Polio - What to Know

How does polio spread?

• Polio spreads from person-to-person through contact with poop, often tiny, invisible amounts from an infected person. More rarely, it can spread through the sneeze or cough droplets from an infected person.
• This can happen when someone is in close contact with an infected person, such as by caring for them or sharing food or utensils with them.
• Polio is very contagious, but not everyone who is infected with the virus will show symptoms. Some have mild or flu-like symptoms that can easily be mistaken for another type of illness.
• Still, all infected people can spread the virus and infect others, even if they have no symptoms.
• The best way Michiganders can ensure they are protected from this highly contagious virus that can cause paralysis and even death is by being up to date with polio immunizations.

What are the symptoms of polio?

There are a range of symptoms people infected with polio may experience, ranging from having no symptoms, to mild and flu-like symptoms, to serious symptoms, including paralysis, permanent disability, or post-polio syndrome, and even death. Although some people will not experience symptoms from polio, it is important to know that this life-threatening virus may still be transmitted to others.

According to CDC, 75% of people infected with polio experience no symptoms. About 25% experience mild or flu-like symptoms that may be mistaken for many other illnesses, such as:

• Fatigue
• Fever
• Headache
• Stiffness
• Muscle or stomach pain
• Nausea/Vomiting
• Sore throat

These symptoms usually last 2 to 5 days, then go away on their own.

A smaller proportion of people will develop more serious symptoms that affect the brain and spinal cord, including:

• Paresthesia (feeling of pins and needles in the legs)
• Meningitis (infection of the covering of the spinal cord and/or brain)
• Paralysis (can't move parts of the body) or weakness in the arms, legs, or both

Paralysis is the most severe symptom associated with polio because it can lead to permanent disability and death. According to CDC, of those paralyzed, 2-10% die when their breathing muscles become immobilized.

Even children who seem to fully recover can develop new muscle pain, weakness, or paralysis as adults 15 to 40 years later. This is called post-polio syndrome.

Michiganders should know:

While immunization is the only way to protect against disease, handwashing with soap is also important to prevent the spread of germs. Alcohol-based sanitizers do not work on some types of germs, like polio.

Who should get immunized against polio?

• All unvaccinated children (17 years of age or younger) or those children not up to date with immunizations should get immunized. This is particularly urgent if they live, work, attend school, or have frequent social interactions with communities where poliovirus has been repeatedly detected in wastewater.
• Most adults 18 and older born and raised in the United States were vaccinated as children and likely to be protected from getting polio, unless there are specific reasons to believe that they were not vaccinated. More information about adult polio vaccination can be found here.
• Adults and children who may have received poliovirus vaccination outside the U.S. should meet the U.S. recommendation for polio vaccination that includes protection against all three poliovirus types. If documentation is available and shows that the child or adult received age-appropriate vaccination with either IPV or trivalent OPV (tOPV), then the person is considered fully vaccinated. To ensure those vaccinated outside the U.S. meet the U.S. recommendations consult a healthcare provider.
• Adults who live or work in the areas where poliovirus has been repeatedly detected in wastewater and are unvaccinated, under-vaccinated, or don't believe they are vaccinated should get all recommended vaccine doses.
• Michigan adults who are unvaccinated, under-vaccinated, unsure of their vaccination status, or not up to date with vaccinations should consult with a healthcare provider. If vaccination is recommended and a provider does not have doses on hand, Michiganders should contact their local health department.

Who should get a booster dose?

 Adults who are completely vaccinated and are planning to travel to countries with increased risk of exposure to poliovirus may receive a single lifetime booster dose of IPV.

Situations that put adults at increased risk of exposure to poliovirus include:

• You are traveling to a country where there is a documented increased risk of exposure to poliovirus.
  • For more information see Polio: For Travelers and ask your healthcare provider if you need to be vaccinated.
• You are working in a laboratory or healthcare setting and handling specimens that might contain polioviruses.
  • In Michigan, this may include individuals who collect or work with wastewater specimens for poliovirus testing.
• You are a healthcare worker or caregiver who has close contact with a person who could be infected with poliovirus.
  • In Michigan, this would include:
    • Healthcare workers who work in areas with community transmission of poliovirus and who could care for patients with poliovirus (e.g., urgent care, emergency department, neurology, pediatrics).
    • Individuals who will or might have exposure to a person known or suspected to be infected with poliovirus, such as household members and other close contacts of a case or suspect case who provide care.
    • Childcare or pre-K providers who work in areas with community transmission of poliovirus and provide diapering or toileting care or assistance.
• You are an unvaccinated or incompletely vaccinated adult whose children will be receiving oral poliovirus vaccine (for example, international adoptees or refugees).
• You are an unvaccinated or incompletely vaccinated adult living or working in a community where poliovirus is circulating.

What should healthcare providers do?

• Improving vaccination coverage for polio and other vaccine preventable diseases is critical to the public health of all Michiganders. Providers should take time in every primary care visit, for both adults and children, to ensure that they are up to date with the recommended vaccines for their age.
• Receiving polio immunizations on-time is critical to keeping Michiganders protected against paralytic polio disease.
• MDHHS urges all healthcare providers, especially pediatricians, to ensure their patients are up to date with their polio vaccine schedule.
• Healthcare providers should consider polio in the differential diagnosis of patients with sudden onset of limb weakness, especially with a recent history of fever and/or gastrointestinal illness.
• Providers should especially be on alert for these symptoms in unvaccinated individuals, those currently at increased risk of community transmission, or those with recent international travel or exposures to international travelers.
• Providers should order and stock IPV so they can provide polio vaccination for their patients who are unvaccinated and/or request polio vaccination.

Resources 

• MMWR: Wastewater Testing and Detection of Poliovirus Type 2 Genetically Linked to Virus Isolated from a Paralytic Polio Case — New York, March 9–October 11, 2022
• MMWR: Public Health Response to a Case of Paralytic Poliomyelitis in an Unvaccinated Person and Detection of Poliovirus in Wastewater — New York, June–August 2022
• CDC Polio Page
• Polio Vaccination: What Everyone Should Know | CDC
• Polio Vaccines for Children | CDC
• Polio: For Travelers | CDC
• Polio Investigation | CDC
• WHO Polio Page
• Immunize.org Page

• Polio: For Healthcare Providers | CDC
• Report of polio detection in United States – GPEI (polioeradication.org)
• Standing orders for polio vaccines

Questions or comments: checcimms@michigan.gov