Opinion | The first reported case of polio in the United States since 2013 was confirmed in New York last week. According to New York health officials, a young adult in Rockland County contracted type 2 “vaccine-derived” poliovirus (VDPV2), which may have been transmitted by someone who received the Sabin live attenuated oral polio vaccine (OPV). The unidentified person, who developed paralysis, was temporarily hospitalized and released. 1 2 3 4 5 6
“VDPV2, or type 2 poliovirus, is a type of poliovirus derived from the oral polio vaccine which utilizes a live form of the virus. For a short period of time, a newly vaccinated individual may potentially transmit the live virus through stool,” said Hannah Newman, MPH, director of infection prevention at Lenox Hill Hospital in New York City.7
In the mid-1990s, co-founders of the National Vaccine Information Center (NVIC) called on the Centers for Disease Control and Prevention (CDC) to discontinue use of live OPV in the U.S. and replace it with the Salk inactivated polio vaccine (IPV) that cannot cause vaccine strain polio.8
Beth Cefalu, the director of strategic communications for Rockland County, said that the polio case in New York is under investigation, but that the infected individual was not believed to have traveled outside the U.S. to a country where type 2 vaccine-derived polioviruses are prevalent.1 3
A STAT News article concluded:
If that is the case, that would indicate someone else inadvertently imported the virus, suggesting there may be additional undetected transmission.1
Most Cases of Paralytic Polio Caused by Vaccine-Derived Poliovirus
In a 2019 article, The Vaccine Reaction reported that the World Health Organization (WHO) had observed a big increase VDPV2 cases that year in multiple countries that administer the OPV to children. The majority of paralytic polio cases identified in the world were caused by outbreaks of VDPV2 cases in Niger, Nigeria, Cameroon, Benin, Ghana, Ethiopia, Somalia, China, Myanmar, Kenya, Central African Republic (CAR), Angola, Somalia, and Papua New Guinea, Indonesia.8 9
NVIC co-founder and president Barbara Loe Fisher noted:
In impoverished communities with substandard sanitation and living conditions, vaccine strain poliovirus can contaminate water sources used for bathing and drinking, which can lead to more cases of vaccine strain polio paralysis. Until polio eradication campaigns stop using live oral polio vaccine, the vaccine strain polio virus will continue to cripple children and adults.8
Vaccine-Derived Poliovirus Detected in London Sewage
Earlier this year, traces of VDPV2 were found in a sewage plant in London. People who have been vaccinated with OPV can shed the poliovirus in their stools and this can be detected in wastewater. The U.K. Health Security Agency (UHSA) said that the virus was likely brought into the United Kingdom by someone who was recently vaccinated with the OPV.7 10
Kimberly Thompson, president of the nonprofit Kid Risk, Inc. in Orlando, Florida, speculates that the poliovirus case in New York may have originated with contaminated sewage, as in the case in London. “With COVID having disrupted immunization [in the U.S.] and travel now having resumed and much more type 2 poliovirus transmission happening, it’s been only a matter of time before we’d have some detection of polioviruses in sewage, as happened recently in the U.K.,” she said.11
Polio Vaccinations Urged by Health Officials
The New York case apparently involves a person who was not vaccinated for the poliovirus. This has led to calls by state health officials and others for those who have not had the polio vaccine to move quickly to get the shot.
“Based on what we know about this case, and polio in general, the Department of Health strongly recommends that unvaccinated individuals get vaccinated or boosted with the FDA-approved IPV polio vaccine as soon as possible,” said Mary Bassett, MD, MPH, health commissioner for the state of New York.1 3 5
“This isn’t normal. We don’t want to see this,” said Jennifer Nuzzo, DrPH, a professor of epidemiology and pandemic researcher at Brown University. “If you’re vaccinated, it’s not something you need to worry about. But if you haven’t gotten your kids vaccinated, it’s really important that you make sure they’re up to date.”6
“We want shots in the arms of those who need it,” said Patricia Schnabel Ruppert, DO, MPH, health commissioner for Rockland County.5
One case of vaccine-derived polio and they’re already calling for shots for a virus believed to have been eradicated in the U.S. since 1979. Are declared victories over disease-causing pathogens that tenuous?
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1 Branswell H. N.Y. state detects polio case, first in the U.S. since 2013. STAT News July 21, 2022.
2 Cutler N. Polio found in Rockland County; vaccines urged to fight virus. Lohud July 21, 2022.
3 Goodman B. New York adult diagnosed with polio, first US case in nearly a decade. CNN July 22, 2022.
4 Kekatos M. What to know about vaccine-derived polio after rare case found in New York. ABC News July 22, 2022.
5 Stieb M. And Now … Polio? New York Magazine July 21, 2022.
6 Stobbe M. New York reports 1st US polio case in nearly a decade. The Associated Press July 21, 2022.
7 Ries J. Polio Detected in UK Sewage, Why Experts are Concerned. Healthline June 23, 2022.
8 Fisher BL, Cáceres M. Polio Eradication Stalls with More Wild-Type and Vaccine Strain Polio Outbreaks. The Vaccine Reaction Dec. 7, 2019.
9 World Health Organization. Statement of the Twenty-Second IHR Emergency Committee Regarding the International Spread of Poliovirus. Oct. 3, 2019.
10 Reed J, Roxby P. Polio virus detected in London sewage samples. BBC June 22, 2022.
11 Rendall J. First Polio Case Detected in the US in About a Decade. CNET July 22, 2022.