- Man who’s lived in an iron lung for more than 70 years after being struck down by polio shared video of what h Daily Mail
- Polio Paul: Meet the man who survived 70 years inside iron lung — a neck-to-toe metal respirator Geo News
- How a man afflicted with polio has survived in an iron lung for 70 years Firstpost
- Man Known as ‘Polio Paul’ Survives 70 Years in an Iron Lung Despite Being Paralyzed From the Neck Down The Messenger
- Guinness World Record: Meet Paul Alexander, sole polio patient who survived seven decades inside an iron lung News9 LIVE
- View Full Coverage on Google News
Tag Archives: polio
Decreasing rates of childhood immunization are a major concern. Our medical analyst explains why
CNN
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Vaccine rates for measles, polio, diphtheria and other diseases are decreasing among US children, according to a new study from the US Centers for Disease Control and Prevention.
The rate of immunizations for required vaccines among kindergarten students declined from 95% to approximately 94% during the 2020-21 school year. It dropped further — to 93% — in the 2021-22 school year.
That’s still a high number, so why is this drop in immunization significant? What accounts for the decline? What might be the consequences if these numbers drop further? If parents are unsure about vaccinating their kids, what should they do? And what can be done on a policy level to increase immunization numbers?
To help us with these questions, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician, public health expert and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also author of “Lifelines: A Doctor’s Journey in the Fight for Public Health.”
CNN: Why is it a problem that childhood immunization rates are declining?
Dr. Leana Wen: The reduction of vaccine-preventable diseases is one of the greatest public health success stories in the last 100 years.
The polio vaccine was introduced in the United States in 1955, for example. In the four years prior, there were an average of over 16,000 cases of paralytic polio and nearly 2,000 deaths from polio each year across the US. Widespread use of the polio vaccine had led to the eradication of polio in the country by 1979, according to the CDC, sparing thousands of deaths and lifelong disability among children each year.
The measles vaccine was licensed in the US in 1963. In the four years before that, there were an average of over 500,000 cases and over 430 measles-associated deaths each year. By 1998, there were just 89 cases recorded — and no measles-associated deaths.
These vaccines are very safe and extremely effective. The polio vaccine, for example, is over 99% effective at preventing paralytic polio. The measles vaccine is 97% effective at preventing infection.
We can do this same analysis for other diseases for which there are routine childhood immunizations.
It’s very concerning that rates of immunization are declining for vaccines that have long been used to prevent disease and reduce death. That means more children are at risk for severe illness — illness that could be averted if they were immunized. Moreover, if the proportion of unvaccinated individuals increases in a community, this also puts others at risk. That includes babies too young to be vaccinated or people for whom the vaccines don’t protect as well — for example, patients on chemotherapy for cancer.
CNN: What accounts for the decline in vaccination numbers?
Wen: There are probably many factors. First, there has been substantial disruption to the US health care system during the Covid-19 pandemic. Many children missed routine visits to the pediatrician during which they would have received vaccines due to pandemic restrictions. In addition, some community health services offered also became disrupted as local health departments focused on Covid-19 services.
Second, disruption to schooling has also played a role. Vaccination requirements are often checked prior to the start of the school year. When schools stopped in-person instruction, that led to some families falling behind on their immunizations.
Third, misinformation and disinformation around Covid-19 vaccines may have seeded doubt in other vaccines. Vaccine hesitancy and misinformation were already major public health concerns before the coronavirus emerged, but the pandemic has exacerbated the issues.
According to a December survey published by the Kaiser Family Foundation, more than one in three American parents said vaccinating children against measles, mumps, and rubella shouldn’t be a requirement for them to attend public schools, even if that may create health risks for others. This was a substantial increase from 2019, when a similar poll from the Pew Research Center found only 23% of parents opposed school vaccine requirements.
CNN: What are some consequences if immunization rates drop further?
Wen: If immunization rates drop further, we could see more widespread outbreaks. Diseases that were virtually eliminated in the US could reemerge, and more people can become severely ill and suffer lasting consequences or even die.
We are already seeing some consequences: Last summer, there was a confirmed case of paralytic polio in an unvaccinated adult in New York. It’s devastating that a disease like polio has been identified again in the US, since we have an extremely effective vaccine to prevent it.
There is an active measles outbreak in Ohio. As of January 17, 85 cases have been reported. Most of the cases involved unvaccinated children, and at least 34 have been hospitalized.
CNN: If parents are unsure of vaccinating their kids, what should they do?
Wen: As parents, we generally trust pediatricians with our children’s health. We consult pediatricians if our kids are diagnosed with asthma and diabetes, or if they have new worrisome symptoms of another illness. We should also consult our pediatricians about childhood immunizations; parents and caregivers with specific questions or concerns should address them.
The national association of pediatricians, the American Academy of Pediatrics, “strongly recommends on-time routine immunization of all children and adolescents according to the Recommended Immunization Schedules for Children and Adolescents.”
CNN: What can be done to increase immunization numbers?
Wen: There needs to be a concerted educational campaign to address why vaccination against measles, mumps, rubella, chickenpox, polio and so forth is so crucial. One of the reasons for vaccine hesitancy, in my experience, is that these diseases have been rarely seen in recent years. Many people who are parents now didn’t experience the devastation of these diseases growing up, so may not realize how terrible it would be for them to return.
Specific interventions should be targeted at the community level. In some places, low immunization levels may be due to access. Vaccination drives at schools, parks, shopping centers, and other places where families gather can help increase numbers. In other places, the low uptake may be because of vaccine hesitancy and misinformation. There will need to be different strategies implemented in that situation.
Overall, increasing immunization rates for vaccine-preventable childhood diseases needs to be a national imperative. I can’t underscore how tragic it would be for kids to suffer the harms of diseases that could be entirely prevented with safe, effective and readily available vaccines that have been routinely given for decades.
