anotherhue 5 days ago

What is a vaccine-derived poliovirus?

A vaccine-derived poliovirus (VDPV) is a strain of the weakened poliovirus that was initially included in oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally occurring virus.

https://www.cdc.gov/vaccines/vpd/polio/hcp/vaccine-derived-p...

Notably, this isn't someone reverse engineering polio from vaccines. (it's still endemic so no need)

Although arguably that's exactly what the virus did itself.

  • andrewclunn 5 days ago
    • tialaramex 4 days ago

      I guess you wanted "Oral" (meaning, you eat the vaccine, often as a drop of liquid on a sugar lump) not "Olfactory" (meaning you smell it)

      OPV is more effective at preventing Polio, the disease caused by the virus. Now, if you live in a country without endemic Polio (e.g. the United Kingdom) then that's not a big deal. You were probably never going to catch Polio anyway, and the risk (to others, not yourself) from vaccine-derived Poliovirus is a big problem, so it makes sense to prioritise that by using IPV (the vaccine based on a "killed" virus) and it is policy in countries with elimination to do so.

      But, if you live in a country with endemic Polio including vaccine-derived Polio, then you perhaps want OPV because of the improved effectiveness.

      Now, the other reason OPV is used in lots of poor countries with endemic Polio is that it's cheaper. It's cheaper to manufacture, and it's cheaper to administer - any idiot can give children a sugar lump with a drop of liquid and tell them to eat it and I believe it's even cheaper to store/ distribute.

      We expect to figure out how to make the dead vaccine more effective than it is now, though perhaps never as effective as OPV - but it likely will not be cheaper, nor easier to use.

      • qwertox 4 days ago

        OPV was standard in the US until 2000, because Polio got close to being eradicated and OPV used to cause new infections where none existed anymore.

        So they switched to IPV, which, even if it is not as effective as OPV, still offered some degree of protection, but did not cause new infections.

        Sounds like an interesting tradeoff / balance act.

        https://doh.wa.gov/you-and-your-family/immunization/diseases...

        • hilbert42 4 days ago

          I had the IPV (Salk) vaccine shot in the 1960s at school during the time of polio epidemics (in those days one never heard of people objecting to vaccines and everyone was terrified of polio so opposition to getting the vaccine was essentially zero).

          About a decade and half later when preparing to travel to countries where disease was more of a possibility than those I'd been to on previous trips, I mentioned to the Dr that I'd had the IPV years earlier. Hardly before I'd had time to utter another word she reached into her refrigerator took out a tiny bottle and said "here's the Sabin [OPV], stick out your tongue". A couple of drops later she said "all done."

          It was all over before I'd had a chance to raise the possibility of the OPV giving one polio (which I'd vaguely heard about) and to that she said "there's a very miniscule chance - hundreds of thousands to one and even then it rarely progresses to its worst form - however in your case it's effectively zero as your earlier Salk shot would certainly protect you from what is an already weakened virus".

          If one hasn't had either the IPV or OPV vaccine and there's even the slightest chance of polio being about then have the shot ASAP. If OPV is your only choice then it's far the least risky of your options. Even if you're a vaccine denier and think COVID wasn't as bad as has been made out then think again about polio - this disease is in another league altogether.

          (One day when I was in primary school a year or two before the IPV became available, a kid disappeared from my class, some months later after holidays we'd heard he'd died of polio. Another kid ended up being only able to walk on crutches and with calipers on his legs. At that time it was not unusual to see people hobbling about on crutchrd and calipers or to hear of survivors having to live permanently inside an iron lung as polio had paralyzed their respiratory muscles. Make no mistake, polio is a truly horrible disease.)

          • gus_massa 4 days ago

            >> there's a very miniscule chance - hundreds of thousands to one and even then it rarely progresses to its worst form

            As far as I know, the OPV is safe for the person that receives it. The problem is that the virus may be transmitted to another person that may transmit it to another person ... and after a few hops mutate and give the vaccine-derived version of polio.

            • makomk 2 days ago

              The oral polio vaccine has a small chance of paralyzing or killing people it's administered to, around one in a million if I remember right - this may sound harmless enough but polio's so rare that for a while it was a bigger cause of paralysis than actual wild polio infections, which is why everyone would like to eradicate polio and stop administering it and why developed countries now use the inactivated vaccine. It also has a small chance of mutating over time if it spreads through the community into a non-attenuated form which is much more virulent and carries a much higher risk of paralysis and death, and this has stymied attempts to eliminate polio and stop vaccinating.

            • hilbert42 4 days ago

              My understanding is that both the recipient can develop polio from OPV and also that the recipient can transmit the disease to others, it's just that the latter case (as you say) is the more common and much more worrying occurrence.

              As my Dr said, the chances of the recipient developing polio from OPV are extremely low although she didn't state the reasons. I gather when it does happen usually there are mitigating circumstances - such as a weak immune system in combination with a vaccine whose viruses haven't been fully attenuated. Remember also that my OPV was a long while ago so these days we'd be working with updated information.

              Although very rare, things can and do go wrong with vaccines - especially so during say a polio epidemic when everybody is in a panicky hurry. You've probably already read that in the 1950s during the early production of Salk's 'dead' IPV there were manufacturing problems where 'live' viruses had escaped into some finished vaccine batches and kids died as a result: https://www.washingtonpost.com/history/2020/04/14/cutter-pol....

              This WP article on the polio epidemic and the botched vaccine provides an excellent summary of events and the sense of panic and fear people had (it describes events essentially as I recall them). At the time I was living in Australia but things were no different, we also had the disease and distance hadn't lessened our knowledge of kids dying from the vaccine in the US.

              The article's quote that “…that polio was second only to the atomic bomb as the thing that Americans feared most,” would have equally applied in Australia. I recall the considerable anxiety and worry my parents had about the vaccine but everyone's fear of polio was much worse, so there was never any hesitation about us kids being immunized.

