Poliovirus Outbreaks June 2023
The U.S. National Institutes of Health says Poliomyelitis (polio) is a viral disease that can range in severity from self-limiting disease to meningitis. In its most severe form, it may present as acute flaccid paralysis (AFP). According to the Polio Global Eradication Initiative (GPEI), there are various countries with poliovirus detections and two polio-endemic endemic countries as of May 2023. The total number of poliomyelitis samples collected in countries with poliovirus transmission was 12,259 from 40 countries in 2022, an increase from 8,945 in 36 countries in 2021. In addition, poliomyelitis has been confirmed in wastewater and ground samples in Africa, the Americas, Asia, Canada, Europe, India, Israel, the United Kingdom, and New York (NY). Furthermore, the U.S. was added to a list of about thirty countries where polio was identified in 2022.
Polio Public Health Emergency of International Concern
On February 2, 2023, the World Health Organization (WHO) confirmed the spread of poliovirus remained a Public Health Emergency of International Concern (PHEIC) concerning Wild poliovirus type 1 (WPV1) and Circulating vaccine-derived poliovirus (cVDPV). To notify the international community, the U.S. Centers for Disease Control and Prevention (CDC) issued an updated Global Polio Alert - Level 2, Practice Enhanced Precautions notice regarding polio outbreaks on March 22, 2023, and poliovirus detections in various countries. In addition, as of March 10, 2023, the New York Department of Health informed New Yorkers planning to visit Israel in 2023 and other countries with circulating poliovirus to confirm their polio immunization status before traveling abroad.
Poliovirus Wastewater Detections 2023
Nearly 80% of U.S. households are connected to municipal wastewater collection systems, writes the National Academies in 2023. These sewer systems contain biological waste, including discharged pathogens. 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 they may indirectly enable virus shedding. As of 2023, Japan, Australia, and New Zealand conduct poliovirus wastewater testing. The U.S. CDC announced on November 30, 2022, that it would expand wastewater testing. In 2022, Dr. José R. Romero, Director of CDC's National Center for Immunization and Respiratory Diseases, indicated that poliovirus testing would continue into early 2023.
Research demonstrates that poliovirus transmission predominantly follows the oral-fecal route. Vaccine-derived polioviruses (VDPVs) can emerge from Sabin strain poliovirus serotypes 1, 2, and 3 contained in the OPV after prolonged person-to-person transmission. Related poliovirus type 2 (PV2) isolates were identified in sewage samples collected in Canada and New York in 2022.
Poliovirus Detroit, Michigan
The U.S. CDC announced plans in 2022 to collect wastewater samples in communities near Detroit, Michigan. Oakland County, Michigan's population is about 1.2 million. In addition, the University of Michigan (UM) announced on March 22, 2023, an update to its online dashboard to include the detection of coronavirus, mpox, influenza-A, norovirus GII, and respiratory syncytial virus in Ann Arbor, Flint, Jackson, Tecumseh, and Ypsilanti. On August 23, 2022, Michigan reported 31% of young children were overdue for routine vaccinations, including polio.
Poliovirus Philadelphia, Pennsylvania
The U.S. CDC announced it would begin collecting wastewater samples from Chester County, PA, with a population of about 500,000 near Philadelphia, PA, for analysis at CDC's polio laboratory.
Poliovirus New York 2023
The U.S. CDC and the State of New York confirmed as of May 1, 2023; sequencing analysis confirmed that (1) circulating vaccine-derived poliovirus (cVDPV2) positive sample of concern had been found in Rockland County, NY, in 2023. In 2022, 101 samples genetically linked to a polio patient (Acute flaccid myelitis) were initially identified in July 2022 in Rockland County, NY. As of May 22, 2023, 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. 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. The Governor of NY, Kathy Hochul, announced she extended Executive Order 21.1, expanding the vaccination authorities for certain NY health providers on October 9, 2022.
