Great comments Melanie; fecal oral is the route of this enterovirus so you are correct screening incoming house staff to see if vaccinated is only to be sure they are vaccinated.  Fore lab worker exposure to live polio viruses here is UCSF protocol: http://or.ucsf.edu/ehs/9399-DSY/12320  which is relevant to our questions.

 

 

 

 

Interesting discussion thread. Leave it to Dr. Upfal!

 

I’m starting with the assumption that once they are here in the US, they are no longer at risk of exposure.

So they could be exposed right before they leave their country. The incubation period is up to 35 days, so it would be possible for them to move here, start a new job, and then come down with polio acquired in their home country.

 

However polio is not spread through the respiratory route. It’s fecal-oral, or oral-oral on occasion, so it’s similar to hepatitis A in that while people might have it, it should pose minimal risk of transmission to coworkers or patients, although high risk to susceptible household contacts.

 

I think more to the point might be screening inpatients who have recently immigrated, as they could be shedding in stool which is being handled by others.

 

Does anyone know how you’d screen – serology or stool sample?

 

Determining what to do with the results is another challenge. If you check by serology or vaccination history, and it’s negative, there’d be no point in vaccinating now as unless they are returning to an affected country they would not be at risk while in the US. (they might want to have a primary vaccination series with their PCP; not sure that would fall to OH though unless you do routine non-work-related vaccines in your program.)

 

Interested to hear what others think. Based on the mode of transmission and the lack of domestic exposure risk, I would not think we’d want to screen HCW. Not sure about food handlers, again would need to know how you test for early infection.

 

 

 

Consider an incoming resident who was living in Syria, and is just now coming to the US for training.  Or anyone who recently spent more than 4 weeks in one of the affected countries (Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia, Nigeria, Cameroon, Pakistan, and Syria).  Per CDC, they should be boosted with IPV 4-52 weeks before leaving the departure country.  However, that may or may not happen, so perhaps we should be screening? 

 

 

From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Swift, Melanie
Sent: Wednesday, June 04, 2014 2:36 PM
To: MCOH/EH
Subject: Re: [MCOH-EH] Polio

Mark, if they are working in the US is there any increased risk from being a HCW? Or are you thinking they might be traveling back and forth to their home country?

 

 

 

Any thoughts about screening HCWs who are arriving from endemic countries (e.g. starting residents, new faculty, other immigrants) for proof of polio immunization? 

 

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