At Children’s Primary Care Clinic in Minneapolis, MN, nurse Lydia Fulton prepares to administer the measles, mumps, rubella (MMR) vaccine as well as a vaccine used to help prevent the diseases diphtheria, pertussis, tetanus, and polio.
Despite a vaccine mandate, the paediatric polio immunisation rate in some neighbourhoods in the New York City metro region is as low as 37%, raising the possibility of an outbreak as the virus circulates locally for the first time in decades.
Polio vaccine is required for all children attending day care and K-12 schools in New York, regardless of whether they are public, private, or religiously affiliated.
There are no religious or personal belief exemptions to New York’s immunisation mandate. Exemptions are granted only when a child has a medical condition that would prevent him or her from receiving a vaccine.
Despite this mandate, the childhood immunisation rate against polio has declined in some places. According to the Centers for Disease Control and Prevention, the immunisation rate for children under the age of two in Rockland County, a New York City suburb, fell from 67% in 2020 to around 60% in 2022. Only 37% of children in this age range are up to date on their polio vaccine in various sections of the county.
According to the CDC, children should receive four doses: one at two months, one at four months, one at six to eighteen months, and one between four and six years old.
According to health department data, the overall polio immunisation percentage for 2-year-olds in New York state is around 79%. According to a CDC report published in October 2021, about 93% of children aged 2 and under were immunised against polio.
However, the occurrence of a young adult contracting polio in Rockland County this summer raised concerns among public health officials. Sewage samples collected in Rockland, Orange, and New York City since May have tested positive for polio, indicating that the virus has been circulating in the metropolitan area for months.
According to the CDC, the Rockland County adult’s case is just the second occurrence of the virus that causes polio spreading locally in the United States since 1979. The findings in the wastewater have been described as worrying by New York State Health Commissioner Dr. Mary Bassett, and the CDC has warned that the virus poses a continued risk to those who have not been vaccinated.
According to the CDC, every case of polio is a public health emergency.
“This is a wake-up call that we need to address our immunisation levels because I’ve never seen a child on an iron lung and I don’t want to,” said Dr. Adam Ratner, director of paediatric infectious disease at NYU Langone Health.
According to Ratner, New York state previously had a religious exemption from its school vaccine laws, which resulted in a decline in immunisation. This exemption was removed in 2019 after a measles outbreak was caused by low vaccination rates. However, the advent of the Covid pandemic in 2020 resulted in school closures and disruptions to health-care professionals, resulting in a decrease in polio vaccine administration, according to the CDC.
“Even after people started going back to the doctor, places were not enforcing vaccine mandates because many schools were remote. So you have this group of children who may still be under-immunized “Ratner stated.
“Getting vaccinated — that is the solution to this problem,” Ratner said of preventing new cases of polio.
In late July, the Rockland County Health Department initiated a campaign to try overcome the vaccine gap, however the CDC stated that not enough doses were administered to significantly enhance vaccination coverage in the county.
According to the CDC, two doses of the polio vaccine are at least 90% effective in preventing virus-induced paralysis, and three doses are 99% to 100% effective.
What exactly is polio?
Poliovirus, which can cause poliomyelitis, or polio, is a severe, extremely contagious virus that terrified parents until immunizations became available in the 1950s. In the late 1940s, polio disabled more than 35,000 persons in the United States each year on average. Polio has no known cure.
The virus has the potential to infect a person’s spinal cord, resulting in irreversible paralysis of the arms and legs. Polio can be lethal in some circumstances because it paralyses muscles required for breathing and swallowing. Although most people who contract the virus do not experience symptoms, they can still spread the virus and make others sick.
The virus, which resides in the intestines and throat, spreads by the fecal-oral route, as doctors call it. Young children are especially vulnerable because they may put feces-contaminated hands, toys, or other objects in their mouth. According to the CDC, the virus can also be spread by respiratory droplets when a person sneezes or coughs.
A effective immunisation effort lowered polio paralysis cases from more than 15,000 per year in the early 1950s to fewer than 10 in the 1970s. There hasn’t been a single case of polio in the United States since 1979.
“We worked extremely hard to get to this stage in the United States. It’s disappointing to see us backsliding on this “Ratner stated.
According to the World Health Organization, two of the three naturally occurring strains of poliovirus have been eradicated globally. However, the virus has been introduced into the United States on occasion by visitors, and the variant that is now circulating in the New York City area almost definitely originated outside.
The Rockland County adult’s strain is connected to a weakened version of the virus used in the oral polio vaccination. The United States stopped utilising this vaccination more than 20 years ago, which means that someone inoculated outside the country brought the virus into the country. The wastewater samples from New York are genetically connected to positive sewage samples from Israel and the United Kingdom.
The oral vaccination employs a weakened virus that can still multiply in the human body, and the strain can return to a kind that affects the nervous system in rare cases. When this occurs, a person who has recently been immunised with the oral vaccine can infect an unprotected person, potentially resulting in paralysis.
“That’s one of the reasons we don’t utilise the oral polio vaccination,” Dr. Waleed Javaid, a hospital epidemiologist at Mount Sinai in New York City, explained. Oral vaccines are utilised in some nations because they are effective, inexpensive, simple to administer, and generally safe.
The United States utilises a polio vaccine that is provided as a series of doses that inactivates the viral strain so that it cannot replicate, spread, or cause disease.
According to the CDC, the polio vaccine certainly protects people for years following the first vaccination series, while the exact period of protection is uncertain. Adults who were vaccinated as children but are at higher risk of polio exposure can get one booster shot. Javaid advised anyone who is concerned, such as those with weakened immune systems, to see their primary care physician to determine whether they are in a risk category and should receive another dosage of the vaccination.
However, there is no need for the general public to panic, according to Javaid. Most people have been inoculated against polio. For those who aren’t, the cure is straightforward: get vaccinated.