Most infected people will not have any visible symptoms.

Common symptoms for polio usually last for 2 to 5 days and include:

• Fever
• Nausea
• Tiredness
• Headache
• Sore throat
• Stomach pain

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 (where someone can't move parts of the body).
  • Up to 10% of people who develop paralysis 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 person's 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 their symptoms start.

If you think you or 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 right away and let them know of your concerns.
• Stay away from other people or where there are large groups of people who are at higher risk of getting sick, such as schools, daycare, and hospital or urgent care 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. This will help you make sure that you do not spread polio to others.

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 risk of polio exposure because of travel or your job, you can get a booster dose of IPV.

If you have insurance:

• Talk to your doctor or check with your local pharmacy to see what vaccines they offer.
• Most health insurance plans cover the cost of recommended vaccines for children and adults.

If you are uninsured or underinsured:

• Programs are available to help cover the cost of vaccines.
• Children 18 years or younger may 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)
• Adults who are uninsured or underinsured may be able to get free or low-cost vaccines at clinics enrolled in the Vaccines for Adults (VFA) program. For more information on who is eligible, read VFA Eligibility Based on Insurance Status.

Locating Vaccine Clinics:

• A list of free and low-cost clinics in Los Angeles County.
• Interactive county map to locate free and low-cost vaccine clinics.
• Call 1-833-540-0473 (Public Health InfoLine) 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.

• Immunization Schedules: Birth to 6 Years Old | 7 to 18 Years Old | 19 Years and Older (AAP & AAFP)
• What You Need to Know: Polio Vaccine | Multi-Vaccine (DTaP, Hib, Hepatitis B, Polio, PCV) (Immunize.org)
• Polio: Questions and Answers (Immunize.org)
• Polio & Vaccines to Prevent Paralytic Polio (AAP)
• Poliomyelitis Facts (WHO)
• Polio (History of Vaccines)
• Paying for Vaccines (LAC DPH)

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 about 25-40% of 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: being unvaccinated or incompletely vaccinated, having recent travel to a country where polio still occurs, or were exposed to a person with recent travel to a country where polio still occurs.

If you suspect polio:

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

Do not wait for laboratory confirmation - report immediately by telephone for both confirmed and suspected cases upon clinical suspicion of polio per Title 17, California Code of Regulations, Section 2500.

Public Health will guide you through the collection of specimens for testing and management of the patient under investigation. Consultation is required before sending specimens to the Public Health Laboratory.

• Weekdays 8:30 am - 5:00 pm: Call 213-351-7800 - Epidemiologist on Duty
• Non-Business Hours, Holidays & Weekends: Call 213-974-1234, option 8 - Administrative Officer on Duty

Treatment for poliomyelitis is supportive. There is no specific treatment for poliovirus.

Polio vaccine provides the best protection against poliovirus.

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

Recommendations for children and adults are as follows:

Infants and Children:

• The American Academy of Pediatrics recommends that children in the United States get 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.

*IPV-containing vaccines can be administered with other vaccines.
**KINRIX or Quadracel® may be used to complete the 4-dose IPV series.
***Preferred for American Indian and Alaskan Native infants based on the Haemophilus influenzae type b (Hib) component.
† The recommended minimum age for dose 3 of VAXELIS® is 24 weeks, the minimum age for completion of the hepatitis B vaccine series.
†† 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.

Accelerated Schedule for Children Traveling Outside the U.S.
Children who will be traveling to a country where polio still occurs 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 the American Academy of Family Physicians' Adults 19 and Older Immunization Schedule.

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 caregivers 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 who were vaccinated outside of the U.S. should complete the polio vaccination series as recommended.

Administration Data: California healthcare providers are required to report data on all valid immunizations that they administer to their patients into the California Immunization Registry (CAIR) within 2 weeks of administration per AB 1797.

Administration Errors: Healthcare providers are strongly recommended to report all vaccine administration errors to the Institute for Safe Medication Practices.

Adverse Events: Healthcare providers are required to report any adverse event on the reportable events list to the Vaccine Adverse Event Reporting System (VAERS) per HR 5546.

Storage and Handling: For general recommendations and guidance access the Vaccine Storage and Handling Job Aids.

• Poliovirus Infection B-73 (LAC DPH)
• Vaccine Information Statements (Immunize.org): Polio Vaccine | Multi-Vaccine
• Standing Orders for Administering Inactivated Poliovirus Vaccine to Infants and Children (Immunize.org)
• Poliomyelitis (polio) (WHO)
• Ask the Experts: Polio (Immunize.org)
• End Polio Now Campaign (endpolio.org)
• Los Angeles Health Alert Network (LAHAN) (LAC DPH)