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Ask the pediatrician: Is polio a serious concern again?
By YVONNE A. MALDONADO
American Academy of Pediatrics
Q: I’ve read about polio
appearing again in the U.S.
Should I be worried about my
kids?
A: It was reported over the
summer that an unvaccinated
man in New York got polio and
has developed paralysis, and there
is evidence of the virus circu-
lating in the state’s wastewater.
The patient reportedly contracted
a form of polio that can be traced
back to the live poliovirus used in
the oral vaccine. This version of
the vaccine has not been used in
the U.S. since 2000. Health offi -
cials said the virus probably orig-
inated overseas in an oral vaccine
distributed there.
People who are vaccinated
should not be concerned, but for
those who are unvaccinated, this
is a red fl ag.
We have not seen polio in the
United States since the 1970s
and ’80s, and polio was declared
eliminated from the Western
Hemisphere in 1994. We know
the polio vaccine works.
Polio is caused by a virus that
aff ects infants and young chil-
dren more often than other age
groups. Most cases of polio are
mild. Paralytic polio causes mus-
cles to be paralyzed, leaving
some people physically impaired
for the rest of their lives.
Before the polio vaccine,
widespread cases of paralytic
polio in the U.S. led many parents
to be worried about letting their
children swim in public pools or
gather at movie theaters or parks.
Since the mid-1950s, the
polio vaccines have led to a dra-
matic decline — with over a
99% reduction in polio cases
around the world. The “natural”
or “wild” type of poliovirus that
infected children decades ago
is eliminated from the U.S. and
much of the rest of the world.
Polio can spread to other
people through contact with
stool (poop) from an infected
person or droplets from a sneeze
or cough. It is transmitted from
contact with fecal matter (stool
or poop) within one to two
weeks after a person is infected
with polio. A person who
gets stool or droplets from an
infected person on their hands
will get infected if they touch
their mouth. Children who are
not vaccinated can get infected
if they put toys or other objects
that have stool or droplets on
them in their mouth.
An infected person can spread
poliovirus to others before they
have symptoms. The virus can
live in an infected person’s stool
for weeks. People can contami-
nate food and water if they touch
it with unwashed hands.
It is hard to detect polio or
prevent it from spreading. Chil-
dren who are not immunized are
at risk. Most people with polio
infection will have no symptoms.
Infrequently, polio can cause
paralysis in the arms and legs or
even death if muscles involved in
breathing are paralyzed.
Symptoms may begin with
a low-grade fever and a sore
throat about six to 20 days after
being exposed to the virus. Chil-
dren also may feel pain or stiff -
ness in their back, neck and legs
for a brief time. Paralysis causes
severe muscle pain.
A person is most contagious
seven to 10 days before symp-
toms occur and can infect others
for another seven to 10 days. No
treatment is available for polio.
Some children fully recover
from polio, but others are dis-
abled for a lifetime or may die
from the disease.
The best protection is the
polio vaccine. In the United
States, the inactivated polio vac-
cine is the only vaccine recom-
mended. IPV is given as a shot
by trained health workers.
Most people in the United
States have been vaccinated
against polio and are at very
low risk for polio infection and
paralysis. People who have not
been vaccinated or who have not
received all doses of polio vac-
cine are at higher risk if they
are exposed to someone who is
infected with polio or someone
who received the oral polio
vaccine.
Stay up to date on all your
children’s vaccines, some of
which may have been overlooked
during the pandemic. Talk to
your pediatrician if you have any
questions or concerns.
█
Dr. Yvonne A. Maldonado is the chief of the
Division of Pediatric Infectious Diseases at
the Stanford University School of Medicine. F
or more information, go to HealthyChildren.
org, the website for parents from the AAP.
Should you get your fl u shot and COVID booster together?
By LISA M. KRIEGER
The Mercury News
The fl u shot is as
familiar an October ritual
as football, foliage and
Halloween.
But health offi cials are
urging Americans to get the
new fl u shot and COVID
booster at the same time —
the sooner, the better.
“Right where we are
now — that’s a good time
to be vaccinated,” infl uenza
expert Dr. Lisa Grohskopf
of the U.S. Centers for Dis-
ease Control and Preven-
tion told the nation’s phy-
sicians in a conference call
late last week.
