Polio
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Poliovirus
poliovirus

Poliomyelitis (polio) is an infectious viral disease that spreads from person to person in stool and saliva. Most infected persons show no symptoms. Minor symptoms can include sore throat, low-grade fever, nausea, and vomiting. Some infected persons (1%-2%) will have stiffness in the neck, back, or legs without paralysis. Less than 1% of polio infections (about 1 of every 1,000 cases) cause paralysis, permanent disability, and even death. However, many paralyzed persons recover completely. Before polio vaccine, was available, each year in the U.S. 13,000 to 20,000 people were paralyzed by polio, and about 1,000 people died of polio. Most of those infected were elementary school children, so it was often called "infantile paralysis."

The incidence of paralytic polio peaked in the U.S. in the 1950s. At its peak incidence, poliomyelitis occurred at a rate of 13.6 cases per 100,000 population.

Since licensure of the Salk (inactivated) polio vaccine in 1955, the incidence of polio has decreased dramatically. The disease was further reduced by the advent of the Sabin (oral) polio vaccine in 1961. The last cases of paralytic polio from natural poliovirus in the U.S. occurred in 1979, and the most recent case from outside the U.S. occurred in 1993. Although polio has been eradicated from the U.S. and the Western Hemisphere, it remains a threat in some countries. The Global Polio Eradication Program is successfully working to eradicate polio, with only 1655 cases reported in 2008.

About the Vaccine

There are two main types of polio vaccine, oral polio vaccine (OPV) given by mouth and inactivated polio vaccine (IPV) given by injection. Both were created in the 1950s and are highly effective at preventing polio. OPV is no longer used in the United States, because it caused eight to ten cases of vaccine-association paralytic polio (VAPP) each year. OPV continues to be used in other countries, because it is easy to administer and it helps to increase community immunity to polio. Currently in the U.S., only IPV is administered. IPV is commonly administered as a combination vaccine with DTaP, hepatitis B vaccine and/or Hib vaccine.

Polio Vaccine Licensed for use in the US
Inactivated Polio Vaccine (IPV)
 

Product: IPOL® (Polio Vaccine Inactivated-IPV)
Manufacturer: Sanofi Pasteur
Year licensed: 1990
Product Insert

 
Combination Vaccines
 

Product Name: Pediarix® (IPV, DTaP, and hepatitis B vaccines)
Manufacturer: GlaxoSmithKline
Year licensed: 2002
Product Insert

Product Name: Pentacel® (IPV, DTaP, and HIB)
Manufacturer: Sanofi Pasteur
Year licensed: 2002
Product Insert

Product Name: Kinrix® (IPV and DTaP)
Manufacturer: GlaxoSmithKline
Year licensed: 2008
Product Insert

Indications Contraindications and precautions
  • Most children and young adults who were not vaccinated with OPV or IPV as children.
  • Laboratory workers who might handle polio virus.
  • Health care workers who treat patients who could have polio.
  • Adults who travel to areas in which polio is endemic or epidemic.
Note: Oral polio vaccine is not recommended for use in the U.S. It is used in mass vaccination campaigns in countries where wild polio infections still occur, and in polio eradication programs.
  • People who have had a life-threatening allergic reaction to the antibiotics neomycin, streptomycin, or polymyxin B.
  • People who have had a severe allergic reaction to a previous dose of polio vaccine.
  • People who are moderately or severely ill should wait until recovery before receiving any vaccine. Minor illnesses, such as a cold, are not a contraindication.
Child
Child Schedule for Routine Vaccination
  • Only IPV is available for routine polio vaccination of children in the United States. A schedule that was begun with OPV should be completed with IPV.
  • Give three doses of IPV or IPV combination vaccine at age 2 months, 4 months, and 6-18 months of age. Dose 1 may be given as early as 6 weeks of age.
  • Give Dose 4 of IPV at 4-6 years of age as a booster dose. Do not give a combination vaccine (Pentacel® or Pediarix®) as Dose 4.
  • Do not give Pediarix® or Pentacel® for Dose 4 of the series.
  • Give Kinrix® only for Dose 5 of DTaP and Dose 4 of IPV in children 4-6 years of age whose previous DTaP doses have been with Infanrix® and/or Pediarix® for the first three doses and Infanrix® for the fourth dose.
Child Dose/Route:
  • Give IPV 0.5 ml IM or SQ in mid-lateral aspect of thigh to infants and small children. Give Pediarix®, Pentacel®, and Kinrix® IM only.
Adult
Older Children and Adult Schedule for Routine Vaccination:
  • Give young adults who have never been vaccinated against polio the first dose of IPV (not a combination vaccine) at any time. Give the second dose 1 to 2 months later, and the third dose 6 to 12 months after the second.
  • Give three doses of IPV, each given four weeks apart, to older children and adults who have never been immunized and who are traveling to areas where polio outbreaks occur.
Adult Dose/Route:
  • Give IPV 0.5 ml IM in the deltoid or SQ posterior-lateral upper arm.
IPV Side Effects*
  • Soreness and redness at injection site
  • Severe allergic reaction (very rare)

Notes:
*Oral polio vaccine may cause vaccine-associated paralytic polio in a very small percentage of those immunized. It is more likely to occur in people who have weakened immune systems. IPV cannot cause paralysis, because the vaccine virus has been inactivated.

Product Name Supplied Storage and Handling
IPOL®
Sanofi Pasteur
Syringe, without needle, 0.5 mL (10 per package)

Vial, 10 Dose
Store refrigerated between 2° to 8°C (35° to 46°F). Do not freeze. Discard if the vaccine has been frozen.

IPOL vaccine should appear clear and colorless.
Kinrix®
GlaxoSmithKline
0.5 mL single-dose vials (10 per package)

Disposable prefilled Tip-Lok® syringes (packaged without needles, 5 or 10 per package).
Store refrigerated between 2° and 8°C (36° and 46°F). Do not freeze. Discard if the vaccine has been frozen.

Kinrix® should appear as a homogeneous, turbid, white suspension after being shaken vigorously. If the vaccine does not resuspend with vigorous shaking, do not use.
Pentacel®
(IPV, DTaP, and HIB) Sanofi Pasteur
Five-dose package containing 5 vials of DTaP-IPV component to be used to reconstitute 5 single-dose vials of lyophilized ActHIB vaccine component Store at 2° to 8°C (35° to 46°F). Do not freeze. Discard if the vaccine has been frozen.

Use immediately after reconstitution.

Pentacel® should appear as a uniform, cloudy, white to off-white (yellow tinge) suspension. Thoroughly but gently shake the vial of DTaP-IPV component, withdraw the entire liquid content, and inject into the vial of ActHib vaccine. Shake the vial until a cloudy, uniform suspension results.
Pediarix®
GSK
Disposable prefilled Tip-Lok® syringes (packaged without needles, 10 per package). Store refrigerated between 2° and 8°C (36° and 46°F). Do not freeze. Discard if the vaccine has been frozen.

Pediarix should appear as a homogeneous, turbid, white suspension after the vial is shaken vigorously.     
This briefing, presented by Ellyn Ogden, covers polio eradication strategies, current global epidemiologic status and a summary of general challenges.
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This briefing, presented by Ellyn Ogden, covers polio eradication strategies, current global epidemiologic status and a summary of general challenges.
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