The news that the poliovirus has been found circulating in New York City wastewater fueled a wide range of reactions in city parents on Monday. Some were unfazed. Others were terrified.
Public health officials, however, had a simple message for them: Get your children vaccinated. If they are vaccinated, they are safe.
In South Williamsburg, a largely Hasidic enclave in Brooklyn where the polio vaccination rate among 5-year-olds is the lowest in the city, mothers in playgrounds pushed swings and watched their children play. With only one case found so far, in a Rockland County resident who became paralyzed, several mothers said they thought of the situation as something to watch out for, but not an imminent threat.
“It is concerning,” said the South Williamsburg resident Esther Klein, 24, who is Hasidic and the mother of a 1-year-old son. “I want to make sure his vaccines are updated,” she added. What would make her alarmed, she said, is if more people started getting sick.
In nearby Domino Park, a few mothers said their pediatricians had reassured them that their children would be fine because they are vaccinated. But Elsa de Berker, 32, said she was fearful for her daughter, who is turning 2 soon, even though her polio vaccines are up-to-date: “It’s terrifying.”
As some parents anxiously called pediatricians offices to ask for guidance and to schedule vaccination appointments on Monday, they were largely reassured: As long as they keep their children on the standard immunization schedule, their children should be protected.
The polio vaccine is highly effective. A first dose is typically given when babies are 2 months old; a second is given two months later. After those two doses, protection against paralytic polio is at least 90 percent.
A third dose is typically given when the baby is 6 months old. That dose brings protection against paralytic polio close to 99 percent. A fourth dose, given after the child turns 4, is intended to ensure that the high protection lasts over a lifetime.
“My advice is follow the vaccine schedule, and everything will be OK,” said Dr. Peter Silver, a pediatrician and the associate chief medical officer for Northwell Health. “I think that if you are vaccinated, you are not at significant risk. The population at risk are the unvaccinated.”
Infants younger than 4 months are generally protected by their mother’s antibodies, assuming their mothers are vaccinated.
The Fight Against Polio
The highly contagious virus was one of the most feared diseases until the 1950s, when the first vaccine was developed.
- New York Case: Officials in a New York suburb reported a case of polio in an unvaccinated adult man in July — the first U.S. case in nearly a decade.
- A Multibillion-Dollar Effort: A partnership of national governments and health organizations has a plan to rid the world of polio by 2026, which is now endemic in just two countries.
- Major Obstacles: Two of the three strains of polio have been eliminated from the Earth. But new barriers to full eradication keep cropping up.
- Childhood Vaccinations Drop: A sharp decline in childhood vaccinations around the world during the coronavirus pandemic — including those for polio — could threaten the lives of millions of children.
In London, the persistent circulation of polio in wastewater since February has led to a recent recommendation that children between 1 and 9 years old get an additional booster dose. But the outbreak in New York has not yet reached that level of concern, according to public health officials. In addition to the case identified in Rockland County, officials have found 20 positive wastewater samples in Rockland and Orange Counties combined, and six positive samples in city wastewater in June and July.
“There is no recommendation at this time that those who are fully vaccinated against polio should receive booster doses or that children undergoing their vaccine series should receive earlier or additional doses,” doctors at Weill Cornell Medicine wrote Monday in an email to reassure their patients.
Anyone unsure of their polio immunization history is eligible to be vaccinated, including adults. Typically, however, anyone born after 1955 will have been vaccinated to attend school. One lifetime booster dose is available for those who are particularly at risk.
While there has only been one case of paralytic polio so far in the New York area, health officials believe they may only be seeing “the tip of the iceberg” in terms of polio’s wider circulation, since paralytic cases are so rare.
The region’s single positive case was found in an unvaccinated 20-year-old man in Rockland County. Doctors suspected acute flaccid myelitis as the cause of his leg paralysis, before he tested positive for polio in July. The infection was not travel-related, as he did not travel during the time he would have been infected, Rockland County health officials said.
While the authorities have not released further biographical details about the man, local officials say he is part of the Hasidic community there. Vaccine skepticism has circulated among some in that community, and it has intensified during the Covid-19 pandemic.
While a majority of Hasidic children are vaccinated, a significant minority are not, both because of concern about vaccines, and because the pandemic has made keeping to vaccination schedules challenging, particularly for those with large families, community members said. The community is not monolithic, however, and there are ongoing tensions within it between those who resist vaccines and those who believe that such reluctance is putting the community at risk.
“From my point of view, this has a lot to do with anti-vaxxers,” said Yosef Rapaport, a Hasidic media consultant and podcaster who supports vaccination. “Being late with vaccination, combined with the growth of the anti-vaxxer movement, and we are just waiting for a catastrophe,” he said.
A pediatrician in Williamsburg, who spoke anonymously to avoid breaking trust with her patients, said that many of the mothers she saw were worried about the safety of vaccines, because of widely circulating misinformation. They often preferred to delay doses until later in childhood, when the child’s immune system is stronger. She said she saw the same trends when measles circulated in the community in 2019.
In Rockland County, health officials have been holding regular free vaccination clinics in an effort to bring rates higher. Refuah Health, one of the main primary health care providers in the area, has administered 450 polio vaccines between July 21 and Aug. 11, a spokeswoman said. More than half of those were for children under 2.
While some providers are reporting an uptick in vaccinations in recent weeks, as of Aug. 1, only 60 percent of children 2 and under had gotten all three recommended polio shots in Rockland and Orange Counties. Low rates were not limited to Hasidic areas however, said Irina Gelman, the Orange County health commissioner.
The rate among children 5 and under across New York City who have three doses of the polio vaccine is 86 percent. But vaccination by ZIP code shows much lower rates across a range of neighborhoods, representing a diverse array of people.
Close behind Williamsburg, with a vaccination rate among children under 5 of 56 percent, was Battery Park City, an affluent neighborhood in Manhattan. Other areas with low childhood vaccination rates include parts of Bedford-Stuyvesant and Brownsville, where a majority of residents are Black, and the southern tip of Staten Island, a politically conservative, mostly white area.
“Wastewater sampling is not specific about the neighborhoods where people are living who are shedding poliovirus,” said Patrick Gallahue, a spokesman for the city’s Department of Health.
New York is not planning a pop-up polio vaccination campaign, but the city is reaching out to health providers in areas where vaccination rates are low to ask them to immediately contact families with delayed vaccinations. About 93 percent of city children under 5 have had at least one dose.
Polio is a virus that spreads from person to person primarily through infected feces that enters the body through the mouth. Approximately 75 percent of people infected with polio have no visible symptoms, yet they can still spread the virus. About 25 percent have mild symptoms, including fever, muscle weakness, headache and nausea. In about 1 in 200 cases, polio can infect a person’s brain and spinal cord, causing permanent paralysis or even death.
Due to the vaccine’s success, and a national vaccination program, polio cases were cut dramatically in the late 1950s and early 1960s. The last case of polio detected in the United States had been in 2013.