Parents of young children wondered—perhaps for the first time in their lives and, collectively, for the first time in generations—how much they should worry about polio. Anabela Borges, a designer who lives in Brooklyn’s Crown Heights neighborhood, said she had friends whose children likely hadn’t been vaccinated. After the announcement on Friday, she said she planned to “inform her friends.” Ms. Borges said she hoped her 7-month-old daughter, Ava, who is old enough to have had three of the four shots recommended for children, was far enough along in the regimen 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 among children 5 and younger is 86 percent, and most adults in the United States were vaccinated against polio as children. But in some city zip codes, fewer than two-thirds of children 5 and under have received at least three doses, a number that worries health officials. The state Department of Health said in a statement that the discovery of the virus underscored “the urgent need to vaccinate every New York adult and child, especially those in the greater New York metropolitan area.” The announcement came three weeks after a man in New York’s Rockland County, 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 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, in a statement. “With polio circulating in our communities, there is nothing more essential than vaccinating our children to protect them from this virus, and if you are an unvaccinated or under-vaccinated adult, choose now to get vaccinated.” Spreading 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 refused to vaccinate them or delayed the vaccine. Health officials fear that the detection of polio in New York’s sewage could predate other cases of paralytic 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.
“Absent a relatively massive vaccination effort, I think it’s very likely to be one or more cases” in the city, said Dr. Jay Varma, an epidemiologist and former deputy city health commissioner. Citywide vaccination rates have dropped amid the pandemic, as pediatrician visits have been postponed and the spread of vaccine misinformation has accelerated. Even before the arrival of Covid, vaccination rates for a number 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 may still carry and shed the virus, even if they do not develop an infection or symptoms. That, epidemiologists say, could mean the virus will be difficult to eradicate quickly, further underscoring why vaccination is so critical to protection, a state health department spokesman said. Many people infected with polio do not have symptoms, but some people will have a fever or nausea. Dr. Bernard Cummins, an infectious disease specialist and medical director of infection prevention for Mount Sinai Health System, urged doctors to be on the lookout for these symptoms and to consider ordering a polio test for patients who are not fully vaccinated. About 4 percent of those infected with the virus develop viral meningitis, and about 1 in 200 will become paralyzed, according to health authorities. “The problem,” said Dr. Cummins, “is that if you have one case of paralysis, there may be hundreds of others that are asymptomatic or have symptoms that are unlikely to be recognized as polio.” The polio virus had previously been found in sewage samples in Rockland and Orange counties, but Friday’s announcement was the first sign of its presence in New York. Neither city nor state health departments provided details on where in the five municipalities the virus had been detected in the sewage. State officials said six “positive samples of concern” had been found in the city’s wastewater, two collected in June and four in July. The last case of polio detected in the United States before the one in Rockland County was in 2013. Before polio vaccines were first introduced in the 1950s, the virus was a source of terror, especially during the summer months when cases were more common. Cities closed swimming pools as a precaution 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—mostly children—with permanent disabilities. More than a third of the deaths were in New York, where the outbreak led to a delay in the opening of public schools. An outbreak 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 polio is endemic. It has been kept at bay in the rest of the world through the widespread use of vaccines. Outbreaks occur beyond these two countries with some regularity, 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. Only inactivated polio vaccine has been used in the United States since 2000. The CDC recommends that children receive four doses, with the final vaccine given between ages 4 and 6. “What we’re seeing is a wake-up call for people who thought the polio virus was just a problem elsewhere,” said Capt. Derek Ehrhardt, epidemiologist and director of polio eradication at 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 recurs in someone with a weakened immune system, it can mutate into an infectious form that can cause paralysis, according to the CDC. Outbreaks of such “circulating vaccine-derived poliovirus” have occurred in many countries in recent years. Open sewers and contaminated drinking water can help accelerate the spread. Health authorities believe the polio virus was introduced to New York by someone who received the live virus vaccine in another country or by an unvaccinated person who contracted polio from a vaccine abroad. Officials say the virus detected in the two counties north of New York is genetically related to the virus from vaccines collected from samples this year in Jerusalem, as well as to sewage samples in London that led to a renewed polio vaccination campaign there. As of Friday, the CDC had confirmed the presence of the polio virus in 20 sewage samples in Rockland and Orange counties, all genetically linked to the Rockland County resident’s case of paralytic polio. The counties are next to each other. Of the 20 specimens, 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. Irina Gelman, Orange County’s health commissioner, said officials assume each positive sample collected in her county indicates a separate person infected with the virus locally, but added that she is awaiting further genetic analysis from the CDC to be sure. Health officials believe hundreds of people in the area may have been infected, he said. The estimate is based on how many people would normally need to have the virus for a single case of paralytic polio, combined with the increase in vaccine-derived polio cases worldwide and very low vaccine coverage in New York areas. “A part of me still hopes that it won’t happen,” he said. “We’re really working with a perfect storm scenario,” he added. “We have low vaccination rates in Orange County for vaccine-preventable diseases, especially among our pediatric populations.” The one case of polio confirmed 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 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 centered among people in the ultra-Orthodox community, although vaccine misinformation and low vaccination rates are also more widespread, Dr. Gelman said. Vaccination rates in Rockland and Orange counties are well below what is needed to prevent the spread of the virus, according to the state Department of Health. Among 2-year-olds, about 60 percent of children in both counties got all three recommended polio shots, according to state data, compared with 79 percent statewide. Tired of Covid and worried by the recent outbreak of monkeypox, New Yorkers’ thoughts have turned to…