              I'm unaware of the full extent of the political fallout from the US vaccine deaths but it's clear the tragedy delayed Australian kids from receiving the vaccine for about four to five years - for instance I didn't get immunized until I was in highschool (I think either in 1960 or '61).

              This delay alone was a tragedy: for had it not happened then I'd be pretty certain that the kid in my primary school class who died of polio would not have done so. And that's just in my small world alone, similar tragic scenarios must have played out across the whole country.

              It is interesting to muse about the public's overwhelmingly positive attitude to polio immunization in the '50s and '60s compared to the often hesitant and indifferent attitude of many with respect to the current COVID epidemic. Back then, despite their worries after the major tragedy of kids dying from a bad batch of vaccine, most people rationally weighed up the risk and rightly considered that being immunized with new fixed-up batches of vaccine was clearly the safest choice. It's a stark comparison with today where we have FUD and misinformation everywhere yet the newer vaccines are not only better but also much, much safer.

              Undoubtedly, eventually some graduate student will do a PhD on the matter and we'll find out why a half century ago people were prepared to take sensible risks whereas today timidity and risk averseness reigns supreme.

              Incidentally, another difference between the 1960s when I was vaccinated and now is that back then once the decision was eventually made to immunize kids it happened without any delay or mucking about. At my school, which was typical of other state schools, kids were vaccinated four classes at a time. Kids were lined up in the school's assembly hall in two rows of about 50 students - a line for boys and one for girls with both lines being vaccinated simultaneously - the same way recruits are vaccinated in the military. The operation commenced after the midmorning break and was complete by lunchtime - about 1,100 kids in total were processed in about two hours.

    • bigDinosaur 4 days ago

      Historically you probably would have preferred the live virus versions to nothing, though. Now it's easier to make the decision you have because vaccine technology has improved so much. It's a reasonable position, although you'd probably still take a live viral vaccine if the disease was otherwise incredibly dangerous and no alternative vaccine existed.

      • tialaramex 4 days ago

        It's not a "decision" in a practical sense for the vast majority of HN readers.

        Imagine I go to a Burger King, and I declare, "Well, I shan't purchase a Big Mac. No, on principle I demand the Whopper". Sure enough the Burger King employees sell me a Whopper. But, that's not because they respect my principled stance against the Big Mac, they don't sell Big Macs and they do sell Whoppers.

        Rich industrialised countries have all eliminated Polio, and thus don't offer OPV at all. I had OPV when I was a child, because I am an old man but the younger people I work with all had IPV. There was no "Which do you want?" question, government policy changed after elimination and availability of a killed vaccine.

gregwebs 4 days ago

If you understand the limitations of the two types of vaccines, this story is just something that should be expected to happen.

Someone traveled from a country where the weakened live version is given to the UK. This live version mutated in that individual to become transmissible (this mutation happens in around one in a million individuals). The UK vaccinates with the non-live version. This non-live version cannot mutate, but it is non-sterilizing- the vaccinated can still become infected in their gut- the vaccine prevents it from getting into their bloodstream and become poliomyelitis. We now we see this outcome in the sewage samples.

  • makomk 4 days ago

    It's not even really that the live version mutated to become transmissible, exactly - the live oral polio vaccine is reasonably transmissible through the usual fecal-oral route full stop. The problem is that as it spreads through a community the vaccine virus - and especially the type 2 poliovirus - tends to mutate in ways that undo the attenuation which allows it to safely be used as a vaccine and cause it to spread, paralyze and kill in the same way that wild-type polio virus does. Viruses with these kind of mutations have been circulating in the developing world for some time and there seems to be concern they may now be in the UK.

    (In fact this is the only kind of type 2 poliovirus in circulation these days - the wild version of it was eradicated a few years ago. There were a bunch of celebratory announcements of this that made it to HN which were probably rather premature. The WHO and their partners had a fancy endgame plan for this involving pulling the type 2 component of the vaccine, at which point it would go extinct for real and we'd no longer have to deal with it. This plan failed spectacularly.)

    • gregwebs 4 days ago

      Thank you for the correction! That point is made very clear here: https://polioeradication.org/polio-today/polio-prevention/th...

      It is listed as both a pro (initially free vaccination for anyone that it gets transmitted to) and a con (once it mutates to become neurovirulent.

      Now that I have some understanding of the limitations of the vaccines the idea that polio will actually be eradicated seems implausible unless we switch everyone over to the live form. I don't pretend to fully understand the subject, but the articles about cases of polio popping up seem to fit my mental model better than the one that expects to eradicate it.

  • lamontcg 4 days ago

    TWiV was discussing this concept awhile back and mentioned the fact that if someone looked for poliovirus in NYC sewer samples that it would certainly turn up. There's a sort of ethical problem here because if you find it you immediately make a big splash and headlines over something entirely expected and not terribly worrisome. They were leaning towards that you just shouldn't look for it -- it doesn't really add anything to science because virologists who study polio knew it'd be there and everyone else would freak out. Well, now we're there more or less.

wozniacki 5 days ago

It looks it stems from pockets of London inhabited by communities historically resistant vaccination and/or a traveler from a country historically resistant to vaccination who has traveled there.

  UK Health Security Agency (UKHSA) experts
  believe a traveller – likely from 
  Pakistan, Afghanistan or Nigeria - shed
  the virus in their stools after being
  given the oral polio inoculation.[1][2]

  It is likely the virus was shed by someone
  who was recently vaccinated against polio
  in a country where it has not yet been
  eradicated, such as Pakistan, Afghanistan
  or Nigeria.[3]



[1] First outbreak of highly infectious polio detected in UK since 1984 – the 6 signs to know

https://www.the-sun.com/health/5615177/first-outbreak-highly...

[2] National incident declared after polio detected in London sewage

https://www.youtube.com/watch?v=tz7zsLJqZ7M

[3] Traces of polio virus found in London sewage as health officials declare national incident

https://news.sky.com/story/traces-of-polio-virus-found-in-lo...

