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Polio

Ask the Experts: Diseases & Vaccines

Polio

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Polio
What is the routine schedule for giving IPV to children?
Four doses of polio vaccine (IPV) are routinely recommended for U.S. children at ages 2 months, 4 months, 6-18 months, and 4-6 years. The first dose may be given as early as age 6 weeks.
What is the schedule for older children who have not completed their IPV series?
The schedule for polio vaccination for unvaccinated or under-vaccinated older children through age 17 years is 2 doses of IPV separated by 4–8 weeks, and a third dose 6–12 months after the second dose. If an accelerated schedule is needed, the child should receive two doses separated by at least 4 weeks and a third (final) dose given at least 6 months after the second dose. Polio vaccine is not routinely administered to persons 18 years of age and older.
Should adults get vaccinated against polio?
In the U.S., all infants and children should receive 4 doses of inactivated poliovirus vaccine (IPV, Sanofi) at ages 2, 4, and 6–18 months, and 4–6 years. The final dose should be administered at age 4 years or older, regardless of the number of previous doses, and should be given 6 months or more after the previous dose. A fourth dose in the routine IPV series is not necessary if the third dose was given at age 4 years or older and 6 months or more after the previous dose. Infants and children traveling to areas where there has been wild poliovirus circulation in the last 12 months should be vaccinated according to the routine schedule. If the routine series cannot be administered within the recommended intervals before protection is needed, an accelerated schedule can be used as follows: 1) the first dose should be given to infants age 6 weeks and older, 2) the second and third doses should be administered at 4 weeks or more after the previous doses, and 3) the minimum interval between the third and fourth doses is 6 months.
If the age-appropriate series is not completed before departure, the remaining IPV doses to complete a full series should be administered when feasible, at the intervals recommended for the accelerated schedule. If doses are needed while residing in the affected country, the polio vaccine that is available (IPV or oral polio vaccine [OPV]) may be administered. See the MMWR article titled "Interim CDC Guidance for Polio Vaccination for Travel to and from Countries Affected by Wild Poliovirus" available at www.cdc.gov/mmwr/pdf/wk/mm6327.pdf, pages 591–4.
If an adult at risk previously received only one or two doses of polio vaccine (either OPV or IPV), he or she should receive the remaining dose(s) of IPV, regardless of the interval since the last dose.
If an adult at increased risk previously completed a primary course of polio vaccine (three or more doses of either OPV or IPV), he or she may be given another dose of IPV to ensure protection. Only one "booster" dose of polio vaccine in a person's lifetime is recommended. It is not necessary to receive a booster dose each time a person travels to an area where polio may still occur.
We have an adult who was diagnosed with polio as a child with some residual effects. This adult will be traveling overseas and the CDC travel website recommends a dose of polio vaccine. Should he be vaccinated with polio vaccine even though he had polio in the past?
Immunity to one of the serotypes of polio does not produce significant immunity to the other serotypes. A history of having recovered from polio disease should not be considered evidence of immunity to polio. It would be appropriate to vaccinate this adult if he will be traveling to an area for which polio vaccination is recommended.
Please describe the new CDC interim recommendations for polio vaccination for infants, children, and adults traveling to and from countries affected by wild polio.
Routine vaccination of persons 18 years of age and older against polio is not necessary because most adults are already immune and also have little risk of being exposed to wild polio virus. Certain adults at increased risk of exposure to poliovirus and should be vaccinated. This includes travelers to areas were polio is common (currently limited to Afghanistan, Pakistan, Nigeria, and certain other countries in sub-Saharan Africa), and laboratory workers who handle specimens that might contain polioviruses.
If the age-appropriate series is not completed before departure, the remaining IPV doses to complete a full series should be administered when feasible, at the intervals recommended for the accelerated schedule. If doses are needed while residing in the affected country, the polio vaccine that is available (IPV or oral polio vaccine [OPV]) may be administered. See the MMWR article titled "Interim CDC Guidance for Polio Vaccination for Travel to and from Countries Affected by Wild Poliovirus" available at www.cdc.gov/mmwr/pdf/wk/mm6327.pdf, pages 591–4.
