The concerted global effort to eradicate polio has been one of the greatest success stories in vaccinations, science, and public health in our lifetimes. Almost the entire world, with the exception of Pakistan and Nigeria, where anti-vaccination fears are prevalent, are considered polio-free,
So I was alarmed to read that a new case has been detected in New York.
An unvaccinated young adult from New York recently contracted polio, the first US case in nearly a decade, health officials said Thursday.
Officials said the patient, who lives in Rockland county, had developed paralysis. The person developed symptoms a month ago and did not recently travel outside the country, county health officials said.
It appears the patient had a vaccine-derived strain of the virus, perhaps from someone who got live vaccine – available in other countries, but not the US – and spread it, officials said.
The person is no longer deemed contagious, but investigators are trying to figure out how the infection occurred and whether other people were exposed to the virus. Most Americans are vaccinated against polio, but this should serve as a wake-up call to the unvaccinated, said Jennifer Nuzzo, a Brown University pandemic researcher.
“This isn’t normal. We don’t want to see this,” Nuzzo said. “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.”
…Rockland county, in New York City’s northern suburbs, has been a center of vaccine resistance in recent years. A 2018-2019 measles outbreak there infected 312 people.
We do not know yet why this person was not vaccinated. But another report says that the region where the case occurred is one in which there is a large ultra-Orthodox Jewish community where the vaccination rates are typically low.
County health officials declined to give personal details about the case, but The New York Times reported that the patient is a man from the Orthodox Jewish community, citing unnamed local elected officials. Community newspaper New York Jewish Week also quoted multiple sources saying the same thing.
Rockland County is home to an ultra-Orthodox Jewish community in which vaccination rates have historically been very low. In 2018 and 2019, Rockland County was the epicenter of a major measles outbreak that continued for nearly a year and sickened 312 people. County health officials reported at the time that only 8% of cases had been vaccinated against measles, mumps and rubella before the outbreak began.
I hope this case was not due to misguided fears about vaccines. Some people cannot get certain vaccinations because of their health conditions which is why everyone who can get vaccinated should do so, so that they do not inadvertently put the lives of the unvaccinated in danger.
I have a personal interest in this, having contracted polio as a child in the 1950s, just before the widespread availability of the vaccinations. I would hate to see the return of this disease because of ignorance of the benefits of vaccinations due to misinformation being spread by people, some with political agendas.
This NY occurrence is from one of the, so-called, circulating vaccine-derived polio virus strains.
In the US they vaccinate with inactive (dead) virus, but in poorer countries they still use vaccines with attenuated live virus (admittedly this is in part because the inactivated virus vaccine has to be injected while the attenuated virus vaccine is taken orally). The attenuated virus vaccines can’t cause illness in the vaccinated -- on the contrary, they provide the immunity expected from a vaccine -- but some of the live virus is excreted. That is no threat to the vaccinated, but in areas of poor hygiene it can spread to others,
Now if the spread virus stays the same, it will provide immunity to the unvaccinated who catch it as well, a win-win, but the big problem is that these attenuated viruses are known, and have been shown, to be able to recombine to form nasty strains again, with all the usual effects of polio, including paraysis. These are the “circulating vaccine-derived” strains. So the continued use of the live virus in vaccines is like a horrid kind of russian roulette where the vaccinated get protected, but there is a risk of a strain being spread widely among the unvaccinated.
Currently only Afghanistan and Pakistan are suffering from endemic wild polio, but they are not the only countries still vaccinating with live virus, so there is a risk of vaccine-derived flare-ups in other places. There are three types of wild polio, and consequently three types of circulating vaccine-derived polio. Type 2 was eliminated in the wild but I believe cVDPV2 still circulates, and has become more prevalent since some places have stopped vaccinating for type 2 (ie. switching to a bivalent rather than trivalent vaccine). I wasn’t able to find out which variant the NY strain was, but the most recent outbreak anywhere that I read on the WHO website was cVDPV3 in April in Israel.
https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON366
It’s a shame that sufficient money and effort can’t be raised to use the inactivated strains everywhere.
file thirteen,
Thanks for that informative post.