  • CommanderData 5 days ago

    > Pakistan and Afganistan

    Interesting there was a fake vaccination campaign conducted by our security forces in those countries.

    https://www.vox.com/first-person/22256595/vaccine-covid-paki...

    Which has likely undermined peoples confidence in vaccines from those communities.

    • legolas2412 4 days ago

      I never understood why this is the position that media has taken. Do you also blame Dr. Fauci for the American vaccine deniers?

      A doctor worked with American intelligence agencies to find the most wanted terrorist in the world. He is then imprisoned in Pakistan on made up charges, and is still in prison. Does the media sympathize with his plight. No. There is barely any coverage of this after 2012. Instead, the media is so concerned with low vaccination rates.

      Is there a reason that media seems so biased to ignore a person's plight? A person who should be celebrated like a hero, not blamed like this.

      • aperson_hello 4 days ago

        Fauci didn't make a fake covid vaccine.

        In this fake vaccination program, we endangered health of some of the poorest and most vulnerable people in the world in order to catch someone who had pretty well fallen off the map and wasn't an active threat to anyone for...political points?

        I have nothing to back this assertion up, but I bet the number of deaths caused by vaccine hesitancy in that part of the world due to this incident is going to dwarf the number who died in 9/11 all said and done. Was that worth it?

        • yonaguska 4 days ago

          Fauci didn't make a fake vaccine but he certainly pushed vaccines in a very dishonest manner. He played a huge role in destroying my faith in the CDC and the FDA.

          • dudeDDRrulez 4 days ago

            Oh you didn’t like this one?

            “To achieve herd immunity, 60% of the population must be vaccinated”

            Next interview, 65%. Next interview, 70%. Then 75%

            While knowing the entire time that herd immunity is impossible with a leaky vaccine.

    • Zenst 4 days ago

      Oh there are many missinformation acpects that got pushed about https://www.france24.com/en/20200919-polio-vaccine-in-the-cr...

      EDIT - definitly worth a read and the aspect worth a quote "However, there still exists a version of the illness known as vaccine-derived polio, which occurs in rare incidents when the weakened virus in the vaccine mutates." Which is the instance at play here in the London sewage monitoring.

    • deadpannini 4 days ago

      The fake vaccination campaign story is plausible, because of the CIA's historic practices, but it is not credible.

      I dug in and was surprised to see that the reporting does not substantiate the narrative. Read the links in that Vox article: you'll see that the story exhibits all the hallmarks of a government-sponsored disinformation campaign. The only sources in the primary reporting (the Guardian article) are from the ISI - Pakistani intelligence. [1]

      The New York Times' articles hint at an alternative story, which is that the ISI needed to produce something to dampen public anger over the raid that led to Osama Bin Laden's death [2]. (That's my own crude, reductive version - it's surely more complicated than that, given the uncomfortable relationship between aid agencies and the Pakistani government):

      > Dr. Afridi has told interrogators for the top Pakistani military intelligence agency, the ISI, that he was introduced to the C.I.A. through Save the Children, according to Pakistani officials and Western aid workers. Save the Children vigorously denies the claim, saying it has been made a scapegoat by a desperate man who, according to senior American officials, has been tortured in Pakistani custody.

      Further along in the same article, we're given more reason not to take this story at face value:

      > Dr. Afridi had a reputation for hustling as well as healing, and he faced multiple allegations of corruption and professional malpractice, according to officials, colleagues and government papers seen by The New York Times.

      > At his private practice, several patients claimed he performed improper operations to make extra money, prompting a local warlord named Mangal Bagh to detain him for a week in 2008 until he paid a fine of $11,100

      Again, it's certainly possible that the gist of the story is correct, but from the publicly available reporting on it, we only have the word of the CIA's counterpart.

      [1] https://www.theguardian.com/world/2011/jul/11/cia-fake-vacci...

      [2] https://www.nytimes.com/2012/05/03/world/asia/bin-laden-raid...

  • asimpleusecase 5 days ago

    Your comment is the one everyone needs to read.

    The vaccine used in the UK is not an attenuated virus. So this was “ imported”. The news is likely being circumspect due to concerns of profiling immigrants or refugees or religious communities most prevalent where this vaccine is used.

    So far no cases have been found of transmission between people.

    I would be interested to know the sensitivity of the test they are using.

    • Mvandenbergh 4 days ago

      Samples are concentrated, then cultured in L20B (mouse cells with polio receptors added) and human rhabdosarcoma (RD) cells) to screen for either non-polio enteroviruses (very common). Samples which are L20B +ve (i.e. likely have polio) are then further passaged into RD for virus growth and RT-PCR to get the polio serotype and intratype.

      Many places which have the resources will then do a full sequence on any +ve samples as well to determine whether there is community transmission since this will show up as a number of related viruses which are all related to each other more closely than they are to the parent strain.

      London screening frequently sees unrelated OPV strains which are due to people who have recently been vaccinated with OPV in places where that is still the preferred vaccine, what is concerning here is that the deep sequencing shows that there appears to be some person to person spread of a vaccine derived strain.

      To answer your question, this is a highly sensitive and extremely specific test. Details no doubt available in the open literature somewhere.

    • easytiger 4 days ago

      > I would be interested to know the sensitivity of the test they are using.

      Bet that isn't discussed anywhere.

      • avs733 4 days ago

        So you can't really have sensitivity and specificity in the classic sense because you are not able to gold standard classify the infection of an individual. However, here is some research on the mater...

