Polio Outbreaks 2023
Polio Outbreaks 2023
Poliovirus (Poliomyelitis) has been recently confirmed in wastewater and ground samples in non-endemic countries in Africa, Asia, Canada, Europe, India, Israel, the United Kingdom, and New York (NY). As of January 6, 2023, the U.S. Centers for Disease Control and Prevention (CDC) sequencing analysis confirmed the presence of circulating vaccine-derived poliovirus (cVDPV2) in a total of 101 positive samples in NY, signaling its continued circulation in the U.S., and a health risk to local residents.
An interactive timeline traces polio outbreaks from 1580 B.C. to 2022.
Polio Public Health Emergency of International Concern
On November 1, 2022, a World Health Organization (WHO) 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. This WHO report (EB152/19, Dec. 2022) provides an update on implementing the Strategic Action Plan on Polio Transition (2018–2023).
In addition, the polio-endemic countries of Afghanistan and Pakistan have been associated with recent outbreaks in other countries, according to the Global Polio Eradication Initiative (GPEI). In addition, on September 13, 2022, the U.S. was added to a list of about thirty countries where circulating vaccine-derived poliovirus (cVDPV) was recently identified. The international spread of cVDPV2 is a reminder that until polio is eradicated, all countries remain at risk of reinfection.
To notify the international community, the U.S. CDC issued an updated Global Polio Alert - Level 2, Practice Enhanced Precautions notice on January 3, 2023, regarding polio outbreaks and poliovirus detections in various countries.
Poliovirus in Wastewater
Globally, poliovirus type 2 (PV2) isolates have been identified in sewage samples collected in Canada, London, Israel, and New York in 2022. The U.S. CDC announced on November 30, 2022, it would expand wastewater testing in the U.S. To enhance local detections, the New York State Department of Health announced on January 23, 2023, that it received $21.6 million in funding to expand its wastewater surveillance and infectious disease monitoring capabilities. Furthermore, the CDC says wastewater data cannot be used to determine or identify who is infected with poliovirus.
And Dr. José R. Romero, Director of CDC's National Center for Immunization and Respiratory Diseases, indicated in November 2022 that poliovirus testing would continue into early 2023.
On December 23, 2022, the Canada IHR National Focal Point reported detecting a vaccine-derived poliovirus type 2 (VDPV2) in various wastewater samples collected in August 2022 from a wastewater treatment plant and a target site in the city of Montreal, Quebec, Genetic sequencing has confirmed it is linked to the cVDPV2 currently affecting New York. No associated cases of paralysis have been detected in Canada. There have been no confirmed or suspected cases of acute flaccid paralysis (AFP) being investigated in the affected Canadian jurisdiction in 2022 - 2023. Additionally, in January 2023, two cVDPV2-positive environmental samples were collected in Canada.
Poliovirus Detroit, Michigan
The U.S. CDC announced plans to collect wastewater samples in communities near Detroit, Michigan. Preliminary testing will last at least four months. Oakland County, Michigan's population is about 1.2 million. On August 23, 2022, Michigan reported 31% of young children were overdue for routine vaccinations, including polio.
Poliovirus Philadelphia, Pennsylvania
Poliovirus New York
Genetically related poliovirus has been detected in wastewater samples collected in Rockland County, Orange County, Sullivan County, Nassau County, Brooklyn (Kings County), and Queens County beginning in April 2022. 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, NY.
As of January 24, 2023, the NY confirmed the presence of poliovirus in a total of 100 positive samples of concern, with 93 samples genetically linked to a polio patient (Acute flaccid myelitis) identified in July 2022, in Rockland County, NY. NY's wastewater network reaches all 62 New York counties and during 2023, will increase the number of participating sewer sheds from 125 to over 215, reaching 16 million New Yorkers, about 81% of the population served by public sewer systems.
In response to the ongoing wastewater findings, the Governor of NY, Kathy Hochul, announced on October 9, 2022, NY was extending Executive Order 21.1, expanding the vaccination authorities for certain NY health providers. 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 regarding polio vaccination options.
As of 2023, New York Health Department states that under specific situations, a one-lifetime booster dose of IPV should be offered to adults who have previously completed their polio vaccination series and are at the highest risk of infection. Areas considered to have community transmission of poliovirus include those where poliovirus has been repeatedly detected in wastewater. As of January 27, 2023, polio booster doses are not recommended for individuals traveling to the New York City metropolitan area, including Rockland, Orange, or Sullivan Counties, merely because of their travel status.
