But infectious disease experts say there’s no need for families of fully vaccinated children to panic. “Inactivated polio vaccine is part of the standard childhood immunization schedule, so for most families it should not be a concern,” said Dr. Gail Shust, a pediatric infectious disease specialist at NYU Langone Hassenfeld Children’s Hospital in New York City. . “It happens to be a highly effective vaccine.” At this point, there’s also no need to seek out a polio booster for a fully vaccinated child or adult, he added. “For children who have gone through the regular vaccination schedule in the United States, there is no reason to get a booster,” Shust said. Instead, concern should be focused on communities with clusters of unvaccinated children and adults, because those are the people at risk of polio, experts say. A young man in New York’s Rockland County — about 45 minutes northwest of the Bronx — was diagnosed in late July with the first case of paralytic polio identified in the United States in nearly a decade. Subsequently, poliovirus was detected in the wastewater of both Rockland County and neighboring Orange County, indicating community transmission of the virus. Polio can lead to permanent paralysis of the arms and legs. It can also be fatal if paralysis occurs in muscles used for breathing or swallowing. About 1 in 25 people infected with the polio virus will develop viral meningitis, and about 1 in 200 become paralyzed. “Many people infected with polio virus are asymptomatic,” Shust said. “It is entirely possible that there are other undiagnosed cases and that there are more people who are infected than we know.” Children should receive at least three doses of polio vaccine by age 18 months, with the fourth dose given between ages 4 and 6, according to the U.S. Centers for Disease Control and Prevention. New York state health officials said they are particularly concerned about neighborhoods where fewer than 70 percent of children between the ages of 6 months and 5 years have received at least three doses of the polio vaccine. About 86 percent of New York children have gotten all three doses, but in Rockland County the rate is just over 60 percent and in Orange County the rate is just under 59 percent, state health officials said. Statewide, nearly 79 percent of children have received three doses by their second birthday, officials said. The polio virus has also been found in London’s sewage, and health officials in the UK have decided to offer polio vaccine boosters to children. “They’re starting to do this in London. We didn’t say this was necessary,” said Dr. William Schaffner, medical director of the Bethesda, Md.-based National Institute of Infectious Diseases. “The only time we’ve given souvenirs in the past is when someone who was vaccinated as a child decided to travel to some developing country where there was a lot of polio and we said, OK, just to be safe. to be prudent, we’ll give you a boost before you leave,” said Schaffner. “It wasn’t really considered necessary, but it was a sensible, extra, easy, safe thing to do.” The polio virus lives in the intestinal tract and can be transmitted through feces, so sewage surveillance is a logical way to detect it, said Vincent Racaniello, a professor of microbiology and immunology at Columbia University in New York. “These viruses have probably been in the wastewater for years,” he said. “We’ve just never looked for them and now we’re starting to look because of this case. And I would say the more we look, we’re going to find it all over the US, especially in the big cities.” Those strains of polio virus likely entered the United States from people in other countries who had gotten the oral polio vaccine, Racaniello and Schaffner said. The oral vaccine was the first to be developed and the easiest to administer, so it is still used as part of the World Health Organization’s polio eradication efforts around the world, experts said. But, Racaniello said, it’s an infectious vaccine, meaning it contains a weakened version of the virus itself. “It reproduces in your intestines and you throw it away — that’s the virus in the sewage,” he said. “This virus circulates very easily and can cause polio, even though it is a vaccine virus. After passing through the human gut, it can regain the ability to cause polio.” The United States stopped using the oral vaccine in 2000 after the U.S. Preventive Services Task Force decided the risk of even a few cases of polio was too great, Schaffner said. “Every year we had about 4 million births and we had somewhere between six and 10 cases of vaccine-related polio,” he said. “We gave a very small number of children and adults paralysis using the oral vaccine.” The US now exclusively uses a four-dose inactivated polio vaccine. “The virus is killed. There is no chance of it multiplying. It cannot be mutated. It can’t cause paralysis,” Schaffner said. “But as an inactivated virus vaccine, it has to be given by needle and syringe, which is more cumbersome and much more expensive and, of course, adds to the number of vaccinations young children have had. , which didn’t make moms very happy.” Schaffner said it is “remarkable” that the polio virus associated with the vaccine is circulating in the United States. “We wouldn’t expect it to be widespread, so we’re just finding that there’s even more transcontinental transmission of these oral polio vaccine viruses than we thought,” Schaffner said. “If you had asked me before this case, I would have said that unless someone has just gone overseas or had a visitor from overseas, you’re not going to find it here because we don’t use [the oral vaccine] in the United States,” added Schaffner, “But we may be a smaller global community even than I thought.” The only true protection is vaccination, and Racaniello hopes the sewage surveillance data will help convince the vaccine-hesitant to go ahead and get their jabs. “Maybe they thought there was no polio virus in the U.S., right? And so they say I don’t need to get vaccinated,” Racaniello said. “And now we can show them it’s there. In fact, I think we need to do more sewage surveillance and show people, look, it’s in every major metropolitan city. You better get vaccinated.” More information The US Centers for Disease Control and Prevention has more on polio. SOURCES: Gail Shust, MD, pediatric infectious disease specialist, NYU Langone Hassenfeld Children’s Hospital, New York. William Schaffner, MD, medical director, National Foundation for Infectious Diseases, Bethesda, Md. Vincent Racaniello, PhD, Higgins Professor, Department of Microbiology and Immunology, Columbia University, New York
