’s beliefs. Medical exemptions are allowed.
Assessing polio vaccination uptake in California is tricky, especially among adults. But available data for school-age children indicates that state coverage is robust.
For the 2019-2020 school year, 96.5% of new kindergarten students were fully vaccinated against poliomyelitis, state digits To display. This represents an increase from 92.6% in the 2013-2014 school year.
Data for more recent years are not available. The state Department of Public Health notes that “routine immunization rates in California, including for the polio vaccine, declined during the initial period of the COVID-19 pandemic.”
“As the new school year approaches, more than one in eight children in California need to catch up on routine vaccines that were missed or delayed during the pandemic,” department officials wrote in a statement to the Times. “Longstanding school vaccination requirements and other measures have helped catch up with needed vaccinations.”
As is always the case with a state as large and diverse as California, comprehensive coverage only tells part of the story. In the 2019-20 school year, fewer than 93% of new kindergarten students in 10 counties — El Dorado, Glenn, Humboldt, Kern, Mendocino, Mono, Nevada, Santa Cruz, Sutter and Trinity — were vaccinated against polio, according to state data.
In Los Angeles, polio vaccination coverage among kindergartners was about 97 percent “and has not changed significantly over time,” according to the county’s public health department. However, data from the COVID-19 years is not readily available.
Ferrer said efforts are underway in LA County to work with pediatricians “to make sure we’re reinjecting children for their routine immunizations.”
“We talk about polio today, but…due to the drop in full vaccinations for children during the pandemic, it could be one of many infectious diseases that we weren’t really worried about by the past,” the director of public health said. “So the big push right now is for us to make sure, again, that families have good information, that they have good access. “