Post-eradication poliovirus facility-associated community risks

Minimizing the risk of poliovirus transmission from the poliovirus facility to an increasingly susceptible community is crucial when global poliovirus transmission and OPV use stops. Community risks of exposure to wild poliovirus as well as Sabin strains are highest from facility personnel who are unknowingly contaminated or infected. Immunization with OPV or IPV prevents poliomyelitis, but neither vaccine fully inhibits silent infection of the gut. Facility environments maintained at low relative humidity (<50%) may reduce poliovirus survival and inhalation risk. Circulating antibodies reduce personnel infection risks from injection or virus entry through breaks in skin or mucous membranes. Community exposure risk through inhalation of contaminated air effluent is likely low in most modern facilities. Community risks through ingestion of liquid effluents are facility-specific and may range from high to low. This assessment of community risks, when combined with assessments of facility-specific hazards and the consequences of wild or Sabin poliovirus transmission, provides the foundation for effective risk management.