For adults who were routinely vaccinated as children, CDC states those adults are considered to have lifelong immunity to poliovirus, but data are lacking. As a precaution, people age 18 years and older who are traveling to areas where there has been wild poliovirus circulation in the last 12 months and who have received a routine series with either IPV or OPV in childhood should receive another dose of IPV before departure. For these adults, available data do not indicate the need for more than a single lifetime booster dose with IPV.
For detailed information about how to protect adults who are unvaccinated, incompletely vaccinated, or whose vaccination status is unknown, refer to the CDC guidance document cited above.
Ten countries (Afghanistan, Cameroon, Equatorial Guinea, Ethiopia, Iraq, Israel, Nigeria, Pakistan, Somalia, and Syria) are currently considered polio-infected. For more information for clinicians, visit CDC's Travel website at wwwnc.cdc.gov/travel/news-announcements/polio-guidance-new-requirements
A 4-year-old's vaccine records show that she had 4 IPVs, given at 2m, 4m, 6m, and age 2. Should she have a booster dose?
Yes. In June, 2009, ACIP updated its recommendations to clarify that an additional dose must be given at age 4-6 years, even if the child previously received 4 doses (either as IPV or as part of a combination vaccine containing IPV).
We frequently see children (mostly from certain foreign countries) who have received 6 or more doses of polio vaccine, all administered before age 4 years. How do we handle this when assessing the child’s immunization history?
Because it is common practice in many developing countries to administer oral polio vaccine to children during both routine visits and periodic nationwide vaccination campaigns, a child’s record may indicate more than 4 doses. Depending on the timing, some of these doses may be invalid according to the U.S. immunization schedule. To be counted as valid, the doses should all be given after age 6 weeks and be separated from each other by at least 4 weeks. If the history is of a complete series of inactivated polio vaccine (IPV) (unlikely given the context), at least one dose should be administered on or after age 4 years and at least 6 months after the previous dose. If a complete series cannot be identified that meet these criteria, then the child should receive as many doses of IPV as needed to complete the U.S. recommended schedule.
We occasionally encounter teen-agers who received 4 doses of IPV before their fourth birthday. Should we recommend a 5th dose of IPV for these children?
Generally, no. ACIP revised its recommendation for IPV in June 2009 to include a dose at 4 through 6 years regardless of the number of doses prior to age 4 years. However, ACIP did not recommend retroactive application of the new minimum age rule for the fourth dose. For children receiving their fourth dose prior to August 7, 2010, four doses separated by at least 4 weeks is sufficient, unless the teenager is traveling to a polio-endemic area. But you might want to check with your state immunization registry manager to see what they accept/expect. Contact information for state immunization managers can be found at www.immunize.org/coordinators.
If an immigrant infant has a record of 1 or 2 doses of OPV in their country of origin how many more doses of IPV should be given?
OPV is not available in the United States. Children who initiated the polio vaccination series with one or more doses of OPV should receive IPV to complete the series. ACIP recommends that when both OPV and IPV are used four doses of OPV or IPV in any combination is considered a complete series. As with an all-IPV series the final dose should be given at 4 through 6 years of age.
Our 23-year-old patient has been accepted to a physician assistant program that requires polio vaccine for all students. She has 2 documented doses of oral polio vaccine (OPV) as a child, then recently had a dose of inactivated polio vaccine (IPV). How many more doses of IPV does she need to complete the series and on what schedule?
U.S. residents 18 years and older generally do not require polio vaccination. However, in this case the person is required to have evidence of vaccination for a medical training program. People who receive a mixed series of OPV and IPV should receive a total of 4 doses. The recent dose of IPV can be counted as the third dose in the primary series. The minimum interval between the third and last doses in the polio vaccination series is 6 months. So the final dose in the series should be given 6 months after the IPV dose.
Is it true that IPV can be given either SC or IM?
Yes.
What is the risk of serious reactions following IPV?
There are no severe reactions known to occur following IPV.
 
This page was reviewed on February 25, 2015
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