AAP offers policy statement on poliovirus

Committee on Infectious Diseases. Pediatrics. 2011;128:805–808.

The Committee on Infectious Diseases reviewed recommendations for the inactivated poliovirus vaccine in a policy statement published recently in Pediatrics.

The statement was offered because polio still exists in parts of the developing world, and committee members said it is necessary to promote immunization to prevent outbreaks and ensure high immunity levels among US children.

The standard schedule for the IPV should be four doses administered at 2, 4, 6 to 18 months and 4 to 6 years, according to the researchers.

If the likelihood of imminent exposure to poliovirus increases — such as in the case of travel to a country where polio is endemic or there is an outbreak — the minimum age and intervals for the first three doses of the vaccine should be followed. The researchers said maternal antibodies can interfere with seroconversion in infants aged younger than 6 months.

They said the standard schedule should be adhered to unless the risk for imminent exposure increases. Most infants who receive vaccination at the minimum age with minimal intervals are protected, according to the statement. “The benefits of using the abbreviated schedule far outweigh any risks of failure to induce a protective immune response,” the committee wrote.

The minimum interval between doses three and four should be 6 months. A 4-week minimum interval should be observed from doses one to two and from doses three to four. The first dose should be given at a minimum age of 6 weeks.

The final dose of the vaccine should be administered when the child is aged 4 to 6 years, regardless of how many doses had been previously administered. The final dose should be given at least 6 months after the previous dose, according to the statement.

In instances when the diphtheria and tetanus toxoids and acellular pertussis-IPV/Haemophilus influenzae type b vaccine is used for the first four doses, a fifth dose of a preparation containing IPV (IPV alone or DTaP-IPV) should be administered on or after the child’s 4th birthday. A minimum of 6 months is the ideal interval between the fourth and fifth doses in these cases.

Immunocompromised or immunodeficient children should be immunized on the same schedule as children with normally functioning immune systems. The inactivated vaccine is safe in such populations. However, the vaccine may have lower efficacy in immunocompromised children.

Adults who may be at an increased risk for exposure to wild-type poliovirus and who previously completed the oral poliovirus vaccine schedule may receive a single dose of IPV.

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