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Clinical Laboratories and Pathology Groups

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New Case of Polio Diagnosed in New York, Poliovirus Found in Wastewater in Two Counties

Experts say it is time ‘to restore our confidence in vaccines’ as many medical laboratories take steps to support testing for the polio virus

Clinical laboratories and microbiologists in the state of New York will want to know that, in July, a man in New York was diagnosed with polio and subsequently the virus was detected in the wastewater of two New York counties.

The area, Rockland County, N.Y., just north of New York City, was also at the forefront of a measles outbreak that occurred in 2018 and 2019. The outbreak was attributed to low vaccination rates within the community.

The unidentified, immunocompetent young man was admitted to a New York hospital after experiencing a low-grade fever, neck stiffness, back and abdominal pain, constipation, and lower extremity weakness. He eventually developed paralysis from the disease, which is irreversible. 

Poliomyelitis, commonly known as polio, is a disabling and life-threatening disease that is caused by the poliovirus. Though it rarely surfaces in the United States, there is now confirmation of the first US case since 2013.

Mary T. Bassett, MD

“The polio vaccine is safe and effective, protecting against this potentially debilitating disease, and it has been part of the backbone of required, routine childhood immunizations recommended by health officials and public health agencies nationwide,” said Mary T. Bassett, MD (left), Health Commissioner at the New York Department of Health, in a press release. Clinical laboratories and microbiologists in New York may want to prepare for an increase in vaccination requests. (Photo copyright: Time.)

Is Polio Back in America? Clinical Laboratories Will Want to Be Prepared

“I think it’s concerning because it can spread,” epidemiologist Walter Orenstein, MD, Professor, Department of Medicine, Division of Infectious Diseases at Emory University School of Medicine told STAT. “If there are unvaccinated communities, it can cause a polio outbreak.”

According to the federal Centers for Disease Control and Prevention (CDC), public health experts are working diligently to discover how and where the infected individual contracted polio. The CDC website states that the risk for people who have received the polio vaccine is very low, but there is concern for those who have not received the recommended doses of the vaccine.

“Most of the US population has protection against polio because they were vaccinated during childhood, but in some communities with low vaccine coverage, there are unvaccinated people at risk,” the CDC noted. “Polio and its neurologic effects cannot be cured but can be prevented through vaccination.”

The US uses an injectable polio vaccine for the poliovirus which contains killed viruses. The vaccine “instructs” the immune system to recognize and combat the virus. This inactivated polio vaccine (IPV) is administered to children as a shot in the arm or leg and is typically given in four separate doses.

“The inactivated polio vaccine we have is very effective and very safe and could have prevented this,” Orenstein told STAT. “We need to restore our confidence in vaccines.”

“Based on what we know about this case, and polio in general, the (New York) Department of Health strongly recommends that unvaccinated individuals get vaccinated or boosted with the FDA-approved IPV polio vaccine as soon as possible,” said Mary T. Bassett, MD, Health Commissioner at the New York Department of Health in a press release.

Poliovirus Found in Wastewater via Use of Gene Sequencing

Poliovirus is very contagious and is transmitted through person-to-person contact. The virus lives in an infected person’s throat and intestines and can contaminate food and water in unsanitary conditions. According to the CDC, typical symptoms of the illness include flu-like symptoms such as:

  • Sore throat
  • Fever
  • Tiredness
  • Nausea
  • Headache
  • Stomach pain

Most of these symptoms will disappear within five days, but polio can invade the nervous system and cause more serious complications, such as meningitis, paralysis, and even death.

After confirmation of the new case of polio, wastewater surveillance detected the presence of the poliovirus in Rockland and Orange counties, New York.

Wastewater analysis can uncover pathogens within a community and has been used in the fight against other infectious diseases, including:

“In some regards, wastewater is a public health dream scenario,” said Mark Siedner, MD, an infectious disease doctor at Massachusetts General Hospital and associate professor at Harvard Medical School, in an interview with Fortune. “Everyone poops, and most people poop every day. It provides real-time data on infection rates. In that regard, it’s an extremely powerful tool, particularly good at detecting early warning signs. Before people get sick, we might get a signal.”

Wastewater analysis can provide insights regarding the types of viruses that people within a community are shedding and if the volume of those viruses are increasing. This information can provide scientists with an early marker for an outbreak of an illness that is on the verge of spreading.

Microbiologists and clinical laboratories should be aware of the specific types of infectious agents public health authorities are detecting in wastewater, even as they perform screening and diagnostic tests on their patients for similar infectious diseases.

