POST 266. August 11, 2022. Polio/ Monkeypox ++.   CDC ”..has deployed a federal team to New York to investigate the case of polio detected in Rockland County. ““Based on earlier polio outbreaks, New Yorkers should know that for every one case of paralytic polio observed, there may be hundreds of other people infected..”

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“The Centers for Disease Control and Prevention has deployed a federal team to New York to investigate the case of polio detected in Rockland County.

The team will also help administer vaccinations in the county.

It’s unclear how long the CDC will remain in the county or if the findings will be released to the public.

“CDC continues to collaborate with the New York State Department of Health to investigate a recent case of paralytic polio in an unvaccinated individual from Rockland County,” the federal health agency said in a statement to ABC News. “These efforts include ongoing testing of wastewater samples to monitor for poliovirus and deploying a small team to New York to assist on the ground with the investigation and vaccination efforts.”

On July 21, the New York State Health Department announced a patient in Rockland County had contracted a case of vaccine-derived polio, the first case in the United States in nearly a decade.

This means the unvaccinated patient was infected by someone who received the oral polio vaccine, which is no longer used in the U.S.

Unlike the polio vaccine given by injection, which uses an inactive virus, the oral vaccine uses a live weakened virus.

In rare cases, the virus spreading through sewage can affect those who are unvaccinated. This is different from wild polio, which infects people by circulating naturally in the environment.

Since then, it’s been revealed the patient was a previously healthy 20-year-old man who had traveled to Europe. He was diagnosed after he went to the hospital when he developed paralysis in his legs.

Last week, the state health commissioner said “hundreds” of people in New York could be infected after the virus was found in wastewater samples in multiple counties.

As of Aug. 5, 11 samples were genetically linked to the Rockland County patient including six samples collected in June and July from Rockland County and five samples collected in July from nearby Orange County, health department data shows.

“Although no additional cases have been identified at this time, these results indicate there is more than one person shedding the virus in their stool in these communities,” the CDC’s statement read. “These individuals might have no symptoms or only mild symptoms, such as a sore throat and fever, but they can unknowingly still spread polio to those who are not protected by vaccination.”” (A)

““Based on earlier polio outbreaks, New Yorkers should know that for every one case of paralytic polio observed, there may be hundreds of other people infected,” Bassett said.

State health officials are urgently calling for people who are unvaccinated to receive their shots as soon as possible.

Hundreds could have polio after an adult in the New York City metro area caught the virus and suffered paralysis last month, the state’s top health official said this week.

New York state Health Commissioner Mary Bassett warned that the confirmed polio case in an unvaccinated adult, coupled with the detection of the virus in sewage outside the nation’s largest city, could indicate a bigger outbreak is underway.

“Based on earlier polio outbreaks, New Yorkers should know that for every one case of paralytic polio observed, there may be hundreds of other people infected,” Bassett said. “Coupled with the latest wastewater findings, the department is treating the single case of polio as just the tip of the iceberg of much greater potential spread.”

Bassett said it is crucial that children are vaccinated by the time they are 2 months old, and all adults — including pregnant women —who have not received their shots should do so immediately.

“As we learn more, what we do know is clear: The danger of polio is present in New York today,” Bassett said…

Rockland County has a polio vaccination rate of 60%, while Orange County has a vaccination rate of 58%, according to health officials. The statewide vaccination rate for polio is nearly 79%.

The U.S. was declared polio free in 1979 and a case had not originated in the country since then, but travelers have occasionally brought the virus into the U.S., according to the Centers for Disease Control and Prevention. New York last confirmed a polio case in 1990 and the U.S. previously confirmed a case in 2013, according to state health officials.

Children should receive four doses of the polio vaccine. The first dose should be administered by 2 months of age, the second dose at 4 months, the third at 18 months and the fourth by age 6, according to state health officials. Unvaccinated adults should receive three doses.

Polio is a highly infectious, devastating virus that can cause paralysis. The virus struck fear into parents’ hearts in the 1940s before vaccines were available. More than 35,000 people became paralyzed every year from polio during that period. But a successful vaccination campaign in the 1950s and 1960s dramatically reduced the number of cases.” (B)

“As New York’s polio outbreak potentially spreads to hundreds of people, authorities are sounding alarms about the resurgent infectious disease that plagued past generations before being eradicated by vaccines decades ago.

