New testing has found that the polio virus had infected at least one Rockland County resident and was present in wastewater sampled at a sewage treatment plant as early as June, the county’s health commissioner said Monday.
The detective work on past wastewater samples began after the state and county reported a case of polio had occurred in Rockland County, the first in the U.S. since 2013. The young adult who was ill was paralyzed during the illness in June, health officials said, but they would not say whether that was a permanent condition.
The person, who had recovered from the virus, had never been vaccinated for polio. They had not traveled, health officials have said.
The June samples that showed the presence of polio came from Rockland County Sewer District #1, which serves the towns of Ramapo and Clarkstown, along with some parcels in Orangetown. Rockland Health Commissioner Dr. Patricia Schnabel Ruppert said that Orangetown’s sewer district – the other plant in Rockland where wastewater is periodically tested for COVID-19 – did not have polio presence.
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Wastewater was already being collected for COVID testing, Schnabel Ruppert said, adding, “The good news is they still had the samples so we could go back.”
Schnabel Ruppert said “it’s too soon to say” whether polio is still present in Rockland or New York.
“It’s a qualitative not a quantitative result,” Schnabel Ruppert said of the single round of wastewater testing. “It could be from one case, or a number of different cases.”
Schnabel Ruppert said that July testing will come soon, and that will provide valuable data.
Another month of positive results from Sewer District #1, or positive polio tests in other sewer systems outside the Ramapo-Clarkstown boundary, would be further cause for concern, she said.
The state Department of Health began testing sewage samples for polio after discovering the Rockland County infection last week. A department spokesman said Monday that the state was testing wastewater from Rockland and other locations and was including past samples it had collected and stored as part of its ongoing monitoring of COVID virus levels in wastewater throughout the state.
The state tests wastewater for COVID at 94 treatment plants in 54 counties, including two plants in Rockland and six in neighboring Orange County. The state didn’t disclose how many and which of those sites are now being examined for polio traces.
“This is being done as extensively as possible, both from Rockland County and beyond, based on available samples from throughout the State,” department spokesman Cort Ruddy said.
Polio, which had virtually vanished in the U.S. due to immunizations, is a viral disease that can cause muscle weakness or paralysis. People who are vaccinated against polio through a sequence of four doses in infancy and early childhood 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 officials had distributed additional polio vaccines in the last few days, according to officials. They said 18 vaccinations had been given on Friday, the day after the county and state announced that a case of polio had been detected within the county. The county administered another 53 vaccine shots on Monday.
Schnabel Ruppert said that on Friday, the county clinic gave polio vaccinations to adults. She said children would likely access vaccines through pediatricians or federally qualified health centers like RefuahHealth or MedRite.
The U.S. advises speeding up the polio vaccine schedule for infants traveling to areas where polio is present. The standard schedule involves three shots between age 2 months, 4 months, 6-18 months and then a booster at age 4. Schnabel Ruppert said there hasn’t been any guidance to accelerate the schedule for all children. “But things change in a heartbeat.”
Most cases of polio are asymptomatic, Schnabel Ruppert said, so it cannot be said that the case detected is the only one. She warned that the virus poses a risk to anyone who has not yet been vaccinated.
“It will find the unvaccinated. We saw that with measles, we all lived that,” said Schnabel Ruppert, who led Rockland County’s health department during a measles outbreak that sickened more than 320 in 2018-2019.
During the measles outbreak, Rockland officials performed extensive contact tracing − something that they did again during COVID’s early days of spring 2020, when Rockland County witnessed one of the fastest growing rates of virus in the nation.
Schnabel Ruppert said Monday that health workers were still undertaking case investigations with close contacts and family of the polio victim. County officials have repeatedly declined to say where the person resides, or with whom.
“We are still working with the family and friends to complete contact tracing we are investigating everything we need to do with this case.”
Meanwhile, Schnabel Ruppert said the county is working on future immunization opportunities. “If we can locate a host site, we’ll go where we need to be.”
With Rockland as a nexus for measles and then COVID early in the pandemic, Rockland County Executive Ed Day has said the county is “battle tested.”
Schnabel Ruppert, though, was more reflective. “When you think of the enormity of this, and the repercussions it can have in our communities, it’s frustrating, it’s sad,” she said.
Schnabel Ruppert reflected on her years working at Helen Hayes Hospital, a state rehabilitation hospital in West Haverstraw. At one time, the facility hosted a school because so many young children with polio were in the facility.
“People forget,” the doctor said about the fear polio struck each summer in the 1940s and early 1950s. “I’m hoping that the grandparents remember, who lived it. I am praying that they come forth and say to their families, ‘We lived through this, please immunize your children.'”
Following transmission chain
The last polio case transmitted within the U.S. was in 1979, according to the U.S. Centers for Disease Control and Prevention, although occasionally travelers with polio have brought infections into the U.S. The last polio case was found in the U.S. was in 2013.
According to the state Department of Health, sequencing on this 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.
Rockland County health officials said that the root of the polio case suggests it may have originated in a location outside of the country where OPV is administered. But, officials added, that does not necessarily mean that’s where it was transmitted.
Up to 95% of people infected with polio have no symptoms but can still spread the virus.
The infected Rockland resident did not travel outside the country during the incubation window, health officials said. The incubation period for nonparalytic poliomyelitis is 3 to 6 days and the incubation period for the onset of paralysis in paralytic poliomyelitis is 7 to 21 days, according to the U.S. Centers for Disease Control and Prevention.
MedRite Urgent Care in Spring Valley started offering polio vaccinations for adults 18 and over on Sunday and plans to continue doing so through Friday. The shots will be given from 12-6 p.m. each day in a tent next to the clinic at 175 Route 59. No appointments are needed.
Daniel Marquez, center manager for the MedRite, said the shots are covered by most insurance plans, and would be free for uninsured patients starting with the arrival on Monday of vaccine supplies from the state Department of Health.
Fewer than 10 people had come so far to MedRite for polio shots as of mid-afternoon on Monday. Marquez said the clinic was encouraging parents whose children need polio shots to take them instead to their primary care doctors.
RefuahHealth has set up polio vaccinations at its Acute Care location, 728 North Main, Spring Valley, from 8 a.m. to midnight, Monday through Thursday, and 9 a.m. to 8 p.m. Friday and noon to midnight Sunday.
Nancy Cutler writes about People & Policy. Click here for her latest stories. Follow her on Twitter at @nancyrockland
Chris McKenna covers government and politics for the Times Herald-Record and USA Today Network. Reach him at cmckenna@th-record.com.
