New York City officials have detected polio in the city’s sewage, confirming that at least one person recently carried the virus in the city.
Surveillance for the virus was launched after a confirmed case was found near Rockland County last month. Wastewater monitoring in Orange County — also just outside the city’s Bronx borough — has also detected at least two polio samples since June.
Officials have warned there could be hundreds – potentially – thousands of undiagnosed cases circulating in the state. Since the majority of cases are asymptomatic or very mild, it is likely that a large majority will go undetected.
In response, the Centers for Disease Control and Prevention (CDC) deployed a team to Rockland County earlier this week to investigate the outbreak and help vaccinate the local community. Rockland and Orange counties only vaccinated 60% of residents — some of the lowest rates in the state.
The Big Apple has an 86% vaccination rate, still well below the 95% threshold deemed necessary to avoid a large-scale epidemic.
Although the incidence of poliomyelitis in the largest city in the United States can be terrifying, a vaccinated person is not considered to be at risk. Many Americans had to be vaccinated to go to school, and no boosters are necessary. More than 90% of the American population has received the poliomyelitis vaccine.
New York City officials have detected a case of polio in the city’s sewage, meaning at least one person in the city is carrying the devastating virus. A case of the virus has already been confirmed in Rockland County, and sewage monitoring in Orange County has also found a case
Common symptoms of polio include high temperatures, extreme fatigue, headache, vomiting, stiff neck and muscle aches
“The risk to New Yorkers is real but the defense is so simple – get the polio shot,” Dr. Ashwin Vasan, the city’s health commissioner, said in a statement.
“With polio circulating in our communities, there is simply nothing more essential than vaccinating our children to protect them from this virus, and if you are an unvaccinated or incompletely vaccinated adult, please choose now to have yourself vaccinate.
“Polio is entirely preventable and its reappearance should be a call to action for all of us.”
Authorities have not confirmed when the sample was taken. There is also no way of knowing if it was a visitor to the city or a resident.
Poliomyelitis: Once the most feared disease in America, it has now become a rarity
Poliomyelitis is a serious viral infection that was once common around the world.
The virus lives in the throat and intestines for up to six weeks, with patients being most infectious seven to 10 days before and after symptoms appear.
But it can spread to the spinal cord, causing muscle weakness and paralysis.
The virus is more common in infants and young children and occurs in conditions of poor hygiene.
How deadly is it?
Most people show no signs of infection, but about one in 20 people have minor symptoms such as fever, muscle weakness, headache, nausea and vomiting.
About one in 50 patients develop severe muscle pain and stiffness in the neck and back.
Less than one percent of poliomyelitis cases lead to paralysis and one in 10 of them leads to death.
Of those who do develop symptoms, these tend to appear three to 21 days after infection and include:
- High temperature
- Sore throat
- Abdominal pain
- sore muscles
- Nausea and vomiting
How does it spread?
People can catch polio through droplets in the air when someone coughs or sneezes, or if they come into contact with the feces of an infected person.
This includes food, water, clothing or toys.
Are there different strains?
There are three strains of ‘wild’ poliomyelitis, which have been largely eradicated throughout Europe, the Americas, Southeast Asia and the Western Pacific.
Types 2 and 3 were eliminated through a global mass vaccination campaign, with the last cases detected in 1999 and 2012 respectively.
The remaining wild polio, type 1, remains endemic in only two countries, Afghanistan and Pakistan.
Wild poliomyelitis has been eliminated in almost every country in the world thanks to vaccines.
But the global rollout has spawned new types of strains known as vaccine-derived polioviruses.
These are strains originally used in live vaccines, but have spread through the community and evolved to behave more like the wild version.
Is poliomyelitis still present in the United States?
The last case of person-to-person transmission in the United States was in 1979, which also marked the last case of wild polio.
But there have been several dozen cases of vaccine-derived poliovirus since, albeit one-time, with no onward transmission.
Am I vaccinated against polio?
Americans have been offered the inactivated polio vaccine (IPV) since 2000.
It is given in four doses, the first shot at two months of age. It is also given at four, six to 18 months and four to six years.
Adoption has declined slightly but remains above 90% nationwide.
It is feared that vaccine hesitancy has increased during the Covid crisis due to misinformation being spread about shots for this virus and school closures.
The polio case discovered in Rockland earlier this year came as a shock. It was the first case detected in the country in more than a decade and could potentially be the first transmitted case in the United States since before the turn of the century.
It was found in a man in his twenties who experienced a severe case, with his symptoms including paralysis.
The man was hospitalized, but returned home to recover. His current whereabouts are unknown.
His case of poliomyelitis was of a strain induced by the vaccine. This form of polio emerged as a result of the oral polio vaccine, which delivers a live form of the virus to a person.
In some cases, the recipient may be infected. For this reason, it is no longer used in America, although some developing countries still use it.
Officials did not confirm whether they knew whether the virus found in sewage samples from the area belonged to vaccine-induced or wild-type strains of the virus.
However, the mere detection of a single case put authorities on high alert.
“Based on past polio outbreaks, New Yorkers should know that for every case of paralytic polio observed, there may be hundreds more infected,” said Dr. Mary Bassett, Health Commissioner of the state earlier this week.
“Coupled with the latest sewage findings, the Department is treating the single polio case as the tip of the iceberg of a much larger potential spread.
A local Rockland official said this week that the actual numbers of cases in the Empire State are likely in the thousands.
“There’s not just one case of poliomyelitis if you see a paralytic case. The incidence of paralytic polio is less than one percent,” Rockland County Health Commissioner Dr Patricia Schnabel Ruppert told the BBC.
“Most cases are asymptomatic or mildly symptomatic, and these symptoms are often missed.
“So there are hundreds, if not thousands, of cases that have happened so that we can see a paralytic case.”
The CDC also got involved in Rockland, sending a team to investigate the circumstances surrounding the polio case and increase vaccination rates in the county.
According to official data, only about 60 percent of Rockland County residents are vaccinated against polio before their second birthday. This is an incredibly low figure that is well below the 95% threshold set by the World Health Organization to prevent an epidemic.
New York City has a much higher figure – at 86% – still well below the 95% threshold.
Polio was once the most feared disease in the United States, causing panic throughout the 1940s.
Parents were afraid to let their children play outside — especially in the summer when the virus seemed to be more common — and public health officials were imposing quarantines on homes and even entire towns where it was spotted.
It was responsible for more than 15,000 paralysis each year and hundreds of deaths.
But in the mid-1950s, the country began rolling out polio vaccines to prevent the disease.
In 1979, the United States declared the virus eliminated. There has been no known transmission on US soil since.
The vaccine has also been rolled out globally, with the virus being pushed back in just a few countries.
We now know that it circulates only in Pakistan and Afghanistan. The WHO warns that as long as it continues to spread there, it remains a threat to the world.
But in recent years — as the virus has receded from national memory — vaccination rates have slowed in the United States.
The latest figures show that about 92.6% of Americans are vaccinated against polio by their second birthday.
The CDC recommends that all children get the polio vaccine.
It is given as four injections in the leg or arm, with the first given at two months, the second at four months, the third at six to 18 months and the final dose at four to six years.
The vaccine is highly effective, with 99% of children enjoying lifelong protection against the disease.