For many New Yorkers − especially those born after the early 1950s when polio disabled more than 35,000 Americans per year prior to widespread vaccination − the health alerts raised sprawling questions about the once-feared virus that had been nearly forgotten…

“It’s tragic because it’s a completely preventable occurrence,” said Dr. William Schaffner, an Infectious Diseases Society of America expert, noting polio vaccines offer near complete protection against illness.

“That’s how vaccines work and that’s why we oblige vaccination, so these things don’t happen anymore,” added Schaffner, a Vanderbilt University Medical Center professor…

Polio poses a threat to anyone unvaccinated against the virus. It is a group that spans children too young to get the recommended four-dose vaccination series, as well as people of all ages who did not get vaccinated for a variety of reasons.

For example, about 1,140,000 New Yorkers are younger than 5. But the polio vaccine is most effective when kids get all four recommended doses, which are typically completed between the ages of 4 and 6. That means tens of thousands of the youngest kids in New York are currently endangered by the polio outbreak.

The polio vaccine has proven nearly 100% effective at preventing illness, which is why widespread vaccination campaigns led to U.S. health officials declaring it eradicated in 1979, despite rare cases imported by international travelers.

In addition to the youngest children, some parents in New York have declined to get thousands of older children vaccinated against polio, despite state law requiring the shots for students at public and private school, excluding medical exemptions.

While only 2% of all schools statewide have polio vaccination rates below 90%, some schools lag behind.

The lagging schools include private and public schools from across the state, as well as several Orthodox Jewish communities in Rockland and Orange counties, which were central to debate over the repeal of the religious exemption to school vaccinations in 2019.

Since the religious exemption ended, many schools have pushed to boost vaccination rates among children previously claiming the exemption, a group of about 26,000 kids statewide, or 1% of school children in 2018.

The number of parents homeschooling children in New York has also increased since 2019, suggesting some of those religious exemption cases prompted parents to pull kids from classrooms to avoid vaccination.

About 54,400 school children were homeschooled last school year, a 65% increase from 33,000 kids homeschooled in the 2019-20 school year, state data show. And growing numbers of Americans joining the national anti-vaccination movement, according to national polling and legislative efforts, also potentially contributed to the rise in homeschooling, although COVID-19 mandates and concerns likely played a role as well.

Some counties in New York also lag behind the statewide vaccination rate for kids at age 2, which stands at about 79%. Rockland County, for example, has a 60% vaccination rate for the age group.” (C)

“A health official in New York State has told the BBC there could be hundreds or even thousands of undiagnosed cases of polio there.

It follows an announcement last month that an unvaccinated man had been paralysed by the virus in Rockland County, New York.

His case has been linked genetically to traces of polio virus found in sewage in London and Jerusalem.

Developed countries have been warned to boost vaccination rates.

Dr Patricia Schnabel Ruppert, health commissioner for Rockland County, said she was worried about polio circulating in her state undetected.

“There isn’t just one case of polio if you see a paralytic case. The incidence of paralytic polio is less than 1%,” she said.

“Most cases are asymptomatic or mildly symptomatic, and those symptoms are often missed.

“So there are hundreds, perhaps even thousands of cases that have occurred in order for us to see a paralytic case.”

Dr Ruppert confirmed that scientists are looking at “a linkage” between the New York paralysis case and traces of poliovirus found in wastewater in London and Jerusalem, after genome sequencing was conducted on samples from the three locations.

“This is a very serious issue for our global world – it’s not just about New York. We all need to make sure all our populations are properly vaccinated,” she said.”  (D)

“A once-eradicated disease has reemerged in New York, and it’s spooking health officials and billionaire philanthropist Bill Gates.

On Aug. 4, New York health authorities announced they had detected polio in wastewater samples from two counties north of New York City. Officials called the results, along with a confirmed case of polio in New York’s Rockland County in July, the “tip of the iceberg” for a wider polio outbreak of the disease that can cause paralysis.

Gates—a longtime champion of polio eradication—weighed in Monday, calling the news an “urgent reminder” that “until we #EndPolio for good, it remains a threat to us all,” on Twitter…

Despite new evidence of polio in New York, the campaign to eradicate the disease has been one of the world’s most successful public health initiatives. There were 350,000 cases of polio in 1988, when the GPEI was founded. That total has fallen to 688 in 2021. Two of polio’s three strains have been eradicated.

The World Health Organization considers polio to be endemic in Pakistan and Afghanistan, meaning that the poliovirus still exists in the wild. Outbreaks in other countries are either sparked by imported cases, or spread by an individual who received the oral polio vaccine, which uses a weakened, but not inactivated, poliovirus that can then infect unvaccinated individuals.

