Polio Outbreaks

Authored by
Staff
Last reviewed
September 26, 2022

Polio Outbreaks 2022

Poliovirus has been confirmed in non-endemic countries in Africa, AsiaEurope, India, the United Kingdom, and New York in 2022. In recent years, the polio-endemic countries of Afghanistan and Pakistan have often reported polio outbreaks, according to the Global Polio Eradication Initiative (GPEI). However, the World Health Organization (WHO), the UK Health Services Agency, the European CDC, and the U.S. NIH say polio is a vaccine-preventable disease. 

On September 13, 2022, the WHO added the USA to a list of about thirty countries where for circulating vaccine-derived poliovirus (cVDPV) is circulating in 2022. This action is related to genetic sequences from a polio patient in Rockland County, NY, and wastewater specimens collected in New York have been linked to poliovirus samples collected in Jerusalem, Israel, and London, UK, indicating community transmission. 

And the WHO recently reaffirmed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern. On September 23, 2022, the WHO's Dr. Zubair Wadood explained in a YouTube video what it would take to eradicate polio from the planet in Science in 5.

This interactive timeline traces the history of polio outbreaks from 1580 B.C. to 2022.

Poliovirus Detection

Poliovirus is very contagious, spreads through person-to-person contact, and lives in an infected person's throat and intestines, says the U.S. CDC. Poliovirus is hard to detect when relying on clinical symptoms in humans, says The BMJ. On September 1, 2022, the CDC's Clinician Outreach and Communication Activity Call presented: How to Recognize and Report Polio and Reinforce Routine Childhood Polio Vaccination. According to CDC, about 25% of people infected with poliovirus will experience symptoms such as Fatigue, Fever, Headache, Stiffness, Muscle or stomach pain, Nausea, or sore throat. And less than 1% become paralyzed. 

The CDC's Health Alert Network published CDCHAN-00474 on September 9, 2022, regarding increases in pediatric hospitalizations in patients with severe respiratory illness who also tested positive for rhinovirus (RV) and/or enterovirus (EV). Upon further typing, some specimens have been positive for enterovirus D68 (EV-D68). Concurrently, pediatric acute respiratory illness sentinel surveillance sites are reporting a higher proportion of EV-D68 positivity in children who are RV/EV positive compared to previous years. Although it primarily causes acute respiratory illness, EV-D68 has been associated with acute flaccid myelitis (AFM), a rare but serious neurologic complication involving limb weakness. And coordinate with state public health laboratory to submit specimens from possible cases of AFM and to the CDC for AFM and polio testing.

Poliovirus in Wastewater

Poliovirus has been confirmed in wastewater in various New York (NY) countries during 2022. On August 2, 2022, the peer-review journal Nature published 'Wastewater monitoring comes of age.' While not every pathogen is reliably shed in feces, estimating case counts based on RNA or DNA concentrations in wastewater remains a work in progress.'

As of September 7, 2022, the U.S. CDC's sequencing analysis confirmed poliovirus's presence (since April 2022) in 57 positive wastewater samples of concern in various NY counties.

Globally, poliovirus type 2 (PV2) isolates have been identified in sewage samples collected in London, Israel, and near India's western border. WPV1 was detected in an environmental sample collected from sewage in Karachi's Landhi area in September 2022.

Polio Cases 2022

Worldwide, the Global Polio Eradication Initiative (GPEI) reports new poliovirus confirmations each week.

Polio Israel

The Israeli Ministry of Health announced on March 10, 2022, that following two confirmations, it was expanding the investigation of sewage sample collection in Jerusalem and additional centers around Israel. First, the International Health Regulations National Focal Point for Israel notified WHO of the detection of the cVDPV3 virus isolated from an acute flaccid paralysis case in the country on March 7, 2022. The Israeli Ministry of Health, under guidance from the Consultant Committee on Poliovirus, resolved to launch a nationwide vaccine operation in April 2022 for additional vaccination against polio for over 2 million children aged six weeks until 17 years. In July 2022, Dr. Sharon Alroy-Preis, the Health Ministry's public health chief, stated to the JPost, 'The poliovirus outbreak has largely been overcome and is under control. And no poliovirus was found in the country's sewage in July 2022.' 