CDC expands wastewater testing for polio to Michigan and Pennsylvania
Wastewater testing will occur in places with low polio vaccination coverage as well as counties with possible connections to the at-risk New York communities linked to the Rockland case of paralytic polio. Logistics for the testing are being worked out between federal and state officials, but once it is underway, testing will last at least four months.
The Michigan and Philadelphia health departments are working with the CDC to identify communities that are under-vaccinated for poliovirus and have wastewater sampling locations. Other state and local health departments are also talking to the CDC about potential wastewater testing.
Polio — once one of the most feared diseases in the United States, with annual outbreaks causing thousands of cases of paralysis — was considered to be eliminated in 1979 after widespread vaccination halted routine U.S. spread. But the virus has been brought into the country by travelers.
Evidence of expanding community spread has landed the United States on a list of more than 30 countries with active circulation of a type of polio known as vaccine-derived poliovirus.
One case of paralytic polio potentially indicates that there may be hundreds of other cases, most of whom experience only mild illness. Polio paralyzes about 1 of every 200 people who contract the virus. There is no treatment other than supportive care; once someone catches polio, it is too late to prevent dire complications of the virus.
Despite the renewed threat, a survey released Wednesday by the Annenberg Public Policy Center found that a sizable portion of Americans is unfamiliar with the risks of polio. Only one-third of U.S. adults know there is no cure for polio, and over 1 in 5 don’t know whether they’ve been vaccinated against polio.
Strains of polio virus can be shed in people’s stool without symptoms, putting unvaccinated people at risk. Finding the virus in sewage or wastewater indicates that someone in the community is shedding the virus. But wastewater data cannot be used to determine or identify who is infected or how many people or households are affected.
If the virus is detected, the CDC’s polio lab will conduct genetic sequencing to pinpoint the specific strain. The CDC is also working with state and local officials to make sure they have “the boots on the ground” to implement vaccination and education campaigns, said José R. Romero, director the CDC’s National Center for Immunization and Respiratory Diseases.
“When will we know that we’re out of the woods? When we get our vaccine rates at the national level — 93 or 94 percent — to have herd immunity in the community,” Romero said, referring to when enough individuals have been vaccinated so their collective immunity prevents the virus from circulating in that population.
In the United States, most people were vaccinated during childhood so the risk to the public is low, officials have said. Modern sewage and wastewater systems are separate from access to clean drinking water, which helps prevent viruses like polio from spreading.
But when the virus is found in communities with low vaccination rates, it can spread among unvaccinated people, putting them at risk for becoming infected and developing polio.
“Wastewater testing can be an important tool to help us understand if poliovirus may be circulating in communities in certain circumstances,” Romero said. “Vaccination remains the best way to prevent another case of paralytic polio, and it is critically important that people get vaccinated to protect themselves, their families and their communities against this devastating disease.”
There are two types of polio vaccines. The United States and many other countries use shots made with an inactivated version of the virus. But some countries where polio has been more of a recent threat use a weakened live virus that is given to children as drops in the mouth. Even though the oral vaccine is easier to administer and may give longer-lasting immunity, it has a key disadvantage: It can lead to vaccine-derived polio, a strain of which was identified in the unvaccinated Rockland County patient. Oral polio vaccine has not been used or licensed in the United States since 2000 because of that risk.
Michigan’s Oakland County, the state’s second-most populous county and part of the Detroit metropolitan area, is the state’s first location for the wastewater polio surveillance because of its low vaccination rates and because vaccine-preventable outbreaks have occurred in the past, said Joe Coyle, director of the Bureau of Infectious Disease Prevention at Michigan’s Department of Health and Human Services.
A 2019 measles outbreak in Oakland County that was started by a visitor from New York “certainly shows there’s vaccine-preventable risk in the population,” Coyle said.
In the 2019 measles outbreak, a Brooklyn man who did not know he was infected with the highly contagious respiratory virus spread it to 39 people as he stayed in private homes, attended synagogue and shopped in kosher markets. The outbreak began in ultra-Orthodox Jewish communities in the New York City region that have traditionally had low vaccination rates and have been a source of anti-vaccine misinformation. The Rockland County man diagnosed with paralytic polio in July lives in a community that was an epicenter of the 2019 measles outbreak.
Although most Americans are protected against polio if they have been fully vaccinated, declining childhood vaccination rates in some pockets of the country and the increase in parents seeking childhood immunization waivers for school entry raises the risk for more vaccine-preventable diseases, Coyle said.
Just under 80 percent of children in Oakland County have received three doses of the polio vaccine by the time they were 19 months old. A total of four shots are required for full immunity. The CDC recommends children get their first polio vaccine at two months, with follow-up shots at four months, between six and 18 months, and between ages 4 and 6.
In a few neighborhoods in South Philadelphia, fewer than 60 percent of children under 5 had received four doses of the vaccine, according to the health department.
Only about 60 percent of 2-year-olds in Rockland County have received their first three shots, according to health department data. In some communities in Rockland County, the vaccination rate is lower than 40 percent.
“Since poliovirus is excreted in stool, monitoring wastewater can potentially find chains of transmission earlier, allowing actions to be taken to break the chains before anyone is paralyzed,” said Walter Orenstein, the associate director of Emory University’s Vaccine Center.
Wastewater surveillance has been critical in finding vaccine-derived polioviruses in the United Kingdom and Israel before any paralytic cases have been detected, Orenstein said.
CDC wants to change ‘antiquated’ rules that hamper agency’s ability to fight Covid, polio and other diseases
CNN
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This summer, when the shocking news emerged that there was a case of polio in New York, the US Centers for Disease Control and Prevention immediately turned to Shoshana Bernstein.
The agency urgently needed to increase polio vaccination rates in Rockland County, New York. And while Bernstein is neither a doctor nor a public health official, she is exactly what the CDC was looking for: a local vaccine educator who’s part of the Orthodox Jewish community, one of several groups that has a low vaccination rate.
