AAP Updates Polio Vaccine Recommendations

Larry Hand

September 26, 2011

September 26, 2011 — The American Academy of Pediatrics (AAP) has updated its recommendation for the administration of poliovirus vaccines, clarifying the standard schedule for immunization, as well as the minimal ages and minimal intervals between doses, according to a policy statement published online September 26 in Pediatrics.

Although the use of oral poliovirus vaccine (OPV) beginning in the early 1960s led to the elimination of polio in the United States, with the last reported outbreak seen in 1979, wild polioviruses still occur naturally in 4 countries: Afghanistan, India, Nigeria, and Pakistan. The fact that these 4 countries exported the virus to other countries that reported polio cases in 2009 points to the potential for the virus to be brought into the United States, the AAP policy statement says.

Twenty countries reported 1349 cases of polio in 2010, and 14 countries have reported 333 polio cases through August 23 of this year.

Inactivated poliovirus vaccine (IPV) replaced OPV as the vaccine of choice in the United States in 2000 in an effort to prevent rare but serious vaccine-associated paralytic polio. The current vaccination schedule, designed to produce immunity early in life, calls for 3 doses of IPV at 2, 4, and 6 through 18 months of age, and a fourth dose at 4 through 6 years of age. The AAP recommends that if risk for exposure is imminent, such as when a person travels to 1 of the 4 countries with wild polioviruses, then the doses should be administered at the minimum ages and intervals.

Within the United States, pockets of underimmunized children could lead to an outbreak if the wild viruses migrate to where those children are living, the AAP says.

The AAP statement says that after an individual receives the IPV series of doses, immunity is "long-term, possibly lifelong." However, another recommendation in its statement is that even adults who completed immunization with OPV or IPV early in life get a single dose of IPV if they are at increased risk for exposure to wild poliovirus in 1 of the countries.

Three combination vaccines and 1 stand-alone vaccine are licensed in the United States. Diphtheria and tetanus toxoids and acellular pertussis adsorbed, hepatitis B (DtaP-HepB-IPV; Pediarix, GlaxoSmithKline), is licensed for the first 3 doses and through 6 years of age. DtaP, IPV, and Haemophilus influenza type b (DtaP-IPV/Hib; Pentacel, Sanofi Pasteur) is licensed for all 4 doses through 4 years of age. DtaP-IPV (Kinrix, GlaxoSmithKline) is licensed for the last dose at ages 4 through 6. IPV (Poliovax, Sanofi Pasteur), the stand-alone vaccine, is licensed for all doses in infants, children, and adults.

The World Health Assembly set a goal in 1988 of eradicating polio worldwide. At that time, an estimated 350,000 cases of polio existed in 125 countries. That number decreased to 1604 cases in 2009.

Pediatrics. Published online September 26, 2011. Full text

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