II. Indications

  1. Primary Immunization series
  2. Unvaccinated or partialy vaccinated adults (CDC/ACIP recommendation, 2023)
  3. Travel to endemic area
    1. Asia
    2. Africa

III. Contraindications: Enhanced Inactivated Polio Vaccine (EIPV)

  1. Allergy to EIPV Vaccine or its components present in trace amounts (neomycin, polymyxin, Streptomycin)

IV. Contraindications: Oral Polio Vaccine (OPV)

  1. Immunodeficiency disorders
  2. Household contacts of immunodeficient person
  3. Pregnancy
  4. Hypersensitivity to Vaccine
  5. Anaphylactic reaction to neomycin or Streptomycin

V. Pathophysiology

  1. Reasoning in switch from oral live (OPV) to injected inactivated (EIPV)
    1. Rare risk of Poliomyelitis with Oral Polio Vaccine (OPV)
    2. See Oral Polio Vaccine complications below
  2. All Inactivated Polio Vaccine (EIPV) will result in no cases of polio in those vaccinated
    1. EIPV however offers less mucosal (GI, mucus membrane) Immunity
      1. Gastrointestinal infection and stool transmission still occurs despite full Vaccination with EIPV
      2. Returning travelers from endemic regions may asymptomatically expose those unvaccinated
      3. Unvaccinated adult developed paralysis from polio in New York City, 2022
        1. NY Public health found the polio virus had been present in wastewater for at least 7 months
        2. Link-Gelles (2022) MMWR Morb Mortal Wkly Rep 71(33): 1065-8 [PubMed]
    2. Polio Virus is still not eradicated worldwide
      1. Circulating types include wild types 1 and Vaccine-derived polio virus
      2. Endemic areas include China and India

VI. Medications

  1. Enhanced Inactivated Polio Vaccine (EIPV, Sabin Vaccine, preferred)
    1. EIPV replaced Oral Polio Vaccine for universal Vaccination in U.S. 1999
    2. Has decades of safety and efficacy data supporting its use
  2. Oral Polio Vaccine (OPV, Salk Vaccine rare use after 1999)
    1. Trivalent Oral Polio Vaccine was introduced in 1960s
    2. Eradicated wild poliovirus from the U.S. by 1979
    3. Oral Polio Vaccine is among the greatest preventive health success stories (author opinion)

VII. Dosing: Adults (EIPV)

  1. Adults: EIPV 0.5 ml SC
  2. Adult Booster for exposure risk (e.g. travel, lab worker): Single lifetime booster dose
  3. Unvaccinated adults (3 dose series)
    1. Dose 1
    2. Dose 2: Give 4 to 8 weeks after dose 1
    3. Dose 3: Give 6 to 12 months after dose 2

VIII. Dosing: Primary Series Schedule (EIPV)

  1. Dose 1: Age 2 months
  2. Dose 2: Age 4 months
  3. Dose 3: Age 6 to 18 months
  4. Dose 4: Age 4 to 6 years

IX. Precautions

  1. EIPV is Safe in HIV and Pregnancy
    1. However, delay Vaccination until after pregnancy unless high risk for exposure
  2. Avoid OPV in HIV and Pregnancy

X. Complications: Oral Polio Vaccine (OPV)

  1. Cases per year Poliomyelitis associated with OPV: 8
    1. One case per 2 million doses
    2. EIPV results in no cases of Poliomyelitis

XI. Resources

  1. CDC Immunization Schedules (last accessed 10/28/2020)
    1. https://www.cdc.gov/vaccines/schedules/

Images: Related links to external sites (from Bing)

Related Studies