Nurse Lydia Fulton prepares to administer the measles, mumps, and rubella (MMR) vaccine in addition to the vaccine used to help prevent diphtheria, pertussis, tetanus and polio at a children’s primary care clinic in Minneapolis, Minnesota.
Courtney Perry | The Washington Post | Getty Images
The polio vaccination rate is as low as 37% in some communities in the New York City metro area, despite the vaccine being mandated, raising the risk of an outbreak as the virus spreads locally for the first time in decades.
Polio vaccination is mandatory in New York for all children attending day care and K-12 schools, regardless of whether they are public, private, or have a religious affiliation.
There are no exceptions to the New York State vaccine for reasons of religion or personal belief. Exemptions are only offered when a child already has a medical condition that prevents them from receiving the vaccine.
Despite this mandate, the rate of polio vaccination of children has declined in some communities. In Rockland County, a suburb of New York City, the vaccination rate for children under the age of two has fallen from 67% in 2020 to about 60% in 2022, according to the Centers for Disease Control and Prevention. In some areas of the province, only 37% of children in this age group are familiar with the 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 between 4 and 6 years old, according to the CDC.
Overall, the polio vaccination rate in New York State for 2-year-olds is about 79%, according to Department of Health data. Nearly 93% of children ages two and younger 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 contracted polio in Rockland County this summer set off alarm bells among public health officials. Wastewater samples collected since May in Rockland County, Orange County and New York City tested positive for polio, strongly indicating that the virus has been circulating in communities in the metropolitan area for months.
The adult case in Rockland County is only the second case of the virus that causes local transmission of polio in the United States since 1979, according to the CDC. New York State Health Commissioner Dr. Mary Bassett described the results of the sewage as alarming, and the CDC warned that the virus posed an ongoing risk to unvaccinated people.
Each case of polio represents a public health emergency, according to the Centers for Disease Control and Prevention.
“This is a wake-up call we must fix this problem with our vaccination levels, because I’ve never seen a child with iron lung and don’t want to,” said Dr. Adam Ratner, director of pediatrics. Infectious Diseases at NYU Langone Health.
New York state previously had a religious exemption from school vaccination mandates, which led to lower immunization, according to Ratner. This exemption was rescinded in 2019 after low vaccination rates led to an outbreak of measles. But the emergence of the Covid pandemic in 2020 caused school closures and health care providers to be disrupted, resulting in reduced administration of the polio vaccine, according to the CDC.
“Even after people started going back to the doctor, because a lot of schools were remote, places weren’t enforcing vaccination instructions. So I got this group of kids who might still not be adequately immunized,” Ratner said.
There is only one way to prevent more cases of polio, Ratner said: “Vaccination – that’s the solution to this problem.”
The Rockland County Department of Health launched a campaign to help close the vaccination gap in late July, but the CDC said that not enough doses were being given to increase the county’s vaccination coverage.
Two doses of the polio vaccine are at least 90% effective in preventing paralysis caused by the virus, and three doses are 99% to 100% effective, according to the CDC.
The polio virus, which can cause a disease called polio, is a devastating and highly contagious virus that frightened parents before vaccines became available in the 1950s. More than 35,000 people in the United States became disabled from polio each year on average in the late 1940s. There is no cure for polio.
The virus can infect a person’s spinal cord, resulting in permanent paralysis of the arms and legs. In some cases, polio is fatal because it paralyzes the muscles needed for breathing and swallowing. Most people who contract 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 especially at risk, from putting their hands, toys or other objects contaminated with feces in their mouths. The virus can also 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 cases from more than 15,000 annually in the early 1950s to less than 10 in the 1970s. Since 1979, not a single case of polio has arisen in the United States
“We got to this point in the United States with a tremendous effort,” 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 introduced the virus into the United States, and the strain now circulating in the New York City area almost certainly originated abroad.
The strain that was infected in adults in Rockland County is weakly related to the virus used in the oral polio vaccine. The United States stopped using this vaccine more than 20 years ago, which means that someone vaccinated outside the country introduced the virus into the United States. New York sewage samples are genetically related to positive sewage samples in Israel and the United Kingdom.
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 who has recently been immunized with the oral vaccine can infect an unvaccinated individual which can lead to paralysis.
Dr. Walid Javid, an epidemiologist at Mount Sinai Hospital in New York City. The oral vaccine is used in some countries because it is effective, cheap, easy to use and usually safe.
The United States uses the polio vaccine given as a series of vaccines in which the virus strain is inactivated so that it cannot reproduce, spread, or cause disease.
The polio vaccine will likely protect people for years after the initial vaccination series, although the exact duration of protection is not known, according to the CDC. Adults who were vaccinated as children but who are at higher risk of exposure to polio can receive a single booster dose. Javid said anyone with concerns, such as people with weakened immune systems, should see their primary care physician and see if they are in a risk category and should receive another dose of the vaccine.
Javid said there was no reason for the general public to panic. Most people are vaccinated and protected from polio. And for those who are not, the solution is simple – receive a vaccination.
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