Avian Flu Diary: New York State DOH: Rockland County Reports A Polio Case

Credit Wikipedia

#16,893

This afternoon the New York State Department of Health announced an exceedingly rare poliovirus infection in a resident of Rockland County, a suburb of New York City. This appears to be the first case reported in the United states in nearly a decade.

The polio vaccine has so thoroughly controlled the virus in most countries that people were genuinely surprised last month with the UKHSA announced that the Poliovirus had been Detected in Sewage from North and East London, suggesting limited community spread of a vaccine-derived poliovirus (VDPV).

Most people in England - just as here in the United States - are fully protected by the polio vaccine, but it is possible that there are a few people who were never fully vaccinated, and who are still susceptible to the virus.

Most western countries stopped using the oral polio vaccine (OPV) in favor of the inactivated polio vaccine (IPV) more than 2 decades ago - and most of the world followed suit a few years ago (see Polio Vaccines: The Big Switch Begins) - but a few countries still use the oral vaccines to combat outbreaks.

The oral (Sabin) polio vaccine (OPV) contains three attenuated (weakened) polio virus strains that activate an immune response in the body, and for a few weeks causes the weakened virus to be shed in the feces.

This is considered a `good’ side effect, particularly in areas with poor sanitation, as this vaccine-virus can spread in the community for a limited time conveying extra immunity.

But, as the WHO explains, every once in awhile this can go awry.

On rare occasions, if a population is seriously under-immunized, an excreted vaccine-virus can continue to circulate for an extended period of time. The longer it is allowed to survive, the more genetic changes it undergoes. In very rare instances, the vaccine-virus can genetically change into a form that can paralyse – this is what is known as a circulating vaccine-derived poliovirus (cVDPV).

And this appears to be what has happened to a Rockland County resident, who appears to have contracted a cCVDPV. This statement does not provide the patient's age, or recent travel history, so we don't know where they may have been exposed.

New York State Department of Health and Rockland County Department of Health Alert the Public to A Case of Polio In the County

Rockland County Community Members Can Schedule a Vaccine Here

ALBANY, N.Y. (July 21, 2022) – The New York State Department of Health (NYSDOH) and the Rockland County Department of Health today alerted the public to a case of polio in a Rockland County resident. State and County health officials are advising medical practitioners and healthcare providers to be vigilant for additional cases.

As the polio vaccine continues to be included on the Centers for Disease Control and Prevention's (CDC) standard child immunization schedule, those already vaccinated are considered to be at lower risk. Notably, the polio vaccine is part of the required school immunization schedule for all children, and therefore school-age children are vaccinated before they start school. However, individuals who are unvaccinated, including those who are pregnant, those who have not completed their polio vaccine series previously, or community members who are concerned they have might have been exposed, should get vaccinated by Rockland County – who will be hosting local vaccine clinics – or partnering health agencies and providers in the area. Individuals who are already vaccinated but are at risk of exposure should receive a booster.

"Based on what we know about this case, and polio in general, the Department of Health strongly recommends that unvaccinated individuals get vaccinated or boosted with the FDA-approved IPV polio vaccine as soon as possible," State Health Commissioner Dr. Mary T. Bassett said."The polio vaccine is safe and effective, protecting against this potentially debilitating disease, and it has been part of the backbone of required, routine childhood immunizations recommended by health officials and public health agencies nationwide."

A viral disease that can affect the nervous system and cause muscle weakness, the polio virus typically enters the body through the mouth, usually from hands contaminated with fecal matter of an infected person. Respiratory and oral-to-oral transmission through saliva may also occur.

Polio is very contagious, and a person can spread the virus even if they aren't sick. Symptoms, which can be mild and flu-like (fatigue, fever, headache, stiffness, muscle pain, vomiting), can take up to 30 days to appear, during which time an infected individual can be shedding virus to others. Though rare, some polio cases can result in paralysis or death.

In this case, sequencing performed by the Wadsworth Center – NYSDOH's public health laboratory – and confirmed by CDC showed revertant polio Sabin type 2 virus. This is indicative of a transmission chain from an individual who received the oral polio vaccine (OPV), which is no longer authorized or administered in the U.S., where only the inactivated polio vaccine (IPV) has been given since 2000. This suggests that the virus may have originated in a location outside of the U.S. where OPV is administered, since revertant strains cannot emerge from inactivated vaccines.

"Many of you may be too young to remember polio, but when I was growing up, this disease struck fear in families, including my own," County Executive Ed Day said. "The fact that it is still around decades after the vaccine was created shows you just how relentless it is. Do the right thing for your child and the greater good of your community and have your child vaccinated now."

Due to the success of the vaccine, which was introduced in 1955, and a national vaccination program, polio cases were cut dramatically in the late 1950s and early 1960s, with the last naturally occurring cases of polio in the U.S. in 1979. More recent polio cases were not wild strains, with the last known case in the U.S. recorded by CDC in 2013.

"Vaccines have protected our health against old and new viruses for decades," New York City Health Commissioner Dr. Ashwin Vasan said. "The fact is, the urgency of safe and effective vaccines has always been here, and we need New Yorkers to protect themselves against completely preventable viruses like Polio."

NYSDOH is coordinating with the Rockland County Department of Health and the New York City Department of Health and Mental Hygiene (NYCDOHMH) to continue the case investigation, proactively respond, and protect communities against spread through urging vaccination, which will be supported by this multi-agency, county-led effort.

"The Rockland County Department of Health is working with our local health care partners and community leaders to notify the public and make polio vaccination available. We are monitoring the situation closely and working with the New York State Department of Health and the Centers for Disease Control and Prevention to respond to this emergent public health issue to protect the health and wellbeing of county residents," Rockland County Health Commissioner Dr. Patricia Schnabel Ruppert said.

Beginning on Friday, July 22, Rockland County will host a polio vaccination clinic at the Pomona Health Complex (Building A) at 50 Sanatorium Road in Pomona, New York from 10:00 am – 12:00 pm. A second clinic at the same location will be held on Monday, July 25 from 1:00 pm to 4:00 pm. Anyone who is unvaccinated – including those who are pregnant – has not completed their polio vaccine series, or are concerned they have might have been exposed, should get vaccinated at the clinics. Individuals who are already vaccinated but are at risk of exposure should receive a booster, which will also be available at the clinics.