        >The location and timing of poliomyelitis cases showed spatial and temporal variability. The sensitivity of AFP surveillance to detect serotype 1 poliovirus infection in a district and its neighbours per month was on average 30.0% (95% CI 24.8–35.8) and increased with the incidence of poliomyelitis cases. The average population sensitivity of a single environmental sample was 59.4% (95% CI 55.4–63.0), with significant variation in site-specific estimates (median varied from 33.3–79.2%). The combined population sensitivity of environmental and AFP surveillance in a given month was on average 98.1% (95% CI 97.2–98.7), assuming four samples per month for each site. https://link.springer.com/article/10.1186/s12879-018-3070-4

        >Four quarterly visits were made to 78 ES sites in 21 states of Nigeria, and ES site characteristic data were matched to 1345 samples with an average enterovirus prevalence among sites of 68% (range, 9%–100%). A larger estimated catchment population, high total dissolved solids, and higher pH were associated with enterovirus detection. A random forests model predicted “good” sites (enterovirus prevalence >70%) from measured site characteristics with out-of-sample sensitivity and specificity of 75%. https://academic.oup.com/jid/article/225/8/1377/5818305?logi...

        Other discussion of environmental surveillance for polio:

        https://journals.asm.org/doi/full/10.1128/AEM.07972-11

        https://link.springer.com/article/10.1007/s12560-017-9314-4

  • Angostura 4 days ago

    This isn’t an outbreak - probably. It’s someone shedding virus particles following vaccination

  • krageon 5 days ago

    Honestly folks on holiday without vaccinations against such things should not be allowed to move around. It's already bad that they don't care to protect their own community.

    • vidarh 5 days ago

      In this case the virus is a result of one of the polio vaccines.

      Whomever brought it would very possibly have done the right thing and gotten vaccinated recently, but the live attenuated polio vaccine very occasionally leads to shed attenuated polio virus reverting to full strength.

      • krageon 5 days ago

        And that's definitely the reason they didn't get vaccinated, which probably wasn't fundamentally egocentric at all /s

        • vidarh 4 days ago

          Huh? They did get vaccinated.

          EDIT: It is possible the import could have come from an unvaccinated person too, having gotten it from someone who has been vaccinated. But that the virus is vaccine-derived means the ultimate source is someone who got the vaccine.

    • dudeDDRrulez 4 days ago

      I realize this might be a shock… But vaccines fail all the time. Their immunity wanes, they cause adverse events and sometimes they spawn rogue strains like what happened with Polio.

      BTW we have a case study unfolding real time on restricting people’s travel based on vaccination status. As the COVID-19 vaccine does not prevent transmission, infection or spread, it was a complete disaster. Meanwhile unvaccinated people with natural immunity who don’t spread were unfairly punished for noncompliance.

    • wonderwonder 4 days ago

      They were vaccinated... If you read the article, the headline is "Vaccine-derived poliovirus... detected" When you take the oral polio vaccine, its a live virus and sometimes that virus can be spread. So in this case, someone who had likely recently been vaccinated via the oral vaccine used a toilet in London and the virus was detected in the sewers.

laputan_machine 5 days ago

In the UK as a child you are offered the Polio vaccine. Uptake is around 95% in the UK overall, and 91% in London.

> “Vaccine-derived poliovirus has the potential to spread, particularly in communities where vaccine uptake is lower,” said Dr Vanessa Saliba, consultant epidemiologist at the UKHSA.

https://www.theguardian.com/society/2022/jun/22/polio-uk-pub...

  • LatteLazy 5 days ago

    It's worth remembering that London is 10m people over a huge area. There are 1001 communities within it. So a 91% overall rate could be 91% everywhere or 99% in many places and 0% in a few. Or anywhere in between.

    The actual numbers seem to be here:

    https://data.london.gov.uk/dataset/immunisation-rates-childr...

    But I am at work so can't really look. Time for me to get a booster maybe...

    • Arnt 5 days ago

      That's data for 1, 2 and 5-year-olds. Not for immigrants who arrived at an older age, of which there are quite a few in some parts of London.

      • Zenst 4 days ago

        Indeed, London is home to many French nationals, so many that https://www.bbc.co.uk/news/magazine-18234930

        So the history of vacinations do become blurred. Actualy for France polio was still not eradicated as of 1988, not so in 2020 but how they count that and what the vaccine uptake was for the generations who have migrated is always going to be a factor. https://www.cdc.gov/polio/progress/index.htm

        Then tourists - London does get a fair few as well, and as covid has shown, virus's dont' hang about.

      • ClumsyPilot 4 days ago

        polio vaccine is reasonably widespread, I don't expect that most proffeshional immigrants would be missing it. i woupd be more concerned about the recent trend of 'conciencious objection' against vaccines

        GPs could do a better job of asking for your vaccine record and actually checking if its up to date though. I only found out that one of my vaccines was outdated (they need to be done again every 10 years) because I spesifically was checking my vaccines for travel.

Havoc 5 days ago

On the plus side, I'm glad to hear London has active sewerage surveillance in place

  • BoxOfRain 5 days ago

    I just wish our water companies weren't cheerfully dumping raw sewage into the Thames like it's a serious commitment to the Victorian steampunk aesthetic.

    • bergenty 4 days ago

      Something like 50% of the wastewater sewer pipes in NYC are combined (sewage + rain overflow). I can’t even imagine how to go about fixing that. You would have to build a parallel line and then literally dig up every existing building’s connection to the waste water line. The problem is severely compounded in a city as old as London.

      • Cthulhu_ 3 days ago

        > I can’t even imagine how to go about fixing that.

        One segment at a time, I guess. But like you said, it gets really complicated in older cities with many hundreds of years of things having been put in the ground. Anyway they can probably process that just fine, it just means that at rainy days there will be higher water content; it means they'll have to scale up. Or if there's overflow, dump it directly if they're already doing it now; if they can reduce the amount of sewage going into surface water, it's already an improvement.

    • deadbunny 5 days ago

      Not just the Thames, it's happening everywhere.

      • tialaramex 4 days ago

        Not everywhere. Most of the industrialised world does not build new combined sewers. So if you live in a city that didn't exist say, fifty years ago, the storm water sewers and foul water sewers have always been separate, and as a result there's no Combined Sewer Overflow.