That’s ahead of time, by
traditional measures. Flu
season most often peaks in
February — and our levels
of protective antibodies are
at their highest about two
weeks after the shot, then
wane over the next four to
six months.
Yet this year’s season
could start early if it fol-
lows the pattern seen else-
where in the world. So a
delay could catch people
unprepared.
There’s another concern:
People may not want to
make two trips to the vacci-
nation clinic — so they may
get the new COVID booster
but fail to return for the fl u.
Is there a perfect time
to be vaccinated?
If you have a crystal
ball, “it’s 14 days before the
fl u attacks the community
that you’re living in,” said
Dr. Darvin Scott Smith,
clinical lead for fl u vaccina-
tion at Kaiser Permanente
Northern California, who
has already gotten his shot.
Here’s the problem:
Seth Herald/Getty Images-TNS, File
A sign directing traffi c to a drive-through fl u shot station.
Nobody knows when that
will be.
Nearly four decades
of CDC data shows that
45% of fl u seasons peak in
February.
But 18% of the time, the
season peaks as early as
December. In another 16%,
it peaks as late as March.
Protection isn’t assured
until two weeks after your
shot.
“It is impossible to pre-
dict the fl u season with any
accuracy,” said Dr. Kelly L.
Moore, president of Immu-
nize.org, a nonprofi t group
that works to increase
immunization rates.
If you want to save time
and travel, said Moore, get
your fl u shot when you get
the new COVID booster,
now widely available at Cal-
ifornia’s pharmacies and
clinics. It’s safe and will
spare you a return trip.
There’s no data to show that
side eff ects will be worse.
A fl u shot won’t pro-
tect against COVID, and a
COVID shot won’t protect
against fl u. The two vac-
cines are very diff erent.
“I really believe this
is why God gave us two
arms — one for the fl u shot
and the other one for the
COVID shot,” White House
COVID coordinator Dr.
Ashish Jha said at a Sept. 6
news briefi ng.
Children who need two
doses of the fl u vaccine —
those six months through
8 years who have never
been vaccinated — should
receive their fi rst dose
immediately, said experts.
A September shot will
create antibodies that can
persist long enough to help
fend off a later infection,
experts said. And even if
they don’t, you’ll get less
seriously ill than if you
weren’t vaccinated at all.
“I’m going to try to get
my fl u vaccine at the ear-
liest opportunity,” said Dr.
Bali Pulendran, professor
of immunology at Stan-
ford University School of
Medicine
“Even if the durability
of the antibody response is
just a few months, I should
be good throughout the
season,” he said.
September also off ers
a practical advantage: It’s
easier to get an appoint-
ment. Everyone won’t all be
rushing in at once, as could
happen once the virus
arrives.
October is the optimal
time from an immunolog-
ical perspective, experts
said. Like all cells, anti-
bodies die of old age. A
Kaiser study found a 16%
increase in the odds of
catching the fl u every addi-
tional 28 days after peak
protection.
That’s especially true
for older adults, who expe-
rience a greater waning of
protection than younger
people.
“Just don’t forget,” said
Moore. “When the oppor-
tunity arises, get it.”
If you’re not vaccinated
by October, it’s not too late.
Vaccines help as long as fl u
viruses are circulating.
Once spring comes,
you may be worried about
protection. But don’t get
a second fl u vaccine, said
Smith.
Forecasting a fl u season
is always a challenge. It can
vary in diff erent parts of
the country. Every year is
diff erent.
Because COVID has
changed our behaviors,
“the old rules — what we
knew about when fl u starts,
when it ends — may not
work this year,” said UCSC
infectious disease expert
Dr. Peter Chin-Hong, who
aims to get his shot in
mid-October.
“I wouldn’t game the
system,” he said. “If the
fl u has a slow burn, you’ll
want it before it peaks.”
There are three reasons
to be cautious, said Smith.
Based on this year’s
experience in the Southern
Hemisphere, fl u season
could come early. U.S.
health offi cials look to Aus-
tralian trends for guidance
— and cases there started
in April instead of the usual
June.
It also was a worse
season than the two pre-
vious years when people
were masked and dis-
tancing, said Kaiser’s
Smith. Behaviors have
changed. People are going
out more.
