No

Vaccine

American Academy of Pediatrics recommends three poliomyelitis vaccines schedules: OPV-only, IPV-only and sequential IPV-OPV.

Inactivated poliovirus vaccine contains three types of poliovirus grown either in monkey kidney or human diploid cells and inactivated with formaldehyde. IPV is of enhanced potency and is highly immunogenic.

OPV schedule ONLY is recommended: when parents or providers who prefer not to have the child receive the additional injections needed if IPV were to be used, for infants and children starting vaccination regimens after 6 months of age in whom an accelerated schedule is necessary to complete immunizations, an OPV-only regimen will minimize the number of injections required at each visit. In populations with low vaccination rates, OPV may be preferred in order to expedite implementation of the routine childhood immunization schedule.

IPV schedule ONLY is recommended: for immunocompromised persons and their household contacts (OPV would be contraindicated); for infants and children in which an adult household member is know to be inadequately vaccinated against poliomyelitis, because unimmunized adults are at increased risk of vaccine-associated paralytic poliomyelitis (VAPP); when the number of injections is not likely to decrease compliance and when IPV is preferred by health care providers or parents or other caregivers.

IPV Primary immunization is also recommended for unvaccinated adults because the risk of VAPP after OPV is slightly higher in adults than in children.

Sequential IPV/OPV schedule is recommended to reduce the total number of injections required to reduce the risk of VAPP while maintaining optimal intestinal immunity, especially for travelers to areas where poliovirus is still endemic. The rationale of sequential use of IPV and OPV is that two doses of IPV induce sufficient humoral immunity to prevent VAPP in recipients from subsequent administration of OPV, given to induce optimal intestinal immunity as well as to sustain humoral immunity.

C

Oral: Leukemia, lymphoma, or other generalized malignancies; diseases in which cellular immunity is absent or suppressed (hypogammaglobulinemia, agammaglobulinemia); immunosuppressive therapy; diarrhea; parenteral administration

Parenteral: Hypersensitivity to any component including neomycin, streptomycin, or polymyxin B; defer vaccination for persons with acute febrile illness until recovery

Although there is no convincing evidence documenting adverse effects of either OPV or E-IPV on the pregnant woman or developing fetus, it is prudent on theoretical grounds to avoid vaccinating pregnant women. However, if immediate protection against poliomyelitis is needed, OPV is recommended. OPV should not be given to immunocompromised individuals or to persons with known or possibly immunocompromised family members; E-IPV is recommended in such situations.

All serious adverse reactions must be reported to the U.S. Department of Health and Human Services (DHHS) Vaccine Adverse Event Reporting System (VAERS) 1-800-822-7967.

Central nervous system: Fever (>101.3°F)

Dermatologic: Rash

Local: Tenderness or pain at injection site

<1%: Fatigue, fussiness, sleepiness, crying, Guillain-Barré, reddening of skin, erythema, decreased appetite, weakness, dyspnea

Decreased effect with immunosuppressive agents, immune globulin, cholera vaccine; separate by 1 month if possible; may temporarily suppress tuberculin skin test sensitivity (4-6 weeks); DTP, MMR, Hib, and hepatitis B vaccines may be given concurrently if at different sites

Refrigerate

Oral:

Infants:

Primary series: 0.5 mL at 6-12 weeks of age, second dose 6-8 weeks after first dose (commonly at 4 months), and third dose 8-12 months after second dose (commonly at 18 months)

Booster: All children who have received primary immunization series, should receive a single follow-up dose and all children who have not should complete primary series

Children (older) and Adults (adolescents through 18 years of age): Two 0.5 mL doses 6-8 weeks apart and a third dose of 0.5 mL 6-12 months after second dose

Subcutaneous: Enhanced-potency inactivated poliovirus vaccine (E-IPV) is preferred for primary vaccination of adults, two doses S.C. 4-8 weeks apart, a third dose 6-12 months after the second. For adults with a completed primary series and for whom a booster is indicated, either OPV or E-IPV can be given (E-IPV preferred). If immediate protection is needed, either OPV or E-IPV is recommended.

Do not administer I.V.

No information available to require special precautions

No effects or complications reported

Be aware of adverse reactions

Do not administer I.V.

Injection (IPOL™, E-IPV, Enhanced-potency Inactivated Poliovirus Vaccine, Poliomyelitis Vaccine, Salk): Suspension of three types of poliovirus (Types 1, 2 and 3) grown in human diploid cell cultures (0.5 mL)

Solution, oral (Orimune®, OPV, Poliovirus Vaccine, Live, Trivalent, Sabin, TOPV): Mixture of type 1, 2, and 3 viruses in monkey kidney tissue (0.5 mL)

Gardner P and Schaffner W, "Immunization of Adults," N Engl J Med, 1993, 328(17):1252-8.