Nearly one million children under 10 in London will be offered an urgent polio booster vaccine after health chiefs confirmed the paralysis-causing virus is spreading in the capital.
In the first outbreak of polio in the UK in more than 40 years, the virus has been detected more than 100 times in sewage water in eight boroughs in the north and north-east of the city.
Parents and carers with children aged one to 10 will be contacted by their GP within the next month and offered a jab appointment.
While the virus is known to cause paralysis in up to one in 100 people it infects, there are particular concerns for young children who are at higher risk.
Health chiefs first declared a national incident in June after picking up on early fragment of the virus, which were thought to be linked to just one household in north east London in February.
But today the UK Health Security Agency announced it has now been detected 116 times in the capital, where vaccine uptake in children is as low as 55 per cent in some places.
No-one has officially been diagnosed with the virus by a doctor yet but experts believe it is transmitting unchecked in London because it has been repeatedly detected in waste water.
Health chiefs noted that the risk to the public is low because most people are already protected from vaccinations given in childhood.
However, uptake rates are some of the lowest in the country in the boroughs where the virus is spreading — Barnet, Brent, Camden, Enfield, Hackney, Haringey, Islington and Waltham Forest.
The level of the virus spotted and the diversity of the samples suggests the virus is transmitting in the population and has ‘gone beyond a close network of a few individuals, the UKHSA said.
The above map, based on UKHSA data, looks at the share of Year 9s who had all three polio jabs in the 2020/2021 academic year. The final polio booster is offered to all children by the age of 14 as part of the NHS school vaccination programme
The polio vaccine is given at age eight, 12 and 16 weeks as part of the six-in-one vaccine and then again at three years as part of a pre-school booster. The final course is given at age 14. The World Health Organization has set the threshold of a successful school jabs programme at 95 per cent uptake, which England is failing to hit by all accounts
The virus was detected at the Beckton sewage treatment works, which covers a population of four million in north and east London
WHAT IS POLIO?
Polio is a serious viral infection that used to be common all over the world.
The virus lives in the throat and intestines for up to six weeks, with patients most infectious from seven to 10 days before and after the onset of symptoms.
But it can spread to the spinal cord causing muscle weakness and paralysis.
The virus is more common in infants and young children and occurs under conditions of poor hygiene.
How deadly is it?
Most people show no signs of infection at all but about one in 20 people have minor symptoms such as fever, muscle weakness, headache, nausea and vomiting.
Around one in 50 patients develop severe muscle pain and stiffness in the neck and back.
Less than one per cent of polio cases result in paralysis and one in 10 of those result in death.
Of those who develop symptoms, these tend to appear three-to-21 days after infection and include:
- High temperature
- Sore throat
- Abdominal pain
- Aching muscles
- Nausea and vomiting
How does it spread?
People can catch polio via droplets in the air when someone coughs or sneezes, or if they come into contacted with the faeces of an infected person.
This includes food, water, clothing or toys.
Are there different strains?
There are three strains of ‘wild’ polio, which has been largely eradicated throughout Europe, the Americas, Southeast Asia and the Western Pacific.
Types 2 and 3 were eliminated thanks to a global mass vaccine campaign, with the last cases detected in 1999 and 2012 respectively.
The remaining, type 1, wild polio remains endemic in only two countries, Afghanistan and Pakistan.
Wild polio has been eliminated in almost every country in the world thanks to vaccines.
But the global rollout has spawned new types of strains known as vaccine-derived polioviruses.
These are strains that were initially used in live vaccines but spilled out into the community and evolved to behave more like the wild version.
Is polio still around in the UK?
The last polio outbreak was in the 1970s.
The last case of person-to-person transmission in the UK was in 1984, which also marked the last wild polio case.
But there have been several dozen cases of vaccine-derived polioviruses, although they have been one-offs, with no onward transmission.
Am I vaccinated against polio?
The polio vaccine is offered as part of the NHS routine childhood vaccination programme.
It is given at age eight, 12 and 16 weeks as part of the six-in-one vaccine and then again at three years as part of a pre-school booster. The final course is given at age 14.
