Polio:

Questions and Answers

INFORMATION ABOUT THE DISEASE AND VACCINES

What causes polio? This problem is called post-polio syndrome (PPS) and
symptoms can include new muscle pain, weakness, or
Polio is caused by a virus.
paralysis. PPS is not infectious. For more information
How does polio spread? or for support for people with post-polio syndrome,
go to www.post-polio.org.
Polio is usually spread via the fecal-oral route (i.e.,
the virus is transmitted from the stool of an infected How is polio diagnosed?
person to the mouth of another person from
The diagnosis is made by laboratory detection of
contaminated hands, food, water, or objects. Some
poliovirus from a stool or throat specimen.
cases may be spread directly via an oral to oral route.

How long is a person with polio contagious?

How long does it take to show signs of paralysis
after being exposed to poliovirus? Patients infected with the polio virus can pass the
virus on for 7–10 days before the onset of symptoms.
The incubation period for onset of paralysis in para-
In addition, they can continue to shed the virus in
lytic polio is 7–21 days after exposure to the virus.
their stool for several weeks after infection.
What are the symptoms of polio virus infection?
Is there a treatment for polio?
About 70% of all individuals infected with poliovirus
There is no “cure” for polio. People infected with
have no apparent symptoms.
polio need supportive therapy, such as bed rest and
Another 24% of infected individuals have symptoms fluids. Standard precautions should be taken to avoid
of a minor, non-specific nature, such as sore throat passing on the virus through any contamination from
and fever, nausea, vomiting, and other common the patient’s stool.
symptoms of any viral illness.
About 1%–5% of infected individuals develop How common is polio in the U.S.?
nonparalytic aseptic (viral) meningitis, with temporary Before a polio vaccine was developed, polio epidemics
stiffness of the neck, back, and/or legs. Less than were common in the United States. For example,
1% of all polio infections result in the classic “flaccid in the immediate pre-vaccine era (i.e., early 1950s),
paralysis,” where the patient is left with permanent between 13,000 and 20,000 paralytic cases were
weakness or paralysis of legs, arms, or both. reported each year. After the development of the
inactivated (Salk) injectable vaccine in 1955 and the
How serious is polio? live (Sabin) oral vaccine in 1961, the number of polio
Although most cases of polio are mild, the cases cases dropped dramatically. In 1960, there were
resulting in flaccid paralysis have made polio a feared 2,525 paralytic cases reported, but by 1965 this
disease for hundreds of years. Of people with number had fallen to 61.
paralytic polio, about 2%–5% of children die and up Due to high vaccination rates in the U.S., no cases of
to 15%–30% of adults die. wild polio have been acquired in the U.S. since 1979
and none in the Western Hemisphere since 1991.
Are there any long-term concerns for persons who However, vaccine-derived community-acquired polio
contracted paralytic polio in childhood? has been detected in the U.S. in Minnesota in 2005
About 25%–40% of people who suffered from and in New York in 2022. The 2022 case of paralytic
paralytic polio as children develop new symptoms in polio was detected in an unvaccinated young adult.
adulthood (usually after an interval of 15–40 years).
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Subsequent investigations found poliovirus in waste the vaccine of choice for the United States from
water samples in multiple counties in New York, 1963 until changes in U.S. policy in the 1990s.
suggesting that transmission of the virus was In 1988, a new trivalent IPV formulation became
occurring in the community. available and by 1997 had become part of the routine
Polio symptoms from vaccine-derived poliovirus schedule for infants and children, given in a series
infection may rarely occur when live vaccine virus with OPV. In 2000, an all-IPV vaccine schedule
mutates and becomes capable of causing disease in was adopted in the United States. IPV is also a
the vaccinated person or in people exposed to the component of some combination vaccines.
mutated virus from the vaccinated person if it
continues to spread. Since live polio vaccine has not How is the vaccine administered?
been used in the U.S. since 2000, these 2005 and IPV is given as a shot in the arm or leg.
2022 cases of vaccine-derived polio occurred after
a traveler infected by vaccine-derived polio virus Why was the U.S. polio immunization
elsewhere entered or returned to the United States. recommendation changed to IPV?
The change to an all-IPV schedule in the United
How common is polio in the world?
States occurred because the few cases U.S. cases
In 1988, the World Health Organization (WHO) of polio that were occurring (8–10 per year) were
adopted the goal of global polio eradication. Although caused by the OPV vaccine itself and not the wild
the initial target date of 2000 was not met, substantial virus. The change to IPV protects individuals against
progress has been made. In 1988, there were paralytic polio, while eliminating any risk of contract-
estimated to be 350,000 reported cases of polio in ing polio from the vaccine. OPV is better at stopping
the world; in 2001, just 483 cases were reported. the spread of the virus to others. For this reason, in
Despite challenges caused by vaccine rumors and other countries, including those where polio is still a
the COVID-19 pandemic, by 2023, there were only threat, OPV is still used. In April 2016, all countries
12 cases of wild-type poliovirus in two countries: using OPV switched from the traditional trivalent
Afghanistan and Pakistan. Challenges remain from OPV to a bivalent OPV formulation for routine
evidence of circulating vaccine-derived polioviruses in vaccination. Vaccination campaigns may use
32 countries. These cases of vaccine-derived polio monovalent oral polio vaccines to contain outbreaks.
highlight the need for high vaccination rates.
Who should get this vaccine routinely?
The Global Polio Eradication Initiative (GPEI)
coordinates polio eradication efforts as a partnership All infants should get IPV unless they have a medical
of public and private organizations working together. reason not to. A primary series of IPV consists of
Since the GPEI was launched in 1988, an estimated three properly spaced doses, usually given at two
18 million people are able to walk who would months, four months, and 6–18 months. A booster
otherwise have been paralyzed. dose is given at 4–6 years, unless the primary series
was given so late that the third dose was given on or
When did the polio vaccine first become available? after the fourth birthday.
The first polio vaccine was an inactivated, or killed,
Does my child need additional doses of polio vac-
vaccine (IPV) developed by Dr. Jonas Salk and licensed
in 1955. cine if he received a combination of OPV and IPV?
No, any properly spaced combination of IPV or
What are the polio vaccines that have followed the trivalent OPV, is considered a complete poliovirus
first Salk vaccine? vaccination series. The last dose in the series must
In 1961, a live attenuated (i.e., weakened) vaccine be given on or after the 4th birthday and at least
was developed by Dr. Albert Sabin. This vaccine was 6 months after the previous dose. One exception
given by mouth instead of as a shot. By 1963, this is for children who received a fourth dose prior to
oral vaccine had been improved to include protection August 7, 2009 for whom 4 doses separated by at
against all three strains of polio and was licensed as least 4 weeks is sufficient, unless the teenager is
“trivalent oral poliovirus vaccine” (tOPV). OPV was traveling to a polio-endemic area.
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Polio: Questions and Answers (continued) page 3 of 3

