Vaccines: Poliomyelitis

Specific vaccination recommendations vary among countries or even within a given country. Local or country-specific guidelines should be consulted.

1. Vaccine: In North America, the only available vaccines contain inactivated poliomyelitis virus (IPV). IPV vaccine may also be available as a combination product with a diphtheria and tetanus vaccine (Tdap-IPV) and a diphtheria, tetanus, and acellular pertussis vaccine (DTaP-IPV). The oral polio vaccine (OPV), consisting of live attenuated poliovirus, is not available in North America due to its association with cases of paralytic polio in the 1980s and 1990s (see adverse events, below), but it is used in some other countries.

2. Indications: Poliomyelitis vaccination is indicated in persons traveling to areas endemic for poliomyelitis (Pakistan and Afghanistan) and laboratory personnel who may be exposed to poliovirus. Patients traveling to an area with an OPV-derived polio outbreak should be vaccinated. Additional risk groups that should be vaccinated with IPV are health care workers in contact with potential poliomyelitis patients, humanitarian workers in endemic countries, and close contacts of children adopted from countries where they have been recently vaccinated with OPV. IPV vaccination is safe in pregnancy, and it may be administered to immunocompromised patients. The WHO issued recommendations applicable during local outbreaks in Asia and Africa to vaccinate those leaving countries with outbreaks after prolonged stay.

3. Contraindications include general contraindications for all inactivated vaccines plus a history of a systemic anaphylactic reaction to neomycin, streptomycin, or polymyxin B.

4. Immunization schedule: The primary childhood vaccination series consists of 4 doses of DTaP-IPV administered IM at 2, 4, 6, and 12 to 23 months of age. A subsequent booster dose is given as part of the primary series at 4 to 6 years of age. Unvaccinated adults should receive a complete primary vaccination series, as above. Adults who were vaccinated in childhood according to the primary immunization schedule and who may be exposed to the infection, including through travel, should receive 1 booster dose of IPV during their lifetime (the manufacturer recommends administration of booster doses every 10 years).

5. Adverse events: The OPV formulation has a risk of 2 to 4/1,000,000 administrations of vaccine-associated paralytic poliomyelitis.