Areas with Ongoing Poliovirus Circulation

Interim Guidance for Poliovirus Containment in Non-Poliovirus Essential Facilities in the United States

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Audience: This guidance applies to laboratories and various facilities that collect, handle, or store infectious materials in or from areas known or suspected to have circulating polioviruses. These are non-essential poliovirus facilities and include public health, clinical, research, and environmental testing laboratories, healthcare providers, vaccine producers, storage facilities, and facilities that treat human waste and sewage.

The guidance outlines measures to mitigate the risks that poliovirus potentially infectious materials (PIM) pose to personnel, the environment, public health, and the global eradication of poliovirus.

For poliovirus-essential facilities (PEFs):

Refer to Containment Guidance for Facilities.

Background on Polio Identification in the U.S.

A single U.S. paralytic polio case was identified in a person in Rockland County, New York, in July 2022. Vaccine-derived poliovirus (VDPV) was detected in subsequent local wastewater samples from multiple counties in the surrounding geographical area. The polioviruses identified from the New York paralytic polio case and wastewater samples meet WHO’s criteria for circulating vaccine-derived poliovirus.

This interim guidance from the U.S. National Authority for Containment (NAC) is based on the World Health Organization’s (WHO) Global Action Plan, 4th edition (GAPIV) and Potentially Infectious Materials (PIM) Guidance documents.

Contact the U.S. NAC at poliocontainment@cdc.gov for additional guidance.

On This Page

Workers who handle specimens that contain polioviruses are at increased risk for exposure. Talk with a healthcare provider to find out if you may need additional poliovirus vaccination.

Guidance for Laboratories

Interim Guidance for Facilities
[PDF - 1 MB]

What You Need to Know

Laboratories in areas of ongoing poliovirus transmission should

  • Implement measures to mitigate the risks to personnel handling VDPV PIM.
  • Inactivate PIM using a validated method. See Policy for U.S. Facilities to Inactive Poliovirus Materials.
  • Report VDPV PIM retained for thirty (30) days or more to the U.S. NAC and notify U.S. NAC of PIM samples transferred to other facilities.
  • Store PIM separately from non-PIM.
  • Destroy any unneeded or nonessential VDPV PIM and complete a NAC Destruction Attestation form.

Forms and Fact Sheets

Guidance for Non-Laboratories

Interim Guidance for Non-Laboratories (e.g., Wastewater Treatment facilities, utilities, healthcare facilities)
[PDF - 1 MB]

What You Need to Know

Non-laboratory facilities in areas of ongoing poliovirus transmission should

Forms and Fact Sheets

What to Do When There is Evidence of Ongoing Poliovirus Circulation in Your Area

Contact your state and/or local health department for information on poliovirus testing and results or before initiating wastewater testing.

List of state public health departments: https://www.cdc.gov/publichealthgateway/healthdirectories/index.html

VDPV PIM Geographic Area

Definition
  • An area with two or more CDC-confirmed, VDPV1-positive wastewater (WW) samples from:
    1. One sewershed more than two months apart2, or
    2. At least two non-overlapping sewersheds with more than one CDC-confirmed, genetically related VDPV-positive WW sample.3 Consider establishing upstream wastewater sampling sites to narrow a multi-county sewershed or a large sewershed within a single county.4

OR

  • A county with two CDC-confirmed, genetically linked VDPV-positive clinical specimens from two unrelated (do not share the same household) persons.

Determination of when the time of circulation has ended is based on time since the last detection; currently, six months following the last detection of VDPV in WW or in a clinical specimen.

Containment Steps to Take

Yes, containment steps are needed if your facility handles PIM in or from a VDPV PIM geographic area.

  1. Report to the NAC:
    • Take the US Poliovirus Containment Survey
    • Report potentially infectious material (PIM) including stool and upper respiratory secretion specimens, concentrated sewage and wastewater samples, and their derivatives (e.g., stool suspensions, extracted nucleic acid) collected and retained forthirty (30) days or more.
    • Report infectious materials (IM). Presumptive poliovirus (PV)-positive samples (i.e., tested positive but not CDC confirmed) must be reported withinseven (7) days of detection.
    • Report any changes in PIM inventory to the U.S. NAC at polioviruscontainment@cdc.gov.
  1. Destroy unneeded or nonessential materials:
    • Unneeded or nonessential materials should be destroyed5, inactivated, or returned to the start of the wastewater treatment process (i.e., return to the treatment train)​.
    • Complete the Destruction Attestation Form and submit​ it to U.S. NAC.
  1. Transfer infectious material to a U.S. PEF:
    • Transfer PV-positive samples or materials to a poliovirus-essential facility (PEF) when CDC-confirmatory testing is complete.​ Extracted nucleic acids may be retained ​if the extraction was performed using methods that have been validated to inactivate PV [PDF – 984 KB].
    • If shipping materials, print and include the Shipping PIM Package Insert to alert personnel.
    • Complete the Material Transfer Form and submit it to the U.S. NAC.

Non-PIM Geographic Area

Definition

No detection of CDC-confirmed presumptive poliovirus (PV)2 in WW samples or any human detection (positive clinical detection).

If new PV-positive WW samples as defined above are detected in an area designated as “non-PIM”, the area is re-classified as a “VDPV PIM” geographic area and should follow containment guidance for a VDPV1 PIM geographic area.

Containment Steps to Take

No containment steps are needed.

Stool and upper respiratory secretion specimens, concentrated sewage, wastewater, and their derivatives collected and retained in non-PIM geographic areas are not considered PIM and do not need to be reported to U.S. NAC.

Strategies to Lower Risks from PIM for All Workers

  • Assess the polio vaccination status of those handling PIM and offer vaccination when indicated to complete the adult series. Those who do not know their polio vaccination status may be offered a polio vaccination booster. CDC has recommendations for polio vaccination.
  • Ensure appropriate standard safety precautions [PDF – 1 MB] (e.g., personal protective equipment, training, handwashing, waste disposal) are in place for workers handling PIM.
  • Use personal protective equipment that considers oral and mucosal membrane protection by all workers handling PIM.
  • Perform risk assessment for specific procedures used with PIM or perform a job-specific analysis.
  • Direct specific questions about protecting workers to the relevant state health department, Occupational Safety and Health Administration (OSHA), National Institute for Occupational Safety and Health (NIOSH), and Environmental Protection Agency (EPA) guidance.
  • Ensure non-laboratory workers follow CDC guidelines for collecting and handling wastewater and guidelines for COVID-19
  • Segregate PIM from non-PIM.
  • Keep PIM in a locked freezer or laboratory and limit access.

Laboratory Workers

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