Uptake has fallen slightly nationally during the Covid pandemic but remains above 90 per cent nationally. Rates are lower in London and in poor and ethnic minority communities.
Just 86.7 per cent of one-year-olds in London have had their first dose dose of polio vaccine compared to the UK average of 92.6 per cent.
There are concerns vaccine hesitancy has risen during the Covid crisis due to misinformation spread about jabs for that virus and school closures.
It announced that the 900,000 one to nine-year-olds in Greater London will be offered a booster poliovirus vaccine within the next month to increase protection against paralysis and help reduce the spread.
On top of the polio samples confirmed in eight boroughs, health chiefs also spotted lower concentrations in sewage neighbouring boroughs.
But it is not yet clear if this means the virus has spread to more places or if infected people have simply travelled to other boroughs.
Parents have been told to take up the offer of a polio booster ‘as soon as possible’, even if their child is up-to-date with their jabs.
The programme will start in the areas where polio has been detected and vaccination rates are low, before being rolled out across London.
The booster jabs are in addition to the NHS childhood vaccination catch-up campaign, launched across London in June to increase uptake among those who had missed their childhood vaccines.
The NHS currently offers the polio jab in the six-in-one vaccination, which is given to children when they are eight, 12 and 16 weeks old.
Protection against polio is further boosted through top-up jabs given youngers before they go to school, as part of the four-in-one booster, and when they are 14, in the three-in-one teenage booster. All of the jabs are needed to be fully vaccinated against polio.
The World Health Organization’s polio vaccination target is 95 per cent. But only three parts of England — Rutland, Country Durham and East Riding — meet this threshold.
Five of the boroughs where the virus has been detected — Hackney, Camden, Haringey, Enfield and Islington —have the worst uptake rates in the country, with as little as 54.7 per cent of youngsters receiving their required vaccines by the age of five.
The remaining three boroughs — Waltham Forest, Barnet and Brent — are in the worst 30 for polio jab uptake.
Dr Vanessa Saliba, consultant epidemiologist at UKHSA, said: ‘No cases of polio have been reported and for the majority of the population, who are fully vaccinated, the risk is low.
‘But we know the areas in London where the poliovirus is being transmitted have some of the lowest vaccination rates. This is why the virus is spreading in these communities and puts those residents not fully vaccinated at greater risk.’
She added: ‘It is vital parents ensure their children are fully vaccinated for their age.
‘Following JCVI advice all children aged one to nine years in London need to have a dose of polio vaccine now – whether it’s an extra booster dose or just to catch up with their routine vaccinations.
‘It will ensure a high level of protection from paralysis. This may also help stop the virus spreading further.’
The last case of polio in the UK was detected in 1984, after it was eradicated due to the vaccine. Before it was rolled out, the virus paralysed 8,000 Britons every year.
But routine sampling for polio at Beckton Sewage Works, which covers 4million people in north east London, spotted traces of the virus in February.
It is normal for around three positive samples each year, but officials said a sample identified in April was genetically linked to one first seen in February which had mutated into a version that can paralyse.
Health chiefs believe the virus has spread to the UK now because a traveller, possibly from Pakistan, Afghanistan or Nigeria, shed the virus in their faeces after getting a live oral vaccine, which is used in some countries with current outbreaks as it has a rapid effect.
The oral vaccine, given via droplets to the mouth, has not been used in the UK since 2004, when Europe was declared polio-free. Britain uses an inactivated polio vaccine, which is given as part of a combined jab to babies, toddlers and teenagers.
Those who receive the oral version shed a weakened version of polio in their stool. This can boost immunity in populations but in places where uptake is too low, the virus can mutate and start acting like the wild-type of the virus — called vaccine-derived poliovirus type 2 (VDPV2) — which can cause paralysis.
If it continues to spread, there is a risk that it will infected someone who is unvaccinated or not fully-jabbed, who may become paralysed.
However, health chiefs believe there is no risk to those who are vaccinated. Most people who contract polio do not have symptoms and will fight off the infection without realising they had it.
And most of the samples detected in London are vaccine-like virus, while only a few are mutated enough to be classed as VDPV2.
But UKHSA teams are now testing London sewage weekly and expanded the number of testing sites in the capital, as well as in other UK nations.
