Poliomyelitis has reappeared in the United States.  Who should get the polio vaccine now?

Poliomyelitis has reappeared in the United States. Who should get the polio vaccine now?

Naturally, these events raised many questions: why does a case of poliomyelitis worry the authorities? What does it mean to find poliovirus in sewage? Who should be worried about getting the disease? If someone was vaccinated years ago, are they still protected now?

To learn more about this disease, which most people alive today have never experienced, I spoke with Dr. Leana Wen, CNN medical analyst, emergency physician and professor of health policy and management. at the George Washington University Milken Institute School of Public Health. She is also the author of “Lifelines: A Doctor’s Journey in the Fight for Public Health”.

CNN: So far, there has only been one documented case of paralysis due to poliovirus in New York City. Why is a case worrying health officials?

Dr AS Leana Wen: An August report from the CDC said “even a single case of paralytic polio represents a public health emergency in the United States.” This is for two main reasons.
First, poliomyelitis is a disease that can have very serious consequences. At its peak in the 1940s and 1950s, polio paralyzed tens of thousands of children every year. Thousands of people have died from the virus.
This changed with the introduction of highly effective vaccines, more than 99% effective in protecting against paralytic poliomyelitis. Thanks to massive vaccination campaigns, the last incidence of wild-type polio occurred in 1979 – and it was considered eliminated in the United States. The re-emergence of such a disease, which can have such serious impacts, is a major threat.
Second, the single case of paralytic polio may be just the tip of a large iceberg. Most cases of poliomyelitis infection are asymptomatic and do not cause paralysis. Symptoms – which can include fatigue, fever and diarrhea – tend to be mild and may resemble those of other viruses. Public health officials are concerned that many more people could be infected with polio and could pass it on unknowingly.
This is of particular concern because Rockland County, where the recent paralytic case of the virus was diagnosed, has a polio vaccination rate of just 60%. In some parts of the county, the vaccination rate is as low as 37%. These numbers are well below the required threshold for herd immunity, meaning there are many people in the region who are vulnerable to polio infection and potential serious consequences.

CNN: What does it mean that poliovirus has been detected in sewage from five counties, including New York?

Magnifying glass: Finding poliovirus in sewage means one of two things: that there are people actively infected with polio who are shedding the virus, or that the virus signal could be from people who have recently received the polio vaccine oral (OPV). OPV is no longer given in the United States — since 2000 the version used in the United States is inactivated polio vaccine (IPV), which is injected — but other countries still use OPV, and it is possible that travelers from these locations shed the vaccine virus.

Wastewater samples in a laboratory at Queens College on August 25 in New York.

In rare circumstances, weakened virus from people who have just received OPV could cause paralytic poliomyelitis in unvaccinated people, which is one of the main reasons why OPV is no longer used in the United States.

Another area of ​​concern is that a sewage sample from Nassau County on Long Island has been genetically linked to the paralytic polio case identified in Rockland County. (The two counties are not adjacent, but about 40 miles apart.) This is further evidence of community spread that goes largely unnoticed.

CNN: How can people get polio?

Magnifying glass: Poliomyelitis is an infectious disease that can be transmitted in several ways. One main route is fecal-oral, which means a person can get poliomyelitis if they come into contact with the feces of an infected person. This can happen, especially in children, by putting things like toys that have been contaminated with feces in their mouths.
Poliovirus can also be transmitted through the respiratory route – for example, if an infected person coughs or sneezes and these droplets land around your mouth. It is worth nothing that vaccinated people can also contract poliomyelitis and pass it on to others, although they themselves are extremely well protected against serious diseases.

CNN: Should New Yorkers be worried about getting polio?

Magnifying glass: Again, people vaccinated against poliomyelitis are extremely well protected against paralytic poliomyelitis and should not be worried at this stage. It should be emphasized, however, that while IPV is very effective in preventing the most serious potential effects of the disease, people who have received the vaccine could still be carriers of poliomyelitis and could transmit it to others. People at risk of serious consequences are the unvaccinated and those who are not fully vaccinated, including young children under 6 who have not yet completed their course of polio vaccinations.

CNN: How many polio shots should someone get?

Magnifying glass: The CDC recommends that children receive four doses of IPV. The first is administered at 2 months, the second at 4 months, the third between 6 and 18 months and the fourth between 4 and 6 years.

Adults who have never been vaccinated against poliomyelitis should receive three doses of IPV. The first should be administered as soon as possible, the second one to two months later and the third six to 12 months after the second.

CNN: If someone was vaccinated years ago, are they still protected? Who should get a polio booster now?

Magnifying glass: Protection against serious diseases remains strong for many years after vaccination; it is thought to probably last a lifetime. Most people vaccinated do not need to receive more doses.
Opinion: How a virus seems to have come back from the dead
However, if someone has not completed their original series of vaccines, they should receive their remaining doses. Some fully immunized people may also receive an additional lifetime booster of IPV under specific circumstances – for example, if they have direct contact with someone suspected of having poliomyelitis or if they are healthcare workers with higher risk of exposure to people with the disease.

CNN: What if you’re not sure you’ve been vaccinated? Suppose you don’t remember being vaccinated and it’s been many years. Is there a blood test you can do to check anyway?

Magnifying glass: You can check with your GP’s office or state health department to see if they have records of your vaccinations. If this is not the case, and there is no other way for you to check – for example, by asking parents or other relatives or carers – you should speak with your provider of health care to get the full set of polio vaccines now. There is no blood test that can reliably detect whether you are fully immunized against poliomyelitis.

CNN: What if you or your family members haven’t been vaccinated against poliovirus yet?

Magnifying glass: People who have not yet received a dose or who are not fully immunized should ensure that they receive their full series of polio vaccines immediately. This is especially important if they live in or around Rockland County in New York – but really everyone should catch up with their routine vaccinations.

It was a tragedy decades ago that so many children became permanently paralyzed and even died of polio. This should not happen again, because we have such effective vaccines that can prevent the serious consequences of the disease.

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