In 2013-2014, Israel detected WPV1 in wastewater samples in its southern regions. And The Lancet reported that between 2005 and 2013, Israel discontinued the administration of the live polio vaccine.

Polio London

The UK Health Security Agency (UKHSA) declared a "national incident" in June 2022 after poliovirus was detected in London sewage. Detection of the current poliovirus since February 2022, and genetic sequencing showing its ongoing evolution, indicate likely circulation in the community, reported The BMJ. In the UK, poliovirus was detected through a surveillance program led by the National Institute of Biological Standards and Control. In addition, some of the vaccine-derived poliovirus type 2 isolates found in the UK were genetically linked to a polio case reported in July 2022 from New York and environmental samples collected in New York and Greater Jerusalem, Israel.

The UKHSA recently stated, 'Vaccination coverage for the 3-dose primary schedule in one-year-olds in London is (71.4%) well below the average and uptake of the booster is even lower at 71.7%. In London, an active call-recall of unvaccinated and partially vaccinated children under the age of 5 is already underway through primary care, with a planned phased extension up to 18-year-olds. However, due to the large pool of partially vaccinated or unvaccinated individuals in the affected areas of London, it is improbable that this IPV-catch-up alone will be sufficient to prevent cases of paralysis or control the VDPV2 spread.

On September 2, 2022, the UKHSA stated sewage sampling had been conducted in London and Glasgow, and no poliovirus has been detected in Glasgow. The additional sites where the sampling will be rolled out are Sewage Treatment Works covering parts of Birmingham, Blackburn with Darwen, Bradford, Brighton and Hove, City of Bristol, Bury, Castle Point, Leeds, Leicester, Liverpool, Luton, Manchester, North Tyneside, Newcastle upon Tyne, Gateshead, Nottingham, Preston, Salford, Sheffield and Watford. These areas outside of London were chosen on the basis of an assessment of risk, which takes into consideration a number of factors.

Polio New York

The State of New York and the CDC confirmed a poliovirus type 2 infection on July 14, 2022, in Rockland Country, NY. With evidence of circulating poliovirus in multiple counties, NY Governor Kathy Hochul issued an Executive Order on September 9, 2022, declaring a State Disaster Emergency, increasing the availability of resources to protect New Yorkers against paralytic disease. The New York State Department of Health (NYSDOH) has confirmed wastewater samples in Nassau, Rockland, Orange, Sullivan, and NYC Health identified poliovirus in sewage, suggesting likely local circulation of the virus. 

And unvaccinated New Yorkers or those not up to date with immunizations who live, work, go to school in or visit Rockland County, Orange County, New York City, Sullivan County, and Nassau County are at the highest risk of contracting the paralytic disease and should speak with their healthcare provider.

Nassau County, NY, publishes vaccination information on this webpage.

New York City, NY, offers people ages four years and older low- or no-cost polio vaccines at this location.

Orange County, NY, publishes vaccination information on this webpage.

Rockland County, NY, offers free Inactivated Polio Vaccines (IPV) at these locations.

Sullivan County, NY, residents (polio vaccination rate of 62%) can contact Public Health at 845-513-2249.

Polio Vaccines - U.S. FDA Approved

The U.S. CDC published a poliovirus vaccine update on September 22, 2022, recommending children get four doses of a polio vaccine. And adults who completed their polio vaccination but who are at increased risk of coming in contact with poliovirus may receive one lifetime IPV booster. The U.S. CDC's website stated on September 15, 2022, that 'for best protection, children should get multiple doses of polio vaccine. Immunity becomes effective about two weeks after the first polio vaccine dose. For polio vaccination recommendations for adults, see Polio Vaccination: What Everyone Should Know.

There are two types of vaccines that can prevent polio: Inactivated poliovirus vaccine (IPV) and the Oral poliovirus vaccine (OPV). IPV is the only vaccine available in the USA. The IPOL IPV vaccine is indicated for active immunization of infants (as young as six weeks), children, and adults to prevent poliomyelitis caused by poliovirus types 1, 2, and 3.

The IPV protects against both wild-type polio and this weakened poliovirus strain. For details and age groups, refer to the ACIP IPV catch-up vaccine table.

