Brady Collins
Polio is a potentially serious disease that can lead to lifelong paralysis and even death. While there is no cure, polio can be prevented with safe and effective vaccination. Since the 1950s, polio vaccines have protected virtually everyone in the United States from the disease. However, recent headlines have brought polio back into the spotlight, with a single case of polio in New York in 2022 leading to a state of emergency. While Americans are highly vaccinated against polio, with more than 92% of children receiving polio inoculations by age 2, there are still pockets of unvaccinated or undervaccinated individuals across the country.
| Characteristics | Values |
|---|---|
| Percentage of children vaccinated by age 2 | 92% |
| Percentage of kindergarten-age students vaccinated | 94% |
| States with the highest vaccination rates | Mississippi, Louisiana, New York (excluding NYC), Nebraska, and Rhode Island |
| States with the lowest vaccination rates | Washington D.C., Idaho, Wisconsin, Hawaii, and Georgia |
| Number of polio cases in the US in 1953 | 35,000 |
| Number of polio cases in the US in 1957 | 5,600 |
| Number of polio cases in the US in 1961 | 161 |
| Number of Americans vaccinated with the Sabin vaccine between 1962 and 1965 | 100 million |
| Percentage of protection against severe polio disease after three doses of the inactivated poliovirus vaccine | 99-100% |
| Number of doses of polio vaccine recommended for children | 4 |
| Type of polio vaccine used in the US since 2000 | Inactivated polio vaccine (IPV) |
| Type of polio vaccine administered orally | Oral poliovirus vaccine (OPV) |
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What You'll Learn
History of polio vaccination in the US
The history of polio vaccination in the US began in the 1950s with the development of two types of vaccines: an inactivated poliovirus given by injection (IPV) and a weakened poliovirus given by mouth (OPV). The first successful demonstration of a polio vaccine was by Hilary Koprowski in 1950, with a live attenuated virus that people drank. However, this vaccine was not approved for use in the United States.
The success of an inactivated polio vaccine, developed by Jonas Salk, was announced in 1955. The Salk vaccine was licensed in 1955 and soon after, children's vaccination campaigns were launched. In the US, a mass immunization campaign led to a significant decline in polio cases, from 35,000 in 1953 to 5,600 by 1957. By 1961, only 161 cases were recorded in the country.
Another important development in the history of polio vaccination in the US was the oral polio vaccine (OPV), developed by Albert Sabin. This vaccine came into commercial use in 1961 and was the vaccine of choice in the United States and most other countries. Between 1962 and 1965, about 100 million Americans received the Sabin vaccine, resulting in a substantial reduction in poliomyelitis cases.
Since 2000, the United States has only used IPV to eliminate the risk of polio variants that can occur with OPV. As part of routine childhood immunization, children in the US are recommended to receive four doses of IPV to protect against polio. This vaccine is usually given in combination with other vaccines such as tetanus, diphtheria, and acellular pertussis.
Thanks to these successful vaccination programs, most people in the United States are protected from polio. However, there is still a risk of transmission from unvaccinated or undervaccinated individuals, as evidenced by a recent case of polio in Rockland County, New York. To ensure continued protection against polio, it is important for individuals to stay up to date with their vaccinations and for public health officials to monitor for any signs of transmission.
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Current polio vaccination rates in the US
The US has been using the inactivated polio vaccine (IPV) since 2000, and it is now the only polio vaccine administered in the country. IPV is given by shot in the leg or arm, depending on the patient's age. The CDC recommends that children receive four doses of the polio vaccine to protect them against severe polio disease, and most adults in the US were vaccinated as children and are therefore likely to be protected.
According to the latest data from the US Centers for Disease Control and Prevention, more than 92% of children in the United States have received polio inoculations by age 2. However, rates vary by state. For example, Mississippi has the highest rate in the country with 98.9% of kindergartners vaccinated against polio, while Washington, D.C. has the lowest rate at 80.4%.
While Americans are highly vaccinated against polio, there have been recent concerns about the spread of polio in the US. In 2022, there was one case of polio in Rockland County, New York, which paralyzed a young adult. While one case may not sound significant, health officials are concerned because unvaccinated and undervaccinated individuals are at risk of severe disease. The oral polio vaccine (OPV), which was used in the US before 2000, could sometimes cause vaccine-associated polio myelitis. This occurs when the weakened virus in the vaccine escapes the gut and causes paralysis. However, this is very rare, occurring only about once in every 3 million times the vaccine is administered.
Despite the high vaccination rate in the US, there are still pockets of under-vaccinated individuals, which could contribute to the spread of polio. Experts have identified several factors contributing to low vaccination rates, including the COVID-19 pandemic, which disrupted primary healthcare and resulted in missed vaccination appointments. Additionally, lax enforcement of vaccination requirements for school attendance may have played a role. To improve vaccination rates, experts emphasize the need for community education and targeted outreach to combat misinformation and hesitancy surrounding vaccines.
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States with low polio vaccination rates
While most Americans are vaccinated against polio, there are still some states with lower vaccination rates than others. Polio vaccination has been part of the routine childhood immunization schedule in the United States for decades, and the CDC recommends that children receive four doses of the polio vaccine to protect them against severe polio disease. However, vaccination rates can vary widely by state, and some states have lower vaccination rates than others.
According to CDC data, Washington, D.C., had the lowest polio vaccination rate among kindergarten-age children for the 2020-2021 school year, with only 80.4% of students vaccinated. Idaho had the second-lowest rate at 86.6%, followed by Wisconsin, Hawaii, and Georgia, all with rates under 90%. In Rockland County, New York, where a case of polio was detected in 2022, only 60% of children had received three doses of the polio vaccine by the age of 2, well below the statewide average of nearly 79%.
