Trevor James
Poliomyelitis, or polio, is a potentially serious disease that can cause lifelong paralysis and even death. Thanks to successful vaccination programs, most people in the United States are protected from polio. However, polio vaccination remains a critical aspect of routine childhood immunization in the US, and the CDC recommends that children receive the inactivated polio vaccine (IPV) to protect against all three types of poliovirus. While most US adults were vaccinated as children, those who were not or who have only received the oral polio vaccine (OPV) outside of the US are advised to complete a primary polio vaccination series with IPV.
| Characteristics | Values |
|---|---|
| Type of vaccine used in the US | Inactivated poliovirus vaccine (IPV) |
| How IPV is administered | Injection in the leg or arm |
| Number of doses of IPV for children | 4 doses |
| Age of children when they receive IPV | 6 weeks, 4 months, 6-18 months, 4-6 years |
| Number of doses of IPV for children travelling to high-risk countries | 5 doses |
| Age of children when they receive the 5th dose of IPV | 4 years or older |
| Number of doses of IPV for adults | 3 doses |
| Type of vaccine not used in the US | Oral poliovirus vaccine (OPV) |
| Countries where OPV is still used | Afghanistan, Pakistan, China, Indonesia, Mozambique, Myanmar, Papua New Guinea |
| Risk of polio in the US | Low |
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What You'll Learn
The importance of polio vaccination for travellers
Although polio has been eliminated in the United States, the disease still occurs in other parts of the world. As such, it is important for travellers to be vaccinated against polio before leaving the country. The CDC recommends that children in the United States receive the inactivated polio vaccine (IPV) as part of their routine immunizations, which consists of four doses given at 2 months, 4 months, 6–18 months, and 4–6 years. IPV is administered via injection in the leg or arm, depending on the person's age.
For travellers, the CDC recommends completing the routine IPV series before departure, especially for those travelling to countries where the risk of contracting polio is higher. This includes countries where wild poliovirus (WPV) is still circulating or where there have been recent outbreaks. As of 2020, Afghanistan, Nigeria, and Pakistan are the only polio-endemic countries, but other countries may have temporary outbreaks. Travellers working in healthcare, refugee camps, or humanitarian aid settings in these countries may be at increased risk of exposure to WPV.
It is important to plan ahead and consult a healthcare provider or travel health clinic, preferably at least six weeks before departure, to ensure that all necessary polio vaccinations are up to date. In some cases, an accelerated vaccination schedule may be recommended if there is insufficient time to complete the routine series. Additionally, adults who have not completed their polio vaccinations may require additional doses before travelling to high-risk areas.
Upon returning from travel, it is important to continue any remaining doses of the IPV series as recommended. This is crucial to ensure full protection against all three types of poliovirus. Furthermore, some countries may require departing travellers to present proof of polio vaccination, such as an International Certificate of Vaccination, to prevent the exportation of WPV.
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The history of polio vaccination in the US
In 1949, a breakthrough occurred when John Enders, Thomas Weller, and Frederick Robbins successfully cultivated poliovirus in human tissue, for which they were recognised with the 1954 Nobel Prize. Following this, in the early 1950s, the first successful vaccine was created by US physician Jonas Salk and his team at the University of Pittsburgh. Salk tested his experimental vaccine on himself and his family in 1953, and later on 1.6 million children in North America and Europe. The results were announced on April 12, 1955, and Salk's inactivated polio vaccine (IPV) was licensed the same day. This vaccine was given by injection and was very effective, reducing annual cases from 58,000 to 5,600 by 1957.
Another important figure in the history of polio vaccination in the US is Albert Sabin, who developed the second type of polio vaccine, the oral polio vaccine (OPV). This vaccine was live-attenuated, meaning it used a weakened form of the virus, and could be given orally. Sabin, like Salk, tested his experimental vaccine on himself and his family before conducting further trials in other countries. Sabin's vaccine came into commercial use in 1961 and was easier to administer than Salk's, as it did not require sterile syringes.
Since 2000, only IPV has been used in the US to eliminate the risk of polio variants that can occur with OPV. This vaccine is given to children as part of their routine immunisations and has been very successful in protecting against polio. Today, most adults in the US are presumed to be protected against polio due to routine childhood immunisation, and polio cases are rare.
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IPV vs OPV
In the United States, polio vaccination has been part of the routine childhood immunization schedule for decades and is still administered to children today. The only polio vaccine that has been used in the US since 2000 is the inactivated poliovirus vaccine (IPV), which is administered through injection in the leg or arm. IPV is a safe and proven way to help the body fight off polio, and it is given as a series of shots.
Outside of the US, the oral poliovirus vaccine (OPV) is used in countries where the risk of getting infected with poliovirus is high. OPV is low-cost and easy to administer to large numbers of people. It is given by mouth as a liquid and contains a weakened live vaccine. However, OPV can very rarely lead to paralysis in those it spreads to when not enough people in the community are vaccinated.
