Polio Vaccination

The polio virus leads to poliomyelitis - an illness which can result in severe permanent neurological disability (paralysis) and death, and affects both adults and children. The poliovirus infects the gut and then travels to the nervous system causing meningitis like illness.

Polio is now rare in UK as a result of a successful immunisation programme.

• Vaccination of under 40's began in 1958 - originally it was with an injectable form of polio and 4 years later an oral form was developed. However, in the last few years this has changed to an injectable form.
• In 2004 the UK switched from live attenuated oral polio vaccine (OPV) to inactivated polio vaccine (IPV) injections. IPV contains inactivated strains of three types of human polioviruses (1, 2 and 3). OPV (Sabin) and IPV (Salk) both give good individual immunity - but OPV can rarely revert back to a virulent strain causing vaccine associated paralytic polio (VAPP).
• OPV however gives better community immunity as the live virus can be passed to unvaccinated contacts of recently vaccinated children; and promotes antibody production in the gut which reduces asymptomatic excretion of any wild polio viruses which may be around - hence a supply of oral vaccine is still available centrally for immunisation of contacts of Polio cases.

Current UK Coverage (2003) - 91% at age 1 year and 94% at 2 years.

2 to 8°C, protect from light, discard if frozen.

Young children

Part of diphtheria/tetanus/pertussis/polio/haemophilus influenza b vaccine.

Adults and teenagers

A combination of tetanus/diphtheria/polio is used.
Need five doses of the polio vaccine, given intramuscularly, to achieve lifelong immunity. These are given as the combined injection (DTaP/IPV/Hib)as part of the immunisation schedule:

• Two months
• Three months
• Four months
• Pre-school booster - three years after primary course. Usually at 4 years of age as DTaP/IPV combined vaccine.
• School leaver booster - between ages of 13 and 18. Given as Td/IPV, 10 years after pre school booster.

If an adult presents who was not immunised as a child then they should receive three doses a month apart, followed by another dose five years later and the last booster dose ten years later. If an adult misses one of the doses then the course should be resumed and not restarted. Preparations containing IPV with low dose diphtheria toxin (Td/IPV) should be used.

After five doses further doses are not usually required unless travelling.

Polio is nearly almost eradicated, but there are some high risk areas.² These areas include: India, Pakistan, Nigeria, Niger, and Afghanistan.³

Travellers should receive an extra booster (as Td/IPV) if their last dose was >10 years ago if they are to visit an endemic area.

IPV vaccine can be given to immunosuppressed children e.g. those with HIV (whatever the CD4 count), and premature babies.

It can also be given to pregnant and breast feeding women if clinically indicated.

• Confirmed anaphylactic reaction to previous IPV vaccine (occur 3/million)
• Confirmed anaphylactic reaction to neomycin, streptomycin or polymyxin B

Stable neurological conditions, febrile convulsions, personal or family history of seizures are not contraindications, although immunisation should be deferred if the child is unwell with fever (vaccinate as soon as possible once child has recovered).

Fever, hypotonic-hyporesponsive episodes (HHE), persistent crying or severe local reaction within 72 hours of previous vaccination are not reasons for not giving subsequent IPV vaccinations.

• Pain, redness and swelling are common.
• Transient nodule at injection site.
• Anaphylaxis is rare (0.65-3 per million).