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If this current outbreak of poliomyelitis reaches more than 3,000 cases per day and is not contained, it could spur outbreaks with a profound impact on public health

A rare strain of poliovirus has reemerged in the United States. The strain appears to have come from Rockland County in New York State.

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Unfortunately, polio has returned to the United States after being eradicated here a generation ago. The poliovirus, which can cause paralysis or death in a small percentage of cases, was discovered in a young adult from Rockland County outside of New York City on July 18, according to the New York State Department of Health’s report to the U.S. Centers for Disease Control and Prevention.

Rockland and neighboring Orange County in New York had the virus detected in their sewage systems, proving the virus was being spread among residents of those areas.

Authorities in the United Kingdom and Israel stepped up their own monitoring in response to the initial case and likewise discovered polio in those countries.

It is possible that a polio outbreak is on the horizon. The Centers for Disease Control and Prevention (CDC) is attempting to keep the government in complete control of poliovirus testing despite calling polio “one of the most feared diseases in the U.S.” To keep an eye out for the virus, only the federal government and a handful of states conduct polio testing.

The Centers for Disease Control and Prevention (CDC) could be hindering research into a potential outbreak by withholding testing materials and protocols that private labs like Massachusetts-based surveillance startup BioBot would need to detect and track the virus.

Vincent Racaniello, a professor in Columbia University’s Department of Microbiology and Immunology, told The Daily Beast, “They want to do it themselves.” Similar to how they wanted to keep tabs on COVID testing at the outbreak’s outset.

The problem is, the CDC itself admits it handled the initial COVID outbreak poorly. Director Rochelle Walensky informed the CDC’s 11,000 employees last week that the organization required a complete overhaul. We have made some pretty public mistakes in testing, data, and communications, to be honest,” Walensky admitted.

The Centers for Disease Control and Prevention (CDC) may be about to make the same mistakes twice. The head of the CDC’s National Wastewater Surveillance System, an epidemiologist at Emory University named Amy Kirby, did not return calls seeking comment.

Direct contact with feces is a major vector for the spread of poliovirus. More than 15,000 people were paralyzed annually by polio outbreaks in the United States before the development of an oral vaccine in the early 1950s and a widespread campaign of childhood vaccinations.

As a result of vaccines, polio has been eradicated. In the 1970s, AIDS had been nearly eradicated everywhere except for a few extremely poor and remote countries like Afghanistan. Whenever it reemerged, it was usually the result of international travel; however, local health authorities swiftly isolated the infected and stopped the spread.

Between 1979 and 2022, the CDC only kept track of poliovirus activity in one U.S. community. An infant girl in a largely unvaccinated Amish community in Minnesota tested positive for poliovirus in 2005. Before the outbreak was stopped, three more children fell ill.

The vaccination rate against polio has reached or surpassed 90% in the world’s wealthiest nations, including the United States. However, anti-vaxxer sentiment has been on the rise, leading to a decline in childhood vaccination rates. It’s not a coincidence that the CDC found poliovirus last month in Rockland County, where vaccination rates are lower than average at around 60%.

Last week, the CDC posted a report emphasizing the importance of maintaining high vaccination coverage to prevent paralytic polio in people of all ages. The report noted that the occurrence of this case, along with the identification of poliovirus in wastewater in neighboring Orange County, underscores the importance of doing so.

With the world already dealing with the ongoing COVID pandemic and the recent outbreak of monkeypox, the stakes in terms of public health could not be higher. Even with a disaster waiting to happen, the CDC has not given private labs the DNA primers they need to test for polio. Rob Knight, director of a genetic-computation lab at the University of California, San Diego, told The Daily Beast, “essentially no one is allowed to do it except public [i.e. government] health labs.”

Private laboratories and the researchers affiliated with them cannot aid the government in its search for polio in other communities without access to primers and other materials. Racaniello drew parallels between the CDC’s reluctance to expand polio testing and its equally tight control of COVID testing in the first few months of the novel-coronavirus pandemic. “Which did not work out well,” Racaniello wrote on Twitter.

The worst case scenario is that polio spreads for weeks before anyone notices, similar to how monkeypox spread undetected at first because many doctors mistook it for herpes or another sexually transmitted disease.

It appears that bureaucratic red tape is to blame for the CDC’s stubbornness. Knight argued that technically speaking, detecting poliovirus in sewage is no more difficult than detecting SARS-CoV-2 or any other virus. Get a sewage sample and put it through a PCR test.

The United States has stricter polio regulations than other countries. According to Knight, “from a regulatory perspective,” every sample that “may contain polio” must be accounted for. As an additional note, he mentioned that polio surveillance is a “paperwork nightmare to get set up.”

The issue of price is also relevant. Private laboratory polio testing expansion could cost millions. Furthermore, the laboratories may seek financial assistance from the government. It’s possible that CDC administrators have seen the growing reluctance of the U.S. Congress to pay for COVID testing and decided it’s simpler for the agency to keep polio testing in-house.

However, when it comes to the health of the public, simpler isn’t always better. Private labs could help the government’s surveillance system if they put in the time and money. University of Nebraska Medical Center infectious disease specialist James Lawler told The Daily Beast, “[i]t should not be hard to do wastewater testing.” As the author puts it, “BioBot and others who are doing surveillance already could stand up quickly.”

When it comes to infectious diseases, both speed and thorough surveillance are crucial. The Centers for Disease Control and Prevention’s (CDC) efforts, along with government funding, could determine whether a once-in-a-generation polio outbreak spreads beyond a couple of small New York counties or remains contained in New York state.

In order to learn more, check out The Daily Beast.