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Polio is back — how concerned should Americans be?


New York’s governor has declared a state of emergency after well being officers detected poliovirus within the wastewater of 5 counties – proof that the illness is circulating. The declaration additionally follows a report from the US Facilities for Illness Management and Prevention of an unvaccinated individual in Rockland County, New York, who was recognized with paralytic polio this summer season – the primary case recognized in the US in almost a decade.

Understandably, these occasions have sparked numerous questions: Why does one case of polio fear officers? What does it imply to seek out poliovirus in wastewater? Who ought to be frightened about contracting the illness? If somebody had the vaccine years in the past, are they nonetheless protected now?

To know extra about this illness, which most individuals alive as we speak have by no means skilled, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency doctor and professor of well being coverage and administration on the George Washington College Milken Institute Faculty of Public Well being. She can be the creator of “Lifelines: A Physician’s Journey within the Combat for Public Well being.”

CNN: To this point, there was just one documented case of paralysis attributable to poliovirus in New York. Why does one case fear well being officers?

Dr.  Leana Wen

Dr. Leana Wen: An August report from the CDC stated that “even a single case of paralytic polio represents a public well being emergency in the US.” That is for 2 predominant causes.

First, polio is a illness with the potential for very extreme penalties. Throughout its peak within the Nineteen Forties and Nineteen Fifties, polio resulted in tens of 1000’s of youngsters changing into paralyzed yearly. Hundreds died from the virus.

This modified with the introduction of vaccines which can be extremely efficient – greater than 99% efficient at defending in opposition to paralytic polio. Because of huge vaccination campaigns, the final incidence of wild-type polio occurred in 1979 – and it had been thought of to be eradicated in the US. The reemergence of such a illness, which might have such severe impacts, is a serious menace.

Second, the one case of paralytic polio could be the tip of a big iceberg. Most circumstances of polio an infection are asymptomatic and don’t trigger paralysis. Signs – which might embrace fatigue, fever and diarrhea – are usually delicate and may resemble these of different viruses. Public well being officers are frightened there are lots of different individuals who could also be contaminated with polio and may very well be transmitting it unknowingly.

That is notably regarding as a result of Rockland County, the place the current paralytic case of the virus was recognized, has a polio vaccination charge of simply 60%. In some components of the county, the vaccination charge is as little as 37%. These numbers are far beneath the brink wanted for herd immunity, and which means there are numerous people within the space who’re weak to polio an infection and potential extreme outcomes.

CNN: What does it imply that poliovirus has been detected within the wastewater of 5 counties, together with New York Metropolis?

Wen: Discovering poliovirus in sewage means one in all two issues: That there are individuals actively contaminated with polio who’re shedding the virus, or that the virus sign may very well be from individuals who not too long ago acquired the oral polio vaccine (OPV). OPV is not given in the US – since 2000, the model used within the US is the inactivated polio vaccine (IPV), which is injected – however different international locations are nonetheless utilizing OPV, and it is doable that vacationers from these locations are shedding virus from the vaccine.

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

In uncommon circumstances, the weakened virus from individuals who simply acquired OPV might trigger paralytic polio in unvaccinated people – which is a serious motive why OPV is not used within the US.

One extra level of concern is {that a} wastewater pattern from Nassau County on Lengthy Island has been genetically linked to the paralytic polio case recognized in Rockland County. (The 2 counties aren’t adjoining, slightly roughly 40 miles aside.) That is additional proof of group unfold that is going largely undetected.

CNN: How can individuals contract polio?

Wen: Polio is an infectious illness that may be transmitted in plenty of methods. A main route is fecal-oral, that means somebody might get polio if they arrive into contact with feces from an contaminated individual. This might happen, particularly in youngsters, by means of placing objects like toys which have been contaminated with feces into the mouth.

Poliovirus is also transmitted by means of the respiratory route – for instance, if somebody who’s contaminated coughs or sneezes and people droplets land round your mouth. It is value nothing that people who find themselves vaccinated might additionally contract polio and move it on to others, though they’re extraordinarily well-protected from extreme sickness themselves.

CNN: Ought to New Yorkers be frightened about contracting polio?

Wen: Once more, people who find themselves vaccinated in opposition to polio are extraordinarily well-protected from paralytic polio, and shouldn’t be involved at this level. It ought to be identified, nevertheless, that whereas IPV is superb at stopping essentially the most extreme potential results of the illness, individuals who acquired the vaccine might nonetheless be carriers of polio and will transmit it to others. These in danger for severe outcomes are people who find themselves unvaccinated and people who are incompletely vaccinated, together with younger youngsters below 6 who haven’t but accomplished their polio vaccine collection.

CNN: What number of polio vaccines ought to somebody obtain?

Wen: The CDC recommends youngsters obtain 4 doses of IPV. The primary is given at 2 months of age, the second at 4 months, the third between 6 and 18 months previous and the fourth between 4 and 6 years previous.

Adults who’ve by no means been vaccinated in opposition to polio ought to obtain three doses of IPV. The primary ought to be given as quickly as doable, the second to 2 months after that and the third six to 12 months after the second.

CNN: If somebody had the vaccine years in the past, are they nonetheless protected? Who ought to get a polio booster now?

Wen: The safety in opposition to extreme illness stays robust for a few years after immunization; it is believed it most likely lasts for a lifetime. There isn’t a want for many vaccinated individuals to get extra doses.

Nevertheless, if somebody has not accomplished their authentic vaccine collection, they need to obtain their remaining doses. Some totally vaccinated individuals can even obtain a further lifetime booster of IPV below particular circumstances – for instance, if they’ve direct contact with somebody suspected of getting polio or if they’re well being care employees with the next threat of publicity to individuals with the illness.

CNN: What in the event you’re undecided whether or not you had been vaccinated? Say you do not recall getting the vaccine, and it has been a few years. Is there a blood take a look at you may take to confirm both approach?

Wen: You may test along with your main care doctor’s workplace or state well being division to see if they’ve data of your immunizations. If they do not, and there’s no different approach so that you can confirm – for instance, by asking dad and mom or different kinfolk or caregivers – you need to converse along with your well being care supplier about getting the complete vaccine collection for polio now. There isn’t a blood take a look at that may reliably detect whether or not you are totally vaccinated in opposition to polio.

CNN: What in the event you or your loved ones members have not but been vaccinated in opposition to poliovirus?

Wen: Individuals who have but to obtain any doses or are incompletely vaccinated ought to ensure that to get their complete polio vaccine collection immediately. That is notably essential in the event that they stay in or round Rockland County in New York – however actually everybody ought to get caught up with their routine immunizations.

It was a tragedy a long time in the past that so many youngsters grew to become completely paralyzed and even died from polio. This could not occur once more, since we’ve got such efficient vaccines that may forestall extreme penalties of the illness.


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