New York has issued a health warning to travelers heading to Israel after a polio outbreak in the country paralyzed an eight-year-old boy.
The state Department of Health said Friday that anyone planning to visit the nation this spring should ensure they are up to date with their polio vaccines.
Four cases of polio have been detected among children in Safed, in the north of Israel, in recent weeks and hundreds more positive sewage samples have been found, indicating that the virus is spreading.
There are renewed fears about polio in the US, especially in New York, after a cluster of cases last year marked the first outbreak in nearly 40 years.
New York also has the largest Jewish population in the United States, with 1.7million people, and at least three direct flights to the country per day.
New York said anyone planning to visit Israel this spring should ensure they are up to date on their polio vaccines
The above map shows the five counties in New York that have detected polio in their wastewater. These were Rockland, Sullivan, Orange, New York City and Nassau
A 20-year-old man from Rockland County, upstate New York, was paralyzed with the virus in July last year.
There have been no other human cases in the state to date, although sewage samples have continued to test positive suggesting it is still present.
Samples have tested positive for the virus 100 times from five counties which are Rockland County, Orange County, Sullivan County, Nassau County and New York City.
It was not clear how the man caught the virus, but he tested positive for a strain used in live vaccines. The US stopped using this jab in 2000, but it is still rolled out in some countries including Afghanistan and Pakistan.
In the UK, a case was linked to someone who had received the live vaccine and maybe infected others.
Polio was once on the verge of global eradication, but amid slowing vaccination rates the preventable disease is making a comeback.
In serious cases, it can leave patients with paralysis and meningitis, or spinal cord inflammation.
There is no cure for this, with doctors instead relying on vaccines to prevent serious illnesses.
Three doses of the vaccines are more than 99 percent effective against paralysis with the virus.
But inoculation rates have been ticking downward nationwide, and in New York just 79 percent of residents are now up to date on polio vaccines.
To reach herd immunity — where the virus can’t spread — the World Health Organization says levels need to be at 80 to 85 percent.
In Rockland County, uptake of the polio vaccine has fallen to 60 percent while in Yates it is down to 54 percent. Only Rockland has reported cases so far.
In its warning, New York state ‘urged all New Yorkers’ to ensure they are fully immunized against the virus.
They said: ‘In recent days, Israel’s Ministry of Health confirmed four children had tested positive for poliovirus in Northern Israel after one unvaccinated child presented symptoms of paralysis.
‘Israel has additionally reported widespread detection of poliovirus in wastewater systems.’
It added: ‘The best way individuals can ensure they are protected from polio is by making sure they are up to date with polio immunizations.’
New York also said it was in touch with health officials in Israel to ensure a ‘co-ordinated response’ to the outbreak.
The Centers for Disease Control and Prevention (CDC) is advising ‘enhanced precautions’ for people traveling to Israel and polio vaccination.
This means travelers should be vaccinated against polio and avoid close contact with any sick animals or people while in Israel.
It also tells people not to touch material used by the sick — such as clothing or bedding — and not to consume wild game or use creams, lotions or powders derived from wild animals.
Most of the samples in New York are from Rockland County (44), followed by Orange County (30), Sullivan County (13) and New York City (five). One sample has also been collected in Nassau county.
In Israel late last month an eight-year-old boy in the north of the country was diagnosed with polio after suffering weakness in his limbs.
Three children who had also been in contact with the boy in the city of Safed, in the north of the country, also tested positive.
They were asymptomatic and it was not clear what their vaccination status was. The boy who was paralyzed had not been vaccinated.
In February last year, another seven children tested positive for the virus — six of which were asymptomatic. The cases were in Jerusalem.
Like in New York, it had also been detected in wastewater from across the country including in Jerusalem.
This prompted a vaccination program to be launched encouraging all communities to get the polio vaccine.
WHAT IS POLIO?
Polio is a serious viral infection that used to be common all over the world.
The virus lives in the throat and intestines for up to six weeks, with patients most infectious from seven to 10 days before and after the onset of symptoms.
But it can spread to the spinal cord causing muscle weakness and paralysis.
The virus is more common in infants and young children and occurs under conditions of poor hygiene.
How deadly is it?
Most people show no signs of infection at all but about one in 20 people have minor symptoms such as fever, muscle weakness, headache, nausea and vomiting.
Around one in 50 patients develop severe muscle pain and stiffness in the neck and back.
Less than one percent of polio cases result in paralysis and one in 10 of those result in death.
Of those who develop symptoms, these tend to appear three-to-21 days after infection and include:
How does it spread?
People can catch polio via droplets in the air when someone coughs or sneezes, or if they come into contact with the feces of an infected person.
This includes food, water, clothing or toys.