Extensive vaccination has almost eradicated polio 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).
For more information, see Polio Advisory Committee on Immunization Practices Vaccine Recommendations and Centers for Disease Control and Prevention (CDC): Polio Vaccination. For a summary of changes to the 2024 adult immunization schedule, see the Advisory Committee on Immunization Practices (ACIP) Recommended Adult Immunization Schedule, United States, 2024.
(See also Overview of Immunization.)
Preparations of Poliomyelitis 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 about 1 of every 2.4 million people who are given the vaccine.
Inactivated polio vaccine is the only polio vaccine that has been given in the United States since 2000. The following combination vaccines are also available:
Indications for Poliomyelitis Vaccine
IPV is a routine childhood vaccine (see CDC: Child and Adolescent Immunization Schedule by Age).
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 (see CDC: Adult Immunization Schedule by Age). Most adults who were born and raised in the United States can assume they were vaccinated against polio as children unless there are specific reasons to believe they were not vaccinated. 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. 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.
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 (see also New York State Department of Health: Wastewater Surveillance). 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 (see New York State Department of Health: Polio Vaccine).
Contraindications and Precautions for Poliomyelitis Vaccine
The main contraindication for IPV is
A severe allergic reaction (eg, anaphylaxis) 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)
Administration of Poliomyelitis Vaccine
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 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 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 third 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.
Adverse Effects of Poliomyelitis Vaccine
More Information
The following English-language resources 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
European Centre for Disease Prevention and Control (ECDC): Poliomyelitis: Recommended vaccinations
