Polio has been discovered in New York City’s sewage, officials say

Polio outbreaks caused regular panic decades ago until a vaccine was developed and the disease was largely eradicated. Then on Friday, New York health officials announced they had found the virus in sewage samples, suggesting that polio is likely circulating in the city again.

Parents of young children found themselves questioning—perhaps for the first time in their lives, and altogether for the first time in generations—how much they should worry about polio.

Anabela Borges, a designer who lives in Brooklyn’s Crown Heights neighborhood, said she had friends whose children were likely not vaccinated. After the announcement on Friday, she said she planned to “make her friends aware.”

Mrs. Borges said she hoped her 7-month-old daughter, Ava, who is old enough to have received three of the four shots recommended for children, was far enough along in the regimen to be protected. “Polio is really dangerous for babies like her,” said Ms. Borges when she and her daughter’s nanny took Ava for a ride in her pram.

In New York City, the overall rate of polio vaccination among children 5 and under is 86 percent, and most adults in the United States were vaccinated against polio as children. Still, fewer than two-thirds of children 5 and under in some city zip codes have received at least three doses, a number that worries health officials.

The state Department of Health said in a statement that the discovery of the virus underscored “the urgency for all New York adults and children to be vaccinated, especially those in the New York metropolitan area.”

The announcement came three weeks after a man in Rockland County, NY, north of the city, was diagnosed with a case of polio that left him paralyzed. Officials now say polio has been circulating in the county’s wastewater since May.

“The risk to New Yorkers is real, but the defense is so simple — get vaccinated against polio,” said Dr. Ashwin Vasan, New York City’s health commissioner, in a statement. “With polio circulating in our community, there is simply nothing more important than vaccinating our children to protect them from this virus, and if you are an unvaccinated or incompletely vaccinated adult, choose now to get the vaccine.”

The spread of the virus poses a risk to unvaccinated people, but three doses of the current vaccine provide at least 99 percent protection against severe disease. Children who are too young to be fully vaccinated are also vulnerable, as are children whose parents have refused to get them vaccinated or have delayed getting them shots.

Health officials fear that detection of polio in New York City’s sewage may precede other cases of paralytic polio.

“In the absence of a relatively massive vaccination program, I think it’s very likely that they will be one or more cases” in the city, said Dr. Jay Varma, an epidemiologist and former deputy secretary of state for health.

The citywide vaccination rate dropped amid the pandemic as visits to pediatricians were postponed and the spread of misinformation about vaccines accelerated. Even before the arrival of Covid, vaccination rates for a number of preventable viruses were low enough in some neighborhoods to worry health officials.

Although effective in preventing paralysis, the vaccine used in the United States in recent decades is less effective in limiting transmission. People who have been vaccinated can still carry and shed the virus even if they do not experience infection or symptoms.

That, epidemiologists say, could mean the virus will be difficult to eradicate quickly, further underscoring why vaccination is so critical for protection, a state health department spokeswoman said.

Many people who become infected with polio do not develop symptoms, but some people will have a fever or nausea. Dr. Bernard Camins, an infectious disease specialist and medical director of infection prevention for the Mount Sinai Health System, urged doctors to be on the lookout for these symptoms and consider ordering polio tests for patients who are not fully vaccinated.

About 4 percent of those who contract the virus develop viral meningitis, and about 1 in 200 will become paralyzed, according to health officials.

“The problem,” said Dr. Camins, “is that if you have one case of paralysis, there could be hundreds of others who are not symptomatic or have symptoms that are unlikely to be identified as polio.”

The polio virus had previously been found in sewage samples in Rockland and Orange Counties, but the announcement Friday was the first sign of its presence in New York City.

Neither the city nor the state health authorities gave details about where in the five boroughs the virus had been discovered in sewage. State officials said six “positive samples of concern” had been identified in the city’s wastewater, two collected in June and four in July.

The last case of polio found in the United States before the one in Rockland County was in 2013.

Before polio vaccines were first introduced in the 1950s, the virus was a source of fear, especially during the summer months when outbreaks were most common. Cities closed swimming pools as a preventative tactic, and some parents kept their children indoors.

