Unvaccinated Rockland County residents got polio vaccine shots on Friday after county officials revealed an infection one day earlier that marked the stunning emergence of a contagious and potentially debilitating disease that had been all but eradicated in the U.S. through immunizations.
County and state officials declined to provide further information on Friday about the county resident who contracted polio, other than to say it was a young adult. The Washington Post, citing an anonymous public health official involved in the investigation, reported Thursday that the infected person was a 20-year-old man who had traveled this year to Poland and Hungary and was hospitalized in June. Rockland health officials said Thursday that the person initially had paralysis but has since been released from the hospital and was no longer contagious.
Elected officials briefed by the state Department of Health say they were told the infected person was a man from Rockland’s large Orthodox Jewish community, but were given no other information about where he was from, his current condition or where he had traveled and may have contracted polio. Cases had plummeted in the U.S. after the vaccine was introduced in 1955, with no naturally occurring infections since 1979.
Rockland officials announced Friday evening they had given polio shots to 18 people of varying ages that day but were not expected to give a fuller update on the case until next week. The county health department has started contact tracing on the infected person. People who are vaccinated against polio have a low risk of catching the virus, which is spread by saliva in mouth-to-mouth contact or by fecal contamination of food or water.
Rockland County lags well behind much of the state in its polio vaccinations, which are required for school children by state law. The state Department of Health said Friday that 61% of Rockland residents had gotten the three required immunization shots by age 2, compared to a 79% immunization rate for 2-year-olds in all 57 counties outside New York City. New York City is excluded because the city collects its own data.
The 61% rate for Rockland rises significantly by the time children reach school, according to data that schools report to the state Department of Health. The department’s data indicates that at least 98% of students are vaccinated against polio at 104 out of 153 public, private and religious schools in Rockland. The other 49 had compliance rates ranging from 79.9% to 97.7%.
The virus that causes polio is shed in the feces and can be detected through wastewater monitoring.
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Rockland County plans to determine if polio has spread in its population by testing sewage samples it already was collecting from two treatment plants in Orangetown to detect levels of the COVID-19 virus. The most water samples were taken at those plants on July 12 and July 19, according to a state tracking database. The polio tests will be performed on them at the Wadsworth Center, the state-run laboratory in Albany, and the results could be available as soon as Monday, John Lyon, chief of staff to Rockland County Executive Ed Day, said Friday.
A test for poliovirus will be added to the wastewater monitoring in neighboring Bergen County “in light of recent events,” said Kartik Chandran, a professor of engineering at Columbia University via email Friday. He has led a wastewater surveillance study in Bergen County of the virus that causes COVID-19 since early in the pandemic.
The poliovirus was found in surveillance of sewage in London from February through June this year. No polio cases were found. The traces were believed to come from someone who had received the oral vaccine. The sustained findings and apparent evolution of the virus over several months of samples caused concern that polio was spreading among a small number of people there.
“I don’t really expect any kind of sustained outbreak because of this,” said Dr. Ronald Nahass, an infectious disease specialist in New Jersey and president of ID Care, a specialty practice with over 50 physicians statewide. “If there’s a small outbreak, it would be among unvaccinated individuals.” Fully vaccinated individuals have nearly 100% protection, he said.
“None of us has had to think about this for a long time,” said Nahass. While polio was nearly eradicated worldwide, it has continued to smolder in pockets. And occasional cases flare up among people in other countries who receive the oral vaccine, which uses a weakened form of the virus. That type of vaccine has not been authorized or administered in the United States since 2000.
In the attenuated form of the virus, which was identified in the Rockland County patient, “The potency or severity [of the virus] is remarkably lessened, but it is not eliminated,” Nahass said.
Vaccination for polio is required for admission to school in New Jersey as well. Statewide, 94.1% of kindergartners met all vaccination requirements for the 2021-2022 school year, according to state data. The rate varied from a low of 87.9% in Ocean County to 98.3% in Salem County. In Bergen County, it was 95.5%.
“At this time, no New Jersey contacts have been identified,” Nancy Kearney, a spokeswoman for the New Jersey Department of Health, said in reference to the Rockland case. The department notified local public health departments and providers Friday to be vigilant for possible cases. But Kearney said the risk is low for highly vaccinated populations, such as New Jersey’s.
According to the New York Department of Health, sequencing on the Rockland County case showed it was revertant polio Sabin type 2 virus. This points to a transmission chain from an individual who received an older form of oral polio vaccine that hasn’t been used in the U.S. in over two decades. Only inactivated polio vaccine has been given in the U.S. since 2000.
The sick individual had not taken that oral vaccine, health officials said, or any polio vaccination. Testing is being done at the state’s Wadsworth Center and at the Centers for Disease Control and Prevention.
Children who have received the oral vaccine shed virus. That could cause infection in an unvaccinated person, the reason the oral form of the vaccine was discontinued in the United States.
Paralysis is rare among those infected with polio, but “devastating if it occurs,” Nahass said. “There’s no treatment for it, once you get it.”
Most people who develop polio have no symptoms. The disease can also cause mild illness, with intestinal complaints, fever and flu symptoms.
The current form of the vaccine in the United States uses inactivated virus.
The American Academy of Pediatrics recommends a four-dose series of inactivated polio vaccines for all children. The doses are given by injection at two months, four months, and six to 18 months, and four to six years of age.
New York requires all children attending day care or school – public or private – to have gotten polio and other required vaccines according to the recommended schedule, unless they are exempt for medical reasons authorized by a doctor. New York no longer grants exemptions for religious reasons. The state Department of Health surveys schools each year on compliance with the vaccine mandate and “follows-up directly with schools that are identified to have low rates on the annual survey,” department spokesman Cort Ruddy said.
The Rockland County Health Department plans to administer another round of polio shots from 1-4 p.m. Monday at at the Pomona Health Complex at 50 Sanatorium Road.
Lindy Washburn, health care reporter for The Record and the USAToday Network-New Jersey, contributed to this report.
Chris McKenna covers government and politics for the Times Herald-Record and USA Today Network. Reach him atcmckenna@th-record.com.
