Chloe Ramirez
Poliovirus is a serious and life-threatening disease that can cause meningitis, limb weakness, paralysis, and even death. Fortunately, polio vaccination has been part of the routine childhood immunization schedule in the United States for decades, and most adults in the country were vaccinated as children and are therefore likely to be protected from the virus. However, in the absence of a federal database of vaccination records, some Americans may be unsure about their immunization status, especially after poliovirus was detected in wastewater samples from New York and London. This has led to an increased interest in learning about the polio vaccine and personal immunization status.
| Characteristics | Values |
|---|---|
| People vaccinated in childhood | Most Americans were vaccinated for polio in early childhood |
| Vaccination rates | Kindergarten vaccination rates for polio have hovered around 95% since at least the 2011-12 school year |
| Vaccination records | There is no federal database of vaccination records |
| Vaccination status | It may be harder to tell in some states |
| Recommended doses | The CDC recommends four doses of the polio vaccine at specific intervals from ages 2 months to 6 years |
| Vaccination requirements | The shots are required for children entering kindergarten in all 50 states and Washington, D.C. |
| Exemptions | Some states allow medical, religious, or philosophical exemptions |
| Booster dose | People who are fully vaccinated but at increased risk of poliovirus exposure may receive 1 lifetime booster dose of IPV |
| Vaccination before travel | People travelling to a country where the risk of getting polio is greater should be vaccinated against polio before leaving for their trip |
| Protection | Two doses of IPV provide at least 90% protection, and three doses provide at least 99% protection |
| Side effects | Mild and usually go away on their own, but serious reactions are possible |
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What You'll Learn
Polio vaccination rates in the US
Polio vaccination has been part of the routine childhood immunization schedule in the United States for decades. The inactivated poliovirus vaccine (IPV) is administered by injection and is 99% effective in children, according to the CDC. IPV is the only polio vaccine that has been used in the United States since 2000. The CDC recommends that everyone get four doses of the polio vaccine at specific intervals from ages 2 months to 6 years. The shots are required for children entering kindergarten in all 50 states and Washington, D.C.
While there is no federal database of vaccination records, kindergarten vaccination rates for polio have been around 95% since at least the 2011-12 school year. According to CDC data, almost 94% of kindergarten-age students in the US received the polio vaccine for the 2020-21 school year, with rates varying by state. Mississippi had the highest rate at 98.9%, while Washington, D.C., had the lowest rate at 80.4%.
However, there are concerns about declining vaccination rates due to factors such as the COVID-19 pandemic and political changes undermining vaccine policy and public trust. The reemergence of polio cases in New York State and the detection of the virus in wastewater samples have highlighted the need to increase vaccination rates and improve community education on vaccine safety and efficacy.
For adults who have never been vaccinated, the CDC recommends getting three doses of IPV. If fully vaccinated but at increased risk of poliovirus exposure, one lifetime booster dose of IPV may be received. The best way to protect against polio and its potentially severe symptoms, including paralysis and death, is to ensure that vaccinations are up to date.
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IPV vaccine efficacy
Inactivated poliovirus vaccine (IPV) is a safe vaccine with very few side effects. Mild redness or pain may occur at the site of injection, and some people may faint after the procedure. IPV has not been known to cause serious problems, and most people do not experience any adverse effects.
IPV is highly efficacious in protecting against poliomyelitis (polio). Two doses of IPV provide at least 90% protection against paralytic polio, and three doses provide at least 99% protection. The efficacy of the vaccine increases with the number of doses administered. A single dose of IPV can prime individuals for a subsequent booster in the event of an outbreak and may also offer some protection against poliomyelitis and poliovirus transmission.
In a case-control analysis during a poliomyelitis outbreak in Senegal in 1986-1987, the estimated efficacy of a single dose was 36%, while the efficacy of two doses was 89%. Similarly, a pilot study in southern India found that the protective efficacy of a single dose was 52%, while two doses increased efficacy to 67%.
In the United States, routine childhood immunization against polio has been administered for decades, and IPV has been the only polio vaccine used since 2000. Most American adults were vaccinated as children and are likely protected from polio. However, due to the lack of a federal vaccination database, it can be challenging for individuals to obtain their polio vaccination records. The CDC recommends that unvaccinated adults receive three doses of IPV.
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The history of polio in the US
Polio, or poliomyelitis, is a disease that attacks the central nervous system and often leaves its victims partially or fully paralysed. In 1789, a London-based pediatrician by the name of Michael Underwood published the first clear description of the paralytic disease in infants in a medical textbook. However, due to the sporadic appearance of the infection, the absence of epidemics until the relatively recent past, and the nonspecific nature and infrequency of the acute illness, there are hardly any other recognizable traces of the disease until the 18th century.
In the early 19th century, small groups of polio-afflicted patients began to be reported in medical literature, but still only as sporadic cases. It was only in industrialized countries in North America and Europe, which had experienced significant improvements in hygiene during the 19th and 20th centuries, that polio transformed into an epidemic disease. Tens of thousands of Americans were stricken by poliomyelitis in the first half of the 20th century. Each summer, polio would spread like the plague, causing pools and beaches to shut down due to the fear that the poliovirus was waterborne. Children were banned from crowded places like movie theatres and bowling alleys, and had to be tested by their parents daily.
In 1908, the poliovirus was discovered by a team led by Viennese immunologist and future Nobel Prize winner, Karl Landsteiner. In 1931, two Australian researchers, Frank Macfarlane Burnet and Jean Macnamara, identified the different serotypes of the poliovirus using immunologic techniques. In 1948, a team at Harvard Medical School in Massachusetts showed how the virus could be grown in large amounts in tissue culture, leading to Jonas Salk's development of an effective killed-virus vaccine in 1953.
