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Polio
What is the current status of polio in the world?
Since the Global Polio Eradication Initiative was launched in 1988, the number of polio cases worldwide has declined by more than 99.99%. Among the three wild poliovirus (WPV) serotypes, only type 1 (WPV1) has been detected since 2012. Global eradication of type 2 WPV was declared in 2015; type 3 WPV was declared eradicated in 2019. The number of detected WPV1 cases has reached a historic low (33 cases in 2018 and 176 in 2019) in the last two countries with endemic WPV1 transmission (Afghanistan and Pakistan).
This decline in polio cases worldwide is attributable primarily to use of the live, attenuated oral poliovirus vaccine (OPV) in national routine immunization schedules and mass vaccination campaigns. The success and safety record of OPV use is offset by the rare emergence of genetically divergent vaccine-derived polioviruses (VDPVs), whose genetic drift from the parental OPV strains indicates prolonged replication or circulation. Circulating VDPVs (cVDPVs) can emerge in areas with low immunization coverage and can cause outbreaks of paralytic polio. In addition, immunodeficiency-associated VDPVs (iVDPVs) can emerge in persons with primary immunodeficiencies and can replicate and be excreted for years. During January 2018–March 2020 new cVDPV outbreaks were confirmed in 26 countries; of those, cVDPV2 strains were the most frequently detected, causing 547 cases in 21 countries.
After the emergence of multiple cVDPV2 outbreaks during the preceding 15 years, in April 2016, all OPV-using countries switched from using trivalent OPV (tOPV; Sabin types 1, 2, and 3) to bivalent OPV (bOPV; Sabin types 1 and 3). To control and prevent cVDPV2 outbreaks, approximately 100 million doses of monovalent type 2 OPV (mOPV2) have been distributed in affected countries: in addition, a novel monovalent type 2 OPV (nOPV2) that is less likely to produce cVPDV disease is in the final stages of preparation to replace the current mOPV2. To maintain protection from poliovirus type 2 paralysis, 176 OPV-using countries have introduced at least 1 dose of injectable inactivated polio vaccine (IPV) beginning in 2015. Additional information about the polio eradication program is available on the CDC website at www.cdc.gov/polio.
What is the routine schedule for giving IPV (IPOL, Sanofi Pasteur) to children?
In the U.S., all infants and children should receive 4 doses of IPV at ages 2, 4, 6–18 months, and 4–6 years. The first dose may be given as early as 6 weeks of age. The final dose should be administered at 4 years of age 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 4 years of age or older and 6 months or more after the previous dose.
Infants and children traveling to areas where there has been wild or vaccine-derived 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: 1) the first dose should be given to infants 6 weeks of age 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) may be administered.
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 U.S. residents age 18 years and older.
Should adults get vaccinated against polio?
Routine polio vaccination of U.S. residents 18 years of age and older—including those working in healthcare or in healthcare-related training—is not recommended. Polio vaccination is recommended for all travelers to countries with wild poliovirus (WPV) or vaccine-derived poliovirus (VDPV) circulation. Countries are considered to have WPV or VDPV circulation if they have evidence during the previous 12 months of ongoing endemic circulation (WPV only), a polio outbreak, or environmental evidence (through sewage sampling) of WPV or VDPV circulation. For additional information on countries with WPV or VDPV circulation and vaccine recommendations, consult the travel notices on the CDC Travelers' Health website (wwwnc.cdc.gov/travel/notices) or the weekly update of reported WPV and VDPV cases at the Global Polio Eradication Initiative website (www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx).
Adults who are traveling to areas where WPV or VDPV is actively circulating and who are unvaccinated, incompletely vaccinated, or whose vaccination status is unknown should receive a total series of 3 doses: 2 doses of IPV administered at an interval of 4–8 weeks; a third dose should be administered 6–12 months after the second. If 3 doses of IPV cannot be administered within the recommended intervals before protection is needed, the following alternatives are recommended:
  • If more than 8 weeks is available before protection is needed, 3 doses of IPV should be administered at least 4 weeks apart.
  • If less than 8 weeks but more than 4 weeks is available before protection is needed, 2 doses of IPV should be administered at least 4 weeks apart.
  • If less than 4 weeks is available before protection is needed, a single dose of IPV is recommended.
If less than 3 doses are administered, the remaining IPV doses to complete a 3-dose series should be administered when feasible, at the intervals recommended above, if the person remains at increased risk for poliovirus exposure.
If an adult at risk previously received only one or two documented 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. It is not necessary to restart the vaccination series.
Adults who have completed a routine series of polio vaccine are considered to have lifelong immunity to poliomyelitis, but data on duration of immunity are lacking. As a precaution, adults 18 years of age or older who are traveling to areas where WPV or VDPV is actively circulating and who have received a routine series with either IPV or OPV in childhood should receive another dose of IPV before departure. For adults, available data do not indicate the need for more than a single lifetime booster dose with IPV. Note: the World Health Organization recommends that countries affected by wild poliovirus or cVDPV outbreaks require residents and long-term (4 weeks or more) visitors show proof of polio vaccination before leaving the country. These recommendations are regularly reviewed and updated. Visit CDC's Travelers' Health site for current details about country-specific requirements (wwwnc.cdc.gov/travel/).