According to the CDC, many carriers of the poliovirus are asymptomatic, and one in four will get flu-like symptoms. However, somewhere between one and five in a thousand cases can suffer from serious and life-threatening symptoms, like paralysis. Even those who recover can have symptoms like muscle weakness and paralysis return years later in a long-lasting condition known as post-polio syndrome…

Efforts to fight the COVID-19 pandemic may be diverting resources away from public health campaigns like polio eradication. Global vaccination coverage for polio fell to 80% in 2021, down from 86% in 2019.

On July 22, Gates called the drop in vaccination rates “heartbreaking” on Twitter, saying that “there’s a lot of work ahead to get back to, and eventually exceed, pre-pandemic vaccination levels.” (E)

“Children ages 1-9 in London were made eligible for booster doses of a polio vaccine Wednesday after British health authorities reported finding evidence the virus has spread in multiple areas of the city but found no cases of the paralytic disease in people.

Britain’s Health Security Agency said it detected viruses derived from the oral polio vaccine in the sewage water of eight London boroughs. The agency’s analysis of the virus samples suggested “transmission has gone beyond a close network of a few individuals.”

The agency said it had not located anyone infected with the virus and that the risk to the wider population was low. The decision to offer young children boosters was a precaution, it said.

“This will ensure a high level of protection from paralysis and help reduce further spread,” the agency said.

The agency said it is also expanding surveillance of sewage water to at least another 25 sites in London and nationally.

Most people across Britain are vaccinated against polio in childhood. According to the World Health Organization, only one in 200 polio infections leads to paralysis; most people don’t show any symptoms…

The Health Security Agency said it was working closely with health authorities at WHO and in the United States and Israel to investigate any links to polio viruses detected in those two countries.” (K)

UPDATES

More than two years into the coronavirus pandemic, Anthony S. Fauci, the nation’s top infectious diseases expert, said he understands people are exhausted, but is urging those who are not up to date on the vaccines to get the shots — this time, as the latest omicron subvariant, BA.5, has become the dominant strain in the United States.

Fauci told Los Angeles radio station KNX News earlier this week that although people who are unvaccinated and those with underlying conditions are at the greatest risk of complications from covid-19, others are not exempt.

“If they don’t get vaccinated or they don’t get boosted, they’re going to get into trouble,” he said…

Fauci said it’s important to get as many people vaccinated and boosted as possible so the virus does not have “ample opportunity to freely circulate.” When the virus is given that opportunity, he said, it can continue to mutate.

“It is about you as an individual, but it’s also about the communal responsibility to get this outbreak under control,” he told the radio station…

“Right now we have boosters that are very effective in diminishing any aspect of the infection,” Fauci told KNX News. “A virus like BA.5, which is the most prevalent circulating virus, is so transmissible that it often breaks through the protection of vaccine. But the vaccines and the boosters still do a very good job at preventing you from progressing to severe disease.” (F)

“U.S. health officials said Wednesday they are not changing the qualifications for being “fully vaccinated” against COVID-19, but they are urging Americans to stay “up to date” on their protection against the virus by getting booster shots when eligible.

The move to keep the existing definition of fully vaccinated — either two doses of the mRNA vaccines from Pfizer and Moderna or a single dose of the Johnson & Johnson vaccine — comes as health officials warned of waning protections from the initial doses. They are encouraging Americans to get additional doses to stave off serious illness and death from the delta and omicron variants.

The decision to keep the initial definition, established more than a year ago when the vaccines first rolled out, means that federal vaccination mandates for travel or employment won’t require a booster dose.

Maintaining the existing definition of “fully vaccinated” could make it more difficult to encourage some Americans who only begrudgingly got their primary doses of the vaccine to get boosted, since they would not face onerous restrictions often imposed on the unvaccinated — including testing requirements or, in some jurisdictions, being barred from indoor dining and other facilities.

“Individuals are considered fully vaccinated against COVID-19 if they’ve received their primary series,” said Centers for Disease Control and Prevention Director Dr. Rochelle Walensky. “That definition is not changing.”

The CDC instead posted information for Americans to more easily determine their eligibility for booster doses so as to remain up to date with their COVID-19 shots.

“We are now recommending that individuals stay up to date with additional doses that they are eligible for,” Walensky added…

On Wednesday, shortly before the White House briefing, the CDC revised an agency web site that had been entitled “When You’ve Been Fully Vaccinated” that defined the term and talked about what people could do after they achieved that level of protection.

