International travel often comes with vaccine reminders, and the Centers for Disease Control and Prevention is now warning travelers to ensure their polio vaccinations are up to date.

The CDC issued a level 2 travel advisory on March 3, warning that poliovirus has been detected in multiple destinations within the past 12 months – including parts of Africa, the Middle East and Europe.

Countries on the list include:

Polio is a crippling and potentially deadly disease that affects the nervous system, according to the CDC. While many people infected with the virus don’t experience symptoms, some may develop fever, fatigue, nausea, headache or muscle stiffness. In rare cases, the disease can cause permanent paralysis or death, particularly if breathing muscles are affected.

The virus spreads primarily through contact with contaminated food or water, often due to poor hand hygiene. Because the virus lives in the feces of infected individuals, it can spread when people don’t wash their hands properly after using the bathroom.