Should Iowans be concerned about polio case in New York?

A spate of polio outbreaks in the past few months in Israel and the United Kingdom, and one recent case of polio paralyzing an unvaccinated adult in New York, has led to warnings from public health officials about its possible spread among unvaccinated and undervaccinated individuals.

The virus was recently detected in wastewater samples taken in New York’s Rockland and Orange counties, an Orthodox Jewish area with low vaccination rates, that suggests the virus is spreading.

The city of Cedar Rapids actively tracks the presence of the COVID-19 virus at its wastewater facilities as part of nationwide study but does not test for any other viruses.

While Iowans and Americans in general are highly vaccinated against polio, Linn County public health officials say the recent cases serve as a reminder and a warning not to forsake vaccines — especially, they say, at a time of declining childhood vaccination rates and rising wariness, distrust and misinformation about vaccine efficacy fueled by the COVID-19 crisis.

There is no cure for polio, but it is preventable through safe and effective vaccination, said Pramod Dwivedi, health director for Linn County Public Health.

“Because of COVID-19, a lot of people have raised questions about vaccine efficacy or (spread) misinformation about side effects vaccines cause,” Dwivedi said. “But this polio vaccine is safe. It has been studied for a long time, and billions of people have been vaccinated safely.”

Most vaccinated

According to the latest data from the U.S. Centers for Disease Control and Prevention, more than 92 percent of children in the United States have received the full course of polio inoculations by age 2.

In Iowa, nearly 90 percent of 2-year-old children were immunized against polio in 2021, according to the Iowa Department of Public Health’s Public Health Tracking Portal.

In Linn and Johnson counties, the rate of immunization among 2-year-olds against polio was about 94 percent.

Almost every child in America has to get a polio vaccine to attend public school. Iowa law requires children enrolled in elementary or secondary schools or licensed child care centers to be vaccinated against a list of infectious childhood diseases, unless exempt for medical reasons or they “conflict with a genuine and sincere religious belief.” The law requires eight types of immunizations by age 5, including three doses of the polio vaccine.

“Linn County is a well-vaccinated community … so we are well-protected,” said Dr. Dustin Arnold, UnityPoint Health-St. Luke’s Hospital chief medical officer.

Dwivedi, too, said he’s not “deeply troubled” by the New York polio case, “but, we need to be very cautious, very careful, and do our level best to make sure that we are protecting our kids and our adults.”

He and Arnold noted during the pandemic many children missed shots and vaccine services were disrupted. They highlighted the importance of staying up to date on recommended vaccinations to prevent the spread of the paralytic and other highly contagious diseases.

“We live in a global village now, right?” Dwivedi said. “One place’s problems becomes another places problem, and you saw that with COVID-19.”

COVID not required

Iowa Gov. Kim Reynolds signed a bill into law in June prohibiting colleges, K-12 school districts and day care centers in Iowa from requiring students and children to be immunized from COVID-19.

While the law addresses only the coronavirus vaccines, Democrats and some health care professionals argued the legislation would undermine parents’ confidence in other effective and well-established vaccines such as those against polio, measles, mumps, rubella and others.

“COVID-19 was an extreme example because we didn’t know much about the behavior behind this virus,” Dwivedi said. “But, with polio, we are well versed. We know how to prevent it. We know how to contain it and how to … manage it. We were almost at the verge of eliminating this scourge — this disease — from our planet.”

How did it spread?

Dwivedi said the highly contagious disease spreads through the mouth from contact with the feces of an infected person — usually from hands or objects contaminated with the stool of an infected person — or droplets from a sneeze or cough, and less often with contaminated water and food.

Polio was once one of the most feared diseases in the U.S. In the early 1950s, before polio vaccines were available, outbreaks caused more than 15,000 cases of paralysis each year, according to the CDC.

Polio was eradicated in the United States in 1979, but it persisted in other parts of the world. In June, the United Kingdom announced it had detected polio in wastewater for the first time in four decades.

In the latest incidents of polio reported, genetic analyses showed that the viruses were all “vaccine-derived,” meaning that they were mutated versions of a virus that originated in the oral vaccine, UnityPoint Health’s Arnold said.

The oral vaccine contains a weakened form of the live virus, with two drops put directly into children’s mouths. Many countries that eliminated polio, including the United States, switched to injectable vaccines containing a killed virus decades ago to avoid such risks, Arnold said, but other countries continue to use the oral vaccine as a cheap, easy-to-administer option to better protect entire populations where polio is spreading.

The Associated Press reported outbreaks typically begin when people who are vaccinated shed live virus from the vaccine in their feces. Symptoms can be mild and flu-like and can take up to 30 days to appear, during which time an infected individual can be shedding virus to others. From there, the virus can spread within the community and, over time, turn into a form that can paralyze people and start new epidemics, according to state and global public health experts.

Since 1979, no cases of polio caused by wild poliovirus have originated in the United States, according to the CDC. However, the wild virus has been brought into the country by travelers with polio. The last time that happened was in 1993.

In the New York case, the virus that infected the unvaccinated adult matched the genetic fingerprint of poliovirus found in sewage samples taken in London and near Jerusalem. It is not clear how the virus moved from one place to another.

What should Iowans do?

If not fully vaccinated against polio, both Arnold and Dwivedi encourage Iowans to reach out to their doctor and ask about how they or their children can get vaccinated.

Since it’s part of the standard immunization schedule for children, pediatricians’ offices and primary care providers should be able to easily get vaccines.

“Vaccination rates had been declining over the years and (the trend) has increased during the pandemic over the last two and a half years,” Dwivedi said. “That’s a worrisome trend, and we must stop that and improve our vaccination, including polio.”

The Associated Press contributed to this report.

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