Infection Control of Poliovirus in Healthcare Personnel

Background

The last cases of indigenously acquired wild-virus poliomyelitis occurred in the United States in 1979. Since then, all cases of endemic poliomyelitis reported in the United States (5 to 10 endemic cases/year) have been related to the administration of oral polio vaccine (OPV). Although the risk of transmission of poliovirus in the United States is very low, wild poliovirus may potentially be introduced into susceptible populations with low immunization levels.

Poliovirus is transmitted through contact with feces or urine of infected persons but can be spread by contact with respiratory secretions and, in rare instances, through items contaminated with feces. The incubation period for non-paralytic poliomyelitis is 3 to 6 days, but is usually 7 to 21 days for paralytic polio. Communicability is greatest immediately before and after the onset of symptoms, when the virus is in the throat and excreted in high concentration in feces. The virus can be recovered from the throat for 1 week and from feces for several weeks to months after onset of symptoms.

Vaccine-associated poliomyelitis may occur in the recipient (7 to 21 days after vaccine administration) or susceptible contacts of the vaccine recipient (20 to 29 days after vaccine administration). Adults have a slightly increased risk of vaccine-associated paralytic poliomyelitis after receipt of OPV; therefore, inactivated poliovirus vaccine (IPV) should be used when adult immunization is warranted. Also, because immunocompromised persons may be at greater risk for development of poliomyelitis after exposure to vaccine virus, IPV rather than OPV is recommended when vaccinating pregnant or immunocompromised personnel, or personnel who may have contact with immunocompromised patients. Health care personnel who may have contact with patients excreting wild virus (e.g., imported poliomyelitis case) and laboratory personnel handling specimens containing poliovirus or performing cultures to amplify virus should receive a complete series of polio vaccine; if previously vaccinated, they may require a booster dose of either IPV or OPV. For situations where immediate protection is necessary (e.g., an imported case of wild-virus poliomyelitis requiring care), additional doses of OPV should be given to adults who have previously completed a polio vaccine series.

Recommendations

a. Determine whether the following personnel have completed a primary vaccination series: (1) persons who may have contact with patients or the secretions of patients who may be excreting wild polioviruses and (2) laboratory personnel who handle specimens that might contain wild polioviruses or who do cultures to amplify virus (Table 1). Category IA

b. For above personnel, including pregnant personnel or personnel with an immunodeficiency, who have no proof of having completed a primary series of polio immunization, administer the enhanced inactivated poliovirus vaccine rather than oral poliovirus vaccine for completion of the series (Table 1). Category IB

c. When a case of wild-type poliomyelitis infection is detected or an outbreak of poliomyelitis occurs, contact the CDC through the state health department. Category IB

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Date last modified: March 1, 2005
Content source: 
Division of Healthcare Quality Promotion (DHQP)
National Center for Preparedness, Detection, and Control of Infectious Diseases