Polio outbreaks regularly caused panic decades ago, until a vaccine was developed and the disease was largely eradicated. Then New York City health authorities announced on Friday that they had found the virus in wastewater samples, suggesting polio is likely circulating in the city again.
Parents of young children wondered—perhaps for the first time in their lives, and together for the first time in generations—how much to worry about polio.
Anabela Borges, a designer who lives in the Crown Heights neighborhood of Brooklyn, said she had friends whose children were likely unvaccinated. After the announcement on Friday, she said she plans to “let her friends know”.
Ms Borges said she hoped her 7-month-old daughter, Ava, who is old enough to have had three of the four recommended injections for children, was far enough in the regimen to be protected. “Polio is really dangerous for babies like her,” Mrs. Borges said as she and her daughter’s nanny took Ava for a walk in her stroller.
In New York City, the overall polio vaccination rate in children ages 5 and under is 86 percent, and most adults in the United States were vaccinated against polio as children. Still, in some city zip codes, fewer than two-thirds of children ages 5 and under have received at least three doses, a figure that worries health officials.
The Department of Health said in a statement that the virus’s discovery “underscored the urgency of every New York adult and child getting vaccinated, especially those in the greater New York metropolitan area.”
The announcement came three weeks after a man in Rockland County, NY, north of the city, was diagnosed with a case of polio, which left him paralyzed. Officials now say polio has been circulating in the province’s wastewater since May.
“The risk to New Yorkers is real, but the defense is so simple — get vaccinated against polio,” said Dr. Ashwin Vasan, New York City’s health commissioner, said in a statement. “Now that polio is 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, choose now to get the vaccine.”
The spread of the virus poses a risk to unvaccinated people, but three doses of the current vaccine provide at least 99 percent protection against serious illness. Children who are too young to be fully vaccinated are also vulnerable, as are children whose parents have refused or delayed getting vaccinated.
Health officials fear the detection of polio in New York City’s sewage may precede other cases of paralyzed polio.
The fight against polio
The highly contagious virus was one of the most feared diseases until the 1950s, when the first vaccine was developed.
“In the absence of a relatively massive vaccination campaign, I think it’s very likely there will be one or more cases” in the city, said Dr Jay Varma, an epidemiologist and former deputy city health commissioner.
Vaccination rates across the city fell during the pandemic as visits to pediatricians were postponed and the spread of vaccine misinformation accelerated. Even before the advent of Covid, vaccination rates for a range of preventable viruses in some neighborhoods were low enough to alarm health officials.
While effective at preventing paralysis, the vaccine that has been used in the United States in recent decades is less effective at limiting transmission. People who have been vaccinated can still carry and shed the virus even if they don’t experience infection or symptoms.
That, epidemiologists say, could mean the virus will be difficult to eradicate quickly, underscoring why vaccination is so critical to protection, a health ministry spokeswoman said.
Many people who become infected with polio develop no symptoms, but some people develop a fever or nausea. dr. Bernard Camins, an infectious disease specialist and medical director of infection prevention for the Mount Sinai Health System, urged doctors to watch for those symptoms and consider ordering polio tests for patients who have not been fully vaccinated.
About 4 percent of those who contract the virus will develop viral meningitis, and about 1 in 200 will become paralyzed, according to health authorities.
“The problem,” said Dr. Camins, “is that if you have one case of paralysis, there could be hundreds of others that are not symptomatic or have symptoms that are unlikely to be identified as polio.”
The polio virus had previously been found in wastewater samples in Rockland and Orange County, but Friday’s announcement was the first sign of its presence in New York City.
Neither the city nor the state health services gave details about where in the five boroughs the virus was found in the wastewater. State officials did say six “positive samples of concern” had been identified in the city’s wastewater, two collected in June and four in July.
The last case of polio found in the United States before that in Rockland County was in 2013.
Before polio vaccines were first introduced in the 1950s, the virus was a source of fear, especially during the summer months when outbreaks were most common. Cities closed swimming pools as a prevention tactic, and some parents kept their children indoors.