Jane Clegg, chief nurse for the NHS in London said: ‘While the majority of Londoners are protected from polio, the NHS will shortly be contacting parents of eligible children aged one to nine years old to offer them a top-up dose to ensure they have maximum protection from the virus.
Parents are being urged to ensure their children’s polio vaccinations are up to date, particularly after the pandemic when school immunisation schemes were disrupted and uptake fell. Pictured, a girl gets her four-in-one pre-school jab offered by the NHS
How the world is STILL vulnerable to polio: Vaccine uptake map reveals how DOZENS of countries including US and UK are below key threshold needed to contain virus
More than 100 countries fail to meet key polio vaccination uptake targets and are vulnerable to the paralysis-causing virus, official figures suggest.
Data from the World Health Organization shows 114 of 160 nations have not hit its threshold of 95 per cent coverage in one-year-olds.
UK health chiefs yesterday revealed that the country could be seeing a resurgence of the disease for the first time in decades after strains were detected in sewage.
Experts deem having more than nine in 10 people in every community vaccinated crucial to prevent the highly contagious virus from spreading.
Being vaccinated is even more important for children than adults because they are more likely to catch and therefore fall ill with the disease.
While the majority will experience mild or no symptoms at all, for as many as one in 100, it can cause permanent paralysis or death.
Among the vulnerable countries are the UK and US, where overall uptake nationally is as low as 93 per cent. But in parts of Africa, as few as four in 10 are immunised.
And 35 nations, including France, Germany and Portugal, have not shared their polio uptake data — meaning even lower numbers could be protected in some places.
‘We are already reaching out to parents and carers of children who aren’t up to date with their routine vaccinations, who can book a catch-up appointment with their GP surgery now and for anyone not sure of their child’s vaccination status, they can check their Red Book.’
Polio can be spread through poor hand hygiene, when an infected person dose not properly wash their hands after using the toilet and then touching food or water that is consumed by others. It can also be transmitted through an infected person’s coughs and sneezes.
The virus multiplies in the intestine and is passed in large quantities through faeces.
Most people will be asymptomatic and fight off the infection without knowing they had it. A small number of people will have a flu-like illness that lasts for three to 21 days, including a fever, sore throat, headache, stomach pain, aching muscles and feeling and being sick.
But it can also attack the nerves in the spin and base of the brain, which can cause paralysis, usually in the legs, which develops over hours or days. If the paralysis spreads to the breathing muscles, it can kill.
Britons who develop paralysis symptoms — such as weak, flaccid or floppy limbs, especially the legs, head and neck — are advised to seek medical advice immediately.
Some sufferers recover movement in the following weeks and months but many people are left with long-term paralysis.
Health Secretary Steve Barclay said parents and guardians ‘will be concerned’ about the detection of polio in London but noted that ‘nobody has been diagnosed with the virus and the risk to the wider population is low’.
He said the rollout will start in ‘the most impacted boroughs, so we can ensure they have the best possible protection and we reduce the chances of transmission’.
Mr Barclay said: ‘We know many countries, including Belgium and Portugal, offer an additional dose as part of their childhood vaccination programme, and the JCVI has considered international data on safety and effectiveness in forming their recommendation, which I have accepted.
‘Vaccines offer the best defence to children, and those around them, so I would encourage families to ensure they are up to date with their routine jabs, and to come forward for the polio booster as soon as they are contacted by the NHS.’
The UKHSA is working with health agencies in New York and Israel — where polio is also spreading — alongside the World Health Organization (WHO) to investigate the links between the viruses detected in each country.
Polio dates back to 1500 BC, crippled rulers in Ancient Egypt and paralysed thousands of children for decades before being almost entirely wiped out by a vaccine that used a weakened version of virus: The disease’s history laid bare
You could be forgiven for thinking polio was a disease resigned to history.
The paralysis-causing disease was officially eradicated in the UK in 2003 and the last domestic outbreak was in the 1980s. But dwindling vaccination rates, in part due to complacency, appear to have allowed polio to creep back in decades later.
The archaic disease has existed as long as human civilisation itself, with the earliest records dating back to ancient Egypt.
