Polio has been detected in New York’s sewage, officials say

Polio epidemics caused regular panics decades ago, until a vaccine was developed and the disease was largely eradicated. Then on Friday, New York City health officials announced they had found the virus in sewage samples, suggesting polio was likely circulating in the city again.

Parents of young children have wondered — perhaps for the first time in their lives and collectively for the first time in generations — how worried they should be about polio.

Anabela Borges, a designer who lives in Brooklyn’s Crown Heights neighborhood, said she has friends whose children are likely unvaccinated. After Friday’s announcement, she said she planned to “raise awareness among her friends.”

Ms Borges said she hoped her 7-month-old daughter Ava, who is old enough to have had three of the four injections recommended for children, was far enough along the diet to be protected. “Polio is really dangerous for babies like her,” Ms Borges said as she and her daughter’s nanny took Ava for a walk in her stroller.

In New York, the overall polio vaccination rate for children 5 and under is 86%, and most adults in the United States were vaccinated against polio as children. Yet in some city zip codes, less than two-thirds of children 5 and under have received at least three doses, a figure that has health officials worried.

The state health department said in a statement that the discovery of the virus underscores “the urgency for every adult and child in New York City to get vaccinated, especially those in the greater New York metropolitan area.”

The announcement came three weeks after a man from Rockland County, NY, north of the city, was diagnosed with a case of polio that left him paralyzed. Officials now say polio has been circulating in the county’s sewage since May.

“The risk to New Yorkers is real but the defense is so simple – get the polio shot,” New York City Health Commissioner Dr. Ashwin Vasan said in a statement. “With polio circulating in our communities, there is simply nothing more essential than vaccinating our children to protect them from this virus, and if you are an unvaccinated or incompletely vaccinated adult, please choose now to have yourself vaccinate.”

The spread of the virus poses a risk to unvaccinated people, but three doses of the current vaccine provide at least 99% protection against serious illness. Children too young to be fully vaccinated are also vulnerable, as are children whose parents have refused to vaccinate them or delayed their vaccination.

Health officials fear that the detection of polio in New York’s sewage could precede other cases of paralytic polio.

“In the absence of a relatively massive vaccination campaign, I think it is very likely that there will be one or more cases” in the city, said Dr. Jay Varma, epidemiologist and former assistant commissioner for the city ​​health.

The citywide vaccination rate has plummeted amid the pandemic as visits to pediatricians have been postponed and the spread of vaccine misinformation has accelerated. Even before Covid arrived, vaccination rates for a range of preventable viruses in some neighborhoods were low enough to worry health officials.

Although effective in preventing paralysis, the vaccine used in the United States in recent decades is less effective in limiting transmission. People who have been vaccinated can still be carriers and shed the virus, even if they don’t have an infection or symptoms.

That, epidemiologists say, may mean the virus will be difficult to eradicate quickly, further underscoring why vaccination is so critical for protection, a state health department spokeswoman said.

Many people infected with polio do not develop symptoms, but some people will have a fever or nausea. Dr. Bernard Camins, infectious disease specialist and medical director of infection prevention for the Mount Sinai Health System, urged doctors to be on the lookout for these symptoms and to consider ordering polio tests for patients who are not fully vaccinated.

About 4% of those who contract the virus get viral meningitis and about 1 in 200 will become paralyzed, according to health authorities.

“The problem,” Dr Camins said, “is that if you have one case of paralysis, there may be hundreds of others who are either not symptomatic or who have symptoms that are not likely to be identified as poliomyelitis.”

The polio virus had previously been found in sewage samples from Rockland and Orange counties, but Friday’s announcement was the first sign of its presence in New York.

Neither the city nor state health departments provided details on where in the five boroughs the virus was detected in the sewage. State officials said six “worrying positive samples” had been identified in the city’s wastewater, two collected in June and four in July.

The last case of poliomyelitis discovered in the United States before that of Rockland County dates back to 2013.

Before polio vaccines were first introduced in the 1950s, the virus was a source of fear, particularly during the summer months when outbreaks were most common. Cities have closed swimming pools as a precaution, and some parents have kept their children inside.