Polio is Appearing Worldwide

The Global Polio Eradication Initiative (GPEI) has announced that new cases of polio have been reported in Israel and the United Kingdom. These are countries where polio cases are extremely rare. 

This indicates that microbiologists and clinical laboratories managers will want to be on constant alert for uncommon infectious diseases that may appear suddenly, even if those illnesses are rare. Accurate and immediate diagnoses of such infectious diseases could play a major role in triggering a public health response to control potential outbreaks while they are in their earlier stages.

JP Schlingman

Related Information:

N.Y. State Detects Polio Case, First in the U.S. Since 2013

US Polio Case Tied to Viruses Detected in UK, Israel, Suggesting Silent Spread

New York Adult Diagnosed with Polio, First US Case in Nearly a Decade

New York State Department of Health and Rockland County Department of Health Alert the Public to a Case of Polio in the County

Public Health Response to a Case of Paralytic Poliomyelitis in an Unvaccinated Person and Detection of Poliovirus in Wastewater—New York, June—August 2022

Polio Found in New York Wastewater as State Urges Vaccinations

Polio is Found in the UK For the First Time in Nearly 40 years. Here’s What It Means

Poliovirus Detected in Sewage from North and East London

Can’t Help Falling in Love with a Vaccine: How Polio Campaign Beat Vaccine Hesitancy

Vaccine-derived Polio Is on the Rise. A New Vaccine Aims to Stop the Spread

Statement of the Thirty-first Polio IHR Emergency Committee

What is Polio?

Did I Get the Polio Vaccine? How to Know If You Are Protected Against the Virus

Polio Detected in New York City Sewage Suggesting Local Circulation of Virus, Health Officials Say

Wastewater Is Trying to Tell Us Something about the Future of COVID, Polio, Monkeypox, and the Next Epidemic to Come

‘Silent’ Spread of Polio in New York Drives CDC to Consider Additional Vaccinations for Some People

Updated Statement on Report of Polio Detection in United States

Disease Investigators Track a Growing Number of Pediatric Hepatitis Cases Appearing Around the World

CDC asks physicians and clinical laboratories to be on the lookout and report symptoms of hepatitis to state health departments

Growing incidences of hepatitis in children are perplexing medical professionals and researchers in several countries around the world. The mysterious outbreak is occurring in otherwise healthy children and, to date, is of unknown origin, though an adenovirus may be involved.

Microbiologists and clinical laboratory scientists who perform virology testing may want to prepare for increased numbers of children presenting with hepatitis symptoms in the US.

On April 21, the Centers for Disease Control and Prevention (CDC) issued a nationwide health alert to notify the public about a cluster of children in Alabama who presented with hepatitis and adenovirus infections. The CDC asked physicians to watch for symptoms in children and to inform local and state health departments of any new suspected cases. 

Also in April, the World Health Organization (WHO) issued its own alert to an outbreak of acute hepatitis of unknown etiology among young children in several countries. In addition to the United States, cases were reported in the United Kingdom, Spain, Israel, Denmark, Ireland, the Netherlands, Italy, Norway, France, Romania, and Belgium.

All the cases reported to the WHO involved children between one month and 16 years of age with the majority of cases occurring in children under five.

According to NBC News, as of May 19, the worldwide number of cases “under investigation” had reached 600 in more than 25 countries. In the US, more than 90% of the patients required hospitalization and 14% of those patients needed a liver transplant. The CDC is investigating five pediatric deaths that may be attributed to the mysterious hepatitis outbreak. 

Jay Butler, MD
 
“Fifteen days ago, CDC issued a nationwide health alert to notify clinicians and public health authorities about an investigation involving nine children in Alabama identified between October of 2021 and February of 2022 with hepatitis or inflammation of the liver and adenovirus infection,” said pediatrician and epidemiologist Jay Butler, MD (above), Deputy Director for Infectious Diseases at the CDC. “We’re casting a broad net to increase our understanding,” he added. “As we learn more, we’ll share additional information and updates.” Hospital-based clinical laboratories that support emergency departments and urgent care centers with testing for hepatitis will want to monitor for upcoming CDC alerts. (Photo copyright: John Amis/AP/CNN.)

Adenovirus/SARS-CoV-2 May Be Linked to Hepatitis Outbreak

The cause of the hepatitis outbreak is as yet undetermined, but the pre-eminent theory among disease experts points to the presence of an adenovirus, which often causes cold and flu-like symptoms in addition to stomach issues. 

NBC News reported that more than half of the US patients, 72% of the UK patients, and 60% of the affected patients across Europe tested positive for human adenovirus type 41. This virus, however, is generally not associated with hepatitis in healthy children, and rarely impacts the liver so severely. 

