First U.S. polio case in nearly a decade confirmed in unvaccinated Rockland County man

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The first U.S. case of polio in nearly a decade has been confirmed in an unvaccinated person in Rockland County, NY, local and state health officials announced Thursday.

While the origins of the case are still under investigation, the 20-year-old had traveled to Poland and Hungary this year and was hospitalized in June, according to a public health official close of the investigation who was not authorized to speak on the recording. He was initially diagnosed with a possible case of acute flaccid myelitis, caused by inflammation of the spinal cord that leads to severe muscle weakness and paralysis. But subsequent testing detected a type of polio that indicates transmission from outside the United States, according to a joint alert Thursday from the New York State Department of Health and Rockland County.

The patient has since been discharged and lives at his Parents’ home with his wife. He is able to stand but has difficulty walking, the official said.

On Thursday, Rockland County and New York state health officials alerted clinicians to be vigilant for further cases. Asked about the possibility of more polio cases emerging locally, Rockland County Health Commissioner Patricia Schnabel Ruppert told a news conference, “We only have one case. Hopefully that’s all we find.

Rockland County Executive Ed Day said the infected patient was not contagious.

“At this time, the risk to the vaccinated public is low, but experts are working to understand how and where this individual became infected,” the Centers for Disease Control and Prevention said in a statement.

Officials did not say why the patient is no longer contagious. But he sought treatment at a New York hospital around June 20, the official said. Patients are most contagious during the first two weeks of illness, said Thomas Giordano, chief of infectious diseases at Baylor College of Medicine.

Poliomyelitis is a highly contagious and potentially fatal viral disease that causes permanent paralysis in people who are not fully immunized in approximately 5 out of 1,000 cases. Most of the American population is protected against the disease because they have been vaccinated in childhood. But in areas with low vaccination coverage, like the ultra-Orthodox Jewish community in Rockland County, unvaccinated people are at high risk. There is no cure for poliomyelitis, but vaccination prevents the disease.

Due to the success of a nationwide vaccination program after the vaccine was introduced in 1955, cases of poliomyelitis were significantly reduced. The last natural cases in the United States were recorded in 1979.

Although still rare, more recent polio infections in the United States have been imported through travel or contact with a person who received oral polio vaccine in another country. The last known US case was recorded by the CDC in 2013.

The virus usually enters the body through the mouth, usually from hands contaminated with the feces of an infected person. Respiratory transmission and oral-to-oral transmission through saliva may also explain some cases.

Up to 95% of people infected with poliomyelitis have no symptoms, but can still be contagious. About 4-5% of infected people experience minor symptoms such as fever, muscle weakness, headache, nausea and vomiting. Symptoms can take up to 30 days to appear. 1-2% of infected people develop severe muscle pain and stiffness in the neck and back. Less than 1% of polio infections result in paralysis.

The Rockland County man lives in a community that has historically been undervaccinated and was the epicenter of the 2019 measles outbreak, according to public health officials who spoke on condition of anonymity.

In this case, genetic sequencing performed by the Wadsworth Center – New York State’s public health laboratory – and confirmed by the CDC, showed a type of polio virus that indicates transmission from someone who has received the oral polio vaccine, according to Thursday’s alert.

There are two types of vaccines that can prevent poliomyelitis. Inactivated polio vaccine, or IPV, is given by injection in the leg or arm, depending on the age of the patient. Only IPV has been used in the United States since 2000.

The oral polio vaccine, or OPV, is still used in much of the world. OPV is no longer licensed or administered in the United States due to its potential to cause vaccine-derived poliovirus. This case suggests the virus may have originated from a location where the oral vaccine is administered, outside of the United States, the alert from New York State and Rockland County said.

Wild-type poliomyelitis is the natural form of the virus. However, some people can be infected with a weakened strain of the virus that was used early on to make the oral polio vaccine. Most countries, including the United States, immunize children with a vaccine made from a form of the virus that is no longer alive.

Vaccine-derived polio can emerge if the weakened live virus in OPV, excreted by vaccinated children, is allowed to circulate in underimmunized populations long enough to genetically revert to a version that causes paralysis, said the CDC in its press release.. Vaccine-derived polio cases “are not caused by a child receiving the polio vaccine.”

“Many of you may be too young to remember polio, but when I was growing up this disease struck fear into families, including mine,” Day said in a statement. “The fact that there are still decades after the creation of the vaccine shows you how relentless it is. Do the right thing for your child and the greater good of your community and get your child immunized now.

The coronavirus The pandemic has led to a drop in routine immunization rates, according to recent reports. Nearly 400,000 fewer children entered kindergarten in the United States in the last school year due to pandemic-related disruptions, raising concerns that no one knows how many children were vaccinated as children against common illnesses, according to federal health data released this spring. All states require childhood vaccinations against diseases such as polio, measles, and whooping cough.

Day lamented the drop in vaccination rates around the world on Thursday, warning: “Ladies and gentlemen, we are playing with fire.”

Polio is endemic in Afghanistan and Pakistan, although many countries in Africa, the Middle East and Asia have also reported cases in recent years. In June, the UK’s Health Safety Agency reported finding poliovirus in samples of sewage taken from the UK’s largest sewage treatment plant, the first time a probable outbreak had been reported. identified in London. But so far, no cases have been detected.

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