Polio FAQ
On Thursday, July 21, the New York State Department of Health and the Rockland County Department of Health issued a public health warning after an unvaccinated man was diagnosed with POLIO. This is the first case of polio in the United States since 2013.
At this point in time, we all need to be educated and empowered in order to be protected against polio. As a former lifeguard, I find the beach warning flags useful to help us gauge how worried/cautious we need to be regarding the latest public health news — flags provide a warning scale and a clear indication of the warranted level of concern. I believe the “swimming area” flag (pictured below - top image) is appropriate for individuals who have received their polio vaccine. For individuals who are not vaccinated against polio, the red/high hazard flag is most appropriate (pictured below - bottom image).
We all need to recognize that polio is a vaccine-preventable disease.
If you (or someone you love) are unvaccinated, polio is a REAL THREAT.
When my grandmother (who lived to be 99 and was born before the great influenza of 1918) first learned that I was going to go to public health school, she shared her experiences/memories of polio in the 1940s and 1950s with me. She told me how much she hated the first week of August each summer; it was that week that she started hearing about the children who would not be returning to school in the fall because of polio. Parents started formally reporting kids in iron lungs or who were paralyzed and unable to return to school. She always said the first week of August was so hard and so sad. She also recounted the story of a neighborhood child who came down with paralytic polio one summer; my grandmother remembered her sadness for the family and the fear she had for her own children. There were sleepless nights watching for symptoms and praying that there would be no fevers, sneezes, or diarrhea.
Polio instilled an eternal fear in those who lived through the early 20th century before a vaccine was available. And even though we haven’t seen polio in the United States for nearly a decade, it is still a disease to be feared; one that we all need to protect ourselves from through vaccines.
Here are answers to a set of FAQs (frequently asked questions) —
What is polio?
Polio is a viral disease. It is part of the enterovirus family of viruses. Polio is unique in a couple of ways — first, it does not have a known animal reservoir; meaning it is a disease that is spread only from one person to another. It does not infect animals (non-humans). It is also an ancient disease. Ancient Egyptian etchings show people with withered legs on crutches. Despite having ancient origins, polio is a stable virus that is not known for mutating or evolving. This makes polio vaccines highly effective; providing what is known as lifetime immunity.
How is polio spread?
The polio virus hangs out in the throat and intestines of individuals who are infected with the virus. Most people are exposed to the virus through fecal-oral contact (meaning they ingest tiny pieces of poop — this can occur through contaminated food or water as well as by putting dirty hands into one’s mouth).
People with the virus, including those who are asymptomatic, are highly contagious.
What are the symptoms of polio?
About 95 percent of individuals with polio remain asymptomatic; yes, 95 percent of people with the polio virus will NOT get sick. BUT they can spread the virus to others. Among the 5 percent of individuals who become symptomatic, the disease begins with flu-like symptoms (including a headache, sore throat, nausea, diarrhea, fever, and fatigue). Some individuals will experience neurological symptoms, such as sensitivity to light and a stiff neck. Less than 1 percent of individuals who contract polio will experience paralysis. Paralytic polio usually causes paralysis on one side of the body and the paralysis ascends through the body (meaning the paralysis starts in the feet and moves up the body, usually on one side). Ascending paralysis caused by polio can reach the diaphragm causing difficulties breathing. Thus landing the individual in an iron lung (pictured above).
Is there a treatment for polio?
NO. Physicians can treat the symptoms brought on by the disease, but there is no treatment (read: no antiviral).
How do we prevent polio?
There are TWO types of vaccines that prevent polio. The U.S. and many other countries use the Salk vaccine (an inactivated/killed version of the virus)1, which is administered through 3 or 4 shots all given to children before their 5th birthdays. In other countries, including locations where the virus is still endemic, a weakened live virus vaccine — known as the Sabin vaccine — is given to children as drops in the mouth.
Both the Salk and Sabin vaccines are SAFE and EFFECTIVE.
Both are greater than 90 percent effective at preventing illness caused by the polio virus. And there is evidence that both vaccines will lead to lifelong immunity (meaning no additional booster shots are needed among those of us who are vaccinated).
Throughout the late 1960s through 2000, the Sabin live virus/oral vaccine was given in the United States. Since 2000, four doses of the Salk vaccine have been given to children in the U.S. I received the Sabin vaccine as a child (in the form of sugar cubes) in the late 1970s. My kids both received the Salk vaccine.
How is the current case in New York connected to the vaccine?
Wild/naturally-occurring polio is spreading throughout the world (namely in Afghanistan and Pakistan). In epidemiology, we call these endemic countries — places where there is still predictable community spread of disease. Additionally, there is another type of polio — vaccine-derived polio that exists. And this is the type of polio that the man in New York was diagnosed with. Vaccine-derived polio is caused by the weakened strain of the virus that is in the vaccine. Individuals who receive the Sabin vaccine (also known as the oral polio vaccine) shed the virus (read: they poop it out). This virus that is shed by an individual who has received the oral polio vaccine can spread and behave like the wild/natural version of the virus; causing illness in individuals who are not vaccinated.
The individual who was diagnosed in New York last week had the vaccine-derived version of the virus. Knowing this helps us (in public health) identify where the virus may have come from, but it does not change the pattern of disease spread, how easily the virus can spread from unvaccinated person to unvaccinated person, or the illness it can cause.
What is the bottom line?
Individuals who have received their polio vaccine have immunity and should not be worried about contracting the disease. Individuals who are unvaccinated are at risk of contracting polio.
GET VACCINATED.
From a community health perspective, there is a reasonable amount of concern about the polio case in New York. Given that one case of paralytic polio has been diagnosed, statistically, at least another 99 cases of the disease are out there; the virus is circulating in the community. Take this and combine it with the fact that there is a global decline in the uptake of childhood vaccinations (including polio) and there is a perfect storm brewing worldwide. This storm is characterized by an uptick in polio cases both here in the US and around the globe. And while we are facing an upswing in COVID cases, a monkeypox pandemic, and are on the verge of a new influenza season — it is all just too much.
We cannot be healthy when vaccine-preventable diseases are spreading globally.
The time has come to get vaccinated. To get our kids and grandkids vaccinated. To ensure our friends and loved ones are vaccinated.
Fighting three global health emergencies at one time — COVID, monkeypox, and polio — does not allow for the creation of healthy communities. Vaccines, in the words of Dr. Bill Foege, are —
“the tugboats of preventive health.”
GET VACCINATED.
As the case in New York is investigated and we learn more about this case (and possibly others), I will keep you updated here.
FUN FACT — On April 12, 1955, Dr. Tommy Francis announced the results of the Salk vaccine clinical trial. He declared that the vaccine was “safe, effective, and potent.” Dr. Tommy Francis is actually a 1921 graduate of Allegheny College, which is where I went to college and where I teach now. I love to think about the fact that both Dr. Francis and I walk the same halls and along the same sidewalks. I feel (in a teeny-tiny way) connected to the development and testing of the Salk polio vaccine.