It is interesting that the most recent outbreak was in Israel since the person in NY is reported to be a member of the ultra-Orthodox Jewish community that has a lot of contact with Israel. However he is said to not have traveled out of the country recently. I do not know how long the virus takes to manifest symptoms and how long people can be carriers.
I cannot imagine that Israel uses the live virus vaccine since it can undoubtedly afford to use the dead virus one. Do you know?
https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON366
@Mano
As John pointed out, they do appear to use the live oral virus vaccine in Israel as well as the inactive virus vaccine; I can only speculate on the reasons for that. I’m no expert in this field, I’m just parroting what I’ve read.
I do know that while wild type 2 seems extinct, wild type 1 has cropped up in Africa occasionally, including a case in Malawi this year. But that’s the first in Africa in five years, and genetic sequencing apparently shows that it spread from Pakistan.
https://www.afro.who.int/news/malawi-declares-polio-outbreak
The oral attenuated-virus vaccine is more effective than the injected killed-virus vaccine, in that the attenuated virus elicits immunity in the gut as well as in the blood, whereas the killed virus only elicits immunity in the blood, as it is injected and doesn’t reach the digestive tract. Normally the wild polio virus enters the body by mouth then makes its way from the gut to the bloodstream and nervous system. The live vaccine mimics the entire natural infection route and thus gives the body a chance to attack the virus before it even gets to the bloodstream. But the downside of the live vaccine is the potential for escape infections. Thus the choice to use the live vaccine or rely only on the killed-virus vaccine depends on how a health system estimates the risk of encountering wild polio vs the risk of the live vaccine itself causing an outbreak. It is possible to use the injected vaccine in times when there hasn’t been an outbreak in a long while and then adding the live vaccine if an outbreak is underway.
I’m wondering how some Hassidic sects fell into the anti-vax attractor. Supposedly they believe in following the advice of experts in specialty arts. Or at least, those experts recommended by the leader of their specific sect. And Hasidic leaders are often in touch with doctors. There are also plenty of Orthodox Jewish doctors for them to choose among, both in Israel and the US. So why not vaccinate on schedule?
Is it kosher?
It’s self-indulgently interesting to track my level of sympathy as I read the story.
“New polio case detected” -- oh, that sucks, what a shame.
“in the US” -- oh, that’s worse, their healthcare is shit, that kid’s likely going to suffer
“an adult” -- an adult? I shouldn’t, but I do care less about that. I hope they weren’t…
“unvaccinated” -- oh dear, sympathy really starting to stretch now, but it’s conceivable that in a backward shithole like the US they simply couldn’t afford to be vaccinated…
“by choice” -- well, almost all my sympathy is gone now
“for religious reasons” -- fuck you I hope you get paralysed before you can infect anyone else.
“ultra-Orthodox Jew” -- just the icing on the cake.
I vaguely remember from early childhood having the vaccine, but I remember having a bunch of vaccines and couldn’t tell you whether the one I had for polio was an injection or some weird tasting stuff squidged onto a sugar lump. I do remember meeting a kid at the seaside who HAD polio (including some apparent partial paralysis), and being vaguely scared of catching it off them.
To someone born in the 60s (just) in the UK, it was a childhood bogeyman almost on a par with rabies.
sonofrojblake @#8,
Whatever the reasons for not getting vaccinated, getting polio is a tragedy for the person and their families and communities.
I would not wish it on my worst enemy.
I can’t agree with you there: Getting polio in a developed country that offers a vaccine for it (for free through the health department if the person doesn’t have health insurance or can’t afford it) and refusing the vaccine is stupidity, not a tragedy.
While people have a capacity for rationality, our decision making process is emotional. Rationality is an add-on. So people keep making decisions that are bad for them because of some intangible (perceived?) benefit. In this case the benefit may be fitting in with one’s support group. The tragedy is that people are in closed groups that lost or never had trust in the medical establishment at their location, so they don’t even know how harmful their choices are to themselves and their families.
