Extensive vaccination has almost eradicated polio Poliomyelitis Poliomyelitis is an acute infection caused by a poliovirus (an enterovirus). Manifestations include a nonspecific minor illness (abortive poliomyelitis), sometimes aseptic meningitis without... read more worldwide. But cases still occur in areas with incomplete immunization, such as sub-Saharan Africa and southern Asia.
There are 3 serotypes of poliovirus (an enterovirus Overview of Enterovirus Infections Enteroviruses, along with rhinoviruses (see Common Cold) and human parechoviruses, are a genus of picornaviruses (pico, or small, RNA viruses). All enteroviruses are antigenically heterogeneous... read more ).
For more information, see Polio Advisory Committee on Immunization Practices Vaccine Recommendations and Centers for Disease Control and Prevention (CDC): Polio Vaccination. A summary of changes to the 2021 adult immunization schedule is available here.
(See also Overview of Immunization Overview of Immunization Immunity can be achieved Actively by using antigens (eg, vaccines, toxoids) Passively by using antibodies (eg, immune globulins, antitoxins) A toxoid is a bacterial toxin that has been modified... read more .)
Inactivated poliovirus vaccine (IPV) contains a mixture of formalin-inactivated poliovirus types 1, 2, and 3. IPV may contain trace amounts of streptomycin, neomycin, and polymyxin B.
The live-attenuated oral poliovirus vaccine is no longer available in the US because it can mutate to a strain that causes polio in about 1 of every 2.4 million people who are given the vaccine.
Combination vaccines with IPV, diphtheria-tetanus-pertussis (DTaP), and sometimes also hepatitis B or Haemophilus influenzae type b (Hib) are also available.
IPV is a routine childhood vaccine (see Table: Recommended Immunization Schedule for Ages 0–6 Years Recommended Immunization Schedule for Ages 0–6 Years Vaccination follows a schedule recommended by the Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics, the American Academy of Family Physicians, and the American... read more ).
Routine primary poliovirus vaccination of adults living in the US is not recommended. Unimmunized or incompletely immunized adults who may be exposed to wild poliovirus (eg, travelers to endemic areas, laboratory workers who handle specimens that may contain poliovirus) should be vaccinated with IPV. Completely vaccinated adults who are at an increased risk of exposure to poliovirus can be given a booster dose of IPV. For current information about which countries are considered at high risk of polio, see the Centers for Disease Control and Prevention's (CDC) Travelers' Health: Destinations and Travelers Health: Polio.
The main contraindication for IPV is
A severe allergic reaction (eg, anaphylaxis Anaphylaxis Anaphylaxis is an acute, potentially life-threatening, IgE-mediated allergic reaction that occurs in previously sensitized people when they are reexposed to the sensitizing antigen. Symptoms... read more ) after a previous dose of the vaccine or to a vaccine component
The main precautions with IPV are
Moderate or severe acute febrile illness (vaccination is postponed until the illness resolves)
Pregnant women who are not at increased risk of polio (they should not be given the polio vaccine even though there is no evidence that the vaccine harms pregnant women or their fetus; however, if pregnant women are at increased risk of exposure to poliovirus and require immediate protection, IPV can be given)
The IPV dose is 0.5 mL IM or subcutaneous.
A 4-dose IM series is given 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 vaccinations and a single-antigen vaccine 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 (Pentacel®) 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 [Kinrix®]) should be given 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 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 3rd dose is given 6 to 12 months later. If protection is needed in 2 to 3 months, 3 doses are given ≥ 1 month apart. If it is needed in 1 to 2 months, 2 doses are given ≥ 1 month apart. If it is needed in < 1 month, 1 dose is given. In all cases, the remaining doses of vaccine should be given later, at the recommended intervals, if the person remains at increased risk.
The following are some English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
Advisory Committee on Immunization Practices (ACIP): Polio ACIP Vaccine Recommendations
Centers for Disease Control and Prevention (CDC): Polio Vaccination: Information for Healthcare Professionals