Public Health Response to a Case of Paralytic Poliomyelitis in an Unvaccinated Person and Detection of Poliovirus in Wastewater — New York, June–August 2022

Abstract

On August 16, 2022, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr).On July 18, 2022, the New York State Department of Health (NYSDOH) notified CDC of detection of poliovirus type 2 in stool specimens from an unvaccinated immunocompetent young adult from Rockland County, New York, who was experiencing acute flaccid weakness. The patient initially experienced fever, neck stiffness, gastrointestinal symptoms, and limb weakness. The patient was hospitalized with possible acute flaccid myelitis (AFM). Vaccine-derived poliovirus type 2 (VDPV2) was detected in stool specimens obtained on days 11 and 12 after initial symptom onset. To date, related Sabin-like type 2 polioviruses have been detected in wastewater* in the patient's county of residence and in neighboring Orange County up to 25 days before (from samples originally collected for SARS-CoV-2 wastewater monitoring) and 41 days after the patient's symptom onset. The last U.S. case of polio caused by wild poliovirus occurred in 1979, and the World Health Organization Region of the Americas was declared polio-free in 1994. This report describes the second identification of community transmission of poliovirus in the United States since 1979; the previous instance, in 2005, was a type 1 VDPV (1). The occurrence of this case, combined with the identification of poliovirus in wastewater in neighboring Orange County, underscores the importance of maintaining high vaccination coverage to prevent paralytic polio in persons of all ages.

Impact of sample clarification by size exclusion on virus detection and diversity in wastewater-based epidemiology

“…The emergence of circulating vaccine-derived polioviruses (cVDPVs), which are usually recombinants with nonstructural region of nonpolio EVC origin, is usually associated with low population immunity to polioviruses alongside vaccine poliovirus strains and circulating nonpolio EV-Cs 51 . The results of this study and our previous findings showing recombination between circulating EV-Cs in the USA 38 indicate that if vaccine strains of poliovirus find their way into this population (as recently documented in June 2022 in a >20 years old man in Rockland County, New York, USA 52 ), the use of inactivated poliovirus vaccine (IPV) suggests that cVDPVs can also emerge in this population, circulate and possibly seed other populations. Hence, monitoring EV-C dynamics in this population (and others globally where IPV is the mainstay of the vaccination effort) becomes critical as part of the eradication campaign.…”

Increase in Acute Respiratory Illnesses Among Children and Adolescents Associated with Rhinoviruses and Enteroviruses, Including Enterovirus D68 — United States, July–September 2022

“…Children with AFM can experience rapid progression of weakness and should be promptly hospitalized and referred to specialty care. ¶ ¶ ¶ Given the detection of a paralytic polio case and wastewater samples positive for poliovirus in New York during summer 2022 (9), clinicians should also test for poliovirus infection in patients suspected of having AFM because of the clinical similarity to acute flaccid paralysis caused by poliovirus. Providers should immediately report possible AFM cases and acute flaccid paralysis cases suspected of polio to local and state health departments and coordinate with health departments and CDC for testing protocols.…”

Newest Guidance and Evidence for Health Care Providers: COVID-19 and Other Vaccines

“… 7 recently, a young adult unvaccinated against polio in Rockland County, NY, where there is opposition to vaccinations, 8 contracted paralytic disease raising concerns that the loss of herd immunity may portend new epidemics. 9 …”