This follows the finding of the virus in sewage in two neighboring New York City counties — Rockland and Orange County from samples collected in May, June and July. While no other cases of polio have been reported in the U.S. so far, a senior official at the U.S. Centers for Disease Control and Prevention said on Wednesday that this is “just the tip of the iceberg,” suggesting there must be “some hundreds of cases circulating in the community.”
This is a serious situation. Poliovirus — a disease that was eradicated in the US in 1979 is now being discovered in three locations in the US. “Polio is completely preventable and its return should be a call to action for all of us,” said New York City Health Commissioner Dr. Ashwin Vasan.
Polio is a vaccine-preventable disease and these latest developments should serve as a warning to all of us. Unfortunately, places like Rockland County have incredibly low polio vaccination rates; 60.5% of two-year-olds have been vaccinated, compared to the national average of 79.1%.
Indeed, the vaccine to fight the disease is one of the most celebrated shots in history. Church bells rang out across America and people flocked to the streets to celebrate with parents hugging their children in relief when the results of the 1955 field test of the vaccine were announced (this is similar to today’s pharmaceutical companies releasing press releases about their data on the efficacy of vaccines).
The celebration was justified; through vaccination, the US eliminated wild or naturally occurring polio virus more than 40 years ago.
As a parent of three, I can’t imagine having to live with the terrifying threat of polio that could potentially infect my children. Before a polio vaccine became available, some parents were hesitant to even let their child go outside for fear of exposure, especially in the summer months when polio seemed to peak.
Taking a trip down memory lane, the worst recorded polio epidemic in the US occurred in 1952 when 58,000 cases were reported. More than 21,000 people contracted mild to debilitating paralysis (most of the victims were children) and more than 3,000 people died. What was once a crippling disease has been thwarted by mass vaccination.
Polio is a highly contagious virus that spreads through personal contact (usually through contact with an infected person’s poo). While most people who become infected experience no symptoms, about 1 in 4 people develop flu-like symptoms and a much smaller fraction of people (less than one in 100) develop more serious symptoms, including paresthesia (pins and needles sensation in the legs). ), meningitis (infection of the spinal cord and/or brain) and paralysis. 5% to 10% of the paralyzed die when the virus attacks their respiratory muscles.
In the past, even those who did recover faced lifelong challenges. The World Health Organization has reported on some of the effects of the disease: Deformed limbs meant many required leg braces, crutches or wheelchairs, and some had to use breathing equipment such as the iron lung, an artificial respiration machine invented to treat polio patients. To make matters worse, decades later, some children developed post-polio syndrome, which can include muscle weakness, joint pain, and feelings of mental and physical fatigue.
But then came the polio vaccine, which offered a high degree of protection and our collective herd immunity has allowed us to ward off the virus (although vulnerabilities still exist in our communities where vaccination rates are low).
Wild polio virus remains endemic in Pakistan and Afghanistan. Although polio cases have fallen by nearly 99% worldwide, the virus remains widespread in those two countries and the threat of imported polio cases remains.
During my 2018 trip to Pakistan, I spoke to officials at the Pakistan National Institute of Health about the importance of biopreparedness for emerging and re-emerging infectious disease threats. I remember driving through the ancient city of Multan, where more recently thousands of Pakistani children were vaccinated against polio in 2020, and thinking how difficult vaccination efforts are in many of these remote areas.
So it’s no surprise that public health officials are concerned when polio is diagnosed or detected in wastewater monitoring, signaling a larger, localized outbreak. The risk to the public is low because most people are protected from their childhood polio vaccinations. However, people most at risk of infection are those who are not or insufficiently vaccinated.
London faces similar concerns to New York’s; polio virus was discovered in the city’s sewers in June. The UK Health Security Agency (UKHSA) has responded with an unprecedented move, and one that highlights the urgency of the situation: About 1 million children under 10 in London will be offered polio booster vaccines as a precaution. According to Dr. Vanessa Saliba, consultant epidemiologist at the UKHSA, said: “The areas of polio virus transmission in London have some of the lowest vaccination rates.”
These latest polio incidents are not one-time events. Immunization coverage is dwindling worldwide and the immunity wall that generations have built in the past is slowly breaking down. The vaccine mistrust that has erroneously stemmed from the Covid-19 pandemic is only driving more people to opt out of vaccinations or under-vaccinate themselves and their children. Others may have interrupted or postponed vaccination programs due to disruptions caused by the pandemic. The latest report from the World Health Organization shows that global immunization coverage — including the polio vaccine along with numerous others such as measles and rubella — fell from 86% in 2019 to 81% in 2021.
As the WHO puts it, “as long as a single child remains infected with polio virus, children in all countries are at risk of contracting the disease. The polio virus can be easily imported into a polio-free country and can spread rapidly among unimmunized populations. ”
Polio should have been a disease relegated to the pages of our history books. It is human behavior and the choices we make that prevent it from becoming another lasting public health success story.