        Some US cities in the middle are like this, nobody (to a first approximation) lived there in 1901, and today there may be a small city with an airport and a decent night life. But in Europe, and on the US coasts, the cities are older.

        In theory, you can separate existing combined sewers. For a town you could maybe attempt this as a large local infrastructure project over the course of a year or two, in a small city this is a large and expensive project that could take decades to complete. For somewhere like London or San Francisco it's unthinkably costly and won't be attempted in the foreseeable future.

        A small sign of willingness to attempt this, combined with the difficult reality of such work goes like this, I live in Southampton, an important port city on England's south coast:

        1. Legally, if you fit a new grey water waste (e.g. from a shower, or a washing machine), it should flow into the sanitary sewer, which your home is plumbed into usually via large black pipes that run mostly vertically up the side of the building. It must not flow into the storm water sewer, which is often smaller rectangular pipes connecting to the gutter where they collect roof water.

        2. But, there's probably a gutter pipe right near where your waste is, while the sanitary sewer could be on the far side of the property. So, does the plumber do the extra work, and charge you for it? Or do they just cut into the storm water sewer and save their time and your money?

        3. Result: Now if you separate the storm water sewer, it has grey water waste flowing into it, and you're dumping that into the sea. Oops.

        • sjburt 4 days ago

          Wait, San Francisco has combined sewers, but they treat the combined sewage before it goes into the bay. Does London not treat their sewage?

          The big problem in San Francisco is that during severe rainstorms the flow rate overwhelms the treatment plant so they have to dump the overflow. but at that point it is mostly rainwater so it's not quite as bad as it sounds.

          • tialaramex 4 days ago

            You have just described Combined Sewer Overflow. Yes, that's how London works too. Whether it's "not quite as bad as it sounds" is a matter of opinion and also should take into consideration just how often such "overflow" happens and what volumes are involved.

            For example, how many cubic metres of rain water makes adding one human turd OK ? A million seems fine, doesn't it? Like, who cares about just one turd in so much rainwater. How about a thousand, that's a swimming pool (not Olympic, but decent sized) with a turd in it, is that OK? Start to feel a bit uncomfortable with how much shit there is in the water? What if it's a hundred? Are you sure San Francisco, or London, can promise you their CSOs have at least that ratio?

            • WorldMaker 4 days ago

              At least on the US side the EPA's CSO laws have "just recently" ratcheted past the point that even "grandfathered" cities are having to make major accommodations for CSO overflow. If you live in a US city with sewers older than 1900 or so and are paying huge sewage taxes, it's likely because your city just built or is in the process of building massive CSO basins, uncombining sewers, and/or other costly capital expense mitigations. It's kind of interesting if you dig into your local projects what they are doing and why and how. (In a semi-related one of those projects my city's water company recently excavated a mid-1800s water main valve that was still in apparently active use up until just recently and it was pretty neat the photos and description of it in the local newspaper. Built to last.)

              (Disclaimer: I vaguely worked on software projects that were CSO mitigation adjacent. Which at least explains some the interest in the projects.)

        • Fatnino 4 days ago

          How about separate but still treat both.

          Then in the event of heavy rainfall there is much less poop in the overwhelmed (mostly) rainwater treatment plant.

          • dragonwriter 4 days ago

            If you separate them, there shouldn’t be any poop in the storm outflow in the first place.

            • Fatnino 4 days ago

              This addresses the case where builders take shortcuts and put the poop down the wrong pipes for convenience.

              • tialaramex 3 days ago

                To a first approximation nobody plumbs toilets into the storm sewers for practical reasons.

                # Solid human waste will clog the smaller pipework and now your toilet waste is overflowing inside the home and the occupants are very angry

                # The fittings don't "fit". The local plumbing supply store has the adaptor you need to run grey waste into rain water drains, even if it says that's not what it's for, but it does not have adaptors to run a large diameter soil pipe into the storm drain, that's a recipe for disaster they want no part in and the part has no other purpose.

                If you indicate that you've got some "good" reason to attempt this, they'll sell you an expensive macerator which solves the first problem by grinding up waste, and as a result the output is smaller diameter waste pipes - but now your project is more expensive and more complicated to install.

lol768 4 days ago

I understand that the vaccine-derived poliovirus originates from the live/attenuated virus used in the oral vaccine. (Or at least, first-gen versions of it! Does nOPV2 conclusively address these issues?)

Can anyone explain why it's rare for inactivated vaccines to be able to be delivered via the oral route? It would have been a lot more efficient/user-friendly to deliver the Coronavirus vaccinations in this manner, but almost all of the vaccines we seem to use nowadays appear to be intramuscular injections.

  • sushibowl 4 days ago

    There are two main challenges to developing an effective oral vaccine:

    * designing a formulation that can survive the harsh gastrointestinal environment. For example, COVID-19 vaccines, especially the mRNA-based ones, are especially fragile and degrade rapidly at room temperature even under normal conditions. * Avoiding mucosal tolerance. Many antigens that would evoke an immediate immune response if encountered in the blood stream are ignored by mucus tissue, to avoid your body creating hundreds or thousands of spurious immune responses every day to antigens occurring in your food. For an oral vaccine to be effective it must get around this tolerance to provoke an effective immune response.

    For respiratory viruses, another promising delivery method would be intranasal, and indeed there are some COVID-19 vaccines in development that use this route[1]. The bottom line is, developing vaccines is already complicated and costly, so unless there is a guaranteed large market demand pharmaceutical companies are unlikely to invest in delivery methods that add additional research challenges.

    [1] https://www.gavi.org/vaccineswork/covid-19-vaccines-could-sq...

    • lol768 a day ago

      Thanks for taking the time to explain these challenges!

