Learning Objectives for this Presentation:
By the end of the presentation, participants will be able to describe the risks of paralytic poliomyelitis among travelers and to discuss recommended polio vaccinations for travelers.

Background:
Paralytic poliomyelitis is rare in the United States due to childhood immunizations and the global Polio Eradication Initiative. In the U.S., the last indigenous and imported wild polio cases occurred in 1979 and 1993, respectively. Following the policy change from oral polio vaccine (OPV) to a sequential inactivated polio vaccine (IPV)–OPV schedule (1997) and then to an all-IPV schedule (2000), vaccine-associated paralytic poliomyelitis (VAPP) has not occurred since 1999.

Objectives:
To investigate a suspect case of paralytic poliomyelitis in a U.S. citizen, and to determine the strain and source of poliovirus causing illness.

Methods:
We interviewed the patient and her family to obtain past medical, vaccination, travel, and exposure history. We reviewed the medical record for clinical, diagnostic and treatment information. Serum and stool specimens were tested by standard techniques.

Results:
A 22 year-old Arizona woman with no history of polio vaccination contracted paralytic poliomyelitis while traveling to an OPV-using country in Latin America. In early March 2005, she developed sore throat, neck and back pain, followed by fever, headache, acute leg weakness and respiratory failure. Electrodiagnostic studies and MRI were consistent with paralytic poliomyelitis. Stool specimens collected March 20 were positive for Sabin strain poliovirus types 2 and 3. Serum specimens were negative for dengue and West Nile viruses and positive for all three polio serotypes. The case was classified as imported VAPP.

Conclusions:
This case of VAPP occurring in an unvaccinated traveler is the first paralytic poliomyelitis case identified in the U.S. since 1999. This case raises questions as to whether current vaccine policy recommendations for travelers should be expanded to include U.S. residents traveling to OPV-using countries.