The New York State Department of Health has declared war on polio (poliomyelitis), a disabling and potentially deadly disease caused by the polio virus.
The discovery this summer that an unvaccinated young man in Rockland County had developed the severe, paralytic form of polio has become a major wakeup call to medical professionals across the state.
Dr. Eli Rosenberg, deputy director of the Office of Science of Public Health, told JewishPress.com in an interview that lone case in Rockland County indicates there are still “hundreds, if not thousands of others that are undetected” due to the way the virus is transmitted.
PCR testing, he said, also “genetically connected one New York City sample to the Rockland County case.”
Rosenberg, an epidemiologist who has played a major role in tracking COVID-19, monkeypox and polio in the state, said there have been “repeated detections of the virus also in Orange, Sullivan and Nassau Counties” as well as in New York City.
There is “ongoing and repeated reliable evidence through wastewater surveillance of polio virus circulating through communities,” he said. “People shed virus in their stool.”
Wastewater surveillance is a public health tool that was developed during the coronavirus pandemic.
“There are, in fact, multiple samples of concern in New York City,” Rosenberg said, although he refrained from offering further details, saying the New York City Department of Health and Hygiene oversees and manages wastewater surveillance in the five boroughs.
Polio Symptoms and Transmission
Polio spreads from person to person orally and through feces (think: poor hygiene, contaminated food or water) and can invade an infected person’s central nervous system – including the brain and spinal cord — causing paralysis. There is no cure. There are, however, vaccines to prevent it.
Of great concern to medical professionals is the fact that approximately 70 percent of polio cases are asymptomatic; mild symptoms can include sore throat and fever that can last up to 10 days.
The virus is particularly dangerous to infants, who are at risk of developing encephalitis (brain tissue infection) and permanent disabilities as a result.
More severe cases exhibit symptoms such as headache, severe muscle pain, swallowing and breathing problems, neck and back stiffness, and paresthesia, an abnormal and usually painless sensation of the skin with no apparent physical cause,
Those who are infected can spread the disease for up to six weeks, even if no symptoms are present.
Those who survive the more severe form of the disease may be vulnerable to “post-polio syndrome,” a condition in which muscle weakness, breathing difficulties and some other debilitating symptoms return later in life – and remain.
From July 21 to November 14, 2022, 42,455 polio vaccine doses were administered to children 18 years and younger in Rockland, Orange, Sullivan, and Nassau Counties – a 21 percent increase compared to the same period in 2021, according to data submitted to the New York State Immunization Information System (NYSIIS).
That’s the good news.
However, as of November 1, 2022, at least 21,753 children aged 2 months up to seven years old in Rockland and Orange Counties were not up to date with their polio vaccines, based on data from the state department of health via the NYSIIS.
That’s bad enough; but look at the numbers when you add the older children and the adolescent populations.
As of August 1, 2022, at least 68,288 children aged 2 months and up to 19 years old residing in Rockland and Orange Counties were not up to date with their polio vaccinations.
Unvaccinated children made up about half of that number, Rosenberg’s office said.
Rosenberg and his team are focusing on reaching children who are unvaccinated – and therefore at the greatest risk – since the first dose of IPV offers up to 90 percent protection against disease.
All health care providers in the state outside of New York City are required to report all immunizations (and history of immunizations) administered to people younger than age 19 to the state department of health. Providers are also required to retroactively add immunizations for patients age 18 and younger – but not all providers have done so for those who received vaccinations before that time, Rosenberg’s office said.
A Real, Serious Concern
“The intersection of low vaccination rates and evidence in the wastewater is a recipe for real, serious concern,” Rosenberg warned.
“Kids who need doses are in the tens of thousands, and those who have not been vaccinated at all are even more at risk for severe disease. In Rockland and Sullivan Counties alone, at least 10,000 have not been vaccinated at all.”
Letters are going out to the families of those children who are behind schedule, he said.
Polio was considered eradicated in the United States in 1979. The current reoccurrence is very bad news for New York’s healthcare community.
“We’re building the plane as we fly it,” Rosenberg said.
About the Vaccine
There are three strains of poliovirus (1,2, and 3). The current strain making the rounds is type 2 (cVDPV2).
