More on Polio & the Breakthrough Population

In a previous blog post, I pointed out that there is a case of polio in Rockland County, NY in the orthodox Jewish population. Additionally, Public Health officials have detected polio virus in the wastewater of Rockland County, Orange County and NYC . They suspect that there must be at least 100 asymptomatic patients in that population as well. Certain facts must be clarified regarding the previous blog post.

Prior to polio vaccination, the world was dealing with the wild polio virus . It was transmitted through the fecal oral route. Paralysis and life-threatening illness occurred in 1 out of 200 patients infected. Most individuals did not even know they had it.

With funding and support from the March of Dimes, Jonas Salk, MD , invented the polio vaccine in injectable form. If you received a polio injection you could not transmit the virus to the unvaccinated.

Several years later the oral Saban vaccine was developed. You took this live attenuated virus prep orally – usually on a sugar cube. Since the natural transmission of polio was by the fecal oral route, the Saban oral vaccine produced a better level of immunity but additionally led to shedding of the virus with the potential to infect unvaccinated patients. At the time this was considered advantageous leading to more immunized patients but, as rare symptomatic cases of polio developed from the vaccine, authorities switched back to an injectable vaccine in the USA. The rest of the world did not necessarily follow suit and continued to use the less expensive live attenuated oral vaccine.

The case in Rockland County is felt to be the result of patient exposure to someone shedding the polio virus from an oral vaccination overseas. If that individual had been vaccinated against polio, they would not have contracted the disease and be shedding virus to others.

In an interesting opinion article in the NY Times, Editorial Board Member Jean Interlandi forwards the argument that lack of vaccination is not a religious issue . She has worked extensively with the orthodox community promoting public health issues and believes it is the young mothers and women who need to be educated and encouraged to vaccinate their children, not the rabbi’s who lead the community.

Ms. Interlandi may be correct but local authorities and politicians have made it far too easy for this group of individuals to ignore public health recommendations and reintroduce measles and its complications, whooping cough and now polio. Offering a carrot rather than a stick may be her best advice but, in my opinion, using both options is long overdue.

Health officials agree that if you are vaccinated you are protected against this non wild form of the virus. The solution is to vaccinate the children of Rockland and Orange County against these once eradicated diseases and allow this religious minority to worship as they please if their actions do not bring risk to the rest of the general population. At this time there are no recommendations for polio boosters in adults, immunosuppressed or the elderly populations.

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