The low vaccination rates in these states are concerning, as they can increase the risk of polio outbreaks. Unvaccinated and undervaccinated individuals are at risk of severe disease, and the spread may not be obvious, especially if the virus is transmitted in communities with poor sanitation and low vaccination rates. Therefore, it is essential to improve vaccination rates in these states through education, targeted outreach, and rigorous enforcement of school immunization laws.
While the oral polio vaccine (OPV) has been critical in reducing polio cases, it has a rare drawback. Very rarely, the weakened virus in the oral vaccine can escape the gut and cause paralysis. This is known as vaccine-associated polio myelitis. As a result, since 2000, the United States has exclusively used the inactivated polio vaccine (IPV), administered through shots in the leg or arm, to eliminate the risk of polio variants associated with OPV.
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Types of polio vaccines
Since 2000, the only polio vaccine that has been used in the United States is the inactivated poliovirus vaccine (IPV). IPV is administered via injection and cannot cause polio. It is usually given in the leg or arm, depending on the patient's age. The CDC recommends that children receive 4 doses of IPV, with the first dose administered at birth. Children who are delayed in getting all recommended doses should finish their series by following the recommended catch-up schedule. Most adults have likely already been vaccinated against poliovirus during childhood. However, if you know or suspect that you are unvaccinated or incompletely vaccinated, you should receive the polio vaccination.
Before 2000, two types of vaccines were used in the United States to inoculate against polio:
- Oral polio vaccine (OPV), sometimes given on sugar cubes or in drops, that was made with live, weakened poliovirus.
- Injected vaccine with killed poliovirus.
The use of OPV was discontinued in the United States due to the rare possibility of the vaccine-induced polio myelitis. In 1961, type 1 and 2 monovalent oral poliovirus vaccine (MOPV) was licensed, and in 1962, type 3 MOPV was licensed. In 1963, trivalent OPV (TOPV) was licensed and became the vaccine of choice in the United States and most other countries. However, due to the rare risk of vaccine-associated polio myelitis, the Global Polio Eradication Initiative recommended that all countries using OPV switch to bivalent OPV (bOPV) in 2016.
The success of the IPV has been demonstrated in India, where a mass vaccination campaign using fractional-dose IPV (fIPV) reached 311,064 children aged 6 weeks to 3 years (94% coverage) over a period of 6 days in 2016. Fractional-dose IPV refers to the administration of 1/5 of the full IPV dose via the intradermal route.
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How polio vaccines are administered
Polio is a very serious infection that can cause paralysis of the muscles, including those that enable us to walk and breathe. There is no cure for polio, but it can be prevented with safe and effective vaccination. The polio vaccine is an active immunizing agent that works by causing the body to produce its own protection (antibodies) against the virus that causes polio.
There are two types of polio vaccines that are administered via injection: poliovirus vaccine inactivated (IPV) and poliovirus vaccine inactivated enhanced potency (eIPV). In the U.S. and Canada, the type of vaccine that is given by injection is eIPV. The recommended dose for both children and adults is 0.5 mL, administered by the intramuscular or subcutaneous route, using a needle length appropriate for the age and size of the person receiving the vaccine. Older children and adults are typically injected in the deltoid muscle for intramuscular injection or the posterior aspect of the upper arm for subcutaneous injection.
The type of vaccine that is administered orally is called poliovirus vaccine live oral (OPV). OPV is made using a live, "weakened" form of the three types of natural, or wildtype, polio virus. The viruses are weakened by growing them in cells that are different from the ones they infect in people. This process is called "cell-culture adaptation," which alters the natural polio virus so that it does not infect human cells as efficiently when it is given in the vaccine. OPV is usually provided in vials containing 10–20 doses of vaccine, with a single dose consisting of two drops.
In the United States, the Salk vaccine (IPV) is administered along with the tetanus, diphtheria, and acellular pertussis vaccines (DTaP) and a pediatric dose of hepatitis B vaccine. Some combination vaccines that contain IPV include Pentacel (DTaP-IPV/Hib), Pediarix (DTaP-IPV-HepB), Kinrix (DTaP-IPV), VAXELIS (DTaP-IPV-Hib-HepB), and Quadracel (DTaP-IPV).
In 2000, public health officials decided that the U.S. should only use shots, which contain the inactivated virus, to vaccinate against polio. This was due to the fact that, while the injected vaccine prevents paralysis, it doesn't necessarily prevent infection. Young adults and children vaccinated with the injected vaccine can still be infected with poliovirus in their intestines and shed the virus in their stool, potentially spreading it to others.
It is important to consult with a doctor or healthcare professional when deciding to get vaccinated, as there are certain risks and considerations to take into account. For example, for a while after immunization, there is a very small risk that any unvaccinated persons living in the same household may develop poliomyelitis (polio) from being around the vaccinated person. Additionally, certain medicines may interact with the polio vaccine, so it is important to inform your healthcare provider of any medications you are taking.
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Frequently asked questions
Yes, most United States citizens are vaccinated against polio. In 2020-2021, almost 94% of kindergarten-age students in the U.S. received the polio vaccine. However, rates vary by state.
While the exact polio vaccination rate in the United States today is unclear, it is estimated that only 79% of 2-year-olds in New York State have received three doses of the polio vaccine.
All U.S. states are currently above the 80% herd immunity threshold for poliovirus.
The CDC recommends that children receive four doses of the polio vaccine with one dose each administered at 2 months old, 4 months old, between 6 months and 18 months old, and between the ages of 4 and 6 years old.
Since 2000, the United States has only used the inactivated poliovirus vaccine (IPV) administered as a shot in the leg or arm, depending on the patient's age.
