Child vaccination delays and general anti-vaccination sentiment amid the COVID-19 pandemic could fuel the U.S.’s worst polio scare in years, raising alarms from New York to California.
In the past few weeks, New York health officials have identified the first person diagnosed with polio in the United States in nearly a decade. The man was paralyzed. Since then, the polio virus has been found not only in the two counties where the patient lived, but also in New York as of Friday.
The virus can spread again around the world. This year, the Jerusalem area has been hit by an epidemic, and the virus appeared in London’s sewage in June.
Now health experts and officials in California are voicing their concerns.
Barbara Ferrer, director of public health for Los Angeles County, said there is ongoing discussion about surveillance for polio in sewage, particularly in areas with low vaccination rates. Experts say this makes sense given the high number of travelers between Los Angeles and New York and the risk of people being infected with polio.
“The detection of poliovirus in New York City sewage samples is alarming,” said Dr. New York State Health Commissioner Mary T. Bassett said in a statement. “For every case of paralysis diagnosed, hundreds more may go undiagnosed.”
New York health officials “view a single case of polio as the tip of the iceberg. As we learn more, what we know is clear: the threat of polio exists in New York today,” Bassett said.
Paralysis caused by polio cannot be cured, said Dr. Peter Chin-Hong, an infectious disease specialist in San Francisco. However, poliomyelitis can be prevented by vaccination, the effectiveness of which exceeds 90%. Infants should be given three doses; the fourth is given to children aged 4 to 6 years.
About 75% of polio cases have no symptoms; others may have flu-like symptoms. After exposure to the polio virus, it may take three to six days for non-paralytic symptoms to appear. Paralysis may occur 7-21 days after infection.
Patients are most commonly infected through the mouth, usually through hands contaminated with the feces of an infected person, but the virus can also be spread by sneezing or coughing.
About one in 1,000 people who get polio may develop paralysis or weakness in an arm or leg, Chin-Hong said. The disease can cause paralysis as the virus infects the spinal cord.
Between 2 and 10 of every 100 people who become paralyzed from polio die because the virus can damage the muscles that help you breathe.
The US Centers for Disease Control and Prevention says, “Even children who fully recover can develop new muscle pain, weakness, or paralysis as adults 15 to 40 years later.” This is called post-polio syndrome.
According to Chin-Hong, the occurrence of polio in New York is enough for clinicians to become familiar with the disease.
“We are concerned because this is the first case detected in the United States in almost 10 years,” Chin-Hong said recently at City Hall.
An outbreak of polio occurred in Rockland County in upstate New York. Rockland County is notable for its significant population of Orthodox Jews, among whom vaccination rates are low.
Outbreaks of infectious diseases have occurred in Rockland County before. In late 2018, the county became the epicenter of a measles outbreak in Orthodox Jewish communities after it was first detected in an unvaccinated teenager. The seven-month outbreak was the longest in the U.S. since 2000, according to the CDC report.
Additionally, Orthodox Jewish communities in Rockland County and Brooklyn have experienced large outbreaks of COVID-19 due to low vaccination rates.
A 20-year-old unvaccinated polio patient who traveled to Hungary and Poland earlier this year was hospitalized in June, The Washington Post reported, citing a public health official who spoke on condition of anonymity. The New York Times reported that the patient was a member of the Orthodox Jewish community.
Genetic analysis of a sample of the polio virus from the patient indicates it came from someone who received the polio vaccine, which has not been used in the United States since 2000, health officials said.
The oral vaccine contains live attenuated poliovirus. “If allowed to circulate long enough in low or unimmunized populations, the virus can cause illness and paralysis in other people,” the CDC says.
The oral polio vaccine is used in some parts of the world because it is given as a drop.
Since 2000, the US has used only an inactivated polio vaccine, which does not cause disease.
After the polio outbreak became public knowledge, New York City officials began testing sewage and fecal samples for signs of the virus. This month, officials confirmed the presence of the polio virus in sewage samples collected in June and July from Rockland County and neighboring Orange County; they said it was evidence of local transmission of poliomyelitis.
