IPV used in Canada so vaccine-associated polio, though very rare, is no longer a risk. Epidemic years had up to 20,000 cases of paralytic disease. Indigenous disease eradicated from the Americas. Still endemic in other parts of the world. Diphtheria Spread by nasal droplets.
Infection leads to severe pharyngitis and cervical adenopathy.
Patient is infectious for up to 2 weeks. Toxin may lead to myocardial and neurologic complications. A transient nodule may develop at the injection site, lasting a few weeks. Highest in 1924 with 9,000 cases that year. Now 2-5 reported cases per year, none reported in 1996.