Incident Management

At a glance

No containment steps need to be taken in non-PIM geographic areas. Facilities that handle PIM in or from a PIM a VDPV PIM geographic area should:

VDPV PIM geographic area

Resource‎

Contact your state and/or local health department for information on poliovirus testing and results before waste water testing. View health department directories.

Definition

A VDPV PIM geographic area is an area with two or more CDC-confirmed, VDPV1-positive wastewater (WWA) samples from:

  • One sewershed more than two months apart.B
  • At least two non-overlapping sewersheds with more than one CDC-confirmed, genetically related VDPV-positive WW sample.C Consider establishing upstream wastewater sampling sites to narrow a multi-county sewershed or a large sewershed within a single county.D

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) collected and retained for thirty (30) days or more. This includes stool and upper respiratory secretion specimens, concentrated sewage and wastewater samples, and their derivatives. It also includes stool suspensions and extracted nucleic acid.

Report infectious materials (IM). Presumptive poliovirus (PV)-positive samples (i.e., tested positive but not CDC confirmed) must be reported within seven (7) days of detection.

Report any changes in PIM inventory to the U.S. NAC at polioviruscontainment@cdc.gov.

2. Destroy unneeded or nonessential materials

Unneeded or nonessential materials should be destroyed, 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.

3. 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.

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

Non-PIM geographic area have no detection of CDC-confirmed presumptive poliovirus (PV)E 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. Professionals should then follow containment guidance for a VDPV1 PIMGF geographic area.

Containment Steps to Take

No containment steps are needed.

The following collected and retained materials and their derivatives in non-PIM geographic areas are not considered PIM:

  • Stool
  • Upper respiratory secretion specimens
  • Concentrated sewage
  • Wastewater,

These materials do not need to be reported to U.S. NAC.

Strategies to lower risks

There are several stragies facilities can enact to mitigate risks while working with PIM.

Review personnel's vaccination status

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.

Implement appropriate safety standards

Ensure appropriate standard safety precautions [PDF – 1 MB] are in place for workers handling PIM. This includes:

  • Personal protective equipment
  • Trainings
  • Handwashing
  • Waste disposal

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.

Adhere to instituional guidance

Direct specific questions about protecting workers to guidance from the following institutions:

  • The relevant state health department
  • Occupational Safety and Health Administration (OSHA)
  • National Institute for Occupational Safety and Health (NIOSH)
  • Environmental Protection Agency (EPA) guidance

Ensure non-laboratory workers follow CDC guidelines for collecting and handling wastewater and guidelines for COVID-19.

Keep PIM and IM seperate

Segregate PIM from non-PIM. Keep PIM in a locked freezer or laboratory and limit access.

Laboratory workers

Use only methods validated to inactive poliovirus for extraction of materials outlined in the Policy for U.S. Facilities to Inactive Poliovirus Materials.

Concentration of PIM and/or extraction of PIM should be performed in primary containment like a certified biosafety cabinet.

Keep Reading: Areas with Ongoing Poliovirus Circulation
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  1. Applies to VPDV type 2 (≥6 nucleotide changes in VP1), VDPV type 1, or type 3 (>10 nucleotide changes in VP1)
  2. Two genetically linked PV positive samples more than two months (approximate shedding period is 4-8 weeks) apart from one sewer shed suggests at least two different people shedding and community-level transmission.
  3. More than one genetically-linked PV positive in separate sewer sheds suggests at least two different people shedding and community-level transmission.
  4. Global Polio Eradication Initiative, Standard Operating Procedure “Responding to A Poliovirus Event or Outbreak”, March 2022, version 4, page 8
  5. Applies to VPDV type 2 (≥6 nucleotide changes in VP1), VDPV type 1 (>10 nucleotide changes in VP1 region), or VDPV type 3 (>10 nucleotide changes in VP1).
  6. Two genetically linked PV positive samples more than two months (approximate shedding period is 4-8 weeks) apart from one sewer shed suggests at least two different people shedding and community-level transmission.
  • Preferred methods of destruction are autoclave or incineration.