Local polio vaccination resources: Nassau County, NY, webpage, New York City locations; Orange County, NY, webpage, Rockland County, NY, areas, Sullivan County, NY, Public Health at 845-513-2249, and Cattaraugus County, (NY) Public Health.
The International Health Regulations National Focal Point for Israel notified the WHO of the detection of the cVDPV3 virus isolated from an acute flaccid paralysis (AFP) case in the country on March 7, 2022. Furthermore, the Israeli Ministry of Health announced on March 10, 2022, that following two poliovirus confirmations, it was expanding the investigation of sewage sample collection in Jerusalem and additional centers outside of Israel. In addition, Isreal launched the Two-Drops OPV vaccination program in April 2022. Simultaneously, vaccination doses were pushed forward, and both the IPV and the live attenuated vaccine (bOPV) were administered. For over six months, there have been no VDPV3-positive sewage samples in the State of Israel and no new clinical cases.
The UK Health Security Agency (UKHSA) declared a "national incident" in June 2022 after poliovirus detection in sewage in London, England. 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. In addition, 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 New York, and environmental samples have been collected in New York and Israel.
The UK poliovirus surveillance program was led by the National Institute of Biological Standards ad Control, confirmed on October 19, 2022; vaccine-like type-2 poliovirus (PV2) isolates were found in sewage samples collected from the London Beckton sewage treatment in February 2022. This analysis has shown that all PV2 isolates identified since then are genetically related. And on November 14, 2022, the UKHSA published guidance: Immediate actions in response to detecting a 'circulating' VDPV2 in London sewage samples. And the environmental surveillance was expanded to assess the extent of VDPV2 transmission in and outside London.
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.
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. The U.S. CDC posts additional clinical and diagnostic information about poliovirus infection as of August 10, 2022.
The U.S. CDC defined acute flaccid paralysis (AFP) in 2004 as "anyone under 15 years of age with acute onset of focal weakness or paralysis or any person with paralytic illness at any age when polio suspected, characterized by flaccid (reduced tone), without other apparent causes.
The WHO, the UK Health Services Agency, the European CDC, and the U.S. National Institutes of Health (NIH) say 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). However, research demonstrates that poliovirus transmission predominantly follows the oral-fecal route. In addition, concerns remain about the potential for persistent transmission of OPV viruses, as these viruses are known to revert toward wild-type neurovirulence.
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.
Polio Vaccines Approved
Polio is a vaccine-preventable disease, says the U.S. CDC. For the latest polio vaccine information, visit this PrecisionVaccinations webpage. As of January 5, 2023, polio booster doses are not recommended for individuals visiting New York merely because of their travel status. However, polio boosters are suggested by the CDC for international travelers when visiting endemic areas.
Polio Outbreak News 2022
January 6, 2023 - The New York Department of Health Poliovirus Wastewater Surveillance Report was updated.
December 23, 2022 - Canada reported detections of VDPV2 in wastewater samples.
December 19, 2022 - The WHO announced polio had become a high-risk disease in Indonesia.
December 7, 2022 - The WHO reported 2.61 million under-five children were immunized with the trivalent oral polio vaccine in Somalia.
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 poliovirus transmission across north-east and north-central London. Based on recent sampling, poliovirus is considered 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 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 6, 2022 - Canada has become the first country in the world to advance to the second stage of poliovirus containment certification.
September 28, 2022 - New York State Department of Health issued Advisory #3 regarding poliovirus detections. It 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. In addition, the percentage of positive EV-D68 test results during July and August 2022 was higher than during the same months of 2017 and 2019–2021 and similar to peak levels observed in 2018. However, 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. In addition, regional vaccine coverage for polio has fallen to about 79%, the lowest since 1994.
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 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 that of the 50 wastewater samples, 31 poliovirus samples were collected in Rockland County, 13 in Orange County, 6 in Sullivan County, and 1 in Nassau County. In response, NY's governor declared a State of Disaster Emergency.
September 6, 2022 - The CDC's Alert - Level 2, Practice, Enhanced Precautions advisory was reissued for various African countries.
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 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 an,d recommendations for polio vaccination in the USA.
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 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 Rockland and Orange Counties communities.
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≥2 months indicates community transmission and ongoing risk for paralysis in unvaccinated persons.
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.
June 22, 2022 - London residents are shedding the type 2 poliovirus strain in their feces.
April 2, 2022 - Israel reported 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 additional 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 poliovirus types 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 significant 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.