  • avs733 4 days ago

    To wildly summarize...for the same reason you are not CONSTANTLY sick. your stomach is a pretty good, but not perfect, immunodefense - i.e., the stomach is a pretty tough environment for survival.

    whether it is worth the trouble also depends on the method of infection. The live attenuated oral polio vaccine creates gut immunity, which is helpful because polio is passed via ingestion of infected materials. Gut immunity is less useful if a disease is passed via inhalation.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132247/

user_7832 4 days ago

An interesting tidbit I haven't seen being mentioned - there's a polio oral vaccine, and an injection, but while the oral drops are much cheaper (and have lesser side effects), there's also a small chance of actually passing the virus.

  • avs733 4 days ago

    To clarify...you are referring to the method of vaccine administration not the type of vaccine.

    Live attenuated viruses create viral shedding, which creates a chance of passing the virus and are administered using oral drops.

    Inactivated virus vaccines, do not create viral shedding, cannot pass off the virus, and are administered using an injection.

    In general, attenuated viruses have the potential to create viral shedding and by extension pass on an infection. The fact that the live attenuated polio vaccine is done via drops is a secondary design decision for , gut immunity, shelf stability, ease of administration, etc. That it is oral drops itself does not cause the chance of passing on the virus.

    Ars technica had a fairly thorough article about all this: https://arstechnica.com/science/2022/06/poliovirus-may-be-sp...

  • zubiaur 4 days ago

    And the oral vaccine, which is not a killed virus, passes through feces.

sph 5 days ago

Possibly dumb question: what's the risk for a European adult that has done all his vaccines since childhood?

  • tgv 4 days ago

    In The Netherlands, children are vaccinated before the age of 1 against (among other) polio since 1962. Vaccination degree is around 95%. There's an interesting tidbit about uptake in strict Protestant circles when there was a polio outbreak in the 1970s: after severaldeaths, they finally agreed taking it orally, as an injection was taboo.

  • qwertox 4 days ago

    Probably none. But you can get a booster like Boostrix-IPV [1]. You wouldn't get it for Polio specifically, but more to freshen up your Tetanus protection, which should be done every 10 years. Let's say you get scratched by a rose while gardening, then you can go to your doctor and let him know that you haven't had a refresh of the most common vaccines in over a decade. Maybe then ask specifically for that one. I got one in my 40s after an accident where the wound then had dirt in it.

    The linked PDF contains the names of that product in different European countries on the last page.

    [1] https://www.medicines.org.uk/emc/files/pil.5302.pdf

  • mateo1 5 days ago

    I'm concerned too, I don't think I was offered a polio vaccine, ever.

    • ricardobayes 5 days ago

      You probably were, it is part of the mandatory course administered to children (at least it was/is in Central/Eastern Europe)

      • bjoli 5 days ago

        Building on this, the vaccination programmes of the EU countries have converged to the extent that I was able to vaccinate my 3 month old in accordance to the Swedish vaccination programme while on vacation in Portugal by just showing up at a health centre and asking for a vaccination in accordance to their vaccination programme.

        They even use the same vaccines.

        If you are younger than 30 you will have had a polio vaccine if you parents followed the national vaccine programme in any European country. If you are younger than 50 chances are that you have been vaccinated as well.

      • mateo1 5 days ago

        Turns out I didn't remember it because it's part of those combined vaccines. I hope my immune memory is better than my cerebral.

        • ggm 5 days ago

          You can get an adult booster. I was a recipient of pink sugar cube, possibly Salk vaccine in the 60s. I got a booster with my son's series in the 90s.

    • pdpi 4 days ago

      That should be easy enough to sort out. Go to your GP and ask them about it, they should be able to make a booster shot happen.

raffraffraff 4 days ago

A few months back my wife told me something about polio that I never knew... Polio emerged as an epidemic after the introduction of sanitation. The reason is that polio doesn't have such a terrible effect on infants, so the entire population has been exposed to it as babies and had developed immunity. So while sanitation reduced a lot of other horrible diseases that come from contaminated water, it prevented the population from getting this natural immunity in childhood, leading to an epidemic. And the people who suffered the worst during that time were the more affluent people who would have had better sanitation available to them. Because even though your neighborhood might be clean, you simply couldn't avoid coming in contact with polio in the great mixing bowl of a town or city.

  • Cthulhu_ 3 days ago

    That's an interesting factoid, thank you for sharing. I've heard related things, e.g. kids who grow up 'too clean' being more susceptible to allergies.

2-718-281-828 5 days ago

What does "vaccine-derived" mean? What is the relation between the detected virus and the virus used in vaccines?

  • Fomite 5 days ago

    In countries that struggle with polio vaccination, we often use a "live attenuated" vaccine - that is, you are getting an infection with live virus, but one that has been engineered to cause little to no disease.

    The advantages of this are that it's very easy to administer (this is the classic "vaccine dropper onto a kid's tongue" image), and because you shed the attenuated virus, you can help boost the immunity of those who aren't directly vaccinated.

    The downside is for the polio vaccine that it occasionally reverts back to a type that causes active disease. This is rare, but definitely happens, and this is one of those cases.

  • M2Ys4U 5 days ago

    There are two types of vaccine in use: An inactivated virus and live, attenuated virus.

    Very occasionally the attenuated virus version can cause onward polio infections, i.e. the vaccinated individual can pass the virus on to others.

    • FartyMcFarter 4 days ago

      Unfortunately some people will assume that all vaccines are the same type as this one, and they'll use this as an argument for why vaccines are bad :(

      • plsbenice34 4 days ago

        Hopefully some people will realise that all vaccines do entail risks, too

        • wonderwonder 4 days ago

          I don't think most people see zero risk with vaccines but they are smart enough to look at the real (not anti vax) statistics and realize that the risks are far outweighed by the benefits to both the individual and the community. Polio, a virus that used to cause 15k cases of paralysis a year in the us and 2k deaths is virtually eliminated due to the vaccine. The risk of course is when the vaccines are defective such as with The Cutter Incident in the 1955. This was probably the root of the modern anti-vax movement. There is also always the chance of a negative reaction to the vaccine as well. With that said, the modern anti-vax movement is for the most part a conspiracy driven group of people that look only for proof that support what they want to see and they are quite happy to not look to deeply into the source of that proof or quite often to even read further than what the local mom posted on facebook.

