Could polio become a ‘public health emergency’?

Since the first case of polio in the United States in nearly a decade was reported in New York in July, health officials have been working to promote polio vaccination in low-coverage areas of “[e]even one case of paralytic polio constitutes a public health emergency.”

Polio has probably been circulating in the US longer than previously thought

In July, New York health officials announced a case of polio in the state after a young adult from Rockland County was paralyzed by the disease. This is the first reported case of polio in the United States since 2013.

Since then, sewage monitoring has found several other samples of poliovirus in Rockland and Orange counties, as well as in New York. Recently 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 being from April.

According to several health experts, polio probably circulated in the United States much longer and more widely than previously thought.

“I think in the coming weeks you’ll see more and more reports of poliovirus in wastewater elsewhere,” said Vincent Racaniello, a virologist at Columbia University.

Davida Smith, of Texas A&M University – San Antonioagreed, saying she was “absolutely convinced” that poliovirus would be found 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 the sewage. It can contaminate you, so if you’re not vaccinated, that can be a problem.”

How health workers can improve polio vaccination rates

In a recent report, the CDC wrote that “[e]even one case of paralytic polio constitutes a public health emergency in the United States.” To limit the potential spread of poliovirus, both federal and local health officials encourage unvaccinated people to get polio shots as soon as possible soon.

Currently, many of the polio samples found in New York are from counties with relatively low polio vaccination rates. In both Rockland and Orange counties, where polio was found, the polio vaccination rate is about 60%, and the CDC found coverage to be “as low as 37.3%” in some ZIP code-specific areas of Rockland County.

Without an effective vaccination campaign, health officials are concerned that the poliovirus could spread from New York to other nearby communities, especially as more people travel.

“Rockland County is basically New York City,” said Perry Halkitis, dean of the School of Public Health at Rutgers University. “New York is basically New Jersey. Rockland County is basically Connecticut.”

“Are there likely dozens, if not hundreds, if not more cases of undetected polio in our population? Probably,” 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 Rockland County town of Rampo, and Shoshana Bernstein, an independent health communicator, worked with trusted community leaders to spread the word for polio vaccination. Additionally, they created carefully worded infographics 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 immunize, we don’t vaccinate. And that’s the message.”

Separately, Sally Permar, chief pediatrician at NewYork-Presbyterian Komansky Children’s Hospital and head of the Department of Pediatrics in Weill Cornell Medicineand Jay Varma, Weill Cornell’s director Pandemic Prevention Response Centerexplain in STATISTICS how the United States could improve vaccine delivery through pediatricians, including by:

  • Funding partnerships between local health departments and pediatricians’ offices to identify children who are not up to date on their vaccinations
  • Making high vaccination rates part of pediatric quality improvement processes, similar to models used for influenza vaccines during their seasonal rollout
  • Offering significant incentive payments through state Medicaid programs to pediatricians who achieve high vaccination rates

According to William Schaffner of 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, “it’s gone but not forgotten,” Schnaffer said. “Polio is forgotten, but not gone.” (DePeau-Wilson, MedPage today, 8/25; Daniel, “Shots,” NPR, 8/24; Permar/Varma, STATISTICS8/26)

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