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 CDC recommendations for polio vaccination for infants, children, and adults traveling to and from countries affected by wild or vaccine-derived poliovirus.
CDC recommends that all travelers to countries affected by wild or circulating vaccine-derived poliovirus (cVDPV) be vaccinated fully against polio. Adults who were fully vaccinated during childhood should receive an additional (single) lifetime booster dose of polio vaccine.
The World Health Organization additionally recommends that countries affected by wild poliovirus or cVDPV outbreaks require residents and long-term (4 weeks or more) visitors show proof of polio vaccination before leaving the country. These recommendations are regularly reviewed and updated. Visit CDC's Travelers' Health site for current details about country-specific requirements (wwwnc.cdc.gov/travel/).
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 years or older (routinely between age 4 and 6 years), even if the child previously received 4 doses (either as IPV or as part of a combination vaccine containing IPV).
This 2009 ACIP recommendation change was not retroactive: it did not apply to children as of its publication on August 7, 2009, who had already received their fourth dose of polio vaccine using the schedule previously considered acceptable. However, some state school requirements or state immunization registry forecasting algorithms may flag these teens as incompletely immunized according to current rules. If issues arise concerning a child who received 4 doses before August 7, 2009, contact your state immunization program to find out what they advise. Contact information for state immunization managers can be found at www.immunize.org/coordinators.
We frequently see children (mostly from certain foreign countries) who have received 6 or more doses of polio vaccine, all administered before 4 years of age. How do we handle this when assessing the child's immunization history?
It is common practice in many developing countries to administer oral polio vaccine to children during both routine visits and periodic vaccination campaigns, so a child's record may indicate more than 4 doses. Some of these doses may not be valid according to the U.S. immunization schedule.
Doses are considered valid if written documentation indicates that doses of polio vaccine were given after 6 weeks of age and the vaccine received was listed as IPV, trivalent OPV (tOPV) or simply "OPV", if the "OPV" was administered before April 1, 2016 and not noted as given during a vaccination campaign.
Why is this? Only trivalent polio vaccine doses count as valid for the U.S. polio vaccination schedule. Trivalent OPV ceased to be used globally in April 2016. OPV administered before April 1, 2016, generally was tOPV. However, OPV doses noted as given during a vaccination campaign do not count as valid because such campaigns may have used monovalent or bivalent OPV.
If the history is of a complete series of IPV, at least one dose should be administered on or after 4 years of age and at least 6 months after the previous dose. If a complete series cannot be identified that meets these criteria, then the child should receive as many doses of IPV as needed to complete the U.S. recommended schedule.
How do I determine if doses of polio vaccine administered outside the United States were trivalent OPV?
Use the date of administration to make a presumptive determination of what type of OPV was received. Only trivalent doses count as valid for the U.S. polio vaccination schedule.
Trivalent OPV was used throughout the world before April 2016. In April 2016, all countries using OPV switched to bivalent OPV (bOPV). In addition, some countries also use monovalent OPV (mOPV) during special vaccination campaigns. Doses recorded as bOPV or mOPV, or doses noted on an immunization record as given during a vaccination campaign, do not count as valid doses for the U.S. polio vaccination schedule.
If the record indicates OPV, and the dose was given prior to April 1, 2016, it can be counted as a valid tOPV dose. If the dose was administered on or after April 1, 2016, it should not be counted as a valid dose for the U.S. polio vaccination schedule because it was not trivalent.
People younger than age 18 years with doses of OPV that do not count towards the U.S. vaccination requirements should receive IPV doses to complete the schedule according to the U.S. polio immunization schedule. See www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6601a6.pdf for more information on this issue.
We occasionally encounter older 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 applying the new minimum age rule for the fourth dose to children who had already completed four doses under the schedule that had been acceptable before the new recommendation was published. A teen who received his fourth IPV dose prior to August 7, 2009, is considered sufficiently vaccinated if he received four doses separated by at least 4 weeks, unless the teenager is traveling to a polio-endemic area. But you might want to check with your state immunization program or 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?
Polio vaccine given outside the United States is valid if written documentation indicates that all doses were given after 6 weeks of age and the vaccine received was IPV or trivalent OPV (tOPV). No doses of OPV given since April 1, 2016, count toward the U.S. polio vaccination schedule. See the prior question for details on assessment of OPV doses by the date of administration.
If both tOPV and IPV were or will be administered as part of a series, the total number of doses needed to complete the series is the same as that recommended for the U.S. IPV schedule. If the child is younger than 4 years of age a total of 4 doses of polio vaccine are recommended. If the child is currently 4 years of age or older, a total of 3 doses completes the series. A minimum interval of 4 weeks should separate doses in the series, with the final dose administered on or after the fourth birthday and at least 6 months after the previous dose. If only tOPV was administered, and all doses were given before 4 years of age, 1 dose of IPV should be given at 4 years of age or older, at least 6 months after the last tOPV dose.
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 either 3 or 4 doses depending on the age at the time of the last dose. In this case the recent dose of IPV can be counted as the third and final dose in the series. The minimum interval between the next-to-last and last doses in the polio vaccination series is 6 months and the last dose should be at age 4 years or older.
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.
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This page was updated on October 22, 2020.
This page was reviewed on August 31, 2020.
 
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