In 1916, polio killed 6,000 people in the United States and left at least another 21,000—mostly children—with a permanent disability. More than a third of the deaths were in New York City, where the outbreak led to a delay in the opening of public schools.

An outbreak in 1952 paralyzed more than 20,000 people and left many children with iron lungs. The first effective vaccine appeared soon after, and the virus began to recede.

Today, there are only two countries, Pakistan and Afghanistan, where polio is endemic. It has been kept at bay in the rest of the world through the widespread use of vaccines.

Cases occur outside these two countries with some regularity, a result of the oral vaccine used in much of the world. The oral vaccine uses a weakened but live virus. It is safe, but a person who receives it can spread the weakened virus to others. Only inactivated polio vaccine has been used in the United States since 2000.

The CDC recommends that children receive four doses, with the last shot administered between ages 4 and 6.

“What we’re seeing is a wake-up call for people who thought poliovirus was just a problem elsewhere,” said Capt. Derek Ehrhardt, an epidemiologist and the Centers for Disease Control and Prevention’s polio eradication incident manager.

The virus lives primarily in a person’s throat and intestines and is most often spread through contact with faeces.

If the weakened virus used in the oral vaccine circulates widely enough in communities with low vaccination rates or replicates in a person with a compromised immune system, it can mutate into a virulent form that can cause paralysis, according to the CDC

Outbreaks of such “circulating vaccine-derived poliovirus” have occurred in several countries in recent years. Open sewers and contaminated drinking water can help speed up the spread.

Health officials believe the polio virus was introduced to New York by someone who had received the live virus vaccine in another country, or by an unvaccinated person who contracted vaccine-derived polio abroad.

Officials say the virus detected in the two counties north of New York City is genetically linked to vaccine-derived virus collected from samples this year in Jerusalem, as well as to sewage samples in London that have prompted a renewed polio vaccination campaign there .

As of Friday, the CDC had confirmed the presence of poliovirus in 20 wastewater samples in Rockland and Orange Counties, all genetically linked to the paralytic polio case in the Rockland County resident. The counties are located next to each other.

Of the 20 samples, two were collected in May, three in June, and eight in July from Rockland County; two were collected in June and five in July in Orange County.

Dr. Irina Gelman, Orange County’s health commissioner, said officials assumed each positive sample collected in her county indicated a separate person infected with the virus locally, but she added that she was awaiting further genetic analysis from the CDC to be sure.

Health officials believe hundreds of people in the area may be infected, she said. The estimate is based on how many people typically need to have the virus for a single case of paralytic polio, combined with the increase in vaccine-derived polio cases globally and the very low vaccine coverage in parts of New York.

“Part of me still hopes that’s not the case,” she said.

“We’re really working with a kind of perfect storm scenario,” she added. “We have low vaccination rates in Orange County for vaccine-preventable diseases, especially among our pediatric populations.”

The one case of polio that has been confirmed so far was in a 20-year-old male ultra-Orthodox Jewish resident of Rockland County, according to several local officials. Orange and Rockland Counties are both home to large numbers of ultra-Orthodox Jews, and anti-vaccine sentiment has spread among some in that community.

A measles outbreak in 2019 was also concentrated among people in the ultra-Orthodox community, although misinformation about vaccines and low vaccination rates are also more widespread, said Dr. Gelman.

Vaccination rates in Rockland and Orange Counties are far below those needed to prevent the spread of the virus, according to the state Department of Health. Among 2-year-olds, about 60 percent of children in both counties had all three recommended polio shots, state data show, compared with 79 percent statewide.

Tired of Covid and alarmed by the recent emergence of monkeypox, New Yorkers’ thoughts turned to a third virus on Friday as they wondered if they were fully vaccinated and if their protection had lasted through the decades.

Gregory Ludd, 46, who lives in Crown Heights and works as a porter, has six children. They are up to date on their vaccinations, he said.

“I’m afraid of it because we really haven’t heard of polio coming out since we were probably little, young kids,” he said. “But all you can do is put your faith in God and just hope it doesn’t happen to your child.”

Lola Fadulucontributed with reporting.

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