The spread of polio in Israel, the United States and the United Kingdom highlights the extremely rare risk of the oral vaccine

An unlikely phenomenon that is becoming more noticeable as the world moves closer to eliminating concurrent diseases naturally, but now facing more cases caused by oral immunization.

LONDON (AP) — For years, global health officials have used billions of drops of an oral vaccine in a remarkably successful campaign to eradicate polio in the last remaining strongholds, often impoverished and politically unstable corners of the world.

Now, in a stunning twist to the decades-long effort to eradicate the virus, authorities in Jerusalem, New York, and London have uncovered evidence that polio is spreading there.

The original source of the virus? The oral vaccine itself.

Scientists have known about this extremely rare phenomenon for a long time. That is why some countries have switched to other polio vaccines. But these accidental oral infections are becoming more egregious as the world moves closer to eradicating the disease and the number of polio cases caused by wild or naturally circulating viruses plummets.

Since 2017, there have been 396 cases of polio caused by the wild virus, compared with more than 2,600 linked to the oral vaccine, according to figures from the World Health Organization and its partners.

“We’re basically replacing the wild virus with the vaccine virus, which is now causing new outbreaks,” said Scott Barrett, a Columbia University professor who has studied polio eradication. “I suspect that countries like the UK and the US will be able to stop transmission fairly quickly, but we’ve thought about that for monkeypox as well.”

The latest incidents represent the first time in several years that vaccine-related poliovirus has turned up in rich countries.

Earlier this year, Israeli authorities detected polio in an unvaccinated 3-year-old boy suffering from paralysis. Several other children, almost all unvaccinated, were found to be carriers of the virus, but without any symptoms.

In June, British authorities reported finding evidence in sewage that the virus was spreading, although no infections were identified in people. Last week the government said all London children aged 1-9 would be offered a booster shot.

In the United States, an unvaccinated young adult suffered paralysis in his legs after being infected with polio, officials in New York revealed last month. The virus has also appeared in the sewers of New York, suggesting that it is spreading. But officials said they weren’t planning a booster campaign because they believed the state’s high vaccination rate should provide enough protection.

The spread of polio in Israel, the United States and the United Kingdom1

Genetic analyzes showed that the viruses in the three countries were all “vaccine-derived,” meaning they were mutated versions of an oral vaccine virus.

The oral vaccine in question has been used since 1988 because it is cheap, easy to administer (two drops are put directly into the mouths of children), and better protects entire populations where polio is spreading. It contains a weakened form of the live virus.

But it can also cause polio in about two to four children per 2 million doses. (Four doses are needed to be fully immunized.) In extremely rare cases, the weakened virus can also sometimes mutate into a more dangerous form and trigger outbreaks, especially in places with poor levels of sanitation and vaccination.

These outbreaks usually start when vaccinated people shed live vaccine virus in their feces. From there, the virus can spread within the community and, over time, transform into a form that can cripple people and trigger new outbreaks.

Many countries that have eliminated polio have switched to injectable vaccines containing decades-killed viruses to avoid such risks; the Nordic countries and the Netherlands have never used the oral vaccine. The ultimate goal is to switch the world to vaccines once wild polio is eradicated, but some scientists argue the switch should happen sooner.

“We probably never would have been able to control polio in the developing world without the (oral polio vaccine), but that’s the price we’re paying now,” said Dr. Paul Offit, director of the Center for Vaccine Education at the Hospital. Philadelphia Children’s.

Last year, the WHO and its partners also began using a new oral polio vaccine, which contains a live but weakened virus that scientists say is less likely to mutate into a dangerous form. But supplies are limited.

To stop polio in Britain, the United States, and Israel, more vaccination is needed, experts say. That’s something Columbia University’s Barrett worries might be difficult in the age of COVID-19.

“What is different now is a reduction in trust in authority and political polarization in countries like the United States and the United Kingdom,” Barrett said. “The assumption that we can rapidly increase the number of vaccines may be more difficult now.”

Oyewale Tomori, a virologist who helped lead Nigeria’s efforts to eliminate polio, said that in the past he and his colleagues were hesitant to describe outbreaks as “vaccine-related,” fearing that people would be afraid of the virus. vaccine.

“All we can do is explain how the vaccine works and hope that people understand that vaccination is the best protection, but it’s complicated,” Tomori said. “In hindsight, it might have been better not to use this vaccine, but at the time no one knew it would turn out that way.

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