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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Polio is Back

One case of polio with neurological complications has been detected in Rockland County , NY. The virus is now present in the wastewater of NYC , Rockland and Orange Counties. Public health authorities believe there are 100 or more cases in that area with symptoms not yet present but the infected shedding the virus.

The disease was detected in a population of ultra-orthodox Jewish residents who do not believe in vaccinations. Statistics released today show that less than 60% of the eligible children in those two counties have been vaccinated against polio. With the disease now being found in the wastewater of NYC, Public Health authorities are considering giving boosters to children ,the immunosuppressed and the elderly. Those decisions are pending.

I remember polio. My friend’s older siblings died from polio. My best friend’s older sister wore a brace on her leg and used a crutch to walk. My maternal grandmother’s best friend caught polio while pregnant. She survived it but we sat with her thirty something daughter born with no legs on the beach daily in the summers. We had crude elementary school level jokes about the disease. “Johnny i see you brought your father’s iron lung to school today for show and tell. What did he have to say about it?” Johnny answered, “ Uggggh”.

I remember the excitement when we received a notice from P.S. 253 that the NYC Public Health Department was going to vaccinate all elementary school children against polio. We lined up in the gym excited to be vaccinated with a shot in the arm. There was no discussion of long-term adverse effects of the vaccine. There was no talk about how effective the shot would be.

When my brother and I became ill that winter with fever and viral illness no one contemplated whether this was a breakthrough case of polio with no neurological consequences or death due to vaccination. We did not have the technology available to determine that anyway. We just knew we would not end up paralyzed, on an iron lung for life or die from polio.

As an adult I have spent years defending the right of religious groups to practice their religion in the privacy of their homes and communities. Isn’t that what America is supposed to be all about?

Growing up in a beachside residential community on the tip of Coney Island called Sea Gate, I witnessed this same community rent and purchase dilapidated multi dwelling structures and use them as summer retreats at the beach . I defended their rights to their privacy despite the fact that if I went out to wash and clean the car after sundown on Friday evening I would be verbally abused or even have objects thrown at me for disturbing their view of the Sabbath.

I still support their right to worship as they please, but not at the expense of violating reasonable public health vaccination recommendations which puts the general population at risk. Their community now has a voting bloc and financial strength to prevent the local enforcement of vaccination mandates. If G-D didn’t want humans to develop medications against dreaded diseases, then it would not have happened.

It’s long since overdue for public officials and health officials in NY City and State to charge these individuals with child abuse, throw them and any leaders who support them in jail and make it clear that if they want their rights to live and pray in peace in the community, they need to start thinking about more than just themselves.