But it was until the 1800s that outbreaks began to really take off.
Millions of Brits will remember the devastation polio caused in the early 1950s and why it was one of the most feared infections in the world. The UK was rocked by a series of polio epidemics in the mid-20th century that saw thousands crippled by the virus each year.
Mary Berry, the ex-Great British Bake Off judge, was hospitalised after contracting polio aged 13, leaving her with a twisted spine and damaged left hand.
Despite being eradicated in most of the world, it still spreads in two countries — Afghanistan and Pakistan — while parts of Africa suffer flare-ups of vaccine-derived versions of the virus.
Here, MailOnline takes a look at the history of the virus:
Polio epidemics, when the virus is constantly spreading within a community, did not start happening until the late 1800s.
But records suggest it dates back to as early as 1570 BC in ancient Egypt.
This is based on a drawing on a stele — a stone slab — which shows a priest with a withered leg and using a cane to help him walk.
And an Egyptian ruler called Siptah, who died in 1188 BC, is thought to have had polio based on his deformed left leg and foot, spotted by archaeologists who found his mummy in 1905.
But apart from these two incidents, polio largely vanished from the record books until it was logged in in 1789 by London-based Dr Michael Underwood.
He published the first clear description of polio in infants, who are particularly vulnerable to the disease, in a medical textbook, calling it ‘debility of the lower extremities’.
Records show polio dates back to as early as 1570 BC in ancient Egypt. This is based on a drawing on a stele – a stone slab (pictured) – which shows a priest with a withered leg and using a cane to help him walk
In the early 1800s, a handful of polio cases were sporadically reported in medical journals.
But scientists believe people were commonly exposed to the virus in the typical unhygienic environments of the time, especially when they were young.
However, polioviruses started causing problems in Europe and North America at the end of the 1800s. This was, bizarrely, blamed on sanitation improving.
Polio spreads through consuming an infected person’s faecal matter — which can happen as a result of poor hand hygiene.
While better water and sewage systems saw the demise of typhoid and cholera, outbreaks of polio became more common.
Three-quarter of those who become infected don’t have symptoms. But around a quarter suffer a flu-like illness, including a sore throat, fever and tiredness.
Up to one in 200 will develop more serious symptoms that affect their brain and spinal cord, including paralysis.
Professor Ian Jones, a virologist at Reading University, explained the virus ‘wasn’t a problem until hygiene improved’.
Previously, low levels of infection would have given immunity to people but the unforeseen circumstance of better living conditions was that this declined and polio ‘took off’, he said.
Professor Paul Hunter, an infectious disease expert at the University of East Anglia, told MailOnline that although polio has been around for centuries or millennia, it was only during the early part of the 20th century that big epidemics of paralytic polio took off.
He explained: ‘When every child got infected with poliovirus in the first couple of years of life you still saw some paralysis but it was only when infections were delayed until older age that such paralysis became more common.
‘Young children who contract poliovirus infection generally suffer only mild symptoms, but delay those infections to teens and adulthood and paralysis becomes more common.’
The first epidemic struck more than a dozen people in Norway in 1868, while the second, which occurred 13 years later, caused a similar number of confirmed cases in Sweden. An outbreak in the US in 1894 saw 132 people infected.
It was in 1916 that the first large-scale epidemic took hold in Brooklyn, New York, with more than 9,000 cases and 2,000 deaths.
The outbreak spread to the rest of the US and led to more than 27,000 cases and 6,000 polio deaths that year.
Newspapers published the names and addresses of infected people, ‘keep out’ notices were nailed to their doors and their families were quarantined.
Parents were urged to keep their children away from public spaces, such as swimming pools, parks and beaches, over virus fears.
The outbreak triggered concern across the world and sped up research into the illness.
Scientists had already made some progress in understanding and treating the virus.
In 1840, German orthopaedic Dr Jacob von Heine had become the first to produce a robust study on polio. He suggested that the disease may be contagious.
By 1908, Austrian physicians Karl Landsteiner and Erwin Popper said that polio may be caused by a virus.
Early treatments of the disease included tying the paralysed limbs of infected patients to splints, in a bid to stop their muscles from tightening.
