Nurse Lydia Fulton prepares to administer the measles, mumps and rubella vaccine (MMR), as well as a vaccine used to help prevent the diseases diphtheria, whooping cough, tetanus and polio at the Children’s Primary Care Clinic in Minneapolis, MN.
Courtney Perry | The Washington Post | Getty Images
The vaccination rate for childhood polio is just 37% in some New York City metropolitan communities, despite a vaccine mandate, increasing the risk of an outbreak as the virus circulates locally for the first time in decades.
Polio vaccination is mandatory in New York for all children attending daycare and K-12 schools, regardless of whether they are public, private or religious.
There are no exceptions to the New York State vaccine mandate for reasons of religion or personal belief. Exemptions are only granted if a child really has a medical condition that would prevent the child from receiving a vaccine.
Despite this mandate, childhood polio vaccination rates have declined in some communities. In Rockland County, a suburb of New York City, vaccination rates for children under 2 fell from 67% in 2020 to about 60% in 2022, according to the Centers for Disease Control and Prevention. In some parts of the province, only 37% of children in this age group are aware of their polio vaccine.
Children should receive four doses: one at 2 months, a second at 4 months, a third at 6 to 18 months and a fourth between 4 and 6 years of age, according to the CDC.
Overall, New York State’s polio vaccination rate for 2-year-olds is about 79%, according to health department data. According to a CDC survey published in October 2021, nearly 93% of children aged 2 and under have been vaccinated against polio in the US.
But the case of a young adult who contracted polio in Rockland County this summer raised alarm bells among public health officials. Sewer samples collected in Rockland County, Orange County and New York City since May have tested positive for polio, strongly suggesting that the virus has been circulating in communities in the metropolitan area for months.
The adult case in Rockland County, according to the CDC, is only the second case of the virus causing polio to be transmitted locally in the U.S. since 1979. New York State Health Commissioner Dr. Mary Bassett, called the wastewater findings alarming, and the CDC has warned that the virus poses an ongoing risk to people who have not been vaccinated.
Each case of polio represents a public health emergency, according to the CDC.
“This is a wake-up call that we need to solve this problem with our vaccination levels, because I’ve never seen a child with an iron lung and I don’t want to,” said Dr. Adam Ratner, director of pediatric infectious disease at NYU Langone Health.
New York state previously had a religious waiver from its school vaccine mandates, which Ratner said led to a drop in immunization. This exemption was abolished in 2019 after falling vaccination rates led to a measles outbreak. But the onset of the Covid pandemic in 2020 caused school closures and disruptions to health care providers, resulting in a decline in polio vaccine administration, the CDC said.
“Even as people started going back to the doctor because a lot of schools were remote, places didn’t enforce vaccine mandates. So you have this cohort of kids who may still be under-immunized,” Ratner said.
Ratner said there is only one way to prevent further cases of polio: “Vaccination — that’s the solution to this problem.”
The Rockland County Health Department launched a campaign in late July to help close the vaccination gap, but the CDC said not enough doses have been administered to significantly increase vaccination coverage in the county.
Two doses of the polio vaccine are at least 90% effective in preventing paralysis from the virus, according to the CDC, and three doses are 99% to 100% effective.
What is polio?
Poliovirus — which can cause the disease called poliomyelitis or polio — is a devastating, highly contagious virus that scared the hearts of parents before vaccines became available in the 1950s. In the late 1940s, an average of more than 35,000 people in the US were disabled by polio each year. There is no cure for polio.
The virus can infect a person’s spinal cord, leading to permanent paralysis of the arms and legs. In some cases, polio is fatal because it paralyzes the muscles needed to breathe and swallow. Most people who contract the virus do not develop any symptoms, but they can still spread the virus to others and make them sick.
The virus, which lives in the gut and throat, spreads through what doctors call the fecal-oral route. Young children are especially at risk if they put hands, toys or other objects contaminated with feces in their mouths. The virus can also spread through respiratory droplets when a person sneezes or coughs, although this is less common, according to the CDC.
A successful vaccination campaign drastically reduced the number of cases of polio paralysis from more than 15,000 per year in the early 1950s to less than 10 in the 1970s. Not a single case of polio has developed in the US since 1979
“We’ve gotten to this point in the US with a huge effort. It’s sad to see us fall back on this,” Ratner said.
According to the World Health Organization, two out of three naturally occurring poliovirus strains have been eradicated worldwide. But travelers have occasionally introduced the virus to the US, and the strain now circulating in the New York City area almost certainly originated from abroad.
The strain the adult caught from Rockland County has been linked to a weakened form of the virus used in the oral polio vaccine. The US stopped using this vaccine more than 20 years ago, meaning someone vaccinated outside the country introduced the virus into the US. New York’s wastewater samples are genetically linked to positive sewer samples in Israel and the United Kingdom.
The oral vaccine uses a weakened virus that can still multiply in the human body and in rare cases, the strain can revert to a type that attacks the nervous system. When this happens, a person recently immunized with the oral vaccine can infect an unvaccinated person, potentially leading to paralysis.
“That’s one of the reasons we don’t use the oral polio vaccine, because there is always a risk of transmission, especially in people who are immunocompromised or have not been vaccinated,” said Dr. Waleed Javaid, a hospital epidemiologist at Mount Sinai in New York. York. York City. The oral vaccine is used in some countries because it is effective, inexpensive, easy to administer and normally safe.
The US uses a polio vaccine that is given as a series of injections that inactivates the virus strain so it cannot multiply, spread or cause disease.
The polio vaccine likely protects people for years after the primary vaccination course, although the exact duration of protection is unknown, according to the CDC. Adults vaccinated as children but at higher risk of polio exposure can receive one booster. Javaid said anyone with concerns, such as those with weak immune systems, should see their GP to see if they fall into a risk category and receive another dose of the vaccine.
But there is no reason for the general public to panic, Javaid said. Most people are vaccinated and protected against polio. And for those who aren’t, the solution is simple: get vaccinated.