Since the first case of polio in the United States in almost a decade was reported in New York in July, health officials have been working to encourage polio vaccination in low-coverage areas since “[e]even a single case of paralytic polio represents a public health emergency.”
Polio has likely been circulating in the US longer than previously believed
In July, New York health officials announced that a case of polio had been discovered in the state after a young adult from Rockland County was paralyzed by the disease. This was the first reported case of polio in the United States since 2013.
Since then, sewage surveillance has detected several more poliovirus samples in Rockland and Orange counties, as well as in New York City. One last one CDC analysis of New York sewage data found changes in the virus’s genome that suggest it may have been circulating around the world for up to a year, with the earliest sample detected from New York dating back to April.
According to some health experts, polio has likely been circulating in the United States for much longer and more widely than previously believed.
“I think you’re going to see over the next few weeks more and more reports of poliovirus in sewage elsewhere,” said Vincent Racaniello, a virologist at Columbia University.
Davida Smyth, of Texas A&M University-San Antonioagreed, saying she is “absolutely convinced” that poliovirus will be detected in wastewater from other American communities in the coming weeks.
“Here’s the thing: Polio is here in the U.S. It’s not gone,” Racaniello said. “It’s in sewage. It can contaminate you, so if you’re not vaccinated, that could be a problem.”
How health officials can improve polio vaccination rates
In a recent report, the CDC wrote that “[e]even a single case of paralytic poliomyelitis represents a public health emergency in the United States.” To limit the potential spread of poliovirus, both federal and local health officials have encouraged people who are unvaccinated to get vaccinated. them against polio as soon as possible.
Currently, many of the polio samples detected in New York have been from counties with relatively low polio vaccination rates. In both Rockland and Orange counties where the polio virus was detected, the polio vaccination rate is about 60%, and the CDC found that coverage was “as low as 37.3%” in some specific Rockland County zip code areas.
Without an effective vaccination campaign, health officials are concerned that the polio virus could spread from New York to other nearby communities, especially as more people travel.
“Rockland County is basically New York City,” said Perry Halkitis, the university’s dean School of Public Health IN Rutgers University. “New York City is basically New Jersey. Rockland County is basically Connecticut.”
“Are there perhaps tens, if not hundreds, if not more cases of undetected polio in our population? Perhaps,” he added. “Are we catching them? Probably not.”
To address vaccine hesitancy in areas with low polio vaccination rates, Mona Montal, chief of staff for the city of Rampo in Rockland County, and Shoshana Bernstein, a freelance health communicator, worked with trusted community leaders to spread the word about polio vaccination. In addition, they created a carefully worded infographic in four different languages, including English, Spanish, Haitian Creole, and Yiddish, to reach more communities.
“People have had PTSD with the word vaccination,” Montal said. “So we’re immunizing, not vaccinating. And that’s the message.”
Separately, Sallie Permar, chief pediatrician at Children’s Hospital of NewYork-Presbyterian Komansky and head of the department of pediatrics in Weill Cornell Medicineand Jay Varma, director of Weill Cornell’s Center for Pandemic Prevention Responseexplained in STAT how the United States can improve vaccine delivery through pediatricians, including:
- Funding partnerships between local health departments and pediatricians’ offices to identify children who are not up to date on their vaccines
- Making high vaccination rates part of pediatric quality improvement processes, similar to models used for seasonal flu shots
- Providing substantial incentive payments through state Medicaid programs to pediatricians who achieve high vaccination rates
According to William Schaffner from Vanderbilt University Medical Centerreports of polio in the United States are a reminder to health care providers and their patients that the virus continues to be a real health concern.
“[It’s] the opposite of the old saying, ‘gone but not forgotten,'” Schnaffer said. “Polio is forgotten but not gone.” (DePeau-Wilson, MedPage Today, 25/8; Daniel, “Shooting,” NPR, 8/24; Permar/Varma, STAT26/8)