Polio Outbreaks 2022

Authored by
Staff
Last reviewed
December 1, 2022

Polio Outbreaks 2022

Poliovirus (Poliomyelitis) has been confirmed in non-endemic countries in Africa, AsiaEurope, India, Israel, the United Kingdom, and New York in 2022. In recent years, polio-endemic countries of Afghanistan and Pakistan have reported polio outbreaks, according to the Global Polio Eradication Initiative (GPEI).

The U.S. Centers for Disease Control and Prevention (CDC) announced on November 30, 2022, it would expand wastewater testing for poliovirus in select jurisdictions across the country outside of New York (NY). The Michigan Department of Health and Human Services (Oakland County, Detroit) and the Philadelphia Department of Public Health (Chester County, Philadelphia) are among the first locations to explore plans to start collecting wastewater samples in specific communities for analysis at CDC’s polio laboratory. 

And on November 18, 2022, the U.S. CDC issued a global Alert - Level 2, Practice Enhanced Precautions, regarding polio outbreaks and poliovirus detections in various countries. A polio patient (Acute flaccid myelitis) was identified in Rockland County, New York, and confirmed by genetic sequences in July 2022. Additionally, wastewater specimens from various NY counties were genetically linked to poliovirus samples collected in Israel and London, England, in 2022, indicating multi-country community transmission. 

Polio Remains International Concern

On November 1, 2022, a World Health Organization Committee unanimously agreed that the risk of the international spread of poliovirus remains a Public Health Emergency of International Concern and recommended the extension of Temporary Recommendations for a further three months. On September 13, 2022, the WHO added the U.S. to a list of about thirty countries where circulating vaccine-derived poliovirus (cVDPV) has been identified in 2022.

The journal JID published an article on October 15, 2022: Polio by the Numbers—A Global Perspective. This interactive timeline traces the history of polio outbreaks from 1580 B.C. to 2022.

Polio Cases 2022

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 Global Polio Eradication Initiative reports new poliovirus confirmations each week.  And Vax-Before-Travel publishes international polio news.

Polio Vaccines Approved

Polio is a vaccine-preventable disease, says the U.S. CDC. As of December 2022, polio booster doses are not recommended for individuals traveling to New York merely because of their travel status. For the latest polio vaccine information, visit this webpage.

Poliovirus Shedding

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. Three types of vaccines can prevent polio but may indirectly enable virus shedding: Inactivated poliovirus vaccine (IPV), the Oral poliovirus vaccine (OPV), and the novel oral polio vaccine type 2 (nOPV2).

Research demonstrates that poliovirus transmission predominantly follows the oral-fecal route, and concerns remain about the potential for persistent transmission of OPV viruses, as these viruses are known to revert toward wild-type neurovirulence

Polio Detection

Poliovirus is 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. 

Poliovirus in Wastewater

As of December 2022, the U.S. CDC's sequencing analysis confirmed poliovirus's presence (since April 2022) in 82 positive wastewater samples of concern in various New York counties. The U.S. CDC published an MMWR on October 28, 2022: Wastewater testing has identified circulating polioviruses genetically related to the virus isolated from the Rockland County patient in at least five New York counties. The CDC says wastewater data cannot be used to determine or identify who is infected with poliovirus.

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

Poliovirus Detroit, Michigan

The U.S. CDC announced plans to start collecting wastewater samples in communities near Detroit, Michigan, for analysis at CDC’s polio laboratory on November 30, 2022. Preliminary testing will last at least four months. Oakland County's population is about 1.2 million.

Poliovirus Philadelphia, Pennsylvania

The U.S. CDC announced on November 30, 2022, it would begin collecting wastewater samples from Chester County, Philadelphia, for analysis at CDC’s polio laboratory. Dr. José R. Romero, Director of CDC’s National Center for Immunization and Respiratory Diseases, indicated poliovirus testing would last at least four months. Chester County's population is about 500,000.