Over the next few months, Bernstein spent hours and hours in meetings with CDC officials, including agency Director Dr. Rochelle Walensky, and then more time preparing presentations on education campaign ideas.
She wasn’t paid a penny for her time.
“If I won the lottery, I’d do this for free because I have a passion for public health,” Bernstein said. “But I can’t. I had to put other projects on hold to do pro bono work for the CDC. I have a family with bills to pay. I had to tell them, ‘I can’t keep doing this if you don’t pay me.’ ”
It’s an old problem for the CDC: Despite having a multibillion-dollar budget, the agency doesn’t have authority from Congress to hire consultants in a timely way when an urgent situation arises.
Walensky plans to appeal to Congress to allow for flexibility to do this kind of hiring in a crisis, similar to the authority vested in some other federal agencies.
“I want to be very clear that [we] are not asking for a blank-slate ability to release resources. What we’re saying is, in certain situations, we need to be nimble and act urgently in culturally sensitive ways that we don’t currently have the capacity to do,” Walensky said.
She told CNN that the agency’s “inability to move quickly and nimbly when necessary” has been “frustrating.”
“We don’t have the ability in even urgent or emergent times to say ‘we need to move quickly here,’ ” Walensky said. “We need to provide resources to people who can actually do the work [to] quickly get that message out.”
Dr. Tom Frieden, the CDC director from 2009 to 2017, said he feels Walensky’s pain. He experienced the same inflexibility during the Ebola outbreak in 2014.
“If we want CDC to get better at fighting diseases, we need to stop tying their hands behind their back,” he said. “This is the kind of torment of working within the government system.”
Their names are Duvi and Rochel, and they could be the key to stopping polio in its tracks in the US.
Over the years, some members of the Orthodox Jewish community have fallen prey to well-orchestrated campaigns of vaccine lies. To counter that, Bernstein is working on several projects, including an animated video with brother and sister Duvi and Rochel and a vaccine hero named Super V.
The characters sprinkle their conversations with Yiddish expressions. Duvi wears a yarmulke, or head covering, and Rochel wears a long-sleeved dress, clothing typical for their community. Singing to the tune of a popular Jewish song, Duvi gives thanks to “Hashem” – or God – for vaccines.
The project is funded by the New Jersey Department of Health, and Bernstein proposed to the CDC that versions of the cartoon could be made for other communities. She also told the CDC about a publication she wrote called “Tzim Gezint” – “To Your Health” – which helped increase awareness of the measles vaccine during an outbreak of the virus in 2018.
Walensky said the CDC liked Bernstein’s ideas but couldn’t pay her.
“Shoshana is somebody who is known to CDC for her work in this exact same community several years ago with measles and her extraordinary work in being able to successfully reach this community,” Walensky said. “One of the things that’s frustrating from my perspective [is] that we don’t have the capacity to be able to finance her or to be able to provide her resources.”
This financial inflexibility was also apparent during the Covid-19 pandemic, when the CDC wanted to develop culturally specific vaccine education programs for communities with low vaccination rates.
A senior CDC official called it an “antiquated” system that “has not evolved over time.” The official spoke on the on the condition of anonymity so she could speak freely on the matter.
The CDC is preparing a presentation to urge Congress it to fix this, Walensky said.
She said she hopes to “move the needle” by using “real-time examples of how public health has been hurt because of our inability to take action” during the pandemic.
One main argument to Congress will be that other federal agencies have the authority to contract with outsiders during emergency situations, according to the anonymous CDC senior official.
Spokespeople for the Federal Emergency Management Agency (FEMA) and the US Agency for International Development (USAID) tell CNN that their agencies can make certain types of contractual arrangements with outside organizations.
The CDC will be asking Congress for flexibility for several kinds of financial arrangements, Walensky said.
For example, during the Ebola outbreak in 2014, the agency tried to encourage people in West Africa to remain at Ebola treatment units, but it proved difficult, the anonymous senior official said.
“You want to be able to [arrange for food] for these families and these children so that they can stay in the confines of the [treatment units] and don’t wander off when they just need a meal,” the official said.
“The lack of flexibility to be able to help on the ground is just so difficult. … It’s heart-wrenching.”
CDC staffers in West Africa faced financial inflexibility for even the simplest of things, such as printing out Ebola educational materials, the anonymous official added.
“I think people would be surprised to know how hard it is to get anything done,” she said.
Ed Hunter believes it.
Hunter retired from the CDC in 2015 after 40 years at the agency. His last position was legislative director in the agency’s Washington office.
He said every CDC director he worked with experienced “the same story: that there’s such limits to what you can do [given] the specificity of the appropriations that come from the Congress and the timelines and the complexity of the federal procurement system.”
“This is something that has been a front and center issue at the CDC for years and a real challenge to solve,” he said.
Walensky said she hopes things will turn out differently this time.
“We’re not asking for money. We’re asking for capacity. We’re asking for authorities to be able to do our job,” she said. “[But] I don’t know if I will be more successful than my predecessors.”
CDC Urges Vaccines as Virus Spreads – NBC New York
About 8% of wastewater samples tested in a 13-county area around New York City in recent months came back positive for polio, the CDC said Friday, indicating sustained community transmission of the virus in the region.
The testing follows the discovery of a case of paralytic polio in an unvaccinated Rockland County man this summer. Thus far, he is the only known case – but the data published Friday make clear the virus has spread widely.
Between March 9 and October 11, researchers collected 1,076 wastewater samples from 48 sites covering 13 counties in the region. Of those, 89 samples, or 8.3% of the total, tested positive for poliovirus type 2.
“Although most persons in the United States are sufficiently immunized, unvaccinated or undervaccinated persons living or working in Kings, Orange, Queens, Rockland, or Sullivan counties, New York should complete the polio vaccination series as soon as possible,” the researchers wrote.
Of the 89 positive samples, 82 were genetically linked to the Rockland County man’s infection, and 80 of those 82 were found in Rockland, Sullivan and Orange counties.