In April 2016, all countries that were still using OPV switched from using trivalent OPV (tOPV) to bivalent OPV (bOPV). This switch led to outbreaks of circulating vaccine-derived poliovirus type 2 (cVDPV2), which increased from two cases in 2016 to 1037 cases in 2020.
The World Health Organization (WHO) recommends that all children be fully vaccinated against polio. Both IPV and OPV have been successful in eliminating polio from most of the world, reducing the number of cases reported each year from an estimated 350,000 in 1988 to 33 in 2018.
In summary, IPV is the only polio vaccine used in the US and is administered through injection, while OPV is used in other countries and is given by mouth. IPV is safe and proven to be effective in preventing polio, while OPV is low-cost and easy to administer but carries a very small risk of causing paralysis in unvaccinated individuals.
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The risk of polio in the US
Poliomyelitis, or polio, is a crippling disease caused by infection with any one of the three related poliovirus types (referred to as types P1, P2, and P3). The risk of polio in the US has been historically high, with annual polio rates in the 1950s exceeding 25,000 cases and outbreaks in 1952 and 1953 resulting in 58,000 and 35,000 cases, respectively.
However, the US has made significant progress in reducing the risk of polio through vaccination efforts. The last cases of indigenously acquired polio in the United States occurred in 1979, and it has been eradicated from the country for decades. Routine childhood immunization against polio has been in place for decades and is still ongoing, with the inactivated polio vaccine (IPV) being the only polio vaccine administered in the US since 2000. This vaccine is safe and effective in preventing polio, with almost all children who receive the recommended doses of IPV being protected from the disease.
Despite these efforts, there are still risks associated with polio in the US. In July 2022, the first case of poliomyelitis was reported in the US after three decades of eradication. The case was detected in an unvaccinated traveller residing in Rockland County, New York, and was found to be infected with a vaccine-derived poliovirus type 2 (VDPV2), suggesting an origin from the oral polio vaccine (OPV). While OPV is no longer used in the US, it is still administered in other countries, and travellers or international adoptees from these regions may pose a risk of importing the virus into the US.
Additionally, declining vaccination rates in recent years, exacerbated by the COVID-19 pandemic, have further heightened the risk of a potential outbreak. The CDC has advised people to vaccinate their children and high-risk populations to mitigate this threat. It is crucial for individuals to ensure they are up to date with their polio vaccinations, especially those planning to travel to polio-endemic or high-risk countries, to minimise the chances of contracting and transmitting the virus.
In summary, while the US has made remarkable strides in eliminating polio through vaccination programs, the recent case of poliomyelitis and declining vaccination rates serve as a reminder that the risk of polio persists. Maintaining high vaccination coverage and adhering to CDC recommendations are vital to preventing future outbreaks and protecting individuals from the potentially devastating consequences of polio infection.
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The future of polio vaccination in the US
Polio vaccination has been a part of the routine childhood immunization schedule in the United States for decades. The inactivated polio vaccine (IPV), administered via injection in the leg or arm, is the only polio vaccine that has been used in the US since 2000. This vaccine is safe and proven to help protect against polio infection, which is highly contagious.
The World Health Organization (WHO) recommends that all children be fully vaccinated against polio, and the CDC advises that children in the US receive IPV as part of their routine immunizations. Children typically receive four doses of IPV, with one dose at each of various age milestones. In some cases, IPV may be given in combination with other vaccines, resulting in a fifth dose.
For adults, the CDC recommends that those who may have received poliovirus vaccination outside the US meet the country's vaccination recommendations, which include protection against all three poliovirus types. Adults aged 18 and older who are unvaccinated or incompletely vaccinated should complete a primary polio vaccination series with IPV.
While polio cases in the US are rare today due to successful vaccination programs, the disease still occurs in other parts of the world. Therefore, it is crucial for individuals, especially those travelling to high-risk areas, to ensure they are up to date with their polio vaccinations.
Looking ahead, the polio vaccine will remain a critical component of public health in the US. Continued adherence to routine childhood immunization schedules and catch-up vaccinations for unvaccinated or incompletely vaccinated individuals will be essential to maintaining herd immunity and preventing potential outbreaks.
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Frequently asked questions
Yes, polio vaccination is still part of the routine childhood immunization schedule in the US.
The US uses the inactivated poliovirus vaccine (IPV), which is administered via injection in the leg or arm.
Children in the US typically receive four doses of the IPV vaccine, with one dose at each of the following ages: when they are infants (as young as 6 weeks old), then 4, 6-18 months, and 4-6 years old.
Most adults in the US were vaccinated against polio as children and are therefore likely protected. However, adults who are known or suspected to be unvaccinated or incompletely vaccinated should complete a primary vaccination series with IPV.
Yes, individuals travelling to countries where the risk of polio is higher should be vaccinated against polio before their trip. The World Health Organization (WHO) recommends that all children be fully vaccinated against polio.