Polio New York 2022

Genetically related poliovirus has been detected in wastewater samples collected from Kings, Nassau, Orange, Queens, Rockland, and Sullivan counties in April, May, June, July, August, September, and October 2022. As of October 28, 2022, 82 samples have been found to be genetically linked to the individual case of paralytic polio in a Rockland County, NY resident, and detections near London and Isreal.

In response, the Governor of New York Governor Kathy Hochul, announced on October 9, 2022, she was extending Executive Order 21.1, based on Executive Order 21 issued on September 9, 2022, until November 8, 2022, expanding the vaccination authorities for certain NY health providers.

On September 28, 2022, a 'Declaration of an Imminent Threat to Public Health for poliovirus' was issued by Mary T. Bassett, M.D., M.P.H. Commissioner of Health, New York. And New York State issued HEALTH ADVISORY Update #3 Regarding Poliovirus, which says 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 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 IPV at these locations.

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

Cattaraugus County, (NY) Public Health Director Dr. Kevin D. Watkins announced on October 5, 2022, he is urging residents who are not vaccinated against polio to get vaccinated.

Poliovirus 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 (AFP) 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 (2-Drops 2022) in April 2022 for additional vaccination against polio for over two million children aged six weeks until 17 years.

Poliovirus London

The UK Health Security Agency (UKHSA) declared a "national incident" in June 2022 after poliovirus was detected in London, England, area sewage. Detection of 118 genetically linked poliovirus isolates related to the serotype 2 Sabin vaccine strain in 21 of 52 samples collected between February 8 and July 4, 2022, reported The BMJ and The Lancet. The UK poliovirus surveillance program was led by the National Institute of Biological Standards, and Control that confirmed on October 19, 2022, vaccine-like type-2 poliovirus (PV2) isolates were found in sewage samples collected from the London Beckton sewage treatment works in February 2022. This analysis has shown that all PV2 isolates identified since then are genetically related to each other. In the UK, sewage spills are frequent.

In addition, some of the vaccine-derived poliovirus type 2 isolates were found in several boroughs in north and east London. were genetically linked to a polio case reported in July 2022 from New York and environmental samples collected in New York and Israel. On September 2, 2022, the UKHSA stated sewage sampling had been conducted in London. And on November 14, 2022, the UKHSA published guidance: Immediate actions in response to detection of a ‘circulating’ VDPV2 in London sewage samples. And the environmental surveillance was expanded in an attempt to assess the extent of VDPV2 transmission in and outside of London.

The UKHSA recently stated, 'Polio 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 five is underway.

On September 29, 2022, the UKHSA confirmed polio vaccinations are offered to children in the greater London area. Dr. Vanessa Saliba, a Consultant Epidemiologist at UKHSA, said, '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. It will ensure a high level of protection from paralysis.'

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. 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 (AFP) surveillance is the 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

November 30, 2022 - “Wastewater testing can be an important tool to help us understand if poliovirus may be circulating in communities in certain circumstances,” said Dr. José R. Romero, Director of CDC’s National Center for Immunization and Respiratory Diseases. “Vaccination remains the best way to prevent another case of paralytic polio.

November 17, 2022 - The latest Annenberg Science Knowledge national panel survey finds that a sizable portion of the U.S. public is unfamiliar with the risks of polio. Only a third of U.S. adults know there is no cure for polio, and over 22% of adults do not know whether they’ve been vaccinated against polio.

November 1, 2022 - The BMJ published a Feature Article: Polio in New York: will it just go away?

October 27, 2022 - New York State Health Department issued a Polio Letter to Providers & Polio Publication Request Form - Notification ID: 109528 - This is an urgent plea: as the most trusted source of medical guidance for your patients and their families, we need your help to make sure that any child who is not vaccinated or up to date with polio immunizations gets all the recommended doses immediately. This is particularly urgent for providers and patients in Rockland, Orange, and Sullivan Counties, where poliovirus has been detected in wastewater repeatedly.