It was retitled “Stay Up to Date with Vaccines,” and used the term “fully vaccinated” sparingly, to describe the primary series. Much of the site discussed additional and booster doses.

Asked about the change, a CDC spokeswoman said the definition of “fully vaccinated” has not changed. But she also said: “CDC will now use the phrase ‘up to date’ when talking about COVID-19 vaccination. CDC recommends that individuals stay ‘up to date’ by receiving any additional doses they are eligible for, according to CDC’s recommendations, to ensure they have optimal protection against COVID-19.”” (G)

“President Biden testing positive for COVID-19 again days after completing a course of Paxlovid has raised the question of whether the length of the antiviral treatment should be reconsidered.

Just days after he completed a five-day round of Pfizer’s COVID-19 antiviral treatment, Biden’s physician, Kevin O’Connor, said in a letter on Saturday that the president had tested positive once again. As of Wednesday, Biden is still testing positive for COVID-19.

This phenomenon has come to be known as “Paxlovid rebound,” when a person tests positive for the coronavirus again even after initially testing negative following a round of treatment with the antiviral. A recent preprint study found that Paxlovid rebound occurred among 3.5 percent and 5.4 percent of coronavirus infections at the seven-day and the 30-day mark after treatment respectively. Biden’s chief medical adviser, Anthony Fauci, also experienced Paxlovid rebound after contracting the virus and started a second round of treatment.

Some experts have called for studies into extending Paxlovid treatments to be prioritized, as early research has suggested that Paxlovid rebound could occur due to insufficient exposure to the drug. Researchers from the University of California, San Diego School of Medicine said last month that the drug may not be reaching enough infected cells in the allotted time.

Paxlovid, under an emergency use authorization issued by the Food and Drug Administration, is administered in two doses taken daily over the course of five days. Physicians are not permitted to prescribe longer rounds of treatment, and clinical data on courses lasting more than five days has yet to be completed.

Earlier this year, Fauci said the National Institutes of Health was in talks with Pfizer about studies looking into longer courses of Paxlovid, though any updates on these possible trials have not been disclosed.

“I’m actually still flabbergasted that we have not set up a clinical trial to figure this out. It’s an easy thing to do,” Robert Wachter, chair of the Department of Medicine at the University of California, San Francisco, told The Hill.

“Wouldn’t cost that much to be able to accumulate enough patients in a week or two and follow them for a few weeks so we could have an answer,” Wachter said, adding that the data needed to potentially extend the length of a round of Paxlovid could have been collected already if trials had been started just a few months ago.

According to Wachter, there aren’t any​ similar antiviral “analogies” to compare Paxlovid to. Viral rebound isn’t usually tested for, and other antiviral treatments aren’t administered in the same manner.”  (H)

“The US Food and Drug Administration issued an emergency use authorization Tuesday that allows health-care providers to change how the Jynneos monkeypox vaccine is administered, stretching out the supply amid high demand.

The vaccine can now be given to high-risk adults intradermally, meaning between the layers of the skin, rather than subcutaneously, or under the skin, as it has been given up till now. This will allow providers to get five doses out of a standard one-dose vial.

The new EUA also allows subcutaneous vaccination in people under 18 who are at high risk of infection.

The move could increase the number of vaccine doses in the national stockpile from 441,000 to over 2.2 million, officials said Tuesday.

But the EUA isn’t going to be a panacea as the outbreak continues to grow and vaccine demand remains high. The US Centers for Disease Control and Prevention has estimated that at least 1.5 million people in the US are eligible for the two-dose vaccine.

“I think we’re going to see that we will likely still run out of vaccines before we run out of arms,” Dr. Demetre Daskalakis, the White House’s assistant national response coordinator, said Tuesday.

The CDC reports 9,492 probable or confirmed monkeypox cases in 49 states, Puerto Rico and the District of Columbia as of Tuesday evening.

“In recent weeks the monkeypox virus has continued to spread at a rate that has made it clear our current vaccine supply will not meet the current demand,” FDA Commissioner Dr. Robert Califf said in a statement. “The FDA quickly explored other scientifically appropriate options to facilitate access to the vaccine for all impacted individuals. By increasing the number of available doses, more individuals who want to be vaccinated against monkeypox will now have the opportunity to do so.”

He added at a briefing Tuesday, “we encourage jurisdictions to utilize alternative dosing method as quickly as possible, and we’ll be your partner in this step every step of the way.”

The move comes less than a week after the Biden administration declared monkeypox a public health emergency, which gives the FDA and other government health agencies more flexibility to fight the spread of the virus…

However, the existing research on the vaccine focuses on recipients’ immune response, not on whether it actually prevents cases of monkeypox.