Sewage samples found in both counties were found to be genetically linked to polio rates.
“If you are an unvaccinated or under-vaccinated adult, choose to get vaccinated now,” says Dr. Ashwin Vasan, commissioner of the New York City Department of Health and Mental Hygiene, said. “Polio is completely preventable and its resurgence should be a call to action for all of us.”
The New York case is genetically related to polio samples identified in Israel and Britain, health officials said.
The outbreak in the Jerusalem area began in February after an unvaccinated 3-year-old became paralyzed and was later publicized as polio, according to the World Health Organization. The last case of polio in Israel was in 1988.
Eight more children have since tested positive for polio, all asymptomatic. According to the Israeli Ministry of Health, eight of the nine children affected by the epidemic were not vaccinated according to their age.
According to the Jerusalem Post, Israeli health officials have responded to the outbreak in Orthodox Jewish areas with a campaign to encourage parents to vaccinate their children. In early July, the epidemic was brought under control, and no polio virus was found in the sewage the previous month.
In New York, Rockland and Orange counties have the lowest polio vaccination rates, with only about 60% of 2-year-olds receiving three doses. The level of vaccination against poliomyelitis of 2-year-old children is 79%.
In New York City, approximately 86% of children aged 6 months to 5 years received three doses. Some neighborhoods in Brooklyn, such as Williamsburg and Bedford-Stuyvesant, have vaccination rates around 60%.
According to Chin-Hong, about 80% of the population should be vaccinated against polio.
The spread of polio could be “a phenomenon where we’re seeing declining vaccination rates in the community,” Chin-Hong said.
“I’m really concerned because, as we saw in 2015, vaccination rates are poor in many communities,” he added, referring to the 2014-15 measles outbreak that began in Disneyland and spread to eight states, Canada and Mexico. mostly by unvaccinated people. “We know that the COVID-19 pandemic has caused the biggest pushback in vaccinations in three decades.”
A study published in October in the journal JAMA Pediatrics found that weekly pediatric immunization rates in eight US health systems were significantly lower in the early stages of the COVID-19 pandemic.
“Interventions are needed to promote further vaccinations,” the report said.
In response to the 2014–15 measles outbreak, California passed a law that prohibits parental faith exemptions from school children, including polio vaccines. Medical exemptions are allowed.
Estimating California’s polio vaccination rate, particularly among adults, is difficult. However, available data for school-age children show that state coverage is strong.
State indicators show that 96.5% of kindergartens in the 2019-20 academic year were fully vaccinated against poliomyelitis. This is 92.6% more than in the 2013–14 school year.
There are no data for recent years. The state Department of Health notes that “in California, routine immunization rates, including for the polio vaccine, declined early in the COVID-19 pandemic.”
“As the new school year approaches, more than 1 in 8 children in California will need to catch up on routine vaccines that were missed or delayed during the pandemic,” department officials wrote in The Times. “School-based immunization requirements and other measures have helped to maintain the necessary immunizations.”
As with a state as large and diverse as California, overall coverage only tells part of the story. In the 2019-20 school year, 10 counties — El Dorado, Glenn, Humboldt, Kern, Mendocino, Mono, Nevada, Santa Cruz, Sutter and Trinity — had fewer than 93 percent of incoming kindergarteners vaccinated against polio, state data show.
In Los Angeles, polio vaccine coverage among kindergartners is about 97% and “has not changed significantly over time,” according to the county Health Department. However, data from the years of COVID-19 is not readily available.
Ferrer said L.A. County is working with pediatricians to make sure “we’re getting kids back on routine vaccinations.”
“We’re talking about polio today, but … because of the decline in full vaccinations for children during the pandemic, it could be one of a number of infectious diseases that we haven’t really worried about before. “, said the public health director. “So the biggest push right now is to make sure again that families have good information, access to it.”