The health minister has warned that the polio outbreak could be the “tip of the iceberg”.

New York state health officials on Thursday urged people who haven’t been vaccinated against polio to get vaccinated “immediately,” saying a single confirmed case of the disease in the state could be the “tip of the iceberg.” a much wider threat.

The emergency call came after officials said polio was detected in sewage samples taken from multiple locations and at different times in two northern New York counties, raising the possibility of community spread.

“In previous polio epidemics, New Yorkers should know that for every case of paralysis, hundreds of others may have been infected.” Dr. State Health Commissioner Mary T. Bassett said.

“With the latest findings of sewage,” Dr. Bassett added that “the department is treating the single case of polio as the tip of the iceberg.”

Polio is caused by polio, and children under 5 years of age are at high risk of contracting it, but anyone who has not been vaccinated is at risk. Polio is highly contagious and is usually spread from person to person when someone comes in contact with the feces of an infected person and then touches their mouth.

Many cases are asymptomatic, and some may cause flu-like symptoms, but the disease, known as poliomyelitis, can be crippling and even life-threatening. There is no cure.

Paralysis is a rare outcome, but before vaccines became widely available in the 1950s, polio outbreaks caused more than 15,000 cases of paralysis a year.

Last month, a case of polio — the first in the United States in nearly a decade — was identified in an unvaccinated adult in Rockland County. No cases have been reported in the United States since 1979.

State and county health officials said the infection in Rockland County came from a person who received the oral polio vaccine in 2000, which was not used in the United States.

The virus that spread in New York may have emerged outside the United States, where the oral vaccine is still in use, officials said. The oral vaccine contains an attenuated virus. It is safe, but if the virus from the vaccine spreads in the community, it can infect unvaccinated people and spread the disease.

In announcing the case, officials stressed that the infected person was no longer contagious and said their efforts would focus on increasing the number of vaccinations and finding out if anyone else had been affected.

Polio was found in Rockland County wastewater samples taken in June before the paralysis was confirmed, officials said. They said Thursday that they also found evidence of the disease in sewage samples taken in June and July from two “geographically distinct” parts of Orange County, which border Rockland.

“The findings,” the state Department of Health said in a news release, “provide further evidence of local rather than international transmission of the polio virus.”

Officials say an infected person in Rockland County was the source of polio found in sewage samples. The investigation into the origin of the virus is ongoing.

As widespread vaccination has proven to be an effective prevention strategy, areas with low vaccination rates may be at particular risk of outbreaks.

In Rockland and Orange counties, about 60 percent of 2-year-olds received all three doses of the polio vaccine, significantly lower than 80 percent of the rest of the state, except for New York City. (According to the World Health Organization, the target vaccination rate to achieve herd immunity against poliomyelitis is 80 percent.)

Most adults in the United States do not need the polio vaccine because they may have been vaccinated as children, but some may be eligible for additional vaccines if they are at high risk for the disease.

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