Salk's vaccine, known as the inactivated poliovirus vaccine (IPV), was put to a massive nationwide test in 1954-55. Called the Francis Field Trial, the test involved 1.8 million children across the United States. The trial was declared a success on April 12, 1955, and over the next four years, more than 450 million doses of the Salk vaccine were distributed. During that time, the incidence of paralytic polio in the United States fell from 18 cases per 100,000 people to fewer than 2 per 100,000.
Despite the success of the Salk vaccine, a polio outbreak occurred in 1955, with Massachusetts reporting more than 2,000 cases that summer. Boston Children's Hospital, the receiving centre for polio patients in New England, typically saw an upsurge in cases each summer, but in 1955, patients started arriving earlier and in higher numbers. The outbreak would go down in history as one of the toughest years for the hospital, with nearly 40 new cases arriving daily at its peak.
In the years 1961-63, approval was given to a new vaccine developed by Albert Sabin at the University of Cincinnati, Ohio. The Sabin vaccine, using a live but attenuated virus, could be given in drops through the mouth and became known as the oral poliovirus vaccine (OPV). Since 2000, only IPV has been used in the United States to eliminate the risk of polio variants that can occur with OPV. Today, polio vaccination has been part of the routine childhood immunization schedule in the United States, with most adults likely vaccinated as children and therefore protected from getting polio.
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How to find polio vaccination records
While most Americans were vaccinated for polio in early childhood, there is no federal database of vaccination records in the US. This makes it difficult to track down polio vaccination records, but not impossible. Here are some ways to find your polio vaccination records:
Contact your state's health department
Around 30 states allow you to request vaccination records through online forms, mobile apps, or online portals. The remaining states require you to submit a request form by fax, email, or mail. The systems for storing and enabling access to vaccination records vary from state to state. For example, in Alabama, you can request records through the vaccination provider or the county health department that administered your vaccine doses. Meanwhile, in Alaska, you need to submit a request form by mail or fax, along with personal identification.
Contact your healthcare provider
Your vaccination records may be stored by your doctor or clinic. However, providers typically keep records for a limited number of years, so if you have changed doctors, you should contact your past healthcare providers.
Contact your school
Schools often require proof of immunization and may keep these records for a few years.
Contact your parents or caregivers
If you were vaccinated as a child, your parents or caregivers may be able to provide information about your polio vaccination.
Check your personal records
The CDC recommends keeping a personal immunization record and storing it with other essential documents. If you have gathered your immunization history, it is important to keep track of your records moving forward.
If you are unable to find your polio vaccination records, the CDC states that it is safe to repeat vaccinations. The CDC recommends that you talk to your doctor about whether you should get vaccinated against polio again. Doctors may also recommend antibody tests to determine whether you've been vaccinated.
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Polio vaccination for travel
Although polio has been eliminated in the United States, the disease still occurs in other parts of the world. It only takes one person with polio travelling from another country to bring polio into the US. Therefore, it is important for US residents to ensure they are vaccinated against polio before travelling internationally.
Polio Vaccination Recommendations for US Residents Travelling Abroad
The CDC recommends that all infants and children in the US are vaccinated against polio with 4 doses of IPV given at ages 2 months, 4 months, 6–18 months, and 4–6 years. The final dose should be administered at age ≥4 years, regardless of the number of previous doses, and should be given ≥6 months after the previous dose. Infants and children travelling to countries where the risk of getting polio is greater should complete the routine series before departure. If the routine series cannot be administered within the recommended intervals before travel, an accelerated schedule can be followed.
For adults who have never been vaccinated, the CDC recommends getting three doses of IPV. If you’ve had three shots or more in the past and you’re travelling to a high-risk area, you can seek out a booster dose. Adults who are incompletely vaccinated (received only 1 or 2 doses of polio vaccine in the past) should get the remaining 1 or 2 doses of IPV (administered at least 4 weeks apart) before departure. If an adult cannot complete the above series before travelling, an accelerated schedule (3 doses of IPV administered at least 4 weeks apart) is recommended.
Polio Vaccination Requirements for Travel to Countries with Active Poliovirus Transmission
On May 5, 2014, the World Health Organization (WHO) declared the international spread of polio to be a public health emergency of international concern. The CDC issued guidance for US residents travelling to or residing in countries with active poliovirus transmission for more than 4 weeks, recommending that they have evidence of administration of polio vaccine (IPV or OPV) within 12 months of travel.
Some countries with active poliovirus transmission may have exit requirements for proof of polio vaccination when leaving the country at borders or through airports. These requirements, if implemented, would be mandatory and are intended to prevent the exportation of WPV.
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Frequently asked questions
There is no federal database of vaccination records in the US, so you may need to ask your parents or caregivers, doctors or public health clinics you visited as a child, or previous employers that required immunizations. Schools may also keep records for a couple of years after students graduate. If you are unsure, it is safe to repeat vaccinations.
The CDC recommends that children get four doses of the polio vaccine at ages 2 months, 4 months, 6–18 months, and 4–6 years. Some states only require three doses.
Most adults in the US were vaccinated as children and are therefore likely to be protected from polio. However, some adults at higher risk for polio—including health care workers, lab workers, and people travelling to certain parts of the world where polio occurs—may want to consider vaccination. Adults who have never been vaccinated should get three doses of the IPV vaccine.