          • benjaminwootton 4 days ago

            Agree. In my entire life I don’t think I’ve heard anyone question if the usual childhood vaccinations are worth taking. They know that risk is greater than reward.

            There was however a lot of skepticism and debate about the Covid vaccine because risk/reward is much more ambiguous.

            • wonderwonder 4 days ago

              Covid was interesting from an antivax perspective. It started off as pretty dangerous and scary. Lots of people dying very fast. Then it started to get less dangerous quickly as it mutated. In the meantime the vaccine was rolled out and people questioned why should I take a novel vaccine for something that for the most part appears no worse than the flu. Which I completely get. Then they started associating every single negative thing that happened to being vaccinated and things went off the deep end. With that said, my brother is not vaccinated against covid and I totally get it.

          • EL_Loco 4 days ago

            I live in a developing south american country. Whenever I'm in a conversation and someone starts questioning vaccines, the first thing I say is "Stop. Tell me, when was the last time you saw or heard of someone getting child paralysis?" They have no answer, because usually the only people you can find carrying the effects of this terrible disease are over fifty years old. The last case documented in my country was in 1989.

            • linuxftw 4 days ago

              It happens all the time, we just call it something else now: https://www.ninds.nih.gov/health-information/patient-caregiv...

              That's just one of a myriad of conditions that cause paralysis.

              • EL_Loco 4 days ago

                You know I was talking specifically about poliomyelitis, the infectious disease caused by the poliovirus, which in many countries (mine included) is called 'child paralysis'.

                • linuxftw 4 days ago

                  Remember the part where I said 'they call it something different now?' You don't have poliomyelitis anymore, you have Guillain Barre, and unfortunately, nobody knows what causes that shrugs. Some other paralyzing ailments are ALS and MS.

            • wonderwonder 4 days ago

              Only argument I have heard against the polio vaccine was from my brother who argued that the infection rates were declining before the vaccine. He couldn't really explain why there is still polio in Pakistan and Afghanistan the only to places that have barriers to vaccination.

          • native_samples 4 days ago

            "they are smart enough to look at the real (not anti vax) statistics and realize that the risks are far outweighed by the benefits"

            What are "anti vax statistics"? Do you think people who refused to take the COVID vaccines were making up their own data from whole cloth? I never saw that. What we do see is that the stats presented by health authorities are often mangled by inappropriate methodologies that appear to be picked in order to arrive at pre-chosen outcomes. When the raw data is obtained and re-analyzed correctly, we get papers like this one:

            https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4125239

            "The excess risk of serious adverse events of special interest surpassed the risk reduction for COVID-19 hospitalization relative to the placebo group in both Pfizer and Moderna trials (2.3 and 6.4 per 10,000 participants, respectively)."

            In case you're the sort of person who evaluates arguments based on credentials not merit, the authors of this paper are all from universities or health services. One is an editor of the BMJ. One is a professional statistician and epidemiologist (https://en.wikipedia.org/wiki/Sander_Greenland)

            You assert that the modern COVID anti-vax movement is "conspiracy driven". But there are two problems with this argument:

            1. It's not really true. Refusal arises because public health officials have repeatedly lied about the vaccines, saying things like they are 95% effective against infection, or that they'll turn people into "dead ends" for the virus. That second one was the rationale for mandates and it was known to be false from the start - the trials never showed any such thing and they had no reason to believe this given that non-sterilizing vaccines are common. As for the first, the governments that publish actual case rates by vaccine status show that they have effectiveness in the minus 300-400% range i.e. vaccinated people get COVID at a much higher rate than unvaccinated people. So that wasn't true either.

            2. Even if it was the case that it was all driven by conspiracy thinking, so what? It's already been proven beyond all reasonable doubt that public health leaders engaged in multiple conspiracies throughout COVID, e.g. virologists writing in private emails that they thought the virus looked like it'd been modified in a lab, and then days later signing an open letter saying the opposite. Or public health flipping from "masks are useless" to "masks are essential" overnight without any new science to drive it.

            Given this history the argument that anyone proposing the existence of a conspiracy is illegitimate is, well, extremely naive.

            "The risk of course is when the vaccines are defective such as with The Cutter Incident in the 1955. This was probably the root of the modern anti-vax movement"

            The anti-vax movement existed from the very start. Research the history of the smallpox vaccine. Parents were choosing to go to prison for violating mandate laws rather than let their children be vaccinated because they'd seen that vaccinated children came down with actual smallpox at much higher rates than expected. Just like today, public health refused to countenance the possibility that there were any possible problems in the vaccination process. They never change. It's a psychological issue.

            • linuxftw 4 days ago

              Information is more freely accessible than it has ever been. If the CDC et al are willing to lie in this modern era with facts right in front of people, who knows what shenanigans they were up to in the 1950's, or really any decade other than the last 2.

              Some guy in a lab coat wrote down he did a clinical trial somewhere in the 3rd world, and the government just takes his word for it. Then when you have a whistle blower like on the Pfizer trials, who claims patients were unblinded and side effects weren't accurately recorded, people just slap the old 'conspiracy' label on it.

              Before 2021, most people didn't even know VAERS and the National Vaccine Injury Compensation Program even existed. Now the CDC is telling us the reporting system they manage is inaccurate. Okay, so what have they been doing for the last 40 years?

              They finally admitted that the vaccines are affecting some women's cycles, but downplayed it by saying 'on average it's about 1 day shorter between cycles.' That doesn't sound like much, but many women have a very short window of time from conception to implantation before their period starts, and that would be more than enough time to render those women unable to carry a baby.

