Poliovirus outbursts unleashed widespread panic decades ago. Then came the eradication of polio with the widespread use of a vaccine. Now comes news that polio is circulating in the city again.

How worried should we all be? In New York City, the polio vaccination rate among children five and under is 86 percent. Most of us adults had vaccinations as children.

However, the New York Times offers this concerning statistic: In some city ZIP codes, fewer than two-thirds of children five and under have received at least three doses, a figure that worries health officials.

The story takes a concerning turn. The announcement of poliovirus in New York City sewage water comes three weeks after a man just north of the city presented with polio that left him paralyzed.

And this punctuation: Officials observe that polio has been circulating in the county’s wastewater since May.

Polio History

Polio was historically one of the most feared diseases, with annual outbreaks resulting in thousands of paralysis cases in the United States alone.

A man with a smaller right leg due to poliomyelitis. https://en.wikipedia.org/wiki/Polio

By the late 1940s, polio outbreaks in the United States progressively increased in size and frequency. More than 35,000 individuals experienced disability annually as a result of the virus. Parents kept their children indoors, especially in the summer when the poliovirus seemed most prevalent.

Public health officials sometimes imposed quarantines on homes and towns experiencing outbreaks.

Following the widespread adoption of the polio vaccine, US officials declared the eradication of polio in 1979 one of public health’s greatest triumphs. Still, polio cases occasionally appear, often in individuals who have traveled abroad.

Since 1979, we in the United States have had no cases of polio caused by wild poliovirus originating here. However, polio has been brought into the USA by travelers with the virus. The last reported case of imported polio occurred in 1993.

Polio transmission

The poliovirus is quite contagious, spreading through person-to-person contact. Polio can contaminate water and food in unsanitary conditions. The virus lives in an infected individual’s throat and intestines. Poliovirus enters humans’ bodies through the mouth.

Spread occurs via contact with an infected portion’s poop (feces). Less commonly, the spread can occur by droplets from the cough or sneeze of an infected person.

Infection can occur if you put infected objects (such as toys contaminated with feces) in your mouth. Alternatively, transmission can occur if you pick up tiny pieces of feces on your hands and touch your mouth.

The United States Centers for Disease Control (CDC) explains that:

An infected individual can spread the virus to others immediately before and up to two weeks after symptoms emerge. The virus can reside in an infected subject’s intestines for many weeks. Moreover, infected people without symptoms can still pass the virus to others.

Polio symptoms

Nerve cells (neurons). https://en.wikipedia.org/wiki/Neuron#:~:text=A%20neuron%20or%20nerve%20cell,do%20not%20have%20nerve%20cells

While most infected persons with polio do not get sick (or know that they are infected), an infection can lead to paralysis or even death. Here are symptoms by polio type:

• Non-paralytic polio. Those with this form of polio don’t develop paralysis but can experience mild, flu-like symptoms lasting up to ten days. Symptoms may include fever, headache, sore throat, vomiting, or generalized fatigue. Some report back, neck, or extremity discomfort or stiffness. Others suffer from muscle tenderness or weakness.
• Paralytic syndrome. Fortunately, this most serious form of polio is rare. Initial symptoms may include severe muscle aches or weakness, reflex loss, or loose and floppy limbs (flaccid paralysis). “Poliomyelitis” (or “polio” for short) is defined as a paralytic disease. Only those with the paralytic infection have the disease.
• Post-polio syndrome. Post-polio syndrome is a cluster of disabling symptoms affecting some people years after a polio infection. Selected symptoms may include fatigue, muscle wasting (atrophy), progressive muscle or joint weakness, and pain. Some experience challenges with breathing or swallowing, while others report sleep problems (for example, sleep apnea). Others report decreases in cold temperature tolerances.

Here are the incidences for these categories: Most people with a polio infection have no visible symptoms. Approximately one in four will have flu-like symptoms that typically last two to five days before resolving.

A smaller number develop more serious symptoms. For example, about one to five out of 100 will experience an infection of the brain or spinal cord covering (meningitis). Paralysis — an inability to move body parts) — or arm or leg weakness happens to about one in 200 to one in 2,000 people, depending on the virus type.

Between two and 10 out of 100 with polio-related paralysis die secondary to the virus affecting the muscles regulating breathing.

An electron microscope image of the polio virus. https://en.wikipedia.org/wiki/Polio

Polio prevention

The most effective means to prevent polio is vaccination. There are two forms of vaccine, including inactivated poliovirus vaccine. This form is given as an infection in a leg or arm, depending on the person’s age. Inactivated poliovirus vaccine is the only type that has been used in the United States since 2000. Some places in the world still use an oral poliovirus vaccine.

The polio vaccine is remarkably protective: Over 99 percent of those who get all the recommended doses of the inactivated vaccine have protection from polio.

In addition, please practice good hand hygiene and wash your hands with soap and water often; alcohol-based hand sanitizers do not kill poliovirus.

Adult vaccination

Adults do not routinely receive vaccines against polio in the USA, given most are already immune. Still, selected high-risk individuals should have a single booster shop of inactivated polio vaccine.

A single booster dose of inactivated vaccine reduces polio risk for a lifetime. Adults at risk include those who are traveling to parts of the world where polio still occurs or those who care for people who have polio.

If you have never had a vaccine or your vaccination status is undocumented, please get a series of primary polio vaccination shots — two doses of inactivated polio vaccine at four- to eight-week intervals and a third dose six to 12 months after the second dose.

Prevention is essential; there is no cure for poliomyelitis. If you think you or someone in your family has symptoms of polio, please call your healthcare provider immediately or go to an emergency room.

Who shouldn’t get the vaccine?

The US Centers for Disease Control asks that you tell the person who is giving the vaccine:

• If the person getting the vaccine has any severe, life-threatening allergies. Suppose the person receiving the vaccine had a life-threatening allergic reaction after a dose of an inactivated polio vaccine or had a severe allergy to any part of it. In that case, caregivers may advise that they not receive a vaccine. Ask your doctor for information about vaccine components.
• If the person getting the vaccine does not feel well. If the individual getting the vaccine has a mild illness (for example, a cold), they can probably get it today. The moderately or severely ill should probably wait until they recover. Your doctor can advise you.

For more information (including potential side effects of the vaccine), please go here:Polio Vaccination: What Everyone Should KnowUpdated August 11, 2022: In July 2022, CDC was notified of a case of polio in an unvaccinated individual from Rockland…www.cdc.gov

Polio risk is well, but vaccination is stunningly effective at preventing paralysis, even if it is not great at limiting transmission.

The virus is now endemic in only two countries, Pakistan and Afghanistan. Vaccines have kept the virus at bay everywhere, even though we will see sporadic cases in non-endemic regions.

In July 2022, an adult from north of New York City tested positive for polio. This finding raised alarms from residents and local officials, some of whom could not recall if they had a vaccine as a child. Health officials believe hundreds of people in the area could be infected.

How might the polio virus in wastewater affect you? According to the New York State Department of Health,

“Wastewater is not a concern in terms of having the ability to infect the general public as the general public does not interact with wastewater, which is based on samples from our sewage system via feces excreted.

“In areas where the wastewater is thoroughly treated before being released back into the environment, and there are good water purification practices, there is very, very, very little risk to the general population, but could be a risk for personnel working in wastewater facilities,” Dr. Marny Eulberg offers.

Fortunately, I had the polio vaccine as a child. We are blessed to have good water purification in the United States. I am not particularly worried about myself, but I wanted to provide information to you. Wastewater personnel may have some risks.

Thank you for joining me today.