NYSDOH Health Advisory: Update Regarding Poliomyelitis in Rockland County, New York State

Clinical Presentation of Poliomyelitis

  • Most people with poliovirus infection have no symptoms or only a non-specific febrile illness. Fewer than 1 in 100 people will develop acute flaccid weakness of the limbs.
  • Progression of weakness is rapid and often associated with fever and muscle pain.
  • Weakness is typically asymmetric and more severe proximally than distally.
  • Deep tendon reflexes are absent or diminished.
  • Bulbar paralysis can result in respiratory distress and often requires mechanical ventilation.
  • There may be a history of fever, sore throat, nausea, and malaise up to one week before weakness onset.
  • Polio is a disabling and life-threatening disease which can affect a person’s brain and spinal cord, leading to paralysis, meningitis, paresthesia, and long-term disability.
  • There can be long-term sequelae, post-polio syndrome, even decades after the original infection.
  • Polio has been eliminated from the United States, but it still occurs in other parts of the world, especially where there are low vaccination rates. Wild-type polio has been eliminated everywhere but Afghanistan and Pakistan.  Recently, cases of polio caused by revertant Sabin-derived strains have been identified in several countries in Europe, Asia, and Africa, and poliovirus has been detected in wastewater in the UK.  The last case of polio identified in the US was in 2013 in an immunocompromised infant who received OPV abroad.
  • The incubation period is 3 to 6 days for non-paralytic poliomyelitis and 7 to 21 days for onset of paralysis in paralytic poliomyelitis.
  • Transmission is fecal-oral, respiratory, or oral-oral.
  • Poliovirus is highly infectious and is most transmissible up to 14 days before and after onset of symptoms, although ongoing fecal shedding can occur for weeks.
  • The best way to protect your patients is to maintain high immunity against polio in the population through vaccination, along with rapid identification and isolation of suspected polio cases.

Polio Immunization Recommendations

  • Children, adolescents, and adults who are unvaccinated or do not know if they were vaccinated are at risk for polio if exposed and should be offered an outbreak dose of IPV if they reside in an area with possible community transmission of poliovirus or if they have other potential exposures.
  • Previously vaccinated individuals who are at risk for exposure because of their community of residence or who have had close contact with a patient infected with poliovirus should also receive a booster dose of IPV.
  • Polio vaccine may be given to children and adults as a stand-alone vaccine (not combined) in an outbreak setting.
  • IPV or the first dose of combination products containing IPV can be given as early as 6 weeks of age and should be considered for administration when infants who are at least 6 weeks old and reside in an area with possible community transmission of poliovirus present for care.
  • Polio vaccine can be given during pregnancy and is recommended if the individual is at risk of exposure. Pregnant persons should discuss the risks and benefit of IPV with their healthcare provider.
  • Polio vaccine may be given at the same time as other vaccines.
  • IPV, the only polio vaccine available in the US, is highly effective, with 90% or more of vaccine recipients developing protective antibody levels to all three poliovirus types after 2 doses, and 99% developing protective antibody levels following 3 doses.
  • Unvaccinated adults at risk for poliovirus infection should get three doses of IPV: two doses separated by 1 to 2 months, and a third dose 6 to 12 months after the second dose. Often during an outbreak, the first dose may be administered by a public health agency but follow up doses can be obtained where the patient receives regular health care.
  • The schedule for polio vaccination for unvaccinated or under-vaccinated children through age 17 years is 2 doses of IPV separated by 4–8 weeks, and a third dose 6–12 months after the second dose. For details and age groups, refer to the ACIP IPV catch-up vaccine table.
  • If you are interested in obtaining IPV for your patients, please contact the Bureau of Immunization via email at immunize@health.ny.gov or by phone at (518) 473-4437.

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