Kinrix is indicated for active immunization against diphtheria, tetanus, pertussis, and poliomyelitis as the fifth dose in the diphtheria, tetanus, and acellular pertussis (DTaP) vaccine series and the fourth dose in the IPV series in children 4 through 6 years of age whose previous DTaP vaccine doses have been with Infanrix and/or Pediarix for the first three doses and Infanrix for the fourth dose.

Pediarix is a vaccine for active immunization against diphtheria, tetanus, pertussis, and infection caused by all known subtypes of hepatitis B virus and poliomyelitis. 

Pentacel is a multi-vaccine consisting of Diphtheria, Tetanus Toxoids, and Acellular Pertussis Adsorbed and Inactivated Poliovirus (DTaP-IPV) component as well as an ActHIB® vaccine component.

Quadracel vaccine is indicated for active immunization against diphtheria, tetanus, pertussis, and poliomyelitis.

Sabin IPV vaccine is indicated to prevent the Wild Polio Virus in the hope of completely eradicating the disease.

Note: The oral vaccine contains a weakened strain of the poliovirus that has changed over time and now behaves similarly to a wild-type polio infection. In addition, OPV can lead to vaccine-derived poliovirus, which can enter the blood and paralyze an unvaccinated person and is not offered in the USA.

Polio Vaccine Price

The U.S. CDC confirmed the Vaccines For Children program is a federally funded program that provides IPV vaccines and medicines at no cost to children to children who might not otherwise be vaccinated because of their inability to pay. For people in the USA not covered by health insurance, a polio booster typically costs about $100. For example, pharmacies may charge about $100 for an IPV polio booster shot. The U.S. CDC Vaccine Price List was updated on July 1, 2022.

This UNICEF table provides an overview of Oral polio vaccine prices contracted with suppliers. And additional polio vaccine prices and discount information are available at InstantRx™.

Post-Polio Syndrome

As polio survivors progress through life, a significant proportion develops neurological symptoms known as Post-Polio Syndrome (PPS), says the U.S. NIH. Characterized by new, gradual, and progressive muscle weakness and wasting, difficulty swallowing, joint or muscle pain, and general fatigue after being stable for many years, the non-contagious PPS typically develops 15 to 40 years after people have recovered from polio. 

The first medical reports of PPS appeared in France in 1875. Further research published in the 1950s identified significant damage to nerve cells within the spinal cord. However, as the UK-based Polio Survivors Network concludes, PPS has no set pattern of nerve damage. Additional clinical and diagnostic information about poliovirus infection is posted by the U.S. CDC as of August 10, 2022.

And the CDC defined acute flaccid paralysis (AFP) in 2004 as "anyone under 15 years of age with acute onset of focal weakness or paralysis (including GBS) or any person with paralytic illness at any age when polio suspected, characterized by flaccid (reduced tone), without other obvious causes. The adoption of the global polio eradication goal in 1988 required the implementation of AFP surveillance in all countries and territories.

Acute Flaccid Myelitis - Polio-Like Virus

Acute flaccid myelitis (AFM) is an uncommon but serious neurologic condition. It affects the nervous system, specifically the area of the spinal cord called gray matter, which causes the muscles and reflexes in the body to become weak. And EV-D68 was the most common virus detected in specimens from patients with AFM. As of September 21, 2022, the CDC has confirmed 15 AFM cases in 2022, and there have been 694 confirmed AFM cases since the U.S. CDC began tracking the disease in 2014.

Acute Flaccid Paralysis surveillance is the gold standard for detecting cases of poliomyelitis. For AFP surveillance standards, please visit the WHO-recommended surveillance standard of poliomyelitis. Date of last update: 10/09/2022.

Polio Outbreak News 2022

September 26, 2022 - The New Jersey Department of Health requested healthcare provider offices and pharmacies consider stocking IPV to increase access for people seeking polio vaccination.

September 20, 2022 - Local media in NYC reported: Dr. Wafaa El-Sadr, a professor at the Columbia University Mailman School of Public Health. "For adults, they haven't thought about vulnerability to polio or the need to get vaccinated. I think the messaging should always say, 'This vaccine is very important whether you're a child or an adult.'"

September 18, 2022 - NBC Chicago reported: "There's no recommendation at this point to get a booster or vaccine for polio if you have had all of your regular childhood vaccines," Dr. Isaac Shinai, a medical director at the Chicago Department of Public Health who oversees COVID-19 laboratory surveillance and testing, said.