But by 1928, an invention called the iron lung was rolled out to revolutionise how the disease was treated. The contraption – a respirator that resembled a ‘coffin on legs’ – was developed for patients whose lungs were so paralysed that they could no longer breathe unaided. Paul Alexander, 76, from Texas, is still in the machine today — 70 years after contracting polio at the age of six in 1952
But by 1928, an invention called the iron lung was rolled out to revolutionise how the disease was treated.
The contraption – a respirator that resembled a ‘coffin on legs’ – was developed for patients whose lungs were so paralysed that they could no longer breathe unaided.
It was first used that decade to save an American child infected with the virus who needed help breathing. The majority patients stayed inside the chamber for short spells until their lungs recovered.
But some struck down by permanent paralysis stayed inside the machines for the rest of their lives.
Paul Alexander, 76, from Texas, is still in the machine today — 70 years after getting polio at the age of six in 1952.
And by 1930, Elizabeth Kenny, a self-trained nurse from Queensland, Australia, developed a treatment applying hot packs to muscles and exercise to keep stimulating nerve cells and avoid long-term muscle damage. The methods are still used today.
As part of the increased focus on research, Australian virologists Sir Macfarlane Burnet and Dame Jean MacNamara identified for the first time that there were three types of the polio virus in 1931.
The fight against the virus was further boosted when a team of scientists at Harvard Medical School, led by Dr Jonas Salk, in the 1940s used blood samples of infected patients to extract and grow the virus in live cells.
By 1955 the team, with the support of funds from the March of Dimes non-profit organisation, developed the first effective vaccine — an injectable inactive (killed) polio vaccine (IPV).
Nearly 2million children in the US were jabbed as part of the largest medical trials ever seen at the time.
They proved successful and 450million doses of the jab were dished out across the country. Cases subsequently fell from 18 per 100,000 people to two per 100,000.
The following decade, a team at the University of Cincinnati in Ohio, led by medical researcher Dr Albert Sabin, developed a second vaccine using a live version of the virus that could be given in drops through the mouth.
This vaccine was much more effective and became the most popular throughout the world.
Politicians in the US didn’t support Dr Sabin’s oral poliovirus vaccine (OPV), so he tested it in the former Soviet Union.
The USSR rolled out the jab and polio subsequently declined. Drops in cases were also seen in nearby Eastern Europe and Japan.
The US licensed the jabbed in 1961 and it became the main vaccine used worldwide.
The fight against polio was further boosted when a team of scientists at Harvard Medical School, led by Dr Jonas Salk, in the 1940s used blood samples of infected patients to extract and grow the virus in live cells. Pictured: Dr Salk at the Municipal Hospital laboratory in April 1955 after announcement of the successful vaccine results
Great Britain was pronounced clear of polio in 2003 with the last case coming in 1984. A young girl is pictured getting her polio jab in May 1956
By 1955 researchers at Harvard Medical School, with the support of funds from the March of Dimes non-profit organisation, developed the first effective vaccine against polio — an injectable inactive (killed) polio vaccine (IPV). Pictured: children getting a lump of sugar while getting a polio vaccine at a mobile unit in Blackburn in Lancashire, England in 1965
Professor Jonathan Ball, a virologist from the University of Nottingham, told MailOnline that polio had a ‘devastating effect’ worldwide and the introduction of the two jabs was ‘immense’.
Studies throughout the 1970s and 1980s revealed the virus was widespread in many richer nations, which pushed leaders to introduce routine vaccination using the OPV in national immunisations programmes.
The jabs saw polio vanish in developed countries. In the UK, cases fell from a peak of 8,000 a year to just a few hundred before being eradicated.
In the US, infections dropped from a peak of 58,000 to zero just a few years after the jab was dished out.
Kathleen O’Reilly, an associate professor in statistics for infectious disease and expert in polio eradication, told MailOnline: ‘After the second world war cases of paralytic polio in England and Wales rose considerably, reaching several thousand cases each year.
‘Vaccines were developed in response to these worrying outbreaks, and were introduced in the late 1950s.
