1. Cain, Joanna E. BSN, RN

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Vaccine-associated paralytic polio (VAPP) has been uncommon in the United States since 2000, when use of the live, attenuated oral polio vaccine was discontinued in favor of an inactivated polio vaccine. A recent report from the Centers for Disease Control and Prevention (CDC) describes the first case of imported VAPP in an unvaccinated American college student who was exposed to live vaccine while traveling abroad.


The 22-year-old woman, who was never immunized against polio because of a religious exemption, was living with a Costa Rican family. The family's infant grandson lived next door and had received the oral vaccine shortly after the student arrived. The young woman developed fever and malaise, which progressed to headache, neck and back pain, and leg weakness. By the time she was transported by air to a Phoenix hospital, she had lower extremity weakness and respiratory failure that required intubation. Cerebrospinal fluid showed lymphocytic pleocytosis and an elevated protein level. Stool specimens sent to a CDC laboratory showed Sabin-strain poliovirus types 2 and 3. After hospitalization and rehabilitation, the young woman went home. She still had weakness in both legs 60 days after the onset of illness.


A CDC panel of polio experts confirmed that this was a case of imported VAPP with the onset of illness occurring before entry into the United States. It illustrates the danger of traveling without recommended immunizations, and the CDC recommends vaccination for all travelers to countries in which polio is endemic or polio outbreaks occur. Information on vaccination requirements for international travelers is available at


Landaverde M, et al. MMWR Morb Mortal Wkly Rep 2006;55(4):97-9.