“There is no traditional assessment of this vaccine … because there weren’t smallpox cases, and the monkeypox outbreaks before this were not large enough to really do a clinical trial,” Dr. Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, said Tuesday. “We want to collect outcome data, as we do with all vaccines. And I’d also point out that the NIH will be mounting a clinical trial and is working through the logistics of that now.”” (I)

“Ahead of the new school year, colleges across the country are repurposing the tools they developed during the pandemic to address the monkeypox outbreak, which the White House recently declared a public health emergency. It’s a different virus, with different risks, and colleges are having to adapt, says Dr. Lindsey Mortenson of the American College Health Association (ACHA).

“Many colleges and universities are thinking about ‘how do we turn the page institutionally?” Mortenson says. ” ‘How do we take all of these public health informed practices and apply them in a different context?’ “

The risk of contracting monkeypox is low, but colleges are beginning to see cases..

“No outbreak stays limited to any one social network,” says Dr. Jay Varma, an epidemiologist at Weill Cornell Medical College. He adds that although the virus has been concentrated in the gay and queer community, “There’s no biological reason it couldn’t spill over into other groups.”

On college campuses, Varma says, areas to watch are those where students come into close physical contact with each other’s skin, including locker rooms, gyms or even theater groups.

The virus has already appeared on some college campuses. Georgetown University in Washington, D.C., University of Texas at Austin and West Chester University in Pennsylvania all told NPR they had at least one confirmed case over the summer…

Monkeypox requires a longer isolation period than coronavirus

COVID-19 is usually contagious for less than 10 days, but a monkeypox infection can last a few weeks. That means a student who contracts the virus may need to isolate for a significant chunk of their semester.

“This presents a very important challenge for the individual, who has to put up with that level of isolation, as well as the university, which needs to make arrangements to support that,” Varma says.

One challenge is that most colleges have shifted back to in-person instruction after going fully remote in 2020. Schools told NPR they are still determining what remote learning will look like for students in isolation.” (J)

(A)CDC sends team to New York to investigate polio case, By Mary Kekatos, https://abcnews.go.com/Health/cdc-sends-team-york-investigate-polio-case/story?id=88095468

(B) New York polio case is the ‘tip of the iceberg,’ hundreds of others could be infected, health official says, by Spencer Kimball, https://www.cnbc.com/2022/08/05/new-york-polio-case-tip-of-iceberg-hundreds-of-others-could-be-infected.html

(C) What’s the real risk from NY’s polio outbreak? What to know from infectious disease experts, by David Robinson, https://www.lohud.com/story/news/health/2022/08/09/what-real-risk-from-nys-polio-outbreak-what-to-know/65396006007/

(D) US doctor issues warning of many undiagnosed polio cases, By Naomi Grimley, https://www.bbc.com/news/health-62469534

(E) Bill Gates, whose foundation funds polio vaccines, warns that the disease’s reemergence in New York is ‘a threat to us all’, BY NICHOLAS GORDON, https://fortune.com/2022/08/09/bill-gates-foundation-polio-vaccine-new-york-positive-case-rockland-county-wastewater/

(F) Fauci warns of ‘trouble’ for those with BA.5 variant if not up to date on vaccines, By Lindsey Bever, https://www.washingtonpost.com/health/2022/08/05/fauci-vaccine-covid-trouble/

(G) WATCH: CDC urges ‘up to date’ COVID shots but won’t change definition of ‘fully vaccinated’, By Zeke Miller and Mike Stobbe, https://www.pbs.org/newshour/health/cdc-urges-up-to-date-covid-shots-but-wont-change-definition-of-fully-vaccinated

(H) ‘Paxlovid rebound’ raises questions over how long antiviral COVID treatment should last, BY JOSEPH CHOI, https://thehill.com/policy/healthcare/3587071-paxlovid-rebound-raises-questions-over-how-long-antiviral-covid-treatment-should-last/

(I) FDA authorizes change in how monkeypox vaccine is given, stretching supply amid high demand, By Katherine Dillinger, https://www.cnn.com/2022/08/09/health/monkeypox-vaccine-intradermal/index.html

(J) How colleges are preparing for a new public health threat: monkeypox, by POOJA SALHOTRA, https://www.npr.org/2022/08/06/1115664984/college-monkeypox

(K) Polio vaccine boosters are offered to London children as the virus spreads, https://www.npr.org/2022/08/10/1116749510/polio-london-children-vaccine-booster