Polio has reappeared in the United States for the first time in a generation. On July 18, the New York State Department of Health told the US Centers for Disease Control and Prevention that it had detected poliovirus, which can cause paralysis or death in a small percentage of cases, in a young adult from Rockland County outside New York. city
New York authorities later detected the virus in sewage from Rockland and neighboring Orange County, evidence of transmission in the local community.
This first case prompted authorities in the United Kingdom and Israel to increase their vigilance; they also found polio.
A polio crisis could be brewing. But despite describing polio as “one of the most feared diseases in the US,” the CDC is trying to maintain full government control over poliovirus testing. Only the feds and certain states that already test for polio would be equipped to control the pathogen.
By withholding the materials and testing protocols private labs, such as Massachusetts-based surveillance startup BioBot, would need to detect and track the virus, the CDC risks allowing the virus to spread unnoticed in some communities, while limiting the study of a possible outbreak. .
“They want to do it themselves,” Vincent Racaniello, a professor in Columbia University’s Department of Microbiology and Immunology, told The Daily Beast. “Just as they wanted to control the COVID tests at the beginning of the pandemic.”
The thing is, even the CDC admits that the initial response to COVID failed. Last week, Rochelle Walensky, the director of the CDC, told the agency’s 11,000 employees that the CDC needed a top-to-bottom overhaul. “To be frank, we are responsible for some pretty dramatic and public failures, from testing to data to communications,” Walensky said.
The CDC could be about to repeat some of its mistakes. Amy Kirby, an Emory University epidemiologist who directs the CDC’s National Wastewater Surveillance System, did not respond to a request for comment.
The poliovirus is spread by direct contact with faecal matter. Before the invention of an oral vaccine in the early 1950s and a widespread childhood vaccination campaign, polio outbreaks caused more than 15,000 cases of paralysis in the US alone each year.
Vaccines crushed polio. By the 1970s, the disease had virtually disappeared from all but a handful of poorer, more remote countries such as Afghanistan. When it reappeared, it was usually as a result of international travel, and local health authorities quickly isolated those infected and stopped its spread.
The CDC tracked poliovirus in an American community only once between 1979 and 2022. In 2005, the Minnesota Department of Health identified poliovirus in an unvaccinated girl in a largely unvaccinated Amish community. Three more children became ill before the virus was contained.
“[It] it shouldn’t be hard to do.”
Today 90% or more of people in the wealthiest countries, including the United States, are vaccinated against polio. But childhood vaccination rates have been falling as anti-vax attitudes catch on with a growing minority of people. It’s no coincidence that Rockland County, where the CDC detected polio last month, has a lower vaccination rate than the rest of the country: about 60 percent.
“The occurrence of this case, combined with the identification of poliovirus in wastewater from neighboring Orange County, underscores the importance of maintaining high vaccination coverage to prevent paralytic poliomyelitis in people of all ages,” he said. underscore the CDC in a report released last week.
The stakes for public health could not be higher as the world faces not only the ongoing COVID pandemic, but also an accelerating outbreak of monkeypox. But the potential disaster hasn’t motivated the CDC to release the DNA primers it would need to detect polio to private labs. “Essentially, no one can do it except the public [i.e. government] health labs,” Rob Knight, head of a genetic computing lab at the University of California, San Diego, told The Daily Beast.
Without the primers and other materials, private laboratories, and the researchers associated with those laboratories, cannot help the government find polio in other communities. Racaniello compared the CDC’s reluctance to expand polio testing to the agency’s similarly tight control of COVID testing during the early months of the novel coronavirus pandemic. “That didn’t work out well,” Racaniello noted in a tweet.
The worst case scenario is that polio spreads for weeks without anyone noticing, just as monkey pox spread unnoticed at first as many doctors mistook it for herpes or some other sexually transmitted disease.
CDC’s recalcitrance appears to be bureaucratic. From a technical standpoint, detecting poliovirus in wastewater is no more difficult than detecting SARS-CoV-2 or any other virus, Knight explained. Take a sample of the sewage, do a PCR test.
But in the US, the regulations on polio are stricter than for other diseases. “From a regulatory standpoint, you have to consider every sample that might contain polio,” Knight said. Polio surveillance, he added, is a “paperwork nightmare to set up.”
There is also the cost factor. Scaling up polio testing in private labs could cost millions of dollars. And labs may want government help to pay for it. CDC leaders may have noticed the growing reluctance of the US Congress to pay for COVID testing and concluded that it is easier for CDC to keep polio testing in-house.
But easier doesn’t necessarily mean better, not when it comes to public health. With a little effort and a little money, private labs could bolster the government’s surveillance system. “[It] It shouldn’t be difficult to test sewage,” James Lawler, an infectious disease expert at the University of Nebraska Medical Center, told The Daily Beast. “BioBot and others already doing surveillance could rise quickly “.
Speed and comprehensive surveillance are important when dealing with infectious diseases. A little effort by the CDC and some government funding could make the difference between a once-in-a-generation polio outbreak that stops in a couple of small New York counties, or a much larger outbreak that it could affect the entire United States.
Or even the whole world.