A total of seven positive samples were found from sites serving the New York City area.
“Wastewater testing in conjunction with high-quality AFM (acute flaccid myelitis) surveillance, has helped clarify the scope of the polio outbreak in New York, which indicates community transmission in a five-county area near the only identified symptomatic patient,” the CDC wrote.
Its researchers stress anyone living in Kings, Orange, Queens, Rockland or Sullivan counties complete their vaccination series against the polio virus as soon as possible.
Last week, the CDC said it was considering using an oral polio vaccine for the first time in two decades in an effort to stop a potential outbreak.
CDC is discussing using oral polio vaccine for first time in 20 years
The Centers for Disease Control and Prevention is considering using the oral polio vaccine for the first time in more than 20 years to stop an outbreak in the greater New York City metropolitan area that left an adult paralyzed over the summer.
“We are in discussions with our New York State and New York City colleagues about the use of nOPV,” said Dr. Janell Routh, the CDC’s team leader for domestic polio, referring to the novel oral polio vaccine.
“It will be a process. It’s not something that we can pull the trigger on and have it appear overnight,” Routh told CNBC on Friday. “There will be lots of thought and discussion about the reintroduction of an oral polio vaccine into the United States,” she said.
The New York State Department of Health, in a statement, said it is collaborating with the CDC on potential future options to respond to the outbreak.
U.S. drug regulators pulled the oral vaccine off shelves in 2000 because it contains a live — but weakened — strain of the virus that can, in rare circumstances, mutate into a virulent form that is contagious and potentially paralyze people who are not vaccinated.
Scientists believe this latest outbreak was caused by someone who was vaccinated with the live virus overseas and started a chain of transmission that eventually found its way to the U.S. Sewage samples in New York are linked to earlier samples in London and Jerusalem. It’s unclear where the transmission began originally.
While the oral vaccine doesn’t normally cause polio that paralyzes people, this one did because it was able to mutate into more virulent strains while spreading among people who weren’t vaccinated.
The U.S. currently uses the inactivated polio vaccine which is administered as a shot and contains chemically killed virus that cannot replicate, mutate or cause disease. While New York state health officials have launched an immunization drive with the inactivated polio shots, that vaccine hasn’t stopped this outbreak.
The CDC has set up a work group within its committee of independent vaccine advisors to develop criteria for when the novel oral polio vaccine might need to be used to stop the current outbreak in the New York City area and potential future ones. The work group met publicly for the first time on Wednesday and includes experts from New York.
“Since this outbreak occurred in New York, it was determined that we need to revisit polio. It’s really that simple,” said Dr. Oliver Brooks, the workgroup chairperson and chief medical officer at Watts Healthcare in Los Angeles.
The problem is that although the inactivated vaccine is highly effective at preventing paralysis, it does not stop transmission of the virus. The oral polio vaccine is much more effective at stopping transmission of the virus and is normally used to quash outbreaks.
The poliovirus strain currently circulating in the New York City metro area mutated from and is genetically linked to the Sabin Type 2 strain used in an older version of the oral polio vaccine.
The U.S., if needed, would use the novel oral polio vaccine which is a safer and newer version that is more stable and carries a much lower risk of mutating into a virus strain that can spread and cause disease in people who are unvaccinated, according to Routh.
The novel oral polio vaccine was developed to stop poliovirus outbreaks caused by the less stable older version of the vaccine, according to the Global Polio Eradication Initiative. More than 450 million doses have been administered in 21 countries around the world.
Any decision to use the novel oral polio vaccine would require either an approval or emergency use authorization from the Food and Drug Administration. CNBC has reached out to FDA for comment.
Routh, during the CDC advisors’ meeting Wednesday, said the goal of the public health response is to prevent further cases of paralysis, but also to eliminate circulation of the virus in wastewater.
“As long as we have wastewater detections of this circulating virus linked back to the case patient’s virus, we know there is ongoing transmission in the community even without paralysis,” Routh said.
The World Health Organization recommends that countries using the inactivated vaccine, such as the U.S., consider deploying the novel oral polio vaccine if the inactivated shots don’t stop the outbreak.
“If we start to see this virus break out of its current geography and population, I think then we need to start thinking about other methods,” Routh said during Wednesday’s meeting.
An unvaccinated adult in Rockland County, New York was paralyzed in June after contracting poliovirus. It was the first known U.S. case in nearly a decade and the first in New York since 1990. There have been no further cases of paralysis so far, though New York state health officials have warned that unvaccinated people are at serious risk and should get up to date on their shots immediately.
The CDC considers a single case of paralytic polio a public health emergency. Most people who catch poliovirus do not show symptoms, so when someone is paralyzed it’s an indication that the virus has been spreading widely and silently.
The New York State Department of Health has detected poliovirus in sewage dating back to April and as recently as September in several counties in the New York City area. The virus has been detected in 70 sewage samples across Rockland, Sullivan, Orange, Nassau, Kings and Queens counties.
The U.S. was declared polio free in 1979.
New York Gov. Kathy Hochul declared a state of emergency in September and Health Commissioner Dr. Mary Bassett declared the spread of poliovirus an imminent threat to public health.
Gates Foundation contributes $1.2 billion to the fight to eradicate polio worldwide
The Bill & Melinda Gates Foundation announced $1.2 billion on Sunday for efforts to eradicate polio worldwide.
Polio was paralyzing tens of thousands of children a year in dozens of countries around the world just a few decades ago, but the virus is now only endemic in Pakistan and Afghanistan.
Part of the success in eradicating the virus is due to the nearly $5 billion that the Gates Foundation has contributed to the Global Polio Eradication Initiative.
This 1964 microscope image made available by the U.S. Centers for Disease Control and Prevention shows damage from the polio virus to human spinal cord tissue.
(Dr. Karp/Emory University/CDC via AP)
“Polio eradication is within reach. But as far as we have come, the disease remains a threat. Working together, the world can end this disease,” Bill Gates said in a statement.