In 1916, poliomyelitis killed 6,000 people in the United States and left at least 21,000 others, mostly children, with permanent disabilities. More than a third of the deaths have occurred in New York, where the outbreak has delayed the opening of public schools.

An epidemic in 1952 paralyzed more than 20,000 people and left many children with iron lungs. The first effective vaccine appeared soon after, and the virus began to recede.

Today, there are only two countries, Pakistan and Afghanistan, where poliomyelitis is endemic. It has been kept at bay in the rest of the world thanks to the wide use of vaccines.

Cases are appearing beyond these two countries with some regularity, due to the oral vaccine used in much of the world. The oral vaccine uses a weakened but live virus. It is safe, but a person who receives it can transmit the weakened virus to others. (Only inactivated polio vaccine has been used in the United States since 2000.)

“What we’re seeing is a wake-up call to people who thought polio was just a problem somewhere else,” said Capt. Derek Ehrhardt, epidemiologist and polio eradication incident manager for the Centers for Disease Control and Prevention.

The virus lives primarily in a person’s throat and intestines and is most commonly transmitted through contact with feces.

If the weakened virus used in the oral vaccine circulates widely enough in communities with low vaccination rates, or replicates in someone with a weakened immune system, it can mutate into a virulent form that can cause paralysis, according to the CDC.

Outbreaks of these “vaccine-derived circulating poliomyelitis viruses” have occurred in many countries in recent years. Open sewers and contaminated drinking water can help speed the spread.

Health officials believe the polio virus was brought to New York by someone who had received the live virus vaccine in another country, or by an unvaccinated person who caught vaccine-derived polio while in New York. foreign.

Officials say the virus detected in the two counties north of New York is genetically linked to vaccine-derived virus collected this year in Jerusalem, as well as sewage samples in London that led to a new polio vaccination campaign there.

On Friday, the CDC had confirmed the presence of poliovirus in 20 sewage samples in Rockland and Orange counties, all genetically linked to the paralytic polio case in the Rockland County resident. The counties are side by side.

Of the 20 samples, two were taken in May, three in June, and eight in July in Rockland County; two were collected in June and five in July in Orange County.

Dr. Irina Gelman, Orange County health commissioner, said officials assumed each positive sample collected in her county indicated a distinct person infected with the virus locally, but added that she was awaiting genetic analysis. further from the CDC to be sure.

Health officials believe hundreds of people in the area could be infected, she said. The estimate is based on the number of people who would typically need to have the virus for there to be a single case of paralytic polio, combined with the increase in vaccine-derived polio cases worldwide and the very low vaccination coverage in some sections of New York.

“Part of me still hopes it won’t,” she said.

“We’re really working with kind of a perfect storm scenario,” she added. “We have low vaccination rates in Orange County for vaccine-preventable diseases, especially among our pediatric populations.”

According to several local officials, the only confirmed polio case so far was in a 20-year-old ultra-Orthodox Jew, a resident of Rockland County. Both Orange and Rockland counties are home to large numbers of ultra-Orthodox Jews, and anti-vaccine sentiment has spread among some in that community.

A measles outbreak in 2019 was also concentrated among members of the ultra-Orthodox community, though misinformation about vaccines and low vaccination rates were also more prevalent, Dr. Gelman said.

According to the state health department, vaccination rates in Rockland and Orange counties are well below those needed to prevent the virus from spreading. Among 2-year-olds, about 60% of children in the two counties received all three recommended polio vaccines, according to state data, compared to 79% statewide.

Weary of Covid and alarmed by the recent emergence of monkeypox, New Yorkers’ thoughts turned Friday to a third virus, as they wondered if they were fully vaccinated, and whether their protection had lasted decades .

Gregory Ludd, 46, a Crown Heights resident who works as a porter, has six children. They are up to date with their vaccinations, he said, but three of them are under 5 years old.

“I’m afraid because we really haven’t heard of polio since we were probably very young children,” he said. “But all you can do is put your faith in God and hope that doesn’t happen with your child.”

Lola Fadulucontributed report.

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