Public Health Response to a Case of Paralytic Poliomyelitis in an Unvaccinated Person and Detection of Poliovirus in Wastewater

New York, June-August 2022

Ruth Link-Gelles, PhD; Emily Lutterloh, MD; Patricia Schnabel Ruppert, DO; P. Bryon Backenson, MS; Kirsten St. George, PhD; Eli S. Rosenberg, PhD; Bridget J. Anderson, PhD; Meghan Fuschino, MS; Michael Popowich; Chitra Punjabi, MD; Maria Souto, MPH; Kevin McKay, MPH; Samuel Rulli; Tabassum Insaf, PhD; Dustin Hill, PhD; Jessica Kumar, DO; Irina Gelman, DPM; Jaume Jorba, PhD; Terry Fei Fan Ng, PhD; Nancy Gerloff, PhD; Nina B. Masters, PhD; Adriana Lopez, MHS; Kathleen Dooling, MD; Shannon Stokley, DrPH; Sarah Kidd, MD; M. Steven Oberste, PhD; Janell Routh, MD


Morbidity and Mortality Weekly Report. 2022;71(33):1065-1068. 

In This Article

Abstract and Introduction


On July 18, 2022, the New York State Department of Health (NYSDOH) notified CDC of detection of poliovirus type 2 in stool specimens from an unvaccinated immunocompetent young adult from Rockland County, New York, who was experiencing acute flaccid weakness. The patient initially experienced fever, neck stiffness, gastrointestinal symptoms, and limb weakness. The patient was hospitalized with possible acute flaccid myelitis (AFM). Vaccine-derived poliovirus type 2 (VDPV2) was detected in stool specimens obtained on days 11 and 12 after initial symptom onset. To date, related Sabin-like type 2 polioviruses have been detected in wastewater* in the patient's county of residence and in neighboring Orange County up to 25 days before (from samples originally collected for SARS-CoV-2 wastewater monitoring) and 41 days after the patient's symptom onset. The last U.S. case of polio caused by wild poliovirus occurred in 1979, and the World Health Organization Region of the Americas was declared polio-free in 1994. This report describes the second identification of community transmission of poliovirus in the United States since 1979; the previous instance, in 2005, was a type 1 VDPV.[1] The occurrence of this case, combined with the identification of poliovirus in wastewater in neighboring Orange County, underscores the importance of maintaining high vaccination coverage to prevent paralytic polio in persons of all ages.

*Wastewater, also referred to as sewage, includes water from household or building use (e.g., toilets, showers, and sinks) that can contain human fecal waste and water from non-household sources (e.g., rain and industrial use).