NY POLIO FEARS ON THE RISE WITH POSSIBLE ‘COMMUNITY SPREAD’ OF THE DANGEROUS VIRUS
Despite the success in fighting the virus, samples of the poliovirus have been detected in wastewater this year, in New York. A 20-year-old Rockland County man became paralyzed after contracting the virus this summer.
New York Gov. Kathy Hochul declared a state of emergency last month, urging residents to get vaccinated.
A research assistant prepares a PCR reaction for polio at a lab at Queens College on August 25, 2022, in New York City.
(ANGELA WEISS/AFP via Getty Images)
Polio was also detected in wastewater in London earlier this year.
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The Global Polio Eradication Initiative will require $4.8 billion in funding through 2026 with the goal of vaccinating 370 million children.
“The fight against polio has done far more than protect children against polio. It has played a key role in strengthening health systems,” Melinda French Gates said in a statement.
More polio detected in New York City wastewater, data shows
More evidence of polio has been detected in New York City wastewater, according to the state Department of Health.
So far, only one case of polio has been identified, in a previously healthy 20-year-old man from Rockland County who developed paralysis in his legs, local officials said.
As of Oct. 7, 70 wastewater samples have detected, including 63 samples genetically linked to the Rockland County patient, according to health department data.
Of the 63 samples, 37 were collected in Rockland County, 16 in Orange County, eight in Sullivan County, one in Nassau County, and one in New York City from Brooklyn “and a small, adjacent part of Queens County.”
The New York City sample was collected in August, the health department said.
A polio vaccine box is displayed at a health clinic in Brooklyn, New York on August 17, 2022.
Ed Jones/AFP via Getty Images
State health officials said most adults do not need the polio vaccine or a booster because they were already fully vaccinated as children.
However, they have stressed the importance of getting vaccinated against or staying up to date with the immunization schedule. Among unvaccinated people, polio can lead to permanent paralysis in the arms and/or legs and even death.
“These findings put an alarming exclamation point on what we have already observed: unvaccinated people are at a real and unnecessary risk” State Health Commissioner Dr. Mary T. Bassett and City Health Commissioner Dr. Ashwin Vasan said in a joint statement. “We have seen more New Yorkers getting vaccinated.”
The statement continued, “But these latest results are a searing reminder that there is no time to waste, especially for young children, who must be brought up to date with vaccinations right away. Paralysis changes life forever. Fortunately, the response is simple: get vaccinated against polio.”
According to the Centers for Disease Control and Prevention, the polio vaccine protects 99% of children who get all recommended doses from severe disease from poliovirus.
The NYSDOH said between July 21 — when the case of polio was announced — and Oct. 2, more than 28,000 polio vaccine doses have been administered to children aged 18 and younger, in Nassau, Orange, Rockland and Sullivan counties.
New York Gov. Kathy Hochul extended the state of emergency declared in response to the polio case and said it will remain until at least Nov. 8 as health officials continue to try and boost polio vaccination rates.
How polio silently spread in New York and left a person paralyzed
A research assistant prepares a PCR reaction for polio at a lab at Queens College on August 25, 2022, in New York City.
Angela Weiss | AFP | Getty Images
When a young adult in a New York City suburb visited an emergency department in June after experiencing weakness in their lower legs, the shocking diagnosis would lead local officials to declare a health emergency in New York and put authorities across the U.S. and around the world on a state of alert.
The individual, a resident of Rockland County, had suffered from a fever, a stiff neck, back and abdominal pain as well constipation for five days. The patient was hospitalized and tested for enterovirus, a family of pathogens that in rare cases can cause weakness in the arms and legs.
New York state’s Wadsworth Center and the Centers for Disease Control and Prevention would subsequently confirm the worst: The young adult was suffering from paralysis after contracting polio, the first known U.S. case in nearly a decade and the first in New York since 1990.
The patient was unvaccinated.
“I was very surprised. I never thought I’d see a case of polio in the United States, certainly not in Rockland County,” said Dr. Patricia Schnabel Ruppert, the county health commissioner. The CDC considers a single case of paralytic polio a public health emergency in the U.S.
Polio is a devastating, incurable disease that once struck fear into parents’ hearts every summer when transmission peaked, threatening children with paralysis. But the virus has faded from U.S. public consciousness over the decades after a successful vaccination campaign crushed transmission in the 1960s.
In the late 1940s, more than 35,000 people were paralyzed from polio in the U.S. every year, according to the CDC. But the advent of an effective vaccine in 1955 dramatically reduced the spread of the disease to less than 100 cases annually by the 1960s.
The virus had been eliminated from the U.S. by 1979, though sporadic cases that originated abroad have been identified over the years.
Digitally generated image of 3D molecular model of polio virus
Calysta Images | Tetra Images | Getty Images
How polio remerged in New York this year remains the subject of investigation, but public health officials believe the virus originated overseas in a country that still uses the oral polio vaccine. American health officials stopped using the oral vaccine more than 20 years ago because it contains live virus that can —in rare circumstances — mutate to become virulent, but it is still common in other countries.
Genetic analysis of New York poliovirus samples indicates a weakened virus strain used in one of the oral vaccines mutated over time to cause the outbreak. Combined with low vaccination rates in some New York communities and greater international travel, this provided an opening for the virus to slip back into the U.S. this year and paralyze the Rockland patient.
“The underlying lesson is this is an infectious disease and it travels easily with population movements,” said Oliver Rosenbauer, a spokesperson for the Global Polio Eradication Initiative, the organization that represents the worldwide campaign to eliminate the virus.
Vaccine-derived virus
The oral polio vaccines are generally safe, effective, cheap and easy to administer. They have played a crucial role in the global campaign to eradicate polio, one of the most ambitious public health initiatives since smallpox was successfully stamped out in 1980. Two of the three naturally occurring poliovirus strains, called wild types, have been eradicated in the 21st century.