Earlier this year, there was an outbreak of type 3 (cVDPV3) polio in Israel. According to the Geneva-based Polio Global Eradication Initiative, however, Israel “has been confirmed as affected by both type 2 and type 3 poliovirus.”
Back in the day, the OPV oral poliovirus vaccine used the weakened form of the virus and prevented all three types. But there were cases of children who became infected from that virus itself, and so it was discontinued. It is not longer licensed in the United States.
In 2000, United States switched to the IPV – the inactivated poliovirus vaccine pioneered by Dr. Jonas Salk that uses an inactive form of the virus. The Ministry of Health in the State of Israel uses the same vaccine.
A new version of the vaccine – NOPV2 – specifically prevents type 2 polio. It’s not out yet and Rosenberg said, “we’re many months away from a decision on that.”
“This is real, the consequences are grave, and we’ve seen trust issues in terms of people trusting vaccines – but we all understand universally that people want to protect their families and keep their children healthy.”
Information about polio and the need for vaccination against the virus is being offered by the department in multiple languages, including Yiddish, Spanish, Haitian-Creole, Chinese and Farsi.
“It could be your neighbor, your kid – just one case. What’s the big deal?” Rosenberg said. “But the problem is, there could be 99 or more out there as well.”
Undetected infections can spread exponentially to infants, children, teens, or adults. There are those still in wheelchairs today who remember precisely what the potential public health catastrophe might look like if among those infected there is one or more with the severe form of poliovirus.
NY is Taking the Long View
“We’re taking a long-term approach to this work,” Rosenberg said. “It took years to get to this problem as a society and we are not going to fool ourselves that a few weeks or months is going to resolve it.”
He cited the impact of public concern over the COVID-19 vaccine – “which came right after the measles outbreak in 2018-2019” — as one of the factors that has had a big impact, creating a loss of confidence in government and healthcare.
“The environment is more difficult right now, which means we have to commit extra hard, and be realistic that it will take more than weeks and months’ to resolve.
“COVID was a real shock to the world. We lost so many,” he lamented. “COVID has numbed us to what ‘bad’ is,” because was, indeed, so much bad during the pandemic.
But polio is bad too. Ask anyone who is age 70 and older.
A Personal Story
This writer has had personal experience with poliovirus. As a small child, I remember my beloved Uncle Harry, who wore a funny shoe on one foot that seemed much bigger and taller than his other shoe.
Uncle Harry walked with a limp, despite the assistance of that shoe. I one day asked my parents about it and was told that he wore the shoe because one leg was shorter than the other. The limp was caused by muscle weakness in the affected leg.
“Uncle Harry had polio as a child,” I was told. “He was lucky – he survived and was still able to walk. Many others weren’t.”
Years later, my aunt quietly warned me that the old adage “Use it or lose it” regarding exercise and muscle tone did not apply to polio survivors and those with similar histories, and especially those with post-polio syndrome (PPS). “Conserve to preserve,” she said.
NY Focusing on Outreach to Large Hasidic Communities
Rosenberg is particularly focused on the issue of vaccination in the Orthodox Jewish and Hasidic communities, which have large families and sometimes choose not to vaccinate their children – or themselves.
“Wastewater has no religion,” he emphasized, “but in the areas of detection – the areas of large Hasidic communities — there were higher rates of detection and lower rates of vaccination.
“We know they are a key part of the equation; these same communities have experienced similar outbreaks,” he stressed. “If you are unvaccinated, your child is unvaccinated, we don’t care what your religion is. If you’re living in these areas, you’re at risk.”
‘This Outbreak Feels Personal’
“This outbreak feels personal” said Rosenberg, who is Jewish. “To me, a core value in Judaism is the importance and the sacredness of the body. Your body is on loan, in a sense, and you need to do everything in your power to protect it and keep it healthy.
“This miraculous thing created in the 50s is an easy thing we can do to protect ourselves and our families.
“Kol Israel areivim zeh l’zeh – all members of the House of Israel are responsible for protecting our health and that of our communities as well,” he said. “We really need to activate that in people. There is a collective response needed for the benefit of all.
“I also worry about the reputation of Jewish communities here and their reluctance about vaccination. If we ignore these issues and have circulation of an eradicated virus, it hurts the reputation and good name of the Jewish communities.
“I am trying to head that off. This is how we fight antisemitism.”