Finally, we have less
overall immunity to the fl u
because we’ve been sitting
it out for two years, with
lower vaccination rates and
reduced exposure to the fl u
virus.
Last year, fl u season was
mild but ran long. Experts
were surprised by a second
small peak, with cases
jumping in April and May.
Infectious disease trends
“are all whacked out,” said
Chin-Hong. It’s not just
fl u — the timing of the
common respiratory syn-
cytial virus (RSV), mon-
keypox and other patho-
gens have proved startling,
he said.
To be sure, fl u vaccines
are far from perfect. CDC
data shows that effi cacy
ranges widely from year
to year, falling to 19% in
2014-15 and climbing to
52% in 2013-14. This year’s
vaccines are “quadriva-
lent,” meaning they target
four diff erent strains of the
fl u virus; of these, two are
diff erent from last year’s
shot.
Circulating viruses may
also genetically drift over
time, so a vaccine that is
well matched in September
may be mismatched in
March.
Scientists are now
striving to build a better fl u
vaccine, so it’s less critical
to time shots perfectly, said
Pulendran.
The biggest worry now
is not whether the shots are
perfectly scheduled — but
that people will skip the
vaccines altogether, or just
forget, said Moore.
“If you sit down at the
Thanksgiving table with
someone who is sick,” she
said, “it’s too late.”
On Nutrition: What to do with leftovers before they go bad
By BARBARA INTERMILL
Tribune News Service
I am aware that some
people, for one reason or
another, do not eat leftovers.
That would not be our house-
hold, even before these days
of high food prices.
It’s estimated that we
Americans waste 30% to
40% of the food we pur-
chase. That equates to 219
pounds of groceries that each
of us tosses in the garbage
every year, according to the
Environmental Protection
Agency. And two-thirds of
that food is a fruit, vegetable
or dairy product that ends up
in a landfi ll instead of nour-
ishing a body with essential
nutrients.
What can we do when
vegetables go bad before we
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It’s estimated that we Americans waste 30% to 40% of the food we
purchase. That equates to 219 pounds of groceries that each of us
tosses in the garbage every year, according to the Environmental
Protection Agency.
Many foods can also be
frozen for future use. I really
don’t like overripe bananas.
So I freeze them, three to a
bag, and they’re ready for my
next batch of banana bread.
Onions and droopy celery
can also be chopped and
frozen for use in soups and
other dishes.
We call our
clean-out-the-refrigerator
meals “conglomerates.”
Last week, for example,
I chopped and sliced the
incredible tomatoes and zuc-
chini our gracious neigh-
bors had left on our porch.
I cooked them with a left-
over half-onion and kernels
shucked from the last of the
sweet corn we got from our
farmer friend. Oh, and that
little Tupperware of leftover
meat and green chile from
my enchildas a few days
ago? That went into the mix,
too. A few seasonings to
boot, and we had a meal that
took me right back to my
native New Mexican roots.
Some leftovers can be a
challenge. I used to cringe
each time I’d open a whole
can of tomato paste when
the recipe called for just one
tablespoon. I never seemed
to use the rest before it devel-
oped creepy mold.
Then I learned leftover
tomato paste can be frozen
in individual portions with
the help of plastic wrap and a
freezer-proof container. Now
I just need to remember it’s
in the freezer.
On a larger scale, many
organizations recover fresh,
edible food no longer needed
by restaurants, grocers and
other food establishments
and distribute them to people
in need.
Local food banks such as
feedingamerica.org or food-
banking.org, as well as pro-
grams like Food Rescue US
(foodrescue.us), use volun-
teers to redistribute surplus
food to food-insecure people
on a daily basis. That’s
encouraging.
No one’s perfect, how-
ever. The other day, I found
a lost gem in the back of
the fridge that had obvi-
ously been hidden for way
too long. In this case, the old
adage still holds true: If in
doubt, throw it out.
█
Barbara Intermill is a registered
dietitian nutritionist and syndicated
columnist. She is the author
of “Quinn-Essential Nutrition:
The Uncomplicated Science of
Eating.” Email her at barbara@
quinnessentialnutrition.com.
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