As recently as 1988, polio paralyzed 350,000 children annually across 125 countries, according to data from the polio eradication initiative. Today, Pakistan and Afghanistan are the only countries in the world where the remaining wild type polio is still endemic with 27 cases confirmed so far this year. The annual number of wild poliovirus cases has declined by 99% since 1988.
The global fight against polio has relied on the oral vaccine’s ability to block transmission of the virus. The oral vaccine uses a live but weakened form of poliovirus that replicates in the gut. This builds immunity in the intestines that can block the virus from shedding in human feces and contaminating the environment.
Although recently immunized people can pass the oral vaccine virus on to others for a few weeks, it’s not normally a problem because the strain is weakened so it does not cause disease, Rosenbauer said. When the weakened virus from the shots spreads from person to person, it can actually help build immunity in a community, he said. The transmission eventually burns out once enough people have immunity, he said.
The problem begins when immunization rates are so low in a community that the weakened virus from the vaccine spreads uninterrupted for a prolonged period and mutates into a virulent strain, called a vaccine-derived poliovirus. And when people who are not immunized catch the mutated vaccine-derived virus, they can become paralyzed like the patient in Rockland County.
“This thing has now circulated and emerged into something different,” Rosenbauer said. “It’s linked to the vaccine, but it’s actually more linked to vaccination coverage because it doesn’t happen overnight, it takes months for these amounts of changes to occur.”
Blood sample positive with polio virus
Jarun011 | Istock | Getty Images
New York has been struggling with dangerously low polio vaccination rates in some communities for years. In Rockland, the vaccination rate for children under age two dropped from 67% in 2020 to 60% in 2022, according to the CDC. In some areas of Rockland, only 37% of kids in this age group are up to date on their vaccine.
The U.S. uses an inactivated polio vaccine administered as a shot. The polio strains in the shots have been killed, meaning the virus cannot mutate into a more virulent form. The inactivated polio vaccine is very effective at preventing disease, but it is does not stop transmission of the virus.
It builds immunity in the bloodstream, which prevents the virus from attacking the spinal chord and causing paralysis. But the inactivated vaccine does not stop the virus from replicating in the gut, which means transmission between people is still possible if there’s an outbreak.
This means that although people immunized in New York with the inactivated polio vaccine are protected against disease, they can still catch and spread the strain that mutated from the oral vaccine. This is likely what’s happening in New York right now, Rosenbauer said.
Polio’s silent spread in New York
Poliovirus has been spreading silently in New York communities for months. After the Rockland County patient developed paralysis, health officials in New York used wastewater surveillance developed during Covid to test sewage samples.
Poliovirus was detected in Rockland County, then in neighboring Orange County, New York City, Sullivan County and later in Nassau County on Long Island. The earliest positive sewage samples dated back to April in Orange County. Polioviruses have been found in 69 sewage samples in New York state so far.
While the Rockland County adult hadn’t traveled internationally, they attended a large gathering eight days before they started experiencing symptoms, which suggests that they had contracted the virus from someone else in the community, Schnabel Ruppert said.
Most people who catch polio don’t show symptoms, while about one out every four people infected have a mild illness similar to the flu. Paralysis occurs in one out of every 200 or one out every 2,000 people who catch the virus depending on the strain. The identification of even single paralytic case is an alarm bell that indicates the virus has been spreading widely in the community.
“When we see one case of paralytic polio, that means there are probably hundreds and hundreds of cases that are out there in the community but not diagnosed because 75% of the cases are asymptomatic,” Schnabel Ruppert said.
The Rockland County health commissioner said she’s very concerned another unvaccinated person in the community could contract paralytic polio. New York Gov. Kathy Hochul declared a state of emergency last month with the goal of boosting the statewide vaccination rate, which currently stands at 79%, to well above 90% to prevent a future outbreak.
New York Governor Kathy Hochul speaks at a news conference on August 03, 2022 in New York City.
Spencer Platt | Getty Images
New York Health Commissioner Dr. Mary Bassett last Wednesday declared the poliovirus outbreak an imminent threat to public health.
“We know that there’s still circulation actively in communities here. And we know that there’s still unvaccinated pockets of the population. And so we’re still worried,” said Dr. Eli Rosenberg, one of the leading state public health officials working on New York’s response to the outbreak.
The London and Jerusalem connection
New York isn’t the only polio-free place where the virus has remerged this year. Poliovirus has also been detected in wastewater in London and Jerusalem. Fortunately, there are no known cases of paralysis in either city, though the U.K. health authorities declared a national incident after detecting the virus.
Israel eliminated polio in 1988 and the U.K. did so in 1982, according to the polio eradication initiative.
The New York poliovirus samples are genetically linked to the specimens found in London and Jerusalem, according to group. The viruses in all three countries are related to the weakened Sabin Type 2 virus used in one of the oral polio vaccines.
The U.S. and the U.K. do not use the oral vaccines at all, and Israel does not use oral vaccines containing the Sabin Type 2 strain, according to the initiative. And the poliovirus samples from the three countries are not linked to known vaccine-derived polio virus outbreaks in other countries such as the Democratic Republic of the Congo, Nigeria, Somalia and Yemen, Rosenbauer said.
Girl receives anti-polio vaccination drops.
Ramesh Lalwani | Moment | Getty Images
This suggests that someone from a country that still administers the oral vaccine containing Sabin Type 2 traveled to Israel, the U.K. or the U.S. and seeded the weakened virus there, Rosenbauer said. It then mutated at some point to become more virulent but it’s unclear whether this evolution occurred in Israel, the U.K. or the U.S., he said.
Israel and U.K. have detected poliovirus in sewage samples dating back to January and February respectively, well before the earliest known U.S. specimen from April, according the World Health Organization.
The CDC, in a statement, said although the Rockland County patient did not travel to a country where vaccine-derived virus is present, it’s possible others in the individual’s community may have visited such a place or a visitor brought it into the U.S.