Why should I vaccinate my child against polio Should a blood test be used to check for
if this disease has been eliminated from the immunity to polio if a person is unsure about their
Western Hemisphere since 1991? vaccination history?
Polio still exists in parts of the world and can easily A blood test can no longer be used to test for immunity
be imported. In addition, vaccine-derived polio can to polio. If there is concern whether an individual is
also circulate and cause paralytic polio in unvacci- immune, they should be vaccinated as recommended
nated people, as occurred in New York in 2022. for their age and polio vaccination history.

Should adults get vaccinated against polio? Who recommends this vaccine?
In the United States, the rate of childhood polio The CDC, the American Academy of Pediatrics (AAP),
vaccination has been well over 90% for decades. the American Academy of Family Physicians (AAFP),
Most U.S. adults may be presumed to be vaccinated the American Academy of Physician Associates
against polio unless there is a good reason to believe (AAPA), and the National Association of Pediatric
otherwise (such as an adult whose parents were Nurse Practitioners (NAPNAP) have all recommended
known to have refused vaccinations). In 2023, CDC that children receive IPV.
recommended that all U.S. adults known or suspected
to be unvaccinated or incompletely vaccinated How safe is this vaccine?
against polio complete a 3-dose primary series. The IPV vaccine is very safe; no serious adverse
Vaccination is especially important for adults at reactions to IPV have been documented.
increased risk of infection, including travelers to
areas where polioviruses are circulating, laboratory or What side effects have been reported with this
healthcare workers who handle specimens that might vaccine?
contain polioviruses, healthcare workers or caregivers Possible side effects include minor local reactions at
in close contact with patients who might be excreting the site of injection (e.g., pain, redness).
polioviruses in their stool after recent arrival from an
area where polioviruses are circulating, and adults How effective is this vaccine?
identified by public health authorities as part of a
IPV is very effective in preventing both wild and
group at risk of exposure in an outbreak.
vaccine-derived polio, but only when all recom-
An unvaccinated adult should receive 3 doses of IPV. mended doses are completed. A single dose of IPV
Dose 2 is given 1–2 months after dose 1, and dose 3 produces little or no immunity, but 99% of recipients
is given 6–12 months after dose 2. If time is limited are immune after three doses.
(e.g., imminent travel to an affected area), it is
acceptable to use an accelerated schedule with at Who should not receive the polio vaccine?
least 4 weeks between each dose.
• Anyone who has had a life-threatening allergic
If an adult received 1 or 2 doses of trivalent OPV or reaction to neomycin, streptomycin, or polymyxin
IPV in the past, they do not need to restart the polio B should not get the IPV shot because it contains
vaccination series. They may complete the series with trace amounts of these antibiotics.
IPV. Bivalent OPV (in worldwide use since April 2016)
• Anyone who has had a severe allergic reaction to a
and monovalent OPV used in some vaccination
dose of polio vaccine should not get another one.
campaigns do not count toward the 3-dose polio
vaccine series. • Anyone who is moderately or severely ill at the time
the shot is scheduled should usually wait until they
Fully vaccinated adults who are at increased risk of
recover to get vaccination.
exposure to polioviruses may receive another dose
of IPV as a one-time booster. Additional boosters Can the IPV vaccine cause polio?
are not needed, regardless of future travel or
No, the inactivated polio vaccine (IPV) cannot cause
exposure risks.
paralytic polio because it contains killed virus only.

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