Sarah Bennett
Poliomyelitis, or polio, is a serious and highly contagious infection that can lead to permanent paralysis and sometimes death. While there is no cure for polio, vaccination is a safe and effective way to prevent the disease. The polio vaccine has been part of routine childhood immunization for decades, and as a result, polio has largely disappeared from the United States and other countries. However, the risk of an outbreak remains if vaccination rates decrease, and polio still exists in other parts of the world. Therefore, maintaining high vaccination coverage is crucial to preventing the spread of polio and protecting individuals from contracting the disease.
| Characteristics | Values |
|---|---|
| Prevent polio | Yes, polio vaccination protects people against naturally occurring polioviruses and VDPVs |
| Prevent paralysis | Yes, polio vaccination helps to prevent paralysis caused by poliovirus |
| Number of doses | 4 doses for children, 3 doses for adults |
| Types of vaccines | Inactivated poliovirus vaccine (IPV), Oral poliovirus vaccine (OPV) |
| Side effects | Mild side effects like soreness, fever, pain, redness, swelling, fussy or tired babies and toddlers |
| Serious reactions | Serious reactions are rare but possible, such as severe and lasting shoulder pain |
| Precautions | Consult a doctor if the child has a serious illness or has had a serious allergic reaction in the past |
| Booster dose | People at increased risk of poliovirus exposure may receive 1 lifetime booster dose of IPV |
| Travel recommendation | Vaccination is recommended before travelling to a country where the risk of getting polio is greater |
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What You'll Learn
The inactivated polio vaccine (IPV)
IPV is given as an injection in the leg or arm, depending on the person's age, and protects against paralytic disease caused by any type of poliovirus, including vaccine-derived poliovirus (VDPV). It is important to note that IPV does not induce intestinal immunity, so it is possible to be infected with the type 2 revertant paralytic strain and pass it on to others through stool. However, those who have been vaccinated will not experience paralysis themselves.
Two doses of IPV provide at least 90% protection against severe disease caused by poliovirus, while three doses offer at least 99% protection. IPV may also be given in the same shot as other vaccines, known as combination vaccines. While IPV is generally safe, mild side effects such as fever, pain, redness, or swelling at the injection site may occur and typically resolve within a few days.
In addition to routine polio vaccinations, individuals may require a polio booster before travelling to areas where the risk of contracting polio is higher. Maintaining high IPV vaccination coverage is crucial to preventing the importation and spread of poliovirus within the United States.
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The oral polio vaccine (OPV)
OPV has several advantages over the inactivated polio vaccine (IPV). OPV does not require health professionals, sterile needles, or syringes for administration. It can be easily transported to remote areas and is suitable for mass vaccination campaigns. Additionally, OPV provides longer-lasting immunity than the Salk vaccine, offering protection against all three poliovirus serotypes. One dose of trivalent OPV confers immunity to all three poliovirus serotypes in approximately 50% of recipients, while three doses provide protection in more than 95% of cases.
OPV is safe, with a very low risk of adverse effects. In extremely rare cases, the weakened vaccine virus in OPV can cause vaccine-associated paralytic poliomyelitis (VAPP) at a rate of approximately 1 in 2.7 million doses. This risk is accepted by public health programmes due to the strong protection OPV provides. However, if not enough individuals are vaccinated, the weakened virus can spread within under-immunized populations and, over time, genetically revert to a form that causes paralysis, known as variant poliovirus or cVDPV.
Different types of OPVs are available, including monovalent OPVs (mOPV1, mOPV2, and mOPV3) that protect against a single serotype of polio and are used during respective outbreaks. The bivalent oral polio vaccine (bOPV) protects against poliovirus types 1 and 3 and is used in many countries' routine immunization schedules. In 2016, a switch from trivalent OPV (tOPV) to bOPV occurred due to the eradication of type 2 wild poliovirus. However, this contributed to outbreaks of circulating vaccine-derived poliovirus type 2 (cVDPV2), leading to the development of the novel oral polio vaccine type 2 (nOPV2), which is genetically modified to be more stable and less likely to revert to a virulent form.
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IPV vaccination dosage
The CDC recommends that children receive four doses of the polio vaccine to protect them against severe polio disease, including paralysis. The specific dosage schedule for children is three doses of 0.5 ml each, approximately four weeks apart, at 6, 10, and 14 weeks of age, followed by a booster dose at least six months after the third dose. This vaccination schedule can be postponed in the event of a severe acute febrile illness, although minor infections like the common cold are not contraindications.
For children who start routine vaccination late (after three months of age), the recommended schedule is slightly different. In this case, the first dose of IPV is administered together with the first dose of bOPV, followed by two subsequent doses of bOPV alone, given four weeks apart. If there is a shortage of IPV, the intradermal route can be used as an alternative by experienced operators, with two doses of 0.1 ml administered at least four weeks apart at 6 and 14 weeks of age.