‘The number of polio cases quickly declined, and since the 1970s only a small number of cases were reported each year. There has not been a single case of polio in the UK since 1984.’
But in poorer nations, where the virus caused fewer outbreaks, uptake was much lower.
The World Health Organization (WHO) launched an worldwide immunisation rollout in 1974, in an attempt to vaccinate all children against polio.
By 1988, the UN health agency set the target of eradicating the virus globally by 2000. Two years later, a global virus surveillance system is set up to detect the virus.
The US logged its last case in 1991, in a three-year-old boy called Luis Fermin Tenorio living in Junin, northern Peru.
The WHO certified the region as polio-free three years later — the duration set by the agency before a nation can be deemed to have eradicated the virus.
A team at the University of Cincinnati in Ohio, led by medical researcher Dr Albert Sabin, developed a second vaccine using a live version of the virus that could be given in drops through the mouth. This vaccine was much more effective than the inactivated one, and became the most popular throughout the world. Pictured: a health worker giving a oral polio vaccine to a child in Karachi, Pakistan
There was also success in ridding the world of two wild types of the virus, with type two eradicated in 2015 and type three stamped out by 2019. However, the WHO global goal of eradicating the virus by 2000 has still not been met. Polio is endemic in Afghanistan and Pakistan. Pictured: a child in Kabul, Afghanistan being given the oral vaccine in November 2021
Nearly every country in the world used the oral polio vaccine in their rollout. But after infections were brought under control in the US and the UK, both countries stopped using this vaccine — in 2000 and 2004, respectively. Other nations followed suit.
While the oral version provides higher levels of protection against infection — meaning it is more effective at limiting spread in endemic countries — the weakened live virus in the vaccine can mutate on very rare occasions and cause paralysis.
It can also spread to others and cause an outbreak of vaccine-derived polio.
Professor Hunter explained that the live vaccine does a better job at stopping infection ‘but can very rarely cause paralysis’.
Meanwhile, the inactivated vaccine ‘doesn’t cause infection and is still excellent at stopping paralysis but not quite as good at preventing infection’, he said.
Only a handful still use the oral vaccine.
In 2002, Europe was certified as polio-free. Its final case was logged in a 33-month-old child in Turkey in 1999.
The Western Pacific was labelled polio-free in 2000, with the last confirmed infection being in a 15-month-old girl called Mum Chanty in Phnom Penh, Cambodia. And the WHO confirmed South East Asia is virus free in 2014.
There was also success in ridding the world of two wild types of the virus, with type two eradicated in 2015 and type three stamped out by 2019.
However, the WHO global goal of eradicating the virus by 2000 has still not been met. Polio is endemic in Afghanistan and Pakistan.
Travellers from these two nations frequently spread the virus to other countries.
China lost its polio-free status in 2011 after the infection spread to the country from Pakistan. However, it regained it after the outbreak fizzled out.
Professor Ball explained: ‘The live vaccine has proven to be incredibly effective at eliminating the virus.
‘But on rare occasions it can revert to wild-type and cause the disease; that’s why countries that do get rid of the virus switch to using killed vaccine to keep their populations safe.’
Professor Jones said the dilemma around polio is now around eradication. ‘Is it worth the cost in terms of money and lives lost to eradicate the last few cases or is it better to maintain where we are?
‘Lastly, another dilemma, if it is eradicated how long do you continue to vaccinate and with what?’
UK health chiefs revealed polio could be spreading in the community for the first time in four decades after the virus was spotted in sewage samples in parts of London on June 22, 2022. It is a vaccine-derived strain.
But there are signs it is spreading between people as officials have picked up several samples from different people, each with new mutations.
Professor Hunter added: ‘Whilst most of the world has moved away from live attenuated vaccine some countries still use it and there is a risk that you can get secondary infections (generally a family member) which very rarely can be associated with paralysis in someone who has not been immunised.
‘The concern here is that even a vaccine derived virus if it continues to spread could eventually recover its full virulence over a year or two and then cause an outbreak of paralytic polio in people who have not been vaccinated and that would be a disaster.
‘So probably the current situation does not pose an immediate threat to public health but if transmission goes on long enough and the virus recovers its virulence it could become a public health disaster.’