Patient Education
What is the polio vaccine given for?
Polio vaccine is given to protect against poliomyelitis, the dreaded childhood disease leading to paralysis of various groups of muscles. Polio is caused by 3 types of poliovirus- type I, II & III.
What are the types of polio vaccine?
There are two types of the polio vaccine, one is live oral polio vaccine (OPV) & the other is injectable killed polio vaccine (IPV). Both these vaccines contain all the 3 types of polioviruses.
Which of the 2 types of polio vaccine is used?
India & many other countries use OPV. IPV is now available in India. IPV was the first polio vaccine to be marketed in the world. Western countries like the USA used IPV for mass vaccination and were immediately rewarded with a significant drop in polio cases. Subsequently, OPV was introduced in the market. Because of the convenient oral route and cost-effectiveness, the whole world started using predominantly OPV. Extensive coverage with OPV in the Western Hemisphere almost eradicated poliomyelitis. Now that there are no cases of clinical polio for 10 years or more, the USA has totally switched over to only IPV and does not use OPV anymore. Similarly in India, with near eradication of polio on the cards, there is a gradual shift from OPV to IPV. Thus, currently, children in India receive both IPV and OPV currently.
After polio is eradicated from a country, it may be prudent to switch over to IPV completely.
How are polio vaccines available?
OPV is available as a vial containing multi doses. The dose is 2 drops per dose. IPV is available as a single dose vial containing 0.5 ml of vaccine.
When are OPV and IPV given?
OPV is given as 2 drops per orally. It is recommended as one dose soon after birth. Later, three doses are given at 6, 10 and 14 weeks of age. A booster is usually given at 15-18 months.IPV is given as an injection intramuscularly. It is administered at 6 – 10 – 14 weeks. Two booster shots are given at 15-18 months and another booster at 4-5 years. IPV is often administered as a combination vaccine with DPT, Hib and Hepatitis B.
What are the side effects of polio vaccines?
OPV has minimum side effects. It can lead to GI upset like diarrhea, vomiting. It does not lead to fever. Most of the side effects seen with OPV +DPT are due to the DPT vaccine. The most important but extremely rare side effect with OPV is vaccine-associated paralysis (VAP). It occurs in 1 in a million doses. The massive benefits of OPV far outweigh the rare risk of paralysis. In the west, though, it can become a medico-legal problem. Hence in the west, people use first IPV to induce systemic antibodies & then use OPV, which will lead to local gut immunity without the risk of vaccine-induced paralysis due to the partial immunity conferred by prior IPV.
IPV can lead to local side effects like pain, swelling, redness, and tiredness in 10-20% of vaccinees. It can lead to fever, which is mild & lasts for 24-48 hours.
What are the contraindications of the polio vaccine?
OPV is contraindicated in patients with low immunity especially if IPV is available. OPV can be given to a patient with diarrhea, but that dose should not be counted & should be followed by an extra dose. IPV is contraindicated if a patient has developed severe adverse effects on its use in the past.
What if a child comes late for the polio vaccine?
Paralytic poliomyelitis can occur until 15 years of age. Most of the children are immune by 5 years naturally due to subclinical infections. Hence, OPV is given to any child who presents till 5 years of age. Such a child should receive 3 primary doses followed by 1st booster 1 year after 3rd primary dose & a second booster 3 years -4 years after the 1st booster dose provided the child is still less than 5 years old then.
Can polio vaccine be given along with other vaccines?
Both OPV/IPV can be given along with other vaccines.
What is pulse polio immunization?
It is a strategy of mass immunization by which one can eradicate poliomyelitis. Extra doses (pulses) of OPV are given to all children below 5 years of age in an area (like country, state, city) at a time on a given day. Such pulses are repeated every year. The aim is to achieve 100% coverage.
How does pulse immunization work?
Wild poliovirus can survive either in the intestines of a susceptible host (usually children <5 years of age) or in the sewage water. In the sewage water, it can survive only for 48 - 72 hrs & hence it has to find shelter into another susceptible host for it to survive & to continue the cycle of transmission. When you give pulse OPV to all the children of <5 years of age, the intestines of these children are flooded by the vaccine viruses, and hence wild poliovirus cannot get entry into it. As wild poliovirus cannot survive for more than 48-72 hrs in the environment, its circulation will drastically fall. When such pulse is repeated after 6 weeks it still further reduces transmission. Such pulses done every year will ultimately eradicate the wild poliovirus from nature.
1. World Health Organization (WHO). Poliomyelitis. Available at URL: http://www.who.int/mediacentre/factsheets/fs114/en/index.html. Accessed on 15th May 2011
2. Dowdle WR, De Gourville E et al. Polio eradication: the OPV paradox. Rev Med Virol 2003;13(5):277-91.
3. Parent du Chatelet I, Merchant AT, Fisher-Hoch S. Serological response and poliovirus excretion following different combined oral and inactivated poliovirus vaccines immunization schedules. Vaccine 2003;21(15):1710-8.
4. Yeh SH, Ward JI, Partridge S et al. Safety and immunogenicity of a pentavalent diphtheria, tetanus, pertussis, hepatitis B and polio combination vaccine in infants. Pediatr Infect Dis J 2001;20(10):973-80.
5. Update on Immunization Policies, Guidelines and Recommendation. Indian Pediatrics2004; 41: 239-244.
6. Mittal SK, Mathew JL. Vaccine associated paralytic poliomyelitis. Indian J Pediatr 2003; 70: 573-577.
7. Thakker N, Shendurniker N. Controversies in Polio Immunization. Indian J Pediatr 2003; 70: 567-571.
8. Core information for the development of Immunization Policy. WHO- Vaccines and Biologicals. 2002 Update.
9. IAP guidebook on Immunization. Available at URL: http://www.iapcoi.com/pdf/IAP%20GUIDE%20BOOK%20ON%20IMMUNIZATION%20INDIVIDUAL%20VACCINES.pdf
10. Iapindia.org [Internet] IAP Vaccine Information. ACVIP: 2020-2021 Available from: https://iapindia.org/vaccine-information/
11. Acvip.org (Internet) Poliovirus Vaccine Advisory Committee on Vaccines & Immunization Practices. Available from: https://acvip.org/