Is polio recurring?

COVID-19. Monkeypox. And now the resurgence of polio. It may seem as if the beginning of a new disease outbreak lurks at every turn. With the discovery of polio, many Americans may be wondering whether we should prepare for the spread of yet another deadly virus.

Howard Forman, MD, Professor of Radiology and Biomedical Imaging, and Public Health (Health Policy), Management, and Economics, with a passion for teaching others about public health, especially regarding vaccines and preventable viral diseases is pouring His inspiration came from his sister, a survivor of congenital rubella syndrome, who was permanently deaf due to the disease. He spoke with Forman about the latest polio outbreak and its impact on public health in the United States.

First, what is polio?

Polio is an enterovirus and is transmitted through what we call the fecal-oral route. About a quarter of people infected with the polio virus develop mild, flu-like symptoms such as fever, gastroenteritis, upset stomach and pain. Because these symptoms are common with many other infections, most people do not know they have polio.

Approximately 1 in 200 to 1 in 1000 people infected with the polio virus will develop polio. Also known as paralytic polio or acute flaccid paralysis, it can present with mild and severe symptoms, such as late post-polio syndrome. Mild disability or acute respiratory failure and death.

Polio has been a concern for decades in the United States. But now it’s making headlines after a New York man was hospitalized with the virus.

I think part of the problem now is that the majority of the population has no memory of polio. You know how it feels to see someone in the hospital for months, on a ventilator or an iron lung. But if you’re under 70, you don’t have these memories. So it’s becoming easier for people to say, “Why do we need the polio vaccine?”

The New York patient may have been in contact with someone who contracted the vaccine-derived poliovirus and was completely asymptomatic. I’m guessing someone, perhaps from Europe, came to visit him. Because I think the poliovirus outbreaks we’re seeing in the Rockland, Orange, and Greater New York areas are of the same genotype as the cases we’re seeing — or at least around London and Jerusalem. Sewage seen. Therefore, he may have been in contact with a person in either of those two regions and become infected. And he got polio because he wasn’t vaccinated and out of luck. If he is vaccinated, he is unlikely to get paralytic polio.

What is vaccine-derived poliovirus? How is it different from wild-type poliovirus?

Vaccine-derived poliovirus has only been identified in the United States. Wild polio is still present only in Pakistan, Afghanistan, Mozambique and Malawi. There are two widely used vaccines that target polio.inactivated poliovirus [injected] Vaccines used in the United States are highly effective. 4 shots required. However, it is also expensive and can only be managed by a medical professional.

A second vaccine, the oral attenuated poliovirus vaccine, has several advantages. The biggest is that it is cheap and can be managed by almost anyone. The term attenuated means that the virus is attenuated and non-virulent. It does not cause disease, but it is a live virus. It is contagious after receiving the oral poliovirus vaccine. Most importantly, the gastrointestinal tract responds by producing specific antibodies. This means that I am relatively protected from contracting or spreading viruses in the future. It also means that I am excreting it, causing other individuals to be exposed. There is good evidence that oral vaccines confers immunity in people who are not actively vaccinated.

The biggest drawback is that one in a million or a little more vaccinated with the oral poliovirus vaccine will get paralytic polio. With the development of a safer vaccine in the United States, it began moving away from vaccines in 1997 and by 2000 had stopped using them entirely, using only inactivated poliovirus vaccines. Another side effect is that a weakened virus can mutate as it spreads and regain virulence as it mutates. Eventually, it can cause paralytic polio again. This is not a problem if you are vaccinated. The problem arises when there are areas with insufficient vaccination. We now know that there are many under-vaccinated regions, not only in the United States, but also in parts of Africa, Asia and Europe.

Scientists then discovered the virus in New York’s sewers. Should we prepare for yet another outbreak?

We probably don’t expect to see many cases of paralytic polio. If unvaccinated he has 10,000 people and eventually he has 8,000 infected, within that group he could have 8 cases of paralytic polio. And we will probably get most of them vaccinated during the pandemic.

But in contrast to COVID, the problem with paralytic polio is that all cases are avoidable. Unlike with COVID, even with the vaccine, some people are expected to be hospitalized or die. This is a situation where if you are vaccinated against polio, you will not get polio.

Are healthcare providers ready to accept the following cases?

Paralytic polio hasn’t been seen in this long, so doctors aren’t necessarily watching it. There is something called childhood acute flaccid myelitis. This is a very serious condition that occurs in infants. Over the past decade or so, this has been much more common than polio, and there are some similar overlapping symptoms. That’s why we warn doctors to consider polio if they’re considering acute flaccid myelitis, and vice versa.

Global efforts have greatly reduced the polio epidemic, but why is eradication so difficult?

All it takes is one unvaccinated individual pocket and one infected traveler from another part of the world. Travelers can step into this pocket, and there’s a ricochet effect from it as the infection begins to spread like wildfire. And New York has under-immunized communities.

What should the US do to contain these outbreaks?

The most important thing is a communication effort for everyone. In particular, start with areas where outbreaks are known to occur, such as New York City, Orange County, and Rockland County. We need to make people aware that our immunization efforts will only succeed if they are sustained. With the exception of smallpox, all of our immunization efforts are underway and are meant to prevent exactly these situations. Convincing parents to vaccinate is much easier for us. When you stop seeing bad results, it’s easy to get complacent and think, “Why would I want to pollute my child’s body with foreign chemicals?” Prior to the COVID pandemic, there was a great deal of misinformation deterring people from vaccination efforts.

What measures can I take to protect myself from infection?

It is helpful to remember that if you can find your vaccination record and confirm that you have been vaccinated, there is nothing wrong with verifying it. If you have questions about it, talk to your family doctor. If you are in an endemic area and have no idea about the vaccination status, we may recommend that you get vaccinated. Polio is not a rare vaccination for people. In fact, this is he one of the most common when it comes to compliance.

Anything else I should know?

I think there are a lot of nuances when it comes to vaccine-derived poliovirus. But first of all, the US no longer uses that vaccine. Not for over 22 years. Second, this is a collective health issue, not an individual issue. No one currently infected with polio in the United States has been infected with the vaccine. They are getting it from infected individuals.