Clinical Guidance for Investigating a Suspected Case of Polio

Recommendations

CDC urges all healthcare providers to:

• Ensure their patients are current on polio vaccine, especially those who may travel or be exposed to recent international travelers.
• Consider polio in the differential diagnosis of patients with sudden onset of limb weakness with history of fever and/or gastrointestinal illness.
  • Especially in unvaccinated individuals or those with recent international travel or exposures to international travelers.

If you suspect a case of polio

• Practice good hand hygiene and contact precautions when interacting with the patient.
• Evaluate the patient for flaccid weakness and document tone, reflexes, and muscle strength.
• Poliomyelitis has been classified as immediately notifiable, extremely urgent. Contact the state or local health department immediately to report a patient with suspected poliomyelitis.
• Work with the state and local health department to order poliovirus testing:
  • Collect appropriate stools (whole stool) and throat specimens (OP swab): 2 specimens of each taken at least 24 hours apart during the first 14 days after onset of paralytic disease.
  • Store specimens at –20 degrees celsius and ship frozen.
• For questions, contact the CDC Emergency Operations Center at 770-488-7100.

The rapid investigation of suspected polio cases is critical to identifying possible poliovirus transmission and implementing proper control measures. For more information see CDC poliomyelitis guidelines for epidemiologic, clinical, and laboratory investigations of AFP to rule out poliovirus infection.

Evaluation

If you have a patient that presents with sudden onset of limb weakness and an MRI with at least some gray matter involvement in the spinal cord, you should report the patient to state/local health department as a possible case of acute flaccid myelitis (AFM).

Follow these steps:

1. Contact your state or local health department as soon as possible for instructions on how to report.
   1. You can direct urgent questions to the CDC Emergency Operations Center (770-488-7100).
   2. Email non-urgent questions to the CDC AFM team at AFMinfo@cdc.gov.
2. Collect biological specimens for testing as soon as possible to increase the possibility of finding a causative agent.
   1. See AFM Specimen Collection Instructions.
   2. Critical note: Try and obtain 2 stool samples collected at least 24 hours apart; both collected as early in illness as possible and ideally within 14 days of illness onset. Poliovirus is most likely to be detected in stool.

Higher suspicion for polio

Clinicians should have a higher suspicion for polio if the patient:

• Is not vaccinated or under-vaccinated against polio.
• Has travelled to areas with higher risk of polio.
• Has had a contact with someone infected with polio.

Reporting

Each state and territory has regulations or laws governing the reporting of diseases and conditions of public health importance. These regulations and laws list the diseases to be reported and describe those persons or groups responsible for reporting such as healthcare providers, hospitals, laboratories, schools, daycare and childcare facilities, and other institutions. Contact your state health department for reporting requirements in your state.

Mitigating risk

Unvaccinated close contacts of suspected cases are at highest risk. Improving vaccination coverage for polio and other vaccine preventable diseases is one of the core missions of CDC.

• Every effort should be made to vaccinate all eligible persons in the communities that may be at risk.
• Take time in every primary care visit, adults, and children, to ensure that they are up to date with the recommended vaccines for their age.

Resources

• Pink Book: Poliomyelitis
• Polio Chapter | Vaccine Preventable Diseases Surveillance Manual
• ACIP Polio Vaccine Recommendations
• Polio Vaccine Information Statement
• Travelers' Health: Polio
• 2020 Yellow Book: Poliomyelitis
• Five things clinicians should know about Polio