Steve Oberste, who heads the CDC’s polio lab, said genetic analysis of the sample from the Rockland patient indicates the virus is about a year old. The links between the specimens in Israel, the U.K. and the U.S. point to some movement between the three countries that spread the virus, Oberste said, but there’s no way to determine the direction of the transmission between the countries.
It’s difficult to trace the epidemiology since the patient didn’t travel, the mutations in the viruses are small and international travel in and out of New York is heavy, he said.
“With a single case there’s no way to know exactly how many infections there were between the vaccine vial and the paralyzed person,” Oberste said.
It’s unlikely public health authorities will figure out the origin of the virus that paralyzed the patient in New York, Oberste said. Dozens of countries around the world – primarily in Africa, the Middle East and South Asia – are still using oral vaccines that contain the Sabin Type 2 strain.
The vaccine virus is the same in every vial, so there’s no identifying feature on it that would allow scientists to trace wastewater specimens found in New York back to a specific country that still uses the oral vaccine containing the Sabin Type 2 strain, Oberste said.
“This started its journey somewhere else on Earth. Where on Earth is very hard to say. But there were mutations that were accumulated across probably successive waves of transmission from person to person to person and landed unfortunately with an unvaccinated resident of Rockland County,” Rosenberg said.
Outbreak risk
The Rockland County adult is the sole paralytic case so far, but the risk of more unvaccinated people developing severe disease is real. In 1992, wild type poliovirus found its way into a community in the Netherlands that refused vaccination for religious reasons, which resulted in 59 cases of paralysis and two deaths.
New York state health officials have repeatedly called on parents to immediately start the vaccination series for their children if they haven’t already and for unvaccinated adults to do the same. Most adults in the U.S. are assumed to have protection against polio because the overwhelming majority of people are vaccinated when they are children, according to the CDC.
Health authorities in New York, Israel and the United Kingdom have all responded swiftly to prevent an explosive outbreak of polio like the one in the Netherlands 30 years ago, Rosenbauer said. The arrival of fall and winter in New York and London should also help slow transmission because polio doesn’t spread as efficiently in colder weather, he said.
An anonymous survivor of polio pushes the handrims of his wheelchair.
Michael Edwards | Istock | Getty Images
“Hopefully, we will have a situation where the sanitation infrastructure is sufficiently strong, vaccination coverage is sufficiently strong, and disease surveillance is sufficiently strong to where the virus stops circulating again,” Rosenbauer said.
The goal of the Global Polio Eradication Initiative is to switch the world to the inactivated vaccine once the oral vaccine has stamped out the remaining wild type poliovirus. This switch would eliminate the risk of vaccine-derived virus outbreaks.
But making the switch will be a difficult needle to thread. The oral polio vaccine is needed to eradicate wild type virus from the world, but it also carries the risk of mutating into a virulent form. And when vaccine-derived virus outbreaks happen, the oral vaccine is used to stop them — even in countries that rely on the inactivated vaccines for routine immunization, according to the CDC.
In Rockland County, more 6,400 doses of the inactivated vaccine have been administered so far this year and about 64% were given in the two ZIP codes with the lowest immunization rates for kids under age two, Schnabel Ruppert said. But there’s still a long road ahead to achieve a vaccination rate of more than 90%, she said. Children need four doses of the vaccine and unvaccinated adults need three.
“This is a long process. For each person, it’s going to take months and months in order to get them vaccinated, to catch up,” Schnabel Ruppert said.
Rosenberg said while receiving the entire vaccination series is crucial, the biggest jump in protection against severe disease and death comes for the first dose, which is why it’s so important for the unvaccinated to get their first shot now.
Rosenbauer with polio eradication initiative said the question is whether immunization campaigns with the inactivated vaccines in New York and London are enough, or whether the oral vaccine might need to be temporarily reintroduced to break the chain of transmission.
The CDC, in a statement, said it is not changing its recommendations on the use of the inactivated polio vaccine at this time. Polio is not endemic in the U.S. and vaccination coverage remains high at more than 92% nationwide, according to CDC.
Polio is spreading in the US for the 1st time in decades. Do you need a booster?
A specific type of poliovirus has been spreading in Rockland County, New York, as well as in neighboring areas, prompting the World Health Organization (WHO) to add the United States to a list of countries (opens in new tab) where similar polioviruses have been detected. The list includes about 30 countries in Europe, Asia and Africa, such as the United Kingdom, Israel, Yemen, Algeria and Niger.
The official addition of the U.S. to this list was announced last week by the U.S. Centers for Disease Control and Prevention (opens in new tab) (CDC) and the news raised questions about what happens next. Do people who received all of their polio vaccine doses as children now need a booster? What should you do if you’re uncertain of your vaccination status, or if you know for sure that you have not received the polio vaccine?
Crucially, there’s no sweeping recommendation for fully vaccinated people to seek polio boosters.
“Certainly, at the moment, there haven’t been any national or local recommendations for people who are secure about their childhood vaccination series to need an additional booster,” said Dr. William Schaffner, a professor of medicine in the division of infectious diseases at the Vanderbilt University School of Medicine in Tennessee. However, he noted that there may be select circumstances — which we’ll detail below — in which it might be reasonable for an individual to seek a booster.
Related: Who created the polio vaccine?
For now, health officials’ primary concern is vaccinating those who haven’t yet completed their polio vaccination series, Schaffner told Live Science.
“Polio vaccination is the safest and best way to fight this debilitating disease and it is imperative that people in these communities who are unvaccinated get up to date on polio vaccination right away,” Dr. José R. Romero, director of the CDC’s National Center for Immunization and Respiratory Diseases, said in the CDC statement. “We cannot emphasize enough that polio is a dangerous disease for which there is no cure.”
