While New York state, London and Israel have ramped up polio vaccinations in an attempt to curb their outbreaks, experts are far more concerned about paralytic polio cases in low-income countries.
Here’s how this year’s closely related polio outbreaks in New York state, London, and greater Jerusalem might have started. A child in Afghanistan or Pakistan received two drops of Albert Sabin’s oral polio vaccine , which contains a weakened, live virus, in December 2021 or so.
But Grassly and other polio experts stress that big outbreaks of paralytic polio cases remain highly unlikely in rich countries, thanks to high vaccination coverage and good sanitation. “There is a risk we will end up reporting one or two cases in London,” Grassly says. Mark Pallansch, a polio virologist who recently retired from the U.S. Centers for Disease Control and Prevention , thinks the same is true for New York state.
The viruses that arrived in New York, London and Israel did not come as full-fledged VDPVs; they were only part way along their journey, with just a few genetic changes from the Sabin type 2 virus. In London, Grassly says, sequence analysis of virus samples collected from wastewater shows a gradual evolution to a VDPV between February and June.
New York state has so far had limited success vaccinating the most resistant communities, says Rockland County Health Commissioner Patricia Schnabel Ruppert. But even in pockets where vaccine coverage remains low, the virus may burn itself out because the susceptible population won’t be large enough to sustain spread, Grassly says.
designed to be just as good at stopping outbreaks as OPV but significantly less likely to revert to its neurovirulent form
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