# Presentation: 898691

## Polio and Polio Vaccine

**Epidemiology and Prevention of Vaccine-Preventable Diseases**
**National Center for Immunization and Respiratory Diseases**
**Centers for Disease Control and Prevention**

**Revised March 2008**

## Note to presenters:

**Images of vaccine-preventable diseases are available from the Immunization Action Coalition website at ****http://www.vaccineinformation.org/photos/index.asp**

## Poliomyelitis

**First described by Michael Underwood in 1789**
**First outbreak described in U.S. ****in 1843**
**21,000 paralytic cases reported in the U. S. in 1952**
**Global eradication in near future**

## Poliovirus

**Enterovirus (RNA)**
**Three serotypes: 1, 2, 3**
**Minimal heterotypic immunity ****between serotypes**
**Rapidly inactivated by heat, formaldehyde, chlorine, ultraviolet light**
**Most poliovirus infections are asymptomatic**

## Poliomyelitis Pathogenesis

**Entry into mouth**
**Replication in pharynx, GI tract, ****local lymphatics**
**Hematologic spread to lymphatics and central nervous system**
**Viral spread along nerve fibers**
**Destruction of motor neurons**

## Outcomes of Poliovirus Infection

**Outcomes of Poliovirus Infection**

## Poliovirus Epidemiology

**Reservoir****	****	****    Human**** **
**Transmission****	****    Fecal-oral****	****	****	****	****	****	****            Oral-oral possible**** **
**Communicability****	****    7-10 days before onset****	****	****	****	****    Virus present in stool****	****	****	****	****    3-6 weeks**

## Poliomyelitis—United States, 1950-2006

**Poliomyelitis—United States, 1950-2006**

## Poliomyelitis—United States, 1980-2006

**Poliomyelitis—United States, 1980-2006**

*****

***Vaccine-acquired paralytic polio (VAPP) in a U.S. resident**
** ****acquired outside the U.S.**

## Vaccine-Derived PoliovirusInfections - MN, 2005

**7-month-old infant with a severe immunodeficiency**
**Infected with type 1 poliovirus that was derived from the vaccine strain**
**7 additional infections in the community**
**None of the infected children were paralyzed or had other symptoms**

***MMWR***** 2005; 54 (No. 41):1053-5**

## Poliovirus Vaccine

**1955****	****Inactivated vaccine**** **
**1961****	****Types 1 and 2 monovalent OPV**** **
**1962****	****Type 3 monovalent OPV**** **
**1963****	****Trivalent OPV**** **
**1987****	****Enhanced-potency IPV (IPV)**

## Inactivated Polio Vaccine

**Contains 3 serotypes of vaccine virus**
**Grown on monkey kidney (Vero) cells**
**Inactivated with formaldehyde**
**Contains 2-phenoxyethanol, neomycin, streptomycin, polymyxin B**

## Oral Polio Vaccine

**Contains 3 serotypes of vaccine virus**
**Grown on monkey kidney (Vero) cells**
**Contains neomycin and streptomycin**
**Shed in stool for up to 6 weeks following vaccination**

## Inactivated Polio Vaccine

**Highly effective in producing immunity to poliovirus**
**>90% immune after 2 doses**
**>99% immune after 3 doses**
**Duration of immunity not known with certainty**

## Oral Polio Vaccine

**Highly effective in producing immunity to poliovirus**
**50% immune after 1 dose**
**>95% immune after 3 doses**
**Immunity probably lifelong**

## Polio Vaccination Recommendations, 1996-1999

**Increased use of IPV (sequential IPV- OPV schedule) recommended in 1996**
**Intended to reduce the risk of vaccine- associated paralytic polio (VAPP)**
**Continued risk of VAPP for contacts of OPV recipients**

## Polio Vaccination Recommendations

**Exclusive use of IPV recommended in 2000**
**OPV no longer routinely available in the United States**
**Indigenous VAPP eliminated**

## Polio Vaccination Schedule 

_**Vaccine**_
**IPV**
**IPV**
**IPV**
**IPV**

_**Age**_
**2 months**
**4 months**
**6-18 months**
**4-6 years***

**Minimum**
_**Interval**_
**  ****---**
**4 wks**
**4 wks**
**4 wks**

***the fourth dose of IPV may be given as early**
** ****as 18 weeks of age**

## Schedules that Include Both IPV and OPV

**Only IPV is available in the ****United States**
**Schedule begun with OPV should be completed with IPV**
**Any combination of 4 doses of IPV and OPV by 5 years constitutes a complete series**

## Pediarix

**Contains IPV, DTaP, and hepatitis B vaccines**
**Minimum age 6 weeks, maximum age 6 years**
**Approved by FDA for first 3 doses of the IPV and DTaP series**
**Not approved for booster doses**

## Polio Vaccination of Adults

**Routine vaccination of U.S. residents 18 years of age and older is not necessary or recommended**
**May consider vaccination of travelers to polio-endemic countries and selected laboratory workers**

## Polio Vaccination of Unvaccinated Adults

**IPV**
**Use standard IPV schedule if possible (0, 1-2 months, 6-12 months)**
**May separate doses by 4 weeks if accelerated schedule needed**

## Polio Vaccination of Previously Vaccinated Adults

**Previously complete series**
**administer one dose of IPV**
**Incomplete series**
**administer remaining doses in series**
**no need to restart series**

## Polio Vaccine Adverse Reactions

**Rare local reactions (IPV)**
**No serious reactions to IPV have been documented**
**Paralytic poliomyelitis (OPV)**

## Vaccine-Associated Paralytic Polio

**Increased risk in persons **_**>**_**18 years**
**Increased risk in persons with immunodeficiency**
**No procedure available for identifying persons at risk of paralytic disease**
**5-10 cases per year with exclusive use ****of OPV**
**Most cases in healthy children and their household contacts**

**Notes:**
Increased risk of VAPP in immunodeficient children and persons >18 years of age.

## Vaccine-Associated Paralytic Polio (VAPP) 1980-1998

**Healthy recipients of OPV****	****41%**
**Healthy contacts of ****OPV recipients****	****	****	****	****31%**
**Community acquired****	****	****  5%**
**Immunodeficient****	****	****	****24%**

## Polio VaccineContraindications and Precautions

**Severe allergic reaction to a vaccine component or following a prior dose of vaccine**
**Moderate or severe acute illness**

## Polio Eradication

**Last case in United States in 1979**
**Western Hemisphere certified polio free in 1994**
**Last isolate of type 2 poliovirus in India in October 1999**
**Global eradication goal**

## Wild Poliovirus 1988

**Wild Poliovirus 1988**

## Wild Poliovirus 2006

**Wild Poliovirus 2006**

## CDC Vaccines and ImmunizationContact Information  

**Telephone     800.CDC.INFO**** **
**Email****	****	****  nipinfo@cdc.gov**** **
**Website****	****  www.cdc.gov/vaccines**