September 14, 2022 - Local New York media reported that 5,064 IPV polio vaccines (77% toddlers) had been administered in Rockland County since July 2022.

September 13, 2022 - Leslie Roberts wrote an article published by Science.org: Polio is back in rich countries, but it poses a far bigger threat to the developing world.

September 12, 2022 - Memorial Sloan Kettering Cancer Center published an article - Polio in NY: What You Should Know.

September 9, 2022 - NY State Health Department confirmed of the 50 wastewater samples, 31 poliovirus samples were collected in Rockland County, 13 in Orange County, 6 in Sullivan County, and 1 sample was collected in Nassau County. In response, NY's governor declared a State of Disaster Emergency.

September 6, 2022 - The Alert - Level 2, Practice Enhanced Precautions, travel advisory published by the U.S. CDC was reissued for various countries in Africa.

September 3, 2022 - There are no reported cases in Florida in 2022, according to the state health department's reportable diseases frequency report. "The Miami-Dade Water and Sewer Department is investigating opportunities to add the monitoring of the polio virus to our wastewater surveillance program," said Jennifer Messemer-Skold, public affairs administrator for the department, reported the Miami Herald.

September 2, 2022 - The UKHSA reported following advice from the Joint Committee on Vaccination and Immunisation, that all children aged 1 to 9 years in London need to have a dose of polio vaccine now – whether it's an extra booster dose or just to catch up.

September 1, 2022 - The U.S. CDC is investigating a case of poliomyelitis, or paralytic polio, in New York state. During a COCA Call, presenters will discuss the history of polio in the USA. CDC staff will also review clinical aspects of poliovirus infection, how to report suspected cases and recommendations for polio vaccination in the USA.

August 28, 2022 - National Geographic published: Why polio is making a comeback.

August 26, 2022 - The New York State Department of Health confirmed today that sequencing analysis performed by CDC has now detected poliovirus in four samples from Sullivan County, two collected in July and two collected in August, which are genetically linked to the case of paralytic polio previously identified in Rockland County. Already, poliovirus had been identified in samples collected in Rockland County, Orange County, and NYC, the types of poliovirus that can cause paralysis in humans.

August 26, 2022 - The Yale School of Medicine published: Is Polio Making a Comeback?

August 25, 2022 - The JAMA Network published a Perspective: What Physicians Need to Know About the Polio Resurgence in New York State.

August 23, 2022 - LA County Health Department alerted healthcare providers to consider polio in symptomatic patients who recently traveled to an area where there is a risk of polio, especially if they are unvaccinated.

August 23, 2022 - In the state of Michigan, 31% of children ages 19 to 35 months are overdue for routine vaccinations, including polio. "You really want to have a large number of people vaccinated, so diseases don't start circulating," says Dennis Cunningham, M.D., medical director of infection control and prevention at Henry Ford Health.

August 22, 2022 - With Poliovirus in Wastewater, Should We Get Boosted?

August 19, 2022 - New York Department of Health HEALTH ADVISORY: Update #2 Regarding Poliovirus in New York State: All children, adolescents, and adults who are unvaccinated or under-vaccinated should be brought up to date with all routine CDC-recommended IPV doses. This is particularly important and urgent if they live, work, attend school, or have frequent social interactions with communities in Rockland and Orange Counties.

August 19, 2022 - The U.S. CDC published: Public Health Response to a Case of Paralytic Poliomyelitis in an Unvaccinated Person and Detection of Poliovirus in Wastewater — New York, June–August 2022. Twenty specimens from wastewater samples collected during May, June, and July were genetically linked to viruses from the patient's stool samples. This case highlights the risk of paralytic disease among unvaccinated persons.

August 18, 2022 - Having funded critical research that led to the polio vaccine in 1955, March of Dimes SVP Dr. Zsakeba Henderson issued the following statement in response to this new threat in New York.

