New York State Governor Kathy Hochul issued an executive order on September 9, 2022, declaring a State Disaster Emergency due to evidence of circulating poliovirus, according to a press release published by New York State Department of Health.1

The order comes approximately 2 months after State Health Department officials had notified the Centers for Disease Control and Prevention (CDC) of a confirmed case of polio in a young adult from Rockland County, New York. This is only the second time that an individual with community-acquired polio has been recorded in the United States since 1979.2

The case involved a young adult who was hospitalized for symptoms suggestive of acute flaccid myelitis — the patient was not vaccinated against poliovirus at the time of hospitalization. Initial symptoms included a 5-day history of fever, neck stiffness, constipation, and a 2-day history of bilateral weakness in the lower extremities. Two stool specimens were obtained from the patient on days 11 and 12 after symptom onset, both of which were positive for poliovirus type 2 via reverse transcription polymerase chain reaction (RT-PCR) testing. Subsequent RT-PCR testing performed by the CDC confirmed these results.


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“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,” noted the CDC.2

According to the CDC, the patient was likely exposed to poliovirus 7 to 21 days prior to the onset of paralysis. The patient did not travel outside of the country during the potential period of exposure but he had attended a large gathering 8 days prior to symptom onset.2     

A total of 260 wastewater samples obtained from the surrounding area were tested for poliovirus, including those initially obtained for COVID-19 surveillance. Of these samples, 21 (8%) were positive for poliovirus via RT-PCR testing and partial-genome sequencing. Of note, 20 wastewater samples previously collected between May and July 2022 were found to share a genetic link with the virus discovered in the 2 stool specimens obtained from the patient with confirmed polio.2

As of September 9, 2022, ongoing surveillance by the CDC has now confirmed poliovirus in wastewater samples obtained from Rockland, Orange, Sullivan, and Nassau Counties, as well as New York City. In addition to prompting Governor Hochul to declare a State Disaster Emergency, these findings provide further evidence of expanding community spread of poliovirus.1

The executive order requires Clinicians in New York to provide polio immunization data to the State’s Department of Health, and it allows the inactivated polio vaccine to be administered by emergency medicine workers, pharmacists, and midwives.1

For clinicians in New York who have completed their polio vaccine series and who might come into contact with poliovirus, State Health officials recommend 1 lifetime booster dose of the inactivated polio vaccine.1

“On polio, we simply cannot roll the dice,” said New York State Health Commissioner Mary T. Basset, MD.

References

1. Protecting New Yorkers through immunization: State Department of Health updates New Yorkers on polio in New York State [press release]. New York State Department of Health; September 9, 2022. Accessed September 11, 2022.

2. Link-Gelles R, Lutterloh E, Ruppert PS, et al. Public health response to a case of paralytic poliomyelitis in an unvaccinated person and detection of poliovirus in wastewater — New York, June–August 2022. MMWR Morb Mortal Wkly Rep. Published online August 16, 2022. doi:10.15585/mmwr.mm7133e2

This article originally appeared on Infectious Disease Advisor