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Factors Allowing Imported Poliovirus To Circulate in New York

Recent outbreaks of indigenous wild polioviruses (WPVs) in New York “carry two key lessons,” according to the author of a Perspective article. “First, polio is a global risk, and high-income countries are not immune. Even though there has not been a U.S. WPV outbreak since 1979, we know all too well that viruses can spread across and between continents readily and unpredictably. Indigenous type 1 WPV (WPV1) remains endemic in Pakistan and Afghanistan. Recent cases in Malawi and Mozambique caused by WPV1 from Pakistan show the risk of importation. The threat of polio is not restricted to WPV, but these and other [vaccine-derived poliovirus (VDPV)] outbreaks demonstrate the ongoing global risks associated with [attenuated oral poliovirus vaccine (OPV)].

“The other key lesson is also not new. The risks of VDPV emergence, outbreaks, and spread are all associated with low vaccination levels. The tight-knit community that was affected in New York, for example, has very low rates of immunization, and it has previously experienced numerous outbreaks of vaccine-preventable diseases; the community is similar in this way to communities in parts of Africa that have experienced VDPV2 outbreaks. In the past 6 years, there have been more than 100 VDPV2 outbreaks from at least 70 independent emergences affecting at least 38 countries, and now the United States, the United Kingdom, and Israel have joined that list. The reasons for low immunization rates are varied, but in general vaccine hesitancy and avoidance, reinforced by disinformation, yield similarly undervaccinated populations.”

Source: New England Journal of Medicine