August 16, 2022 - The U.S. CDC issued an MMWR - Public Health Response to a Case of Paralytic Poliomyelitis in an Unvaccinated Person and Detection of Poliovirus in Wastewater — New York, June–August 2022. Among tested samples, 21 (8%) yielded positive poliovirus results using RT-PCR and partial genome sequencing, including 13 from Rockland County and eight from Orange County. The detection of VDPV2 genetically linked to the virus from the patient and in wastewater specimens from two counties in New York State over the course of ≥2 months indicates community transmission and ongoing risk for paralysis in unvaccinated persons.

August 16, 2022 - At Altamonte Springs, Florida, city leaders confirmed they might start testing wastewater for poliovirus.

August 15, 2022 - GAVI reported: Post-Polio Syndrome - Decades after recovering from polio, some survivors are developing progressive muscle weakness and fatigue that can severely impair their quality of life.

August 12, 2022 - Poliovirus Confirmed in NYC's wastewater by the New York State Department of Health. and NYC Health issued: 2022 Health Alert #20: Update on Poliovirus in New York City.

August 11, 2022 - The Rockland County, NY Health Department will offer a polio vaccination clinic in Spring Valley on August 17, 2022. The Health Department also offers polio vaccinations at 50 Sanatorium Road in Pomona on Mondays and Wednesdays.

August 10, 2022 - The UKHSA confirmed a total of 116 PV2 isolates had been identified in 19 sewage samples collected in London, England, between February and July 2022. Most are vaccine-like viruses, and only a few have sufficient mutations to be classified as vaccine-derived poliovirus. And the Joint Committee on Vaccination and Immunisation advised that a targeted IPV booster dose should be offered to all children between the ages of 1 and 9 in London boroughs.

August 10, 2022 - According to the Global Polio Eradication Initiative, the Democratic Republic of the Congo, Mozambique, and Yemen reported more polio cases this week.

August 8, 2022 - Global Polio Eradication Initiative: Short report on type 2 poliovirus detected in the USA, Israel, and the UK.

August 7, 2022 - NBC4 News NY reported - The "CDC continues to collaborate with the New York State Department of Health to investigate their recent polio case, including ongoing testing of wastewater samples to monitor for poliovirus and deploying a small team to New York to assist on the ground with the investigation and vaccination efforts," a spokesperson confirmed. The polio virus has now been found in seven different wastewater samples in two adjacent counties north of New York City.

August 4, 2022 - "Based on earlier polio outbreaks, New Yorkers should know that for every one case of paralytic polio observed, there may be hundreds of other people infected," State Health Commissioner Dr. Mary T. Bassett said. HEALTH ADVISORY #1: Update Regarding Poliomyelitis in Rockland County, New York State.

July 29, 2022 - The Global Polio Eradication Initiative has been informed of a case of paralytic polio (type 2 VDPV) in an unvaccinated individual in Rockland County, NY. Following the detection, the Global Polio Laboratory Network has confirmed that the VDPV2 isolated from the case is genetically linked to two Sabin-like type 2 isolates collected from environmental samples in early June 2022 in both New York and Israel, as well as to the recently-detected VDPV2 from environmental samples in London, UK

July 26, 2022 - The Rockland County Department of Health vaccinated 71 people against polio at the County's first two clinics in response to a case of polio in a resident.

July 22, 2022 - New York State issued HEALTH ADVISORY: Poliomyelitis Case in Rockland County, New York State.

July 13, 2022 - Israel's Ministry of Health published updated polio vaccination guidelines #6.

July 3, 2022 - Israel's Operation Two Drops polio vaccine program reached over two million children.

June 22, 2022 - London residents are shedding the type 2 poliovirus strain in their feces.

June 22, 2022 - Israel is providing live attenuated poliovirus vaccines as part of student health services.

April 29, 2022 - Morbidity and vaccination campaign against the polio virus in Israel.

April 2, 2022 - Israel reports potentially eight polio cases in 2022.

March 15, 2022 - The Israeli Ministry of Health, under guidance from the Consultant Committee on Poliovirus, launched a nationwide vaccine operation, 'Two-Drops,' for supplementary vaccination against polio for children.

September 2021 - Getting a Fair Shot: Progress and Disparities in Early Childhood Vaccination in New York State. The lowest regional rates of early childhood vaccination coverage were consistently found in the Lower Hudson and Long Island regions (in 2020, 54% and 59%, respectively.

The Global Polio Eradication Initiative publishes polio vaccine and outbreak news.