LOST IN TRANSLATION — Alarmed by a polio case in New York state and detection of the virus in wastewater in the region, White House and state health officials are developing ways to monitor, detect and try to halt any spread of polio decades after the virus was declared eradicated in the United States. Any strategy they set will center on vaccination. There is no cure or treatment. But unlike the 1950s and '60s, when the public largely embraced new vaccines as salvation from a disease that terrified communities and condemned paralyzed children to iron lungs, public health officials today have to deal with rising anti-vax misinformation and disinformation. So the last thing they need is a particularly inartful and confusing expression — "vaccine-derived polio" — to make their job even harder, several worried experts told Nightly. It's so easy to think "vaccine-derived" means that people contract polio from the vaccine itself. That's not the case, stressed Heidi Larson, a medical anthropologist who is one of the world's leading experts on vaccine hesitancy and founding director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine. "You do not get the virus from taking the vaccine," she added. "Vaccine-derived polio" is what afflicted a 20-year-old man in Rockland County, outside New York City. He is unvaccinated and he lives in an area with particularly low vaccination rates, estimated at around 60 percent or lower. He is now partly paralyzed. And traces of polio have been found in wastewater in his region, at other sites in New York and nearby states. New York Gov. Kathy Hochul declared a state of emergency, calling for stepped-up vaccination efforts in a state where polio immunization rates have dropped below 80 percent. To make things even more complicated, the global "polio eradication campaign" refers to "wild" or "endemic" polio — where Afghanistan and Pakistan are the two remaining trouble spots (although even they've made lots of progress recently). The U.S. ended "wild" polio in 1979 and was declared polio-free about 15 years later. In glowing international eradication updates from public health groups, "vaccine-derived" polio doesn't count — even though it still paralyzes and kills people. So what does this pesky term, "vaccine-derived polio," actually mean? The United States, and many wealthy countries, use a polio injection that contains zero, zilch, nary a drop of live polio virus. Many lower-income countries, for a variety of economic and logistic reasons, use an oral vaccine that contains a teeny, tiny trace of a weakened, or "attenuated," form of the virus. People who are immunized that way (usually babies and young children) are not "deriving" polio from it. They are getting protection from it. The oral vaccine is extremely safe, Larson said. But people who get the oral version do excrete minute traces of the virus, which can reach the water supply and sometimes mutate. Exposure to that mutated version is how people "derive" polio. Those water-borne traces "don't infect anyone when people are vaccinated," Larson told Nightly. "Where it thrives … is where there's low vaccination." During Covid, vaccination programs lagged across the world, for polio and other childhood diseases. The spread of anti-vax sentiments isn't helping. A recent cluster of cases in Nigeria are vaccine-derived. A case identified in Malawi a few months ago was genetically linked to the wild strain in Pakistan, so travel probably played a role. "Polio isn't eradicated until it's eradicated everywhere," Larson said. The polio case discovered in the Rockland County man has been genetically linked to strains of vaccine-derived virus found in water in Israel and the U.K. How it traversed the globe and reached a New York suburb is still being investigated. While most of us think of polio as causing paralysis or trapping children in iron lungs, those severe cases are relatively rare. For every paralytic case of "wild" polio, there are probably 100 to 200 more mild cases. For the vaccine derived type that the patient in Rockland County, as few as one in 2,000 could suffer paralysis, according to one expert familiar with CDC work on the case. These milder cases may not be recognized as polio but they can still spread to other people. And while doctors are still taught about polio, many of them have never seen a case — and it's not necessarily the first thing they think of when they see a patient with flu-like symptoms. Plus, some cases are so mild that people don't seek medical care, but they could still infect the unvaccinated. The Centers for Disease Control on Sept. 1 offered a webinar to refresh U.S. doctors on polio history and diagnosis — and a reminder to check that their patients are up to date on vaccination. In an era when we're still dealing with Covid, monkeypox and possibly a bad flu outbreak this year, the last thing we want to see befall people is polio. Don't let confusing "vaccine-derived" terminology "deter you from protecting yourself," said my Johns Hopkins colleague Josh Sharfstein, who, as a former FDA deputy commissioner and a former Maryland and Baltimore health commissioner, has learned a thing or two about public health crisis communication. Most Americans are already vaccinated — but for anyone who wasn't, or who can't access childhood vaccination records to find out — getting another shot as an adult is not dangerous, both Sharfstein and Larson stressed. Meanwhile, the number of counties with vaccine-derived polio had been declining. This year it's up again, to around 30, according to the CDC. This month, the U.S. was added to the list. Welcome to POLITICO Nightly. Reach out with news, tips and ideas at nightly@politico.com. Or contact tonight's author on Twitter at @JoanneKenen. The FDA today warned about the dangers of cooking chicken in NyQuil as part of a broader update on the dangers of social media challenges. Yes, really.
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