Israel Pediatric Association urges immediate vaccination drive against polio

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The Israeli Pediatric Association (IPA) issued an urgent call on Sunday to the government and the medical community to address the ongoing polio outbreak quickly and aggressively.

The Governing Body – the umbrella organization for the Israel Ambulance Pediatric Society and the Israel Clinical Pediatric Society – issued a position paper outlining the causes of the outbreak and the steps needed to contain it. The paper said the first priority is 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 complete protection against the viral disease that can cause paralysis, disability, and death.

Four children have been diagnosed with polio since the end of February. The first was an unvaccinated 8-year-old boy in Safed who was taken to hospital with paralysis in his limbs. The other three were in contact with the boy and tested positive, but did not show any symptoms.

According to Dr. Liat Ashkenazi-Hoffnung, director of the day care hospital department at Schneider Children’s Medical Center, the current polio outbreak is caused by the cVDPV2 polio strain, which has not previously circulated in Israel.

“We know that this strain is identical to the 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, and the pressure seems to have been brought to bear on Israel,” Ashkenazi-Hoffnung said.

“The OPV [oral polio vaccine] it does not prevent the spread of this strain of cVDPV2 administered in Israel. That means the only way to fully protect a child and those they interact with against this strain is to get the IPV vaccine,” she said.

Dr. Liat Ashkenazi Hoffnung, director of the day care hospital department at Schneider Children’s Medical Center. (Courtesy of Schneider Children’s Medical Center)

In Israel, the polio vaccination regimen involves four IPV shots given before 18 months of age, and another when the child is in second grade. Infants and children are also given two doses of the oral polio vaccine (OPV) which is taken by mouth to provide full protection and to prevent the virus from being passed through the stool into the sewage system. It also prevents young children from infecting others.

Poliomyelitis is spread mainly through faecal-oral contamination. Less commonly, the disease can be transmitted through droplets of saliva emitted into the air.

“If we could achieve global extinction [of polio]then we would be able to move to IPV alone, but since there are strains, the OPV is the only way to reduce stool excretion,” said Ashkenazi-Hoffnung.

Between 1988 and 2022, no clinical cases of polio were reported in Israel. The symptomatic disease reappeared in March last year when an unvaccinated girl in Jerusalem became paralyzed and was diagnosed with polio. This, together with the fact that vaccine-induced poliovirus type 3 (VDPV3) was found in random samples of sewage and stool, put Israel on the World Health Organization’s Poliomyelitis Eradication Initiative list of countries with outbreaks.

This was followed last year by a national campaign to fully vaccinate unvaccinated children from birth to 17 years of age.

The second dose of OPV has only been part of the regimen since 2015, so older children who only received one dose were expected to receive the second through the 2022 campaign. The campaign succeeded in increasing polio vaccination coverage provided to children, and 37,000 received their shots during the campaign. Ninety-six percent of children also received their two doses of OPV.

A medical clown makes faces as an Israeli boy receives a polio vaccination, August 19, 2013. (Yossi Zeliger/Flash90)

“We reached 85 percent OPV coverage among younger children, which is great. And among young children and teenagers aged 10-17, we reached 50% percent, which is not bad,” said Ashkenazi-Hoffnung.

“The virus spread on the sewage was cleaned, and WHO took the dot off the map next to Israel,” she said.

Clinical cases of poliomyelitis occur in unvaccinated populations

According to Israel Pediatric Society 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 do not always comply with routine visits to well-child clinics and pediatricians. These families tend to live in close quarters, where diseases can easily be passed from one child to another.

“To vaccinate or not to vaccinate is not an ideological issue 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 at risk of polio and urged both adults and children to practice good hygiene (especially thorough and frequent cleaning) as well as vaccination.

Israel Pediatric Society President Prof. Zachi Grossman (Courtesy)

Grossman and Ashkenazi-Hoffnung are members of the Administration’s working group on children with polio, as well as the Ministry of Health’s ad hoc committee on polio. They both said the position paper issued on Sunday was meant to inform family physicians, pediatricians and other health care workers about the polio outbreak. If a child comes in with a limp or other weakness, stool tests should be done to determine if the polio virus is the cause, the working group said.

According to Grossman, the paper was also a petition to the government to allocate more resources to an immediate vaccination drive.

“The highest level of government must support the creation of mobile vaccination units that will go out to neighborhoods and homes. We’re not going to get a lot of the unvaccinated kids out unless we go to them,” Grossman said.

The Ministry of Health said that it is planned to launch such an operation on March 29.

“There is a defined budget aimed at increasing manpower to deliver vaccines to homes. A vendor was selected after a tender, and nurses working for the vendor will be professionally trained… The home vaccination service will be available to families who request it, and there will be an expansion of vaccination efforts at the well-child clinics,” said the ministry in an email.

Following the current polio outbreak, the New York State health department requested on March 10 that residents be 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 advised the public to take precautions against polio before traveling also to the United Kingdom, Ukraine, Afghanistan, Pakistan, Indonesia, Nigeria, Côte d’Ivoire, and several other countries in Central Africa.

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