Public Health Chief Says Likely Hundreds of Asymptomatic Polio Cases in Israel

Health services say sewage testing revealed the virus only in the Jerusalem area. Health Ministry urges residents to push vaccine doses forward

Ido Efrati
Ido Efrati
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A polio vaccine in Tel Aviv, 2013.
A polio vaccine in Tel Aviv, 2013. Credit: Moti Milrod
Ido Efrati
Ido Efrati

Following the Health Ministry’s announcement that a 4-year-old Jerusalem girl was diagnosed with polio, Dr. Sharon Alroy-Preiss, head of public health services at the ministry, said Monday, “There are at least dozens or hundreds [of people in Israel infected with polio] who are apparently asymptomatic. We do not expect a wave of children to show up with symptoms, but we understand that the virus is around. A vaccinated child is a protected child.”

Alroy-Preis stressed that “we are very far from an uncontrolled outbreak. We are preventing it by locating those around and vaccinating the unvaccinated.” Ministry sewage tests show that the polio virus is present only in the Jerusalem district, she added.

The girl, who was unvaccinated against polio, represents the first case in Israel since 1988, the Health Ministry announced Sunday.

Alroy-Preis said the supposition is that she was infected by an immunosuppressed person who was vaccinated against polio, and the weakened virus mutated in that person’s body, probably due to the immune system’s difficulty in expelling the virus.

The Health Ministry further announced that the Jerusalem District health bureau launched an epidemiological investigation and will be contacting people who were in close contact with the girl for specific instructions. Decisions on further steps will be made in accordance with the investigation results.

Alroy-Preis said her office seeks “to ensure that all children, especially in the Jerusalem District, will be in their best immune condition – meaning that they complete their vaccinations as per Health Ministry recommendations. As for polio, there are four vaccine doses given over the first year of life. Current recommendations are to push the vaccinations forward, (to give) the first dose at six weeks of age and the second at 12 weeks, to ensure that we’re protecting the children. For now only in the Jerusalem District.”

The 4-year-old girl was brought in for treatment at Hadassah Ein Karem hospital. Prof. Shimon Reif, head of pediatrics at the hospital, said that initial suspicion was aroused due to neurological symptoms such as weakness in the leg muscles and others. “Tests conducted with the involvement of a pediatric neurologist confirmed that it is polio,” said Reif. The girl was treated at the hospital for a week, and following improvement in her condition she was transferred for rehabilitative treatment due to muscle damage – a familiar phenomenon among polio patients.

As far as is known, the infected girl initially developed a weakness on one side of her body, but was not hospitalized. The case was discovered following routine monitoring for the virus conducted by the Health Ministry in the sewage in the area where the girl lives. Such findings occur from time to time in the monitoring, but until now no illnesses were found.

The polio vaccine is currently administered in four doses at the ages of two months, four months, six months and one year. A booster shot is administered as part of the second-grade vaccinations around age seven. The rate of those who received all four doses among those born in 2020 in Jerusalem stands at 83 percent, but there are areas where vaccination rates are particularly low, around 50 percent. The Health Ministry is now working on segmenting the population in order to concentrate its efforts on vaccinating those who have not yet done so.

In 2013 there was a polio outbreak in Israel leading to a national vaccination drive. The drive was launched based on samples of the virus in the wastewater, indicating its presence and spread in Israel. Over the course of the drive close to one million children were vaccinated within about four months, many in areas where vaccination rates were low. Following the drive vaccination rates rose, and Israel once again enjoyed herd immunity.

The virus has three [known] strains and most people infected develop no symptoms at all, or mild symptoms typical of many illnesses, such as fever, loss of appetite, sore throat, and weakness. Some 4-8 percent of those infected contract a mild case of meningitis, characterized by full spontaneous recovery within days. A tiny fraction of cases – about one in a thousand people infected – will develop paralysis symptoms. In addition, the penetration of the virus to the nervous system may lead to respiratory failure, which is one of the most common and threatening complications of the disease.

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