First US polio case in nearly a decade highlights importance of vaccination

The first polio case in the United States since 2013 rocked New York state. Especially since it occurred in an area where many people were not vaccinated against the disease.

Rockland County recently announced that young adults living in the area were partially paralyzed by polio.The poliovirus has been eradicated in the United States and most countries for decades. Infected people are believed to have contracted the virus from international travelers. Three weeks after the case was announced, the New York State Department of Health said the virus had been detected in samples of New York City wastewater since May, after it was detected in samples from Rockland and nearby Orange in his counties. It said it was detected. Only 60% of people in Rockland County and 59% of people in Orange County are vaccinated against polio, but statewide nearly 80% of people are vaccinated against polio.

Ananda Banjopadhyay, deputy director for polio at the Bill & Melinda Gates Foundation, said: “It is relatively unexpected and disappointing that there are cases of paralysis from a completely preventable disease like polio. That’s it,” he said. Public health officials are particularly concerned in 2019 because of large measles outbreaks in Rockland County and other parts of New York City, home to large Orthodox Jewish communities.

Polio outbreaks can be harder to detect than measles. As with COVID, many polio cases are asymptomatic. Only one of her four people with the virus develops cold-like symptoms (likely not to suspect polio), and only 200 of her infected develop paralysis. to her alone. Scientists in London routinely monitor the city’s wastewater for pathogens and this year discovered polio in sewage. This allowed public health officials to begin a rapid response, including providing booster shots for children aged 1 to her 9. But in the United States, where most jurisdictions don’t monitor sewage extensively, cases are usually discovered only after someone is paralyzed.

terrible disease

Polio was a deadly disease until the first polio vaccine was developed in the 1950s. Anyone can be infected, but the ease with which the virus spreads meant that most people were infected as children and either became immune or paralyzed. Those infected in the 1952 pandemic had to spend weeks or decades in an ‘iron lung’, a negative pressure ventilator that allowed them to breathe. Many of those still alive today are in wheelchairs and some are still in iron lungs.

As a result of extensive vaccination and public health awareness efforts, the World Health Organization (WHO) declared the Americas polio-free in 1994. Her Kimberly Thompson, a public health expert and president of the nonprofit Kid Risk in Orlando, Florida. Since then, the wild virus has been eradicated in all countries except Afghanistan and Pakistan. “A lot of people didn’t know it still existed,” she adds.

So if today’s parents weren’t afraid of polio, they might decide it wasn’t important to vaccinate their children against polio. “For each new parent, the question is how they view it,” says Thompson. “But the choices people make for their children are lifelong unless they get vaccinated in adulthood.”

Even polio-free countries need to recognize that they are not without risk, says Bandyopadhyay. “We’ve known for a long time that a virus like polio, as long as it’s in one corner of the world, is essentially just a flight away,” he says.

The unusual properties of the oral polio vaccine (OPV) pose an additional threat. If you were born in the United States after 2000, you are likely to have received the injectable inactivated polio vaccine (IPV). Prior to that year, however, his OPV containing a weakened version of the virus was in use. People who receive this vaccine excrete the weakened virus in their feces for several weeks. This means that other people who come in contact with it may be inoculated as well. Therefore, almost everyone born before 2000 has immunity to the virus.

However, that secondary exposure has a dark side. In very rare cases, a weakened virus can reactivate and infect vaccinated or unvaccinated people around them. This is what happened in New York State. Such ‘vaccine-derived’ cases account for all modern polio cases in polio-free countries.

With approximately 1,000 polio cases worldwide each year in 2000, this risk has led the United States to switch exclusively to IPV, which cannot be reactivated. However, IPV does not spread to others, so unimmunized people in countries with IPV have no immunity at all. Nevertheless, people who receive this injectable vaccine can acquire, carry and spread the polio virus to others, even though they have no symptoms.

OPVs are still used around the world today because they are easy to store and manage. The WHO has encouraged countries to switch from this oral vaccine since 2016.

This effort has somewhat backfired, as many countries have been slow to deploy IPV and continue to use OPV or never vaccinate. Thompson says that when most people in a community are vaccinated, vaccine-borne polio cases are very rare. Poliovirus in vaccines can revert to a relatively normal virus and spread in the same way.

As a result, since 2016, the world has seen almost 2,500 more cases of vaccine-derived polio than public health experts had expected. And in 2020, the WHO granted emergency authorization to a new oral polio vaccine (nOPV2) that does not reactivate because it is more resistant to mutations. received the new vaccine.

However, polio is unlikely to be completely eradicated anytime soon. The plunge in child immunization rates resulting from the COVID pandemic has not solved the problem. For example, in 2021, tens of millions of children around the world did not receive routine immunizations against diseases such as polio and measles. In July, WHO officials said these diseases could become more widespread if these trends continue.

Large numbers of children may also be affected in under-vaccinated communities, such as the New York area, which has a large Orthodox Jewish population. Public health officials in New York have launched vaccination campaigns aimed at reaching these communities, including bulletins in Yiddish.

Brima Marcus, an Orthodox Jewish nurse in Brooklyn, New York, says nothing in Orthodox Jewish law or tradition prohibits vaccination. The reason for low vaccination rates, she said, is that anti-vaccine activists tend to target close-knit communities where their message spreads with little trouble. came down to Rockland County in an attempt to counter the public health message of vaccination. “We have a group of passionate and fierce anti-vaccine activists who put all their energy and passion behind their cause. The rest of us are just doing their jobs, so silence is waiting for us,” says Marcus.

In the absence of counterarguments, activist messages containing the discredited idea that vaccines cause autism tend to spread quickly among concerned parents. “People want to do the right thing. It’s a community [of people that are] We are very dependent on each other,” says Marcus. “These pockets of deep mistrust and misinformation are much wider because of these close social ties.” Rumors circulate in her community that the person who did, in fact, did not have polio and was paralyzed for other reasons.

But Aaron Gratt, an infectious disease doctor at Mount Sinai South Nassau, Long Island, who is also a rabbi, said polio cases may wake people up 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] they were afraid of it. I hope I never have to go back to that level of sickness. ”