The Israel Pediatric Association (IPA) issued an urgent call on Sunday for the government and medical community to address an ongoing polio outbreak quickly and aggressively.
The IPA — the umbrella organization for The Israel Ambulatory Pediatric Association and Israel Society for Clinical Pediatrics — released a position paper outlining what it said were the reasons for the outbreak and the steps needed to curb it. The paper said that first priority was to identify and vaccinate the 175,922 Israeli children who have not received any doses of the inactivated polio vaccine (IPV), a series of shots that provide full protection against the viral disease that can cause paralysis, disability, and death.
Four children have been diagnosed with polio since late February. The first was an unvaccinated 8-year-old boy in Safed who was brought to the hospital with paralysis in his limbs. The other three had been in contact with the boy and tested positive, but did not exhibit any symptoms.
According to Prof. Liat Ashkenazi-Hoffnung, director of the day care hospitalization department at Schneider Children’s Medical Center, the current polio outbreak is caused by the cVDPV2 polio strain, which had not previously circulated in Israel.
“We know that this strain is identical to one found in London and New York and that there was also a clinical case in New York. Israel has populations that interact with populations in those places, which is apparently how the strain was introduced to Israel,” Ashkenazi-Hoffnung said.
“The OPV [oral polio vaccine] administered in Israel does not prevent the spread of this cVDPV2 strain. That means the only way to fully protect a child and those he interacts with against this strain is to receive the IPV vaccine,” she said.
In Israel, the polio vaccination regimen involves four IPV shots given before age 18 months, and another when the child is in second grade. Babies and toddlers are also given two oral polio vaccine (OPV) doses taken by drops into the mouth to provide full protection and prevent the shedding of the virus through the stool into the sewage system. It also prevents young children from infecting others.
Polio is primarily spread through fecal-oral contamination. Less commonly, the disease can be passed through saliva droplets emitted into the air.
“If we could reach global eradication [of polio], then we would we would be able to move to IPV only, but since there are circulating strains, the only way to diminish stool excretion is by the OPV,” Ashkenazi-Hoffnung said.
Between 1988 and 2022, there were no clinical cases of polio reported in Israel. The symptomatic disease reemerged in March of last year when an unvaccinated girl in Jerusalem presented with paralysis and was diagnosed with polio. This, together with the fact that vaccine-derived poliovirus type 3 (VDPV3) was found in random sewage and stool samples, landed Israel on the World Health Organization’s Polio Eradication Initiative’s list of countries with outbreaks.
This was followed by a nationwide campaign last year to fully vaccinate unvaccinated children from birth to age 17.
It is only since 2015 that a second OPV dose has been part of the regimen, so it was hoped that older children who had received only one dose would get their second through the 2022 campaign. The campaign succeeded in providing polio vaccination coverage for babies, with 37,000 receiving their shots during the campaign. Ninety-six percent of babies also received their two OPV doses.
“We reached 85 percent OPV coverage among younger children, which is excellent. And among the preteens and teens ages 10-17, we reached 50% percent, which is not bad,” Ashkenazi-Hoffnung said.
“The sewage was cleared of the circulating virus, and WHO removed the dot off the map next to Israel,” she said.
Clinical cases of polio emerge among unvaccinated populations
According to Israel Pediatric Association president Prof. Zachi Grossman, communities with low vaccination rates are not anti-vaxxers per se. Rather, they are generally Haredi families with many children who don’t always keep up with routine visits to well-baby clinics and pediatricians. These families also tend to live in close quarters, where diseases can easily be passed from one child to another.
“Vaccination or non-vaccination is not a matter of ideology for these people. It’s a practical and technical issue of getting their kids to the clinics,” Grossman said.
However, he warned that children from all communities are vulnerable to polio and urged adults and children alike to practice good hygiene (especially thorough and frequent handwashing) in addition to vaccinating.
Grossman and Ashkenazi-Hoffnung are members of the IPA’s working group on children with polio, as well as the Health Ministry’s ad hoc committee on polio. They both said that the position paper issued on Sunday was meant to make family physicians, pediatricians, and other healthcare workers aware of the polio outbreak. If a child comes in with a limp or other weakness, stool tests should be carried out to determine whether the cause is the polio virus, the working group said.
According to Grossman, the paper also constituted a plea to the government to allocate more resources toward an immediate vaccination drive.
“The top level of the government has to support the creation of mobile vaccination units that will go out to neighborhoods and homes. We will only reach many of the unvaccinated kids if we go to them,” Grossman said.
The Health Ministry said that it is planning to launch such an operation on March 29.
“There is a designated budget aimed at increasing manpower to bring vaccinations to homes. A vendor has been chosen following a tender, and nurses working for the vendor will undergo professional training… The home vaccination service will be available to families requesting it, and there will be an expansion of vaccination efforts at the well-baby clinics,” the ministry said in an email.
Following the current polio outbreak, the State of New York’s health department called on March 10 for residents to get vaccinated against polio before traveling to Israel. The department’s statement urged all travelers to follow guidelines from the US Center for Disease Control, which has advised the public to take precautions against polio before also traveling to the United Kingdom, Ukraine, Afghanistan, Pakistan, Indonesia, Nigeria, Côte d’Ivoire, and several other central African countries.