Biggest polio threat in years sparks alarms from New York to California
LOS ANGELES — Delays in getting children vaccinated during the COVID-19 pandemic and antivaccination sentiment in general may be fueling the most serious threat of polio in the U.S. in years, raising alarms from New York to California.
In the last few weeks, health officials in New York identified the first person in nearly a decade in the U.S. to be diagnosed with polio. The person suffered paralysis. Since then, the polio virus has been found in wastewater not only in two counties in the area where the patient lives but also, as of Friday, in New York City.
The virus may be rebounding worldwide. The Jerusalem area this year suffered an outbreak, and the virus showed up in London wastewater in June.
Now, health experts and officials in California are voicing concern.
Los Angeles County Public Health Director Barbara Ferrer said there’s discussion about tracking polio in wastewater, especially in areas with low vaccination rates. This makes sense, experts said, given the high numbers of travelers between Los Angeles and New York and because people can be contagious with polio while having no symptoms.
“The detection of poliovirus in wastewater samples in New York City is alarming,” Dr. Mary T. Bassett, the New York State Health Commissioner, said in a statement. “For every one case of paralytic polio identified, hundreds more may be undetected.”
Health officials in New York are “treating the single case of polio as just the tip of the iceberg of much greater potential spread. As we learn more, what we do know is clear: The danger of polio is present in New York today,” Bassett said.
There is no cure for paralysis caused by polio, said Dr. Peter Chin-Hong, a UC San Francisco infectious-diseases expert. But polio can be prevented by immunization, which is more than 90% effective. Babies should be given three doses; a fourth is given to children between 4 and 6.
About 75% of people who get infected with polio have no symptoms; the others can have flu-like symptoms. It can take three to six days after exposure to the polio virus for nonparalytic symptoms to appear. Paralysis can occur seven to 21 days after infection.
Patients generally get infected through the mouth, typically by hands contaminated with an infected person’s fecal matter, but the virus can also spread through an infected person’s sneeze or cough.
Paralysis or weakness in the arms or legs can occur in 1 out of every 1,000 people infected with polio, Chin-Hong said. The disease can cause paralysis because the virus can infect the spinal cord.
Between 2 and 10 of every 100 infected people who have polio-induced paralysis die, because the virus can harm the muscles that help them breathe.
“Even children who seem to fully recover can develop new muscle pain, weakness or paralysis as adults, 15 to 40 years later,” the U.S. Centers for Disease Control and Prevention says. This is known as post-polio syndrome.
Chin-Hong said the emergence of polio in New York is concerning enough for clinicians to familiarize themselves with the disease.
“We’re worried, because this is the first case in the U.S. identified in almost 10 years,” Chin-Hong said at a recent town hall.
The case of paralytic polio occurred in Rockland County, a suburban area just north of New York City. Rockland County is notable for having a significant population of Orthodox Jews, among whom there are low immunization rates.
Outbreaks of infectious diseases have hit Rockland County before. In late 2018, the county was the epicenter of a significant measles outbreak in Orthodox Jewish communities after being first detected in an unvaccinated teenager. The seven-month outbreak was the longest in the U.S. since 2000, according to a CDC report.
Additionally, large outbreaks of COVID-19 have been observed in Orthodox Jewish communities in Rockland County and in Brooklyn, linked to low rates of vaccination.
The polio patient is a 20-year-old unvaccinated man who traveled to Hungary and Poland earlier this year and was hospitalized in June, the Washington Post reported, citing a public health official who spoke on condition of anonymity. The New York Times reported that the patient is a member of the Orthodox Jewish community.
Genetic analysis of a polio virus sample from the patient indicates that it was picked up from a person who had received the oral polio vaccine, which has not been used in the U.S. since 2000, health officials said.
The oral vaccine contains a weakened live polio virus. “If allowed to circulate in under- or unimmunized populations for long enough … the virus can revert to a form that can cause illness and paralysis in other people,” the CDC says.
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