The state of emergency. For a disease that has only recently affected a patient, it seems like a real honor. But things are different in the US state of New York. With polio, it’s like icebergs – find a patient and there are sure to be many more infections that you are unaware of.
The infection usually manifests itself as an inconspicuous sore throat, if you notice it at all. But in those who have not been vaccinated, things go wrong once in about a hundred or a thousand times, the virus attacks the nervous system and the patient is paralyzed. The infamous polio, which is sometimes fatal and the victims who survive often go away weakened or handicapped forever.
Meanwhile, the virus has appeared in five locations in and around New York City. Every reason for the state of emergency, which basically means louder alarm bells will ring, doctors will be empowered and authorities will be in a higher state of preparedness. “We can’t take any chances with polio,” Mary Bassett, the state health commissioner, said earlier this week. “If you or your child are still walking around unvaccinated, the danger of a paralytic disease is real. I urge New Yorkers not to take any chances.”
The developments in New York are the latest setback in a struggle that has been going on for thirty years now and has cost at least € 16 billion. In fact, WHO intended to get the virus out of the world around the year 2020, after it had already been promised for 2000, 2004 and 2012. But the virus once again slipped into the hands of doctors in Pakistan. and Afghanistan, two countries plagued by violence, skepticism about religious vaccines and general inhospitality. Difficult, because in recent years ‘Pakistani’ polio has reappeared elsewhere as well. As in Malawi, where the virus emerged last year, and in Mozambique, where there has been an outbreak since May.
Live vaccine.
But that’s not what happened in New York, or Jerusalem, any other place where a case has been revealed. There, the virus has another, more surprising origin: vaccines against it. Because fire is sometimes fought with fire, many countries have used an oral vaccine consisting of live, attenuated polio virus. Cheap, easy to take and more effective against polio transmission than injected vaccines used in Western countries like the Netherlands. But it has a drawback: the vaccine is still “alive”, if you can use that word for viruses.
This is usually not a problem. RIVM polio expert Erwin Duizer outlines how the living polio virus was found in May in a sewer in the Dutch “Bible Belt,” which crosses the country diagonally from Zeeland to Drenthe. Closer examination revealed that it was only a fragment of the excreted polio vaccine. “Then it’s a relief. Then we know: apparently this belongs to someone who was recently vaccinated abroad and then came here. ‘ After all, those who have been vaccinated still shed the vaccine virus through their feces for a few weeks.
Things were different in Niger, Nigeria, Congo, Somalia and New Guinea, among others: there the innocent viruses in the vaccine mutated into pathogenic versions, ostensibly because they could circulate in poorly vaccinated communities or could “mature” in the body of someone with a malfunctioning immune system. ‘These mutations often don’t produce a more dangerous virus. But on the other hand: the virus only needs six to ten mutations to become something that can be pathogenic, “Duizer says.
And now such an enhanced vaccine virus is also roaming in Western countries. British virologists raised the alarm as early as June. For four consecutive months, genetically closely related polio virus remains were found in the London sewers. A sign that a vaccine strain had begun to evolve and has now found a way to circulate again among humans.
common ancestor
Those polio viruses that emerged in London, Jerusalem and New York have a common ancestor. “So that tribe is pretty widespread already,” Duizer says. The remedy is, somewhat paradoxically, more vaccinations. With the “ordinary” injectable vaccine, which is included in childhood vaccinations in Western countries like the Netherlands, polio is the “p” of the DKTP vaccine in children, to be exact. Although the vaccine doesn’t prevent all transmission of the virus, it slows it down considerably, Duizer explains, mostly because it ensures that the throat can produce fewer viruses. “And that discharge from the throat, when you cough, for example, can be a very efficient route of distribution.”
Also, in New York and Israel, the emphasis will once again be on hand washing. After all, polio spreads mainly through feces and hands, from where it can – unpleasant but true – enter the mouth, whether through food or not. “Revivals like the ones in New York are extraordinary and very unfortunate. But that doesn’t mean polio eradication is getting worse, ‘explains Duizer. “Actually, this was only expected. And we also know what to do about it: increase the vaccination rate and work towards good hand hygiene. ‘
In the Netherlands, the last polio outbreak dates back to 1992, in the Streefkerk area near Rotterdam. In a series of infections among Protestants who had not been vaccinated, 71 patients were discovered. Two were killed. That outbreak was still caused by a “natural” polio virus, not a mutated version of the vaccine virus.
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