Most infected people will not have any visible symptoms.

Common symptoms for polio include:

• Fever
• Nausea
• Tiredness
• Headache
• Sore throat
• Stomach pain
  These symptoms usually last 2-5 days.

Polio can cause several health complications that affect the brain and spinal cord. About 1-5 out of 100 people develop meningitis (brain and/or spinal cord infection). About 1 out of 200 people develop paralysis (can't move parts of the body). For those who develop paralysis, 2-10 out of 100 people die. Some children who recover from polio can develop new muscle pain, weakness, or paralysis as adults (post-polio syndrome).

• The virus mainly spreads through close contact with an infected person.
• The virus mainly lives in an infected person’s throat or intestines and is most commonly spread through contact with an infected persons feces (poop), such as contaminated food or water.
• The virus also spreads through air when an infected person sneezes or coughs.
• An infected person can spread the disease immediately and up to 2 weeks after symptoms appear.

If you think you or your someone in your family may have polio because you or they have symptoms, have not been vaccinated against polio, and/or have been traveling:

• Stay home and call your doctor and let them know of your concerns.
• Stay away from other individuals or large groups in places such as school, daycare, and waiting rooms, before speaking to your doctor.
• Wash your hands with soap and water often, especially after going to the bathroom, changing diapers, and before eating or preparing food.

Because of widespread vaccination efforts, polio has been largely eliminated in the United States. However, there was a case of polio detected in an unvaccinated person in the United States in 2022. The best way to protect yourself and keep the U.S polio-free is through vaccination.

• The inactivated polio vaccine (IPV) is very safe and effective at preventing polio.
• Three doses provide at least 99% protection against polio, and two doses at least 90% protection.

Children should usually get four doses of polio vaccine at ages:

• 2 months old
• 4 months old
• 6 through 18 months old
• 4 through 6 years old

If an adult has never been vaccinated against polio, they should get three doses of IPV:

• The first dose at any time
• The second dose 1 to 2 months after the first dose
• The third dose 6 to 12 months after the second dose

If you have had one or two doses of polio vaccine in the past, you should get the remaining third dose. If you are at of polio exposure because of travel or your job, you may receive a booster dose of IPV.

There are many places to get IPV vaccine. If you have insurance, talk to your doctor or check with your local pharmacy to see what vaccines are offered. Most health insurances cover the cost of all recommended vaccines for children and adults.

If you are uninsured or underinsured, there are programs available to help cover the cost of vaccines. Children who are 18 years of age or younger are eligible to receive vaccines at no cost through the Vaccines for Children (VFC) Program if they are:

• Eligible for or are enrolled in Medi-Cal
• American Indian or Alaskan Native
• Uninsured (do not have health insurance)
• Underinsured (private health insurance does not cover the full cost of vaccines)

Click to see if your child is eligible to receive VFC vaccines: English | Spanish

Uninsured or underinsured adults can access free or low cost vaccines at select clinics enrolled in the Vaccines for Adults (VFA) program. For more information on who is eligible, read VFA Eligibility Based on Insurance Status. You can use the following resources for more information on locating clinics:

• A list of free and low-cost clinics in Los Angeles County.
• Interactive county map to locate free and low-cost vaccine clinics.
• LACDPH Vaccine Preventable Disease Control Program website for patients and their families to get more information on vaccines.

You can also dial 2-1-1 for a list of free or low cost vaccine clinics. This includes Vaccines for Children (VFC) provider locations that serve Medi-Cal eligible children and uninsured or underinsured adults. Learn more about specific vaccine information for different age groups:

• Vaccines for Infants and Children (LACDPH)
• Vaccines for Adolescents and Teens (LACDPH)
• Vaccines for Adults (LACDPH)

• Poliomyelitis Facts (WHO)
• Child and Adolescent Vaccine Assessment Tool (CDC)
• What is Polio? (CDC)
• Paying for Vaccines (LAC DPH)
• Polio: Questions and Answers (Immunize.org)
• Polio Vaccine: What You Need to Know (Immunize.org)
• Polio Vaccination (CDC)
• Vaccine Safety (CDC)
• The Adult Vaccine Assessment Tool (CDC)

Clinical Presentation:

• Acute illness can range from asymptomatic infection to paralytic disease. About 1 out of 4 people with poliovirus infection will have flu-like symptoms that can include: sore throat, fever, headache, muscle aches, nausea and vomiting, tiredness, and stomach pain.
• Acute flaccid weakness and muscle pain leading to paralysis usually progresses within 2-3 days of illness onset and is often permanent.
• Post – polio syndrome (PPS) affects between 25 -40 of every 100 polio survivors and usually occurs 15 – 40 years after the initial infection. Persons with PPS may experience health problems such as muscle weakness, mental and physical fatigue, and joint pain.

Consider polio in patients with aseptic meningitis and acute flaccid paralysis, especially if they  have epidemiological risk factors including: individuals who are unvaccinated, incompletely vaccinated, recently traveled abroad to a country where polio still occurs, or were exposed to a person who recently traveled internationally.

