Poliomyelitis Vaccine

Inactivated poliovirus vaccine (poliovirus vaccine, inactivated, IPV) contains a mixture of formalin-inactivated poliovirus types 1, 2, and 3. IPV may contain trace amounts of (poliovirus vaccine, inactivated, IPV) contains a mixture of formalin-inactivated poliovirus types 1, 2, and 3. IPV may contain trace amounts ofstreptomycin, neomycin, and polymyxin B.

IPV is the only polio vaccine that has been administered in the United States since 2000. The following combination vaccines are also available:

• Diphtheria toxoid/inactivated poliovirus vaccineDiphtheria toxoid/inactivated poliovirus vaccine

• Diphtheria toxoid/hepatitis B vaccine/inactivated poliovirus vaccineDiphtheria toxoid/hepatitis B vaccine/inactivated poliovirus vaccine

• Diphtheria toxoid/Haemophilus influenzae type B conjugate vaccine/inactivated poliovirus vaccineDiphtheria toxoid/Haemophilus influenzae type B conjugate vaccine/inactivated poliovirus vaccine

• Diphtheria toxoid/Haemophilus influenzae type B conjugate vaccine/hepatitis B vaccine/inactivated poliovirus vaccineDiphtheria toxoid/Haemophilus influenzae type B conjugate vaccine/hepatitis B vaccine/inactivated poliovirus vaccine

The live-attenuated oral poliovirus vaccine is no longer available in the United States because it can mutate to a strain that causes polio in approximately 1 of every 2.9 million people who are given the vaccine (1). However, it is the preferred vaccine in many resource-limited settings in the world because the benefits may outweigh the risks.

IPV is a routine childhood vaccine (1).

Routine primary poliovirus vaccination of adults living in the United States is not recommended unless the adult is known or suspected to be unvaccinated or incompletely vaccinated (2). Most adults who were born and raised in the United States after 1955 can assume they were vaccinated against polio as children unless there are specific reasons to believe they were not vaccinated (3). Unimmunized or incompletely immunized adults should complete a 3-dose primary series. Completely vaccinated adults who are at an increased risk of exposure to poliovirus can be given a one-time booster dose of IPV. Current information about which countries are considered at high risk of polio is available (4, 5).

In the United States, a case of vaccine-derived polio was identified in an unvaccinated person who acquired it in New York State in July 2022 (6). New York residents in areas with repeated poliovirus detection may be at higher risk of infection and should follow updated vaccination recommendations from the New York State Department of Health (7).

The main contraindication for IPV is:

• A severe allergic reaction (eg, anaphylaxis) after a previous dose of the vaccine or anaphylaxis to a vaccine component (streptomycin, neomycin, polymyxin B)

The main precautions with IPV are:

• Moderate or severe acute febrile illness (vaccination is postponed until the illness resolves)

• Pregnant patients who are not at increased risk of polio

Pregnant patients who are not at increased risk of polio should not be given the polio vaccine even though there is no evidence that the vaccine harms pregnant patients or their fetus; however, if pregnant patients are at increased risk of exposure to poliovirus and require immediate protection, IPV can be administered.

The IPV dose is 0.5 mL IM or subcutaneous.

A 4-dose IM series is administered at age 2 months, 4 months, 6 to 18 months, and 4 to 6 years. Typically, a combination vaccine is used for the first 3 doses and a single-antigen vaccine is used for the last dose. If children miss an IPV dose at age 4 to 6 years, they should be given a booster dose as soon as possible.

When DTaP-IPV/Hib is used for the 4-dose schedule (at ages 2, 4, 6, and 15 to 18 months), an additional booster dose of IPV-containing vaccine (IPV or DTaP-IPV) should be administered at age 4 to 6 years, resulting in a 5-dose schedule; however, DTaP-IPV/Hib should not be used for the booster dose at age 4 to 6 years. The minimum interval between doses 4 and 5 should be ≥ 6 months to optimize the booster response.

A primary 3-dose series of IPV is recommended for unvaccinated adults at increased risk of exposure to poliovirus. The recommended interval between doses 1 and 2 is 1 to 2 months; the third dose is administered 6 to 12 months later. If protection is needed in 2 to 3 months, 3 doses are administered ≥ 1 month apart. If it is needed in 1 to 2 months, 2 doses are administered ≥ 1 month apart. If it is needed in < 1 month, 1 dose is administered. In all cases, the remaining doses of vaccine should be administered later, at the recommended intervals, if the person remains at increased risk.

Common mild adverse effects include tenderness, erythema, localized swelling, and induration at the injection site. Reactions such as fever, irritability, and tiredness are also reported but are typically mild and transient.

Serious adverse effects are notably rare.

Data has shown favorable safety profiles for IPV administered in combination vaccines or simultaneously with other vaccines with respect to reactions that are allergic (eg, anaphylaxis), neurological (eg, encephalitis), or autoimmune (eg, Guillain-Barre syndrome) (1).

For more information about adverse effects of these vaccines, refer to the prescribing information.

The following English-language resources may be useful. Please note that The Manual is not responsible for the content of these resources.

1. Advisory Committee on Immunization Practices (ACIP): ACIP Recommendations: Polio Vaccine

2. Centers for Disease Control and Prevention (CDC): Polio (Poliomyelitis)

3. CDC: Travelers' Health: Destinations

4. CDC: Travelers Health: Polio

5. European Centre for Disease Prevention and Control (ECDC): Poliomyelitis: Recommended vaccinations