Nurse Lydia Fulton prepares to administer the measles, mumps and rubella (MMR) vaccine as well as a vaccine used to help prevent diphtheria, pertussis, tetanus and polio diseases to the Children’s Primary Care Clinic in Minneapolis, MN.
Courtney Perry | The Washington Post | Getty Images
Childhood polio vaccination rates are as low as 37% in some New York metropolitan area communities despite a vaccination mandate, increasing the risk of an outbreak as the virus is circulating locally for the first time since decades.
Polio vaccination is mandatory in New York for all children attending daycare centers and K-12 schools, whether public, private, or have a religious affiliation.
There are no exemptions to the New York State vaccination mandate for reasons of religion or personal belief. Exemptions are only granted when a child truly has a medical condition that would prevent them from receiving a vaccine.
Despite this mandate, child polio immunization rates have dropped in some communities. In Rockland County, a suburb of New York, the vaccination rate for children under 2 has risen from 67% in 2020 to around 60% in 2022, according to the Centers for Disease Control and Prevention. In some parts of the county, only 37% of children in this age group are up to date on 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 at 4 to 6 years old, according to the CDC.
Overall, New York State’s polio vaccination rate for 2-year-olds is about 79 percent, according to health department data. Nearly 93% of children 2 and under have been vaccinated against polio in the United States, according to a CDC survey published in October 2021.
But the case of a young adult who caught polio in Rockland County this summer has set off alarm bells among public health officials. Sewage samples taken since May in Rockland County, Orange County and New York City have tested positive for polio, strongly indicating that the virus has been circulating in metropolitan area communities for months.
The Rockland County adult’s case is only the second case of the virus that has caused local transmission of polio in the United States since 1979, according to the CDC. New York State Health Commissioner Dr. Mary Bassett called the sewage results alarming, and the CDC warned that the virus poses an ongoing risk to unvaccinated people.
Each case of polio represents a public health emergency, according to the CDC.
“It’s a wake-up call that we need to address this issue with our vaccination levels because I’ve never seen a child on an iron lung and I don’t want to,” said Dr Adam Ratner, director of the pediatric department. infectious diseases at NYU Langone Health.
New York State previously had a religious exemption from its school vaccination mandates, which led to a drop in vaccination, according to Ratner. This exemption was removed 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, leading to a drop in polio vaccine administration, according to the CDC.
“Even once people started going back to the doctor, because a lot of schools were remote, places weren’t enforcing vaccination mandates. So you have this cohort of kids who may still be underimmunized “, Ratner said.
Ratner said there was only one way to prevent more cases of polio: “Get vaccinated – that’s the solution to this problem.”
The Rockland County Health Department launched a campaign to help close the vaccination gap in late July, but the CDC said there were not enough doses administered to significantly increase vaccine coverage. in the county.
Two doses of the polio vaccine are at least 90% effective in preventing paralysis from the virus, and three doses are 99% to 100% effective, according to the CDC.
Poliovirus – which can cause the disease called poliomyelitis or poliomyelitis – is a devastating and highly contagious virus that struck fear into the hearts of parents before vaccines became available in the 1950s. More than 35,000 people in the United States United became disabled from polio every year on average in the late 1940s. There is no cure for polio.
The virus can infect a person’s spinal cord, causing permanent paralysis of the arms and legs. In some cases, poliomyelitis is fatal because it paralyzes the muscles needed for breathing and swallowing. Most people who catch the virus do not develop symptoms, but they can still spread the virus to others and make them sick.
The virus, which lives in the intestines and throat, is spread through what doctors call the fecal-oral route. Young children are particularly at risk of putting hands, toys or other objects contaminated with feces in their mouths. The virus can also be spread through respiratory droplets when a person sneezes or coughs, although this is less common, according to the CDC.
A successful vaccination campaign dramatically reduced polio paralysis cases from over 15,000 a year in the early 1950s to less than 10 in the 1970s. Since 1979, not a single case of polio has appeared in the USA
“We’ve come to this point in the United States with tremendous effort. It’s sad to see us go backwards with this,” Ratner said.
Globally, two of the three naturally occurring strains of poliovirus have been eradicated, according to the World Health Organization. But travelers have occasionally brought the virus into the United States, and the strain now circulating in the New York area is almost certainly from abroad.
The strain the Rockland County adult caught is linked to a weakened form of the virus used in the oral polio vaccine. The United States stopped using this vaccine more than 20 years ago, meaning someone vaccinated outside the country brought the virus into the United States. New York sewage samples are genetically linked to positive sewage samples in Israel and the UK.
The oral vaccine uses a weakened virus that can still replicate 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, which can lead to paralysis.
“That’s one of the reasons we don’t use the oral polio vaccine because there’s always a risk of transmission, especially for people who are immunocompromised or unvaccinated,” said Dr Waleed Javaid, epidemiologist at Mount Sinai Hospital in New York. The oral vaccine is used in some countries because it is effective, cheap, easy to administer and normally safe.
The United States uses a polio vaccine given in a series of injections in which the viral strain is inactivated so that it cannot replicate, spread or cause disease.
The polio vaccine likely protects people for years after the primary vaccination series, although the exact duration of protection is unknown, according to the CDC. Adults vaccinated as children but who are at higher risk of being exposed to poliomyelitis can receive a booster. Javaid said anyone with concerns, such as people with weakened immune systems, should see their primary care physician and find out if they are in a risk category and should receive another dose of the vaccine.
But there’s no reason for the general public to panic, Javaid said. Most people are vaccinated and protected against poliomyelitis. And for those who are not, the solution is simple: get vaccinated.