Polio virus re-emerges in rich economies, exposing immunization gaps

Polio virus re-emerges in rich economies, exposing immunization gaps

Public health authorities in rich economies are scrambling to stave off the return of polio after the virus reappeared in several countries where it was nearly eradicated.

Health officials in New York City said Friday that they had detected polio in samples taken from the sewer system. Last month, a man in suburban New York was diagnosed with the first US case since 2013.

In London, health officials said this week they would offer a polio booster vaccine to hundreds of thousands of children after the virus was detected in London’s sewage. Israel earlier identified its first cases since 1988 and there has been a build-up in war-torn Ukraine, where health services are under enormous pressure.

The situation raises concerns that hesitancy over vaccination and global conflicts could allow a disease that was on the verge of global eradication to return.

For most of the 20th century, polio, short for poliomyelitis, was one of the most feared childhood diseases, killing and maiming tens of thousands of people each year. But the development of a vaccine in the 1950s and a global campaign against the disease launched in 1988 reduced the number of infected to just 175 cases by 2019 and reduced the number of countries where it is endemic to two – Pakistan and Afghanistan.

But its resurgence in Europe and the US, along with disruptions to vaccination programs — the Covid-19 pandemic and war in places like Ukraine and Afghanistan — have public health officials sounding the alarm.

“Globally, there has been a huge drop in routine vaccinations as countries have been involved in the Covid-19 pandemic response. If you scratch the surface, it shows the vulnerability of countries’ immunization systems,” said Siddhartha Datta, the World Health Organization’s regional adviser on vaccine-preventable diseases in the European region.

Last month, the WHO and Unicef ​​released figures showing the biggest sustained decline in childhood vaccinations in three decades, with at least 25 million infants missing out on life-saving shots in 2021. Just under 7 million children missed the third dose of the polio vaccine last year, compared to 2019, before the coronavirus pandemic.

Health officials in New York warned on Friday that hundreds of people may have already contracted the virus after the polio diagnosis on July 21 of an unvaccinated man who developed paralysis in Rockland County, about 50 miles northwest of New York.

The suburban county has one of the lowest vaccination rates in the US. Authorities have set up vaccination centers, distributed flyers urging people to get vaccinated, and are considering offering a polio booster shot to boost people’s immunity.

Dr. Mary Leahy, executive director of Bon Secours Charity Health System, one of Rockland’s largest hospital groups, said the virus likely infected many people without their knowledge because three-quarters of those infected show no symptoms.

“They have polio, but they walk around and they don’t know they have it. Only 25 percent develop flu-like symptoms. . . less than 1 percent will develop paralysis.”

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Genetic studies of the New York case linked it to polio viruses in Israel and London, suggesting cross-border links. The viruses detected are examples of vaccine-derived polio, a strain related to the weakened live poliovirus contained in the oral polio vaccine. They can cause disease and paralysis if allowed to circulate in populations with unvaccinated people long enough and then mutate.

Rockland County has a two-year-old vaccination rate of 60 percent, well below the national average of 78 percent. The WHO says that 95% vaccination coverage is required to ensure herd immunity.

Rockland is home to a large and growing Orthodox Jewish population. Dorrit Reiss, a law professor at the University of California, Hastings College of Law, said the Orthodox community in the Rockland area was actively sought out by national anti-vaccination campaigners who held rallies and distributed leaflets raising concerns about immunization.

“There is nothing in Judaism that is against vaccines, but some specific Jewish Orthodox communities are concerned. They live closed lives in multi-generational homes with large numbers of children, so in a very real sense this is an area that is vulnerable to outbreaks,” she said.

Local tensions over vaccination remain high after measles outbreaks in 2018 and 2019 infected hundreds of people concentrated in the ultra-Orthodox community of Rockland.

New York Jewish Week and other local publications have reported that the man who contracted polio in Rockland is Orthodox, although local health officials have not confirmed this due to concerns about stigmatizing the community.

A New York state senator last month also identified an infected polio patient as an Orthodox Jew and claimed that some private Jewish schools had a history of failing to comply with vaccination requirements. He later retracted his statement after objections from Jewish groups.

“One thing about this polio case is that this is Rockland County, where there was a massive measles outbreak two years ago — so that suggests vaccine hesitancy,” said Dr. Marny Eulberg, a retired physician and polio survivor who has studied the disease for decades. .

“That’s a problem because many young parents these days have not seen polio, it’s not part of their consciousness. And the reality is that once you get polio, the treatment today is no better than it was in the 1950s: so the best response is to get vaccinated.”

Health officials in Rockland say polio fears are prompting some previously hesitant people to sign up and get vaccinated.

“We saw one mother who was anti-vax and had not given any other vaccinations, who brought her two children in for the polio vaccine because paralysis scares her,” said Amanda Salzman, director of communications for Refuah Health in Rockland.

Salzman said the clinic has administered nearly 500 polio vaccines so far, out of a total of 2,000 countywide.

Health experts say the latest cases show the need to be cautious about vaccinations and for governments to support global efforts to eradicate polio. This program calls for $4.6 billion in funding to complete vaccinations in Afghanistan and Pakistan.

“There is a huge need to identify funding,” said Dr Jay Wenger, who leads the polio eradication program at the Bill & Melinda Gates Foundation. “The important thing is to get it, then we won’t have these virus episodes in New York, London or anywhere.”

More news from Donato Paolo Mancini in London

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