              It's lunacy.

              • Fomite 4 days ago

                The inaccuracy of the VAERS system has been known for the entirety of my career - it's not meant to be accurate, it's meant to be permissive, because there are other systems that are much narrower but also more accurate.

                People discovering things because they start paying attention doesn't make them new.

                • linuxftw 4 days ago

                  > Established in 1990, the Vaccine Adverse Event Reporting System (VAERS) is a national early warning system to detect possible safety problems in U.S.-licensed vaccines.

                  Do you think VAERS functions adequately in this capacity? Which vaccines have had safety signals that lead to rescinding the license, or otherwise limiting use? Or is the FDA batting 1000?

                  • Fomite 4 days ago

                    VAERS (along with other systems) has helped pick up and prompt investigations for both the J&J COVID-19 vaccine and investigating myocarditis in adolescent males for the mRNA vaccine.

                    VAERS is also important for monitoring the rotavirus vaccines - it was one of the data sources that pulled the RotaShield vaccine off the market due to increased risk of intussusception in 1999.

                    • native_samples 4 days ago

                      Sadly the CDC has just admitted it has never looked at VAERS for COVID vaccines. At all. Ever.

                      https://childrenshealthdefense.org/defender/cdc-vaers-covid-...

                      "Since CDC officials stated publicly that “COVID-19 vaccine safety monitoring is the most robust in U.S. history,” I had assumed that at the very least, CDC officials were monitoring VAERS using the methods they described in a briefing document posted on the CDC website in January 2021 (and updated in February 2022, with minor changes) [PRRs]. I was wrong."

                      This had to be forced out of them with a FOIA request but their response to the request (for documents related to VAERS analysis of COVID vaccines) says:

                      "no PRRs were conducted by the CDC. Furthermore data mining is outside the the agencies purview, staff suggest you enquire with the FDA"

                      The CDC run VAERS but have never actually done any data mining on it, despite telling the public that the monitoring of COVID vaccines was the most robust in history. Which means that statement they gave is either a lie, or it's true and VAERS has actually never been used to detect safety signals.

                      • linuxftw 3 days ago

                        CHD and ICAN have produced a bevy of FOIA requests that have utterly destroyed CDC's and FDA's credibility for anyone that has been interested enough to look into the topic.

                        There was a FOIA request a few years ago (can't remember the name of the organization, search engines have buried these type of results) that the agency in charge of post-license safety review of vaccines has never conducted a single review since the law passed in the 80s or early 90s.

            • wonderwonder 4 days ago

              If you read through my post you would see that I was specifically talking about polio. Indeed in another post I say I understand why people decided against the covid vaccine.

              "You assert that the modern COVID anti-vax movement is "conspiracy driven" Where?

              You pretty much just made up everything you say I said. I get it you had something you wanted to get off your chest so you dropped it on me. No worries.

              • native_samples 4 days ago

                Unfortunately that wasn't clear. You talk about vaccines (in general), the modern anti-vax movement (in general) and so on, each time without qualification. If your points were restricted to one type, it'd make sense to prefix the word vaccine with that type. Especially because there really isn't a modern anti-polio vaccine movement is there? Pre-COVID it was really restricted to MMR.

                Still, there's a secondary question here: how do we know polio vaccines are genuinely so different? COVID vaccines are one of the first mandatory vaccines to be developed and forced on people in the internet era. Thanks to that and the lawsuit that's forcing documents out of the FDA, the world has far more insight into the development and marketing of these vaccines than any previous public health campaign in history. What we see from this evidence is disturbing, and it seems to be a pattern, which raises the question of whether this is really the first time public health people have been misleading people about vaccine effectiveness and safety.

                If it's not, then it becomes hard to say much with any certainty on the topic, as those sources control all the data.

    • arghwhat 5 days ago

      *in use for polio.

      Many other types of vaccine exist, and modern vaccines tend to be neither inactivated nor attenuated virus.

shadowgovt 4 days ago

Interesting.

The tricky thing about finding it in London is that since they found it in sewage sampling, they don't yet know if it originated from the UK's vaccine program or an international source. They'll have to do more digging to narrow it down.

EDIT: as per peer comment from the UKHSA, it's believed to be from an international traveler or resident from a country where polio is still endemic and not yet eradicated. This is a good reminder to keep up on one's vaccinations, as herd immunity statistics are impacted by ubiquitous international travel.

  • Fomite 4 days ago

    Given the UK's vaccine program uses the inactivated vaccine form, it's almost certainly an import case.

hulitu 4 days ago

> It is important that all countries, in particular those with a high volume of travel and contact with polio-affected countries and areas, strengthen surveillance in order to rapidly detect any new virus importation and to facilitate a rapid response.

If the virus is vaccine derived, shouldn't they search for the vaccine which is causing it ?

  • Fomite 4 days ago

    They know the vaccine that's causing it - this isn't new, it's just very rare in a country that predominantly administers the inactivated vaccine. This is just the result of the joint probability of someone recently being vaccinated with the live attenuated vaccine, being in London (likely traveling there), and the vaccine converting to a more pathogenic type.

andy_ppp 5 days ago

If I’ve had the vaccine as a child and possibly a booster around 15 years ago should I get a booster now?

  • 6nf 5 days ago

    Doesn't seem to be recommended unless you're actually going to be working with polio patients or something. Childhood vaccine is sufficient.

  • avs733 4 days ago

    >Two doses of inactivated polio vaccine (IPV) are 90% effective or more against polio; three doses are 99% to 100% effective.

    >It is not known how long people who received IPV will be immune to poliovirus, but they are most likely protected for many years after a complete series of IPV.

    https://www.cdc.gov/vaccines/vpd/polio/hcp/effectiveness-dur...

scotty79 4 days ago

I think we should move to mRNA technology for most of our vaccines.