October 21, 2022 - The U.S. CDC published an MMWR: Progress Toward Poliomyelitis Eradication — Pakistan, January 2021–July 2022. WPV1 cases in Pakistan decreased from 147 in 2019 and 84 in 2020 to a single case in 2021 but increased to 14 cases in 2022 as of July 31. These 14 WPV1 cases are clustered among children in southern Khyber Pakhtunkhwa province, many of whom have never received a poliovirus vaccine.

October 19, 2022 - The UK Health Security Agency is investigating the extent of transmission of poliovirus across north-east and north-central London. Based on recent sampling, poliovirus is considered to be present in sub-areas of the Beckton plant covering all or parts of the following London boroughs: Barnet, Brent, Camden, Enfield, Hackney, Haringey, Islington, and Waltham Forest. The sampling has also detected the virus in lower concentrations and frequency in areas adjacent to the Beckton catchment area to the South (immediately below the Thames) and to the East.

October 12, 2022 - The Lancet published: Sustained detection of type 2 poliovirus in London sewage between February and July 2022. Interpretation: Environmental surveillance allowed early detection of poliovirus importation and circulation in London, including whole-genome sequences generated through nanopore sequencing, established linkage of isolates, and confirmed transmission of a unique recombinant poliovirus lineage that has now been detected in Israel and the USA.

October 11, 2022 - The latest wastewater testing results collected in New York City from Brooklyn (Kings County) and Queens County in August 2022, tested by CDC, confirmed it is genetically linked to the polio case previously identified in Rockland County, NY.

October 9, 2022 - New York state extends and expands Executive Order 21.1 - Continuing the Declaration of a Statewide Disaster Emergency Due to the Ongoing Spread of Polio in the State of New York.

October 6, 2022 - Canada has become the first country in the world to advance to the second stage of poliovirus containment certification.

October 4, 2022 - The U.S. needs to plan for what happens if the IPV and hygiene measures do not stop polio transmission in the greater NY area, say Nina Schwalbe and Jay Varma.

September 28, 2022 - New York State Department of Health issued Advisory #3 regarding poliovirus detections and recommended polio-preventive vaccinations, and the Commission issued a Declaration of an Imminent Threat to Public Health for poliovirus.

September 27, 2022 - The U.S. CDC published an MMWR that stated: In August 2022, clinicians in several geographic areas notified the CDC of an increase in hospitalizations of pediatric patients with severe respiratory illness and positive rhinovirus/enterovirus test results. The percentage of positive EV-D68 test results during July and August 2022 was higher than that during the same months of 2017 and 2019–2021 and similar to peak levels observed in 2018. EV-D68 cases are likely undercounted because type identification is not routinely performed, and reporting is not mandatory.

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

September 21, 2022 - The Pan American Health Organization confirmed Brazil, the Dominican Republic, Haiti, and Peru are at very high risk for the reintroduction of polio. Regional vaccine coverage for polio has fallen to about 79%, the lowest since 1994, PAHO 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 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 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 17, 2022 - Long-Term Immunogenicity of Inactivated and Oral Polio Vaccines: An Italian Retrospective Cohort Study. Protective antibodies against all three polioviruses persisted for at least 18 years after administration of the last vaccine dose.

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

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 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 2022 polio vaccine program reached over two million children.

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

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 2022,' 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.

January 13, 2017 - CDC Guidance for Assessment of Poliovirus Vaccination Status and Vaccination of Children Who Have Received Poliovirus Vaccine Outside the United States.

August 5, 2016 - Seroprevalence of Poliovirus Antibodies in the United States Population, 2009–2010. Seroprevalence was high (83.1 %–97.0 %) for all three types of poliovirus in the US population during 2009–2010. While there were observed differences by serotype with type 2 having the highest seroprevalence and type 3 having the lowest, consistent with previous observations, no large immunity gaps to poliovirus suggesting an imminent substantial population risk from a poliovirus importation were observed at a population level.

February 15, 2011 - Challenges in infant immunity: implications for responses to infection and vaccines.

1997 - Duration of Poliovirus Excretion and Its Implications for Acute Flaccid Paralysis Surveillance: A Review of the Literature.