Baseline polio vaccine recommendations
Since 2000, the U.S. has only used the inactivated polio vaccine (IPV), a shot that’s typically injected into the arm or leg and contains a “dead” poliovirus that cannot cause disease, according to the CDC (opens in new tab). Another kind of polio vaccine, the oral polio vaccine (OPV), is similarly effective, but its use was halted in the U.S. because it contains live, but weakened, poliovirus, Live Science previously reported. These weakened viruses can be shed in the stool of vaccinated people and, in rare instances, can evolve to behave like wild, naturally occurring polioviruses capable of causing illness and potentially paralysis in unvaccinated people.
Due to this risk, the U.S. now only administers the IPV, but “vaccine-derived” polioviruses can still potentially be imported from places that use the OPV — and that’s exactly what happened in the current outbreak.
“It reveals how vulnerable we are to importations — not only of polioviruses, but of other viruses, germs, from abroad,” Schaffner said.
To guard against polio, the CDC recommends U.S. children get four doses of the IPV, with one dose given at each of the following ages: 2 months old, 4 months old, between 6 and 18 months old, and between 4 and 6 years old. The CDC also offers several “catch-up schedules” (opens in new tab) for children who start their vaccination series late or get delayed between doses.
Adults who have never received a polio vaccine should get three doses of the IPV. These individuals can get their first dose anytime, receive the second dose one to two months later, and get the third dose six to 12 months after that, the CDC recommends. Adults who received only one or two doses in the past should seek additional doses, to reach the recommended three.
Most U.S. residents complete their polio vaccine series in childhood and aren’t generally recommended to get boosters later in life. “This is just a testimony to the very solid, lifelong protection you get from the polio vaccine,” Schaffner said.
The first polio vaccines became available in 1955 and the shots have been recommended as routine vaccinations since then, according to Verify (opens in new tab). An adult is considered fully vaccinated if they’ve gotten at least three doses of either the IPV or the “trivalent” OPV (tOPV), meaning the OPV that guards against all three types of poliovirus, P1, P2 and P3. Alternatively, an adult is fully vaccinated if they’ve gotten four doses of any combination of the IPV and the tOPV, according to the CDC (opens in new tab).
Two doses of the IPV are at least 90% protective against paralytic polio, which can occur when the virus infiltrates the central nervous system and causes weakness or paralysis in the arms, legs or both; this can lead to permanent disability and death. Three doses are at least 99% protective, according to the CDC.
Related: Africa declared free of wild poliovirus
Who needs a polio booster?
There are instances in which fully vaccinated adults may consider a one-time polio booster.
For example, a booster would be recommended if you work in a lab or health care setting where you handle poliovirus specimens, or if you are a health care worker who treats patients with polio or may interact with the close contacts of people infected with the virus. You may also seek a booster if you’re traveling to a country where the risk of polio exposure is “greater.” For example, wild poliovirus still circulates in Afghanistan and Pakistan, and long-term visitors should get an IPV booster between four weeks and one year prior to traveling there, according to the Global Polio Eradication Initiative (opens in new tab). (No similar recommendations have been extended to the U.S. yet.)
So far, only one case of paralytic polio has been detected in the U.S. outbreak; this occurred in an unvaccinated adult in Rockland County. Subsequently, poliovirus was detected in wastewater samples from Rockland County, Orange County, Sullivan County, New York City and Nassau County, the New York State Department of Health reported (opens in new tab).
The health department currently recommends polio boosters for the following New Yorkers:
- Individuals who will or might have close contact with a person known or suspected to be infected with poliovirus or such person’s household members or other close contacts.
- Health care providers who work in areas where poliovirus has been detected and might handle specimens that might contain polioviruses or who treat patients who might have polio.
- Individuals with occupational exposure to wastewater.
People in the affected counties who have weakened immune systems might also consider a booster, Vincent Racaniello, a poliovirus expert at Columbia University Vagelos College of Physicians and Surgeons, said in a statement (opens in new tab). And if you’re unsure of how many polio vaccine doses you’ve received, you may also consider getting boosted, he said.
There are some antibody tests for polio, but these aren’t recommended for assessing vaccination status because there’s limited access to tests that screen for antibodies against all three types of poliovirus, according to a 2017 Morbidity and Mortality Weekly Report (opens in new tab) published by the CDC. “In the absence of the availability of testing for antibodies to all 3 serotypes, serologic testing is no longer recommended to assess immunity,” the report states.
For U.S. residents beyond New York, the risk of polio exposure is likely similar to before the outbreak, Schaffner said — that is, negligible. However, people exposed to the virus in New York could potentially hop on a plane and carry polio to additional places; for that reason, vaccination remains important no matter where you live, he said.
It’s also key to note that “while IPV is very good at preventing the most severe potential effects of the disease, people who received the vaccine could still be carriers of polio and could transmit it to others,” Dr. Leana Wen, an emergency physician and professor of health policy and management at The George Washington University Milken Institute School of Public Health, told CNN (opens in new tab).
Those vaccinated with the IPV can still pass poliovirus in their stool if they’re ever exposed to the pathogen, even though they are protected against paralysis, according to the Pan American Health Organization (opens in new tab). That’s because the IPV generates a very strong antibody response in the blood but isn’t as effective at generating immunity in the intestines.
About polio
Poliovirus most often spreads through contact with the feces of an infected person; less commonly, it can be transmitted through respiratory droplets that are released when an infected person sneezes or coughs, according to the CDC (opens in new tab). Frequent handwashing with soap and water can help prevent the spread of the virus; notably, however, alcohol-based hand sanitizers do not kill polioviruses.
Most people who catch polio don’t develop any visible symptoms. About 25% develop flu-like symptoms, including sore throat, fever, fatigue, stomach pain and nausea. A far smaller fraction of infected people develop severe symptoms, such as meningitis, an infection of the tissue surrounding the spinal cord and/or brain; or paralysis, which can lead to permanent disability and death.
Sometimes, people who seem to recover from polio develop new muscle pain, weakness or paralysis decades later; this is known as post-polio syndrome.
Originally published on Live Science.