Medical experts are also considering the possibility that COVID-19 infections could somehow be an underlying cause since the hepatitis outbreak occurred during the pandemic. The WHO is investigating whether exposure to the SARS-CoV-2 coronavirus might have prompted the immune systems in the infected children to react abnormally to adenoviruses that are typically non-life threatening. 

“The big focus over the next week is really looking at the serological testing for previous exposure and infections with COVID,” Phillipa Easterbrook, MD, a senior scientist at the WHO headquarters in Geneva, told NBC News.

Hepatitis, or inflammation of the liver, is typically caused by heavy alcohol use, exposure to toxins, certain medical conditions and medications, or a virus.

According to the CDC, symptoms of hepatitis include:

  • Fever
  • Fatigue
  • Loss of appetite
  • Nausea
  • Vomiting
  • Abdominal pain
  • Dark urine
  • Light-colored stools
  • Joint pain
  • Jaundice

The most recent children diagnosed with hepatitis presented with some or most of these symptoms, particularly stomach issues and fatigue. However, one symptom was present in all the children.

“The big symptom that made all of these kids different was that they all showed signs of jaundice, which is the yellowish coloration of the skin and eyes,” Markus Buchfellner, MD, a pediatric infectious disease fellow at the University of Alabama, told NBC News.

Buchfellner was the first person in the US to notice an unusual pattern of hepatitis among children. He reported his findings to the CDC last fall in 2021.

“We were able to uncover the possible association with the adenovirus 41 strain because it is our standard practice to screen patients diagnosed with hepatitis for adenovirus,” he said. “For us to dig deeper into this medical mystery and see if this strain is the cause of these severe hepatitis cases, we first need more data on how widespread the outbreak is.”

Adenovirus 41 is usually spread through fecal matter, which makes hand washing critical, especially after visits to the bathroom or diaper changes. This type of adenovirus typically presents as diarrhea, vomiting, and fever, and is often accompanied by respiratory issues.

Clinical Labs Performing Gene Sequencing Can Help

Medical scientists around the world are responding to this threat to the youngest and most vulnerable among us. Research is underway into identifying additional cases, determining what is causing the hepatitis globally among children, and establishing preventative measures.

Pathologists and clinical laboratory managers in the US will want to be on the alert for positive hepatitis tests in children whose specimens were tested at their facilities. With advances in gene sequencing that make testing economical and expeditious, more labs have the ability to not only detect hepatitis, but also to identify any genetic variants that may be associated with the increased number of pediatric hepatitis cases appearing around the world.

JP Schlingman

Related Information:

As Mysterious Child Hepatitis Cases Swell, Scientists Study Symptoms and Causes

With Usual Suspects Ruled Out, Disease Detectives Try to Crack Mystery of Viral Hepatitis Cases in Kids

CDC Alerts Providers to Hepatitis Cases of Unknown Origin

Hepatitis Outbreak in Children: What to Know

CDC Gives New Information about Mysterious Hepatitis Cases in Children

CDC Investigating 109 Unusual Hepatitis Cases in Kids in Outbreak

WHO: Multi-country—Acute, Severe Hepatitis of Unknown Origin in Children

UK Research Team Develops Diagnostic USB Device That Detects HIV and Measures Viral Load from Human Blood for Use in Developing Countries

Clinical laboratory assays on a USB stick could become a powerful tool in the treatment and containment of HIV-1 in low-resource regions, such as sub-Saharan Africa

Imagine a small USB device that plugs into a computer and, using a small sample of blood, is capable of detecting the presence of HIV and measuring its viral load in that individual. Such technology exists and was created by a team of scientists in the United Kingdom (UK).  However, it is not yet ready for use by clinical laboratories.

Researchers at Imperial College London company, DNA Electronics, have developed a diagnostic USB stick that measures the presence of human immunodeficiency virus (HIV), as well as the viral load in a person’s blood, and in less than 30 minutes. The platform promises to be an important milestone for the medical laboratory treatment and containment of pandemic diseases that pose a serious threat to global health.

A story published on the mobile technology news blog Quartz pointed out that more than 24-million of the 37-million people worldwide infected with HIV live in sub-Saharan Africa. It is widely recognized that high cost and lack of access to medical care and clinical laboratory services remain a barrier to diagnosis, treatment, and containment of the disease. “[I]mproving diagnostics is now a key part of global strategies to combat [HIV],” wrote the study authors in a paper published in Nature Research journal Scientific Reports. (more…)

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