It strikes me that we have either been exceedingly lucky to have not heard of more than 2 cases of paralytic polio since reports began to circulate 6 months ago; or the circulating vaccine-derived strains are either less transmissible or less virulent than we imagine them to be. I freely admit that I am just spitballing here; when I look through the literature there seems to be consensus to the contrary, that the mutations in past vaccine-derived poliovirus made it just as formidably transmissible and virulent as the wild-type polioviruses.

Perhaps the New York outbreak will yet lead to a massive polio outbreak, unlike the warnings thus far raised in London and Jerusalem. Meanwhile, I await a virologist to explain the seeming contradiction between the disaster we would expect from these emergent strains in multiple countries and what we are actually seeing. Truly, like so much in medical science, it’s a mystery.

What is not at all mysterious is the appropriate response to these reports of circulating polioviruses. Yes: vaccination! Here in the U.S., we can’t invoke vaccine mandates and herd immunity to stop a potentially massive outbreak of a vaccine-derived poliovirus, at least not without authorizing either new or old OPV vaccines for distribution. What we can do is make the problem go away in our own families via the IPV vaccine. It works, and it’s safe. To that effect, I can say that, as the current Giver of Vaccines in my clinic, I take full disclosure seriously, perhaps to a fault, because I don’t want parents to lose trust in medicine if they are blindsided by a vaccine reaction or read about terrible adverse events afterwards and feel misled by me. When it comes to IPV, though, I really struggle to come up with any concerns; maybe their arm might get sore?