In 1916, polio killed 6,000 people in the United States and left at least another 21,000 — most of them children — with permanent disabilities. More than a third of the deaths fell in New York City, where the outbreak led to a delay in opening public schools.
An outbreak in 1952 caused paralysis in more than 20,000 people and left many children in iron lungs. Shortly after, the first effective vaccine hit the market and the virus began to retreat.
Today, there are only two countries, Pakistan and Afghanistan, where polio is endemic. It has been kept at bay in the rest of the world due to the wide use of vaccines.
Cases occur with some regularity outside those two countries, a result of 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 spread the weakened virus to others. Since 2000, only an inactivated polio vaccine has been used in the United States.
The CDC recommends that children receive four doses, with the final injection given between ages 4 and 6.
“What we’re seeing is a wake-up call for people who thought poliovirus was just a problem elsewhere,” said Captain Derek Ehrhardt, an epidemiologist and the Centers for Disease Control and Prevention’s polio eradication incident manager.
The virus mainly lives in a person’s throat and intestines and is usually spread through contact with feces.
If the attenuated virus used in the oral vaccine circulates widely enough in low-vaccination communities, or replicates in someone with a compromised immune system, it can mutate into a virulent form that can cause paralysis, according to the CDC.
In recent years, outbreaks of such a “circulating vaccine-derived poliovirus” have occurred in many countries. Open sewers and contaminated drinking water can help accelerate the spread.
Health authorities believe that the polio virus was introduced into New York by someone who had received the live virus vaccine in another country, or by an unvaccinated person who contracted vaccine-derived polio abroad.
Officials say the virus detected in the two counties north of New York City is genetically linked to the vaccine-derived virus collected from samples this year in Jerusalem, as well as wastewater samples in London that have sparked a renewed polio vaccination campaign. over there.
On Friday, the CDC had confirmed the presence of polio virus in 20 wastewater samples in Rockland and Orange County, all genetically linked to the case of paralyzed polio in the Rockland County resident. The provinces are next to each other.
Of the 20 samples, two were collected in May, three in June and eight in July from Rockland County; two were collected in June and five in July in Orange County.
dr. Orange County Health Commissioner Irina Gelman said officials assumed every positive sample collected in her county indicated an individual person locally infected with the virus, but added that she was waiting for further tests to be sure. genetic analysis from the CDC.
Health officials believe hundreds of people in the area may be infected, she said. The estimate is based on the number of people who would normally have to have the virus for a single case of paralytic polio to occur, combined with the worldwide increase in vaccine-based polio cases and the very low vaccination coverage in the United States. parts of New York.
“Part of me still hopes that’s not the case,” she said.
“We’re really working with a kind of perfect storm scenario,” she added. “We have low vaccination rates in Orange County for vaccine-preventable diseases, especially among our pediatric populations.”
The only confirmed case of polio so far was in a 20-year-old male ultra-Orthodox Jewish resident of Rockland County, according to several local officials. Orange and Rockland counties are both home to large numbers of ultra-Orthodox Jews, and anti-vaccination sentiment has spread among some in that community.
A measles outbreak in 2019 was also concentrated among people in the ultra-Orthodox community, although misinformation about vaccines and low vaccination rates are also more widely found, said Dr. Gelman.
According to the Department of Health, vaccination rates in Rockland and Orange counties are well below the level needed to prevent the virus from spreading. Among 2-year-olds, about 60 percent of children in both counties had all three recommended polio shots, state data shows, compared with 79 percent statewide.
Tired of Covid and alarmed by the recent rise of monkey pox, New Yorkers’ minds turned to a third virus on Friday, as they questioned whether they had been fully vaccinated and whether their protection had lasted for decades.
Gregory Ludd, 46, a Crown Heights resident who works as a doorman, has six children. They are up to date on their vaccinations, he said.
“I’m afraid because we’ve never heard of polio coming out since we were probably young, young kids,” he said. “But all you can do is put your trust in God and hope that doesn’t happen to your child.”
Lola Fadulureporting contributed.