The New York State Department of Health announced on January 23, 2023, to enhance local detections, it received $21.6 million to expand its wastewater surveillance and infectious disease monitoring capabilities. As a result, NY's current wastewater network will expand to over 215 water sheds, reaching about 81% of NY's population served by public sewer systems. 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. On March 23, 2023, Rockland County reported administering about 1 200 polio vaccinations.
As of March 2023, the New York Health Department confirmed that under specific situations (HEALTH ADVISORY Update #3), 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.
Poliovirus Montreal Canada
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 confirmed it was linked to the cVDPV2 recently detected in New York. Additionally, in January 2023, two cVDPV2-positive environmental samples were collected in Canada. As of January 30, 2023, there have been no confirmed or suspected cases of acute flaccid paralysis (AFP) being investigated in the affected Canadian jurisdiction in 2022 - 2023.
Polio Israel 2023
As of March 10, 2023, Israel has been confirmed with cVDPV2 and cVDPV3 in the wastewater sewage of many localities. In early March 2023, JPost reported the Health Ministry announced that an unvaccinated child from the Safed region in Galilee arrived at Ziv Medical Center and was found positive for (cVDPV2) acute flaccid paralysis (AFP). On March 2, 2023, the Times of Israel reported the Health Ministry confirmed three other children tested positive for poliovirus.
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 collected in 2022, reported The BMJ and The Lancet. In addition, environmental samples of vaccine-derived poliovirus type 2 isolates were found in north and east London boroughs that were genetically linked to polio cases in New York and Israel.
Acute Flaccid Myelitis
The U.S. CDC reported on March 2, 2023, one confirmed Acute Flaccid Myelitis (AFM) (Polio-like virus) case out of 7 reports of patients under investigation in 2023. AFM is an uncommon but neurologic severe condition caused by viruses, including enteroviruses (EV-D68). During 2022, the CDC reported 43 confirmed AFM cases in 24 states, indicating a 35% increase from 2021. There have been 723 confirmed AFM cases (children) since the CDC began tracking them in August 2014.
Acute Flaccid Paralysis
Acute Flaccid Paralysis (AFP) surveillance is the standard for detecting cases of poliomyelitis in anyone under 15 years of age. AFP is defined by the acute onset of weakness or paralysis with reduced muscle tone in children. There are many infectious and non-infectious causes of AFP, such as polio. Genomic sequence analysis identified 43 cVDPV emergence groups in active transmission from AFP cases during 2020–2021. These included 24 cVDPV emergence groups (20 cVDPV2 and four cVDPV1) in 22 countries in 2021.
For AFP surveillance standards, visit the WHO-recommended surveillance standard of poliomyelitis. In addition, as of March 2023, the Pan American Health Organization (PAHO) published AFP Surveillance Data segmented by Country for 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. The UK-based Polio Survivors Network concluded 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.
Polio Vaccines Approved
Polio is a vaccine-preventable disease, says the U.S. CDC. For the latest polio vaccine information, visit this PrecisionVaccinations webpage.
Polio Outbreak News 2023
April 26, 2023 - The DR Congo reported 15 cVDPV1 cases and 21 cVDPV2 cases, and Madagascar confirmed four cVDPV1 cases.
April 7, 2023 - The PAHO issued an Epidemiological Update - Poliomyelitis in the Region of the Americas.
March 22, 2023 - The U.S. CDC expanded its Level 2 travel advisory focused on polio outbreaks.
March 16, 2023 - cVDPV2 cases in seven children in Burundi and the Democratic Republic of the Congo were linked with the nOPV2 vaccine.
March 10, 2023 - New York issued a travel advisory for anyone visiting Israel.
February 23, 2023 - Wastewater sequencing analysis by the CDC confirmed the presence of poliovirus in a total of 100 positive samples of concern in New York.
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 Somalia's trivalent oral polio vaccine.
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.
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 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 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.
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 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 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.
August 26, 2022 - The New York State Department of Health confirmed 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 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.
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 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 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.
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.
1997 - Duration of Poliovirus Excretion and Its Implications for Acute Flaccid Paralysis Surveillance: A Review of the Literature.