While the CDC recommends four doses of IPV for children, it is considered safe for them to receive a fifth dose if necessary. This additional dose may be given as part of a combination vaccine that includes other immunizations. It's important to note that children who will be travelling to areas with a higher risk of polio should complete their vaccination series before their trip. If the routine schedule cannot be completed, an accelerated schedule may be recommended.
For adults who have never been vaccinated against polio, the CDC recommends receiving three doses of IPV. Each dose is 0.5 ml, the same volume as for children. The vaccine can be administered via the intramuscular or subcutaneous route, with the needle length appropriate for the age and size of the person being vaccinated. The deltoid muscle is typically used for intramuscular injection, while the posterior aspect of the upper arm is used for subcutaneous injection.
Overall, IPV is a critical tool in the fight against polio, protecting against severe disease caused by poliovirus in almost everyone who has received the recommended doses. Two doses provide at least 90% protection, while three doses offer at least 99% protection.
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OPV side effects
OPV, or oral poliovirus vaccine, is a safe and effective vaccine that contains live, weakened poliovirus. It is administered in the form of oral drops and has been instrumental in eradicating wild polioviruses globally. OPV is highly effective in preventing natural poliovirus-induced neurological damage, and most individuals are protected after just one dose.
However, OPV is associated with certain side effects, known as adverse events following immunization (AEFI). While OPV-related AEFIs are not uncommon, they are under-reported. Active AEFI surveillance during mass immunization campaigns is crucial to detect rare and severe adverse events.
Some of the common side effects associated with OPV include:
- Fever
- Pinkeye (conjunctivitis)
- Severe fatigue
- Injection site reactions (hives, itching, and skin redness)
- Irritability
- Loss of appetite
- Headache
- Belly pain
- Diarrhea
In addition to these common side effects, there are also potential risks associated with OPV:
- OPV may not induce an adequate immune response when administered within one month of other live virus vaccines, such as MMR.
- Concurrent administration of OPV with certain vaccines, such as cholera, typhoid, or plague vaccines, may lead to significant adverse reactions and should be avoided.
- OPV contains live attenuated poliovirus, and if allowed to circulate in under-immunized or unimmunized populations for too long, the weakened virus can revert to a form that causes illness and paralysis. This is known as vaccine-derived poliovirus (VDPV).
- OPV is typically administered to infants multiple times to ensure immunity to all three types of poliovirus. However, infants who receive OPV before the age of six weeks may experience reduced vaccine effectiveness due to interference from maternal antibodies.
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Preventing polio transmission
Polio is a serious infection that can cause permanent paralysis and sometimes death. It is highly contagious and mainly affects children under five years old. The poliovirus spreads easily from person to person, usually through contact with the faeces of an infected person, for example, from not washing hands properly before touching the mouth, or from contaminated food or water. It can also spread through coughs or sneezes, although this is less common.
The best way to prevent polio transmission is through vaccination. The polio vaccine has been part of routine childhood immunization schedules in many countries for decades, and as a result, polio has largely disappeared from the United States and other countries with high vaccination rates.
There are two types of polio vaccines:
- Inactivated Poliovirus Vaccine (IPV): This is given as a series of shots, typically four doses, at 2 months, 4 months, 6 to 18 months, and again at 4 to 6 years of age. IPV has been the only polio vaccine used in the United States since 2000. It provides protection against severe disease caused by poliovirus, with two doses providing at least 90% protection, and three doses providing at least 99% protection.
- Oral Poliovirus Vaccine (OPV): OPV is a safe and effective vaccine that contains a combination of one, two, or three strains of live, weakened poliovirus, given in the form of oral drops. While OPV is no longer used in the United States, it has been instrumental in eradicating wild polioviruses worldwide.
In addition to vaccination, other measures can help prevent polio transmission:
- Clean water and good hygiene practices: Access to clean water and good hand hygiene habits can prevent the spread of poliovirus, which is often transmitted through contaminated water or faecal-oral routes.
- Modern sewage systems and wastewater management: Proper sewage treatment and wastewater management can help prevent the spread of poliovirus in the environment.
- Booster doses: Individuals who are fully vaccinated but at increased risk of poliovirus exposure, such as those travelling to high-risk areas, may receive a booster dose of IPV for added protection.
- Surveillance and immunization strategies: Global efforts to eradicate polio have included building effective surveillance and immunization systems, which are crucial for identifying and containing outbreaks.
By combining vaccination, good hygiene practices, and public health strategies, we can effectively prevent polio transmission and work towards a world free of this debilitating disease.
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Frequently asked questions
Yes, the polio vaccine protects against polio, a potentially fatal infection that can lead to permanent paralysis.
There are two types of polio vaccines: inactivated poliovirus vaccine (IPV) and oral poliovirus vaccine (OPV). IPV is given as a series of shots, while OPV is administered orally in the form of drops.
IPV provides at least 90% protection after two doses and at least 99% protection after three doses. OPV has also been instrumental in eradicating wild polioviruses around the world.
If you are fully vaccinated but at increased risk of poliovirus exposure, you may receive one lifetime booster dose of IPV. Additionally, if you are travelling to a country where the risk of polio is higher, you should receive a polio booster vaccination before your trip.
