Polio in Israeli sewage systems ignites debate on vaccination

As Israeli children begin their school year, one particular requirement for students is taking on a somewhat sudden and newfound sense of urgency—inoculation against polio.

The disease, which many in Israel had believed to be completely eradicated for more than two decades, has recently been identified in sewage systems—first in the south and then in the north of the country—during routine testing.

Many across Israel are invoking thoughts of a biblical-style plague outbreak, even though no formal cases of the disease have been reported.

“There has not been an outbreak of polio since a few cases were reported in Israel in 1988,” Dr. Mati Ehrlichman, director of the Glaubach Department of Pediatric Emergency Medicine at Jerusalem’s Shaare Zedek Medical Center, told JNS.org.

Yet suddenly, as a result of the sewer system findings and the potential for immune-deficient children to contract the disease, Israel’s Health Ministry has launched a rapid campaign to immediately inoculate children using an oral form of polio vaccination (OPV), which the Health Ministry has not offered children for nearly 10 years.

Like many sudden Israeli initiatives, the decision to vaccinate has been met with some opposition and controversy, by a group that believes that spreading the vaccination may be more dangerous than the disease itself.

A petition was recently taken to Israel’s Supreme Court to halt the issue of the vaccine. The petition was quickly heard and rejected. The controversy surrounds the ability of the oral vaccination to spread to those who have not received it.

“There are two kinds of vaccination against polio,” said Dr. Ehrlichman. “One is called IPV (Inactivated Poliovirus Vaccine) and it is not given orally. Jonas Salk, who was Jewish, invented it in the ’50s. The OPV (Oral Polio Vaccination) was invented years later by Albert Sabin.”

“The only difference between the two is that the IPV is not a live vaccine. The OPV is live vaccine. The IPV, the non-live vaccine is a little better because there is no chance of developing wild polio virus. But it only vaccinates the one who is getting the vaccine, not the others who are not getting the vaccine. With OPV, even those who are not receiving the vaccine can get vaccinated, because the vaccine can be passed from one to another across the country,” Ehrlichman explained.

It is this ability to spread itself that has some in Israel worried that an outbreak of polio may be more likely to develop from the widespread distribution of the vaccination than from of the traces of the virus itself found in sewage.

Furthermore, the oral vaccine is not typically administered in developed nations.

Health officials, however, contend that the ability of the oral vaccine to protect an entire population from an outbreak well outweigh the risks that the vaccine may actually spread polio.

According to Ehrichman, the chances that the virus would spread through the vaccine itself are extraordinarily rare, due to the fact that it is not the full virus that is being administered, but rather a heavily weakened version of the virus designed to help individuals develop immunity to the full virus.

“It is not the virus,” Ehrichman said. “It is the live attenuated virus within the vaccine. The benefit is that those who have not received the vaccine, they can be vaccinated even without getting the vaccine by mouth.”

During the 1950s, Israeli children were initially only offered the IPV, as this was and still is considered to be an effective form of vaccination for those who take it. Then, according to Ehrlichman, in 1988 there were some cases of wild Polio, so the Health Ministry added OPV. From 1988 to 2004, all Israeli children got both vaccinations. After 2004, the Health Ministry decided to stop the OPV vaccination, like other developed countries, and to give only IPV.

“Now, because we have found some wild polio in the sewer, the Health Ministry has decided to administer OPV, with the hope that the entire disease will be eradicated,” Ehrlichman said. “The adding of this vaccination is not dangerous at all, and it is only added as another opportunity to eradicate the virus.”

“The chances are very low that anybody should get the virus. But as we saw in 1988, some children got the virus, so we should be careful,” Ehrlichman added.

When asked how polio, a disease that is only endemic in three countries—Afghanistan, Nigeria, and Pakistan—could spread to Israel, a developed nation whose children have been receiving vaccinations for decades, Ehrlichman posited, “I think it is possibly coming from Arab states, or from Bedouin in Sinai.”

“In the Palestinian Authority, children are given both vaccinations. In Egypt they give both. In Jordan they are giving both vaccinations because the disease was never fully eradicated,” Ehrlichman said.

Even if contracted, the chances that a child would become permanently disabled from the virus are slim. For most individuals who contract the virus, the symptoms are relatively minor, and most symptoms—including paralysis—are often fully resolved.