If you suspect polio:

• Practice good hand hygiene and contact precautions when interacting with patients suspected or confirmed with having poliovirus.
• Ensure that only staff that are fully vaccinated against poliovirus provide care for patients with suspected or confirmed polio.
• Contact LAC Department of Public Health immediately (instructions below) and collect appropriate specimens as below.

Contact the Acute Communicable Disease Control (ACDC) Program to report a case, obtain technical assistance with specimen collection or completion of forms for polio.

Report confirmed or suspected cases of polio within 1 working day of identification by phone (California Code of Regulations, Section 2500).

Acute Communicable Disease Control

• Business Hours: Monday – Friday 8 am – 5 pm
• Phone: (888) 397 – 3993
• After Hours: (213) 974 – 1234
• Fax: (888) 397-3778 or (213) 482-5508

Treatment for poliomyelitis is supportive.

Polio vaccine provides the best protection against poliovirus.

Two doses of inactivated polio vaccine (IPV) are at least 90% effective o against paralytic polio; three doses are at least 99% effective.

Recommendations for children and adults are as follows:

Infants and Children:

• CDC recommends children in the United States receive IPV to protect against polio, or poliomyelitis, as part of their routine immunizations. IPV can be given at the same time as other vaccines.
• Children get four doses of IPV, with one dose at each of these ages:
  • 2 months
  • 4 months
  • 6 through 18 months
  • 4 through 6 years - before entering kindergarten

At least one dose of polio vaccine is recommended on or after age 4 years regardless of the number of previous doses.

Combination vaccines containing IPV are also available and can be used to reduce the number of injections administered during the clinic visit. (See table below)

Combination Vaccines w/IPV*	Number of Doses	Age	Recommended Age	Dose/Route
Pediarix (DTaP-HepB-IPV) GlaxoSmithKline	3	2, 4, & 6 months	6 weeks-6 years	0.5mL Intramuscular (IM)
Pentacel (DTaP-IPV/Hib) Sanofi Pasteur	4	2, 4, 6, and 15-18 months	6 weeks-4 years	0.5mL Intramuscular (IM)
VAXELIS (DTaP-IPV-Hib-HepB)** MSP Vaccine Company	3	2, 4, and 6 months	6 weeks-4 years	0.5mL Intramuscular (IM)
Kinrix (DTaP-IPV) GlaxoSmithKline	1	4-6 years	4-6 years	0.5mL Intramuscular (IM)
Quadracel (DTaP – IPV) Sanofi Pasteur	1	4-6 years	4-6 years	0.5mL Intramuscular (IM)

*Polio vaccine can be administered with other vaccines.
*Kinrix is approved only for dose 5 of DTaP and dose 4 of IPV.
*Quadracel is approved only for dose 5 of DTaP and dose 4 or 5 of IPV.
*ACIP prefers that, whenever feasible, the doses of vaccine in a series come from the same manufacturer.
**Preferred for American Indian and Alaskan Native infants based on the Haemophilus influenzae type b (Hib) component.

Accelerated Schedule for Children Traveling Outside the U.S.

Children who will be traveling to a  country where the risk of getting polio is high should complete the series before leaving for their trip. If a child cannot complete the routine series before leaving, an accelerated schedule is recommended as follows:

• One dose at age 6 weeks or older
• A second dose 4 or more weeks after the first dose
• A third dose 4 or more weeks after the second dose
• A fourth dose 6 or more months after the third dose

Adults:

• Adults who are unvaccinated or have an incomplete vaccination history should receive the remaining doses of IPV (1, 2, or 3 doses) to complete a 3-dose primary series. Unless there are specific reasons to believe they were not vaccinated, most adults who were born and raised in the United States after 1954 can assume they were vaccinated against polio as children.

For more information on polio vaccine recommendations for adults, see Advisory Committee on Immunization Practices.

Special situations:

• Adults at increased risk of exposure to poliovirus who completed primary series may receive one lifetime booster dose of IPV.
• Situations that put adults at risk of exposure to poliovirus include:
  • Travelers going to countries where polio is epidemic or endemic.
  • Laboratory and healthcare workers who handle specimens that might contain poliovirus.
  • Healthcare workers or other care givers caring for someone infected with poliovirus.
  • Adults identified by public health as being part of a group or population at high risk of exposure because of an outbreak.

Children and adults vaccinated outside of the U.S. should complete the polio vaccination series as recommended.

For more detailed information, see: Polio Vaccination: Information for Healthcare Professionals

• ACIP Recommendations: Polio Vaccine (CDC)
• Poliomyelitis Pink Book (CDC)
• Manual for the Surveillance of Vaccine-Preventable Diseases (CDC)
• Polio Vaccination: Information for Healthcare Professionals (CDC)
• Polio Vaccine Information Statement (VIS) (CDC)
• Poliomyelitis (polio) Overview (WHO)
• Los Angeles Health Alert Network (LAHAN) (LAC DPH)
• You Call the Shots (CDC)
• End Polio Now campaign (endpolio.org)
• Polio Clinical Resources (Immunize.org)
• ACIP Storage and Handling Guidelines for Immunization (CDC)
• Ask the Experts: Polio (Immunize.org)