John Morales @7, kashrut is supposed to not be a priority when it comes to saving a life.
OK, this is interesting: It looks like Haredi (Ultra-Orthodox) mothers in Israel have low vaccination rates despite recommendation of the rabbis. So for some reason they choose to ‘think for themselves’ in just the worst way.
Yes this community has recently been anti-vaccine, as shown by the second quote mentioning a measles outbreak a few years back which was also the result of not vaccinating, to the extent that the local Health Department has been working with the rabbis to try to change the situation.
Katydid @#10,
Stupidity and tragedy need not be mutually exclusive. People can do stupid things and yet the consequences of their acts can still be tragic.
Tragedy IMO is more along the lines of Native Americans being infected by the conquistadors. The Native Americans had no experience with smallpox and other diseases.
Tragedy is not when someone knows that a vaccine is effective but they choose not to vaccinate because they’d rather follow whacko conspiracy theories.
ETA: or freeload off society, which is what the Ultra-Orthodox do.
Katydid @15, according to the paper I linked to in @13, there is a subset that are just like the ‘vaccine hesitant’ in other communities -- they fall into some social rabbit-hole while ‘doing their own research’, and decide that source is more correct than both the mainstream doctors and the leaders of their communities. I’m not sure if such people can be said to ‘know’ that the vaccine in question is effective. Other Haredim do vaccinate because their leaders tell them to do so to preserve life and they trust said leaders and the healthcare personnel they recommend. It looks like the internet is weakening the power of the rabbis, but not always with good outcomes.
#17 Katydid
“Estimated time of arrival”??
@18 Holms
‘Edited to add…”
It’s a common abbreviation.
@ ^
Sorry Holms is 19 duh.
@Anat, you’re awfully defensive about the Ultra-Orthodox. I was speaking of people who know better and refuse to vax--you’ll find them in the USA too--as in this guy, who lives in a country with routine vaccination of children--for free, if you live in poverty as many of the ultra-Orthodox do because the men don’t work. Moreover, vaccination rates in NYC have historically been high, so anti-vax in the Ultra-Orthodox is a newer thing. Gotten from the Ultra-Orthodox in Israel? Not sure.
Otherwise in the USA, you have the Amish and Hutterites, who vaccinate for some things and not others, the (discredited) Wakefield believers, and others who are often Darwin award winners.
All these folks put the rest of us at risk, including those too young to be vaccinated and those who have medical conditions (such as cancer treatement) that mean they can’t be vaccinated.
This is why people who are twice vaccinated and twice boosted for Covid are coming down with the ever-evolving virus. Because others are stupid.
I am of a certain age that I had primary school mates who wore leg braces due to contracting polio as children.
And those were the “lucky” ones, the others were dead.
And then there were the regular Rubella scares, striking terror into pregnant women worried about birth defects.
I still have my polio vaccination scar on my upper arm from over 60 years ago, I consider it a badge of honour.
I have zero sympathy for anybody who opposes vaccination for any reason, you are one and all invited to fuck right off.
#21 SB
But no edit was made… Ah well.
@mano, 9: I disagree. Some illnesses and deaths just aren’t tragedies.
@#25,
I agree that not all deaths are tragedies. For example, the expected deaths of old people or those with incurable diseases are sad but not tragedies. The deaths of people who have committed awful crimes are not tragedies either. What I was arguing that the deaths of people who die because of poor decisions can be tragedies and this case is one of them.
People indulge in risky behaviors all the time, especially young people who tend to be not very good at making realistic cost-benefit analyses. Not getting vaccinated is one such decision, often based on ignorance or because they have been persuaded by ignorant people not to get it.
@Holms, are you just mentally challenged or pugnacious?
@ Steve Oberski; I agree. I grew up as a military brat, then joined the military. I grew up seeing people who didn’t have the benefit of vaccination, and instead got polio. The other day on a tv program that takes place in the 1950s, one character had a baby that died of heart defects shortly after birth because the mother had German Measles. These things used to be common.
Not getting a shot when there’s one freely available is just stupid.
#27 Katy
I like pointing out silliness.