Polio Vaccine Recommendations

Introduction

Polio vaccination has been part of the routine childhood immunization schedule in the United States for decades. Adults who received any childhood vaccines in the United States almost certainly were vaccinated for polio.

Inactivated polio vaccine (IPV) is the only polio vaccine that has been given in the United States since 2000. It is given by shot in the arm or leg, depending on the person's age.

This page summarizes CDC's current polio vaccine recommendations. Access the official, full text below:

Routine recommendations for children

CDC recommends that children in the United States receive IPV to protect against polio, or poliomyelitis, as part of their routine immunizations. IPV is given by injection in the leg or arm, depending on the person's age. It can be given at the same time as other vaccines.

Children get 4 doses of IPV, with one dose at each of these ages:

• 2 months
• 4 months
• 6 through 18 months
• 4 through 6 years

A single-antigen vaccine called IPOL is licensed in the United States for active immunization of infants (as young as 6 weeks of age), children, and adults for the prevention of poliomyelitis caused by all three poliovirus types. Several combination vaccines licensed in the United States also contain IPV, including Pentacel (DTaP-IPV/Hib), Pediarix (DTaP-IPV-HepB), Kinrix (DTaP-IPV), VAXELIS (DTaP-IPV-Hib-HepB), or Quadracel (DTaP-IPV). Children getting these vaccines might get one more (fifth) dose of IPV. It is safe for children to get a fifth dose of IPV.

Children who have not started their polio vaccination series or who are delayed in getting all recommended doses should start right away; or finish their series by following the recommended catch-up schedule.

Accelerated schedule for children traveling outside the U.S.

Children who will be traveling to a country where the risk of getting polio is greater should complete the series before leaving for their trip. If a child cannot complete the routine series before leaving, an accelerated schedule is recommended as follows:

• One dose at age 6 weeks or older
• A second dose 4 or more weeks after the first dose
• A third dose 4 or more weeks after the second dose
• A fourth dose 6 or more months after the third dose

If the accelerated IPV schedule cannot be completed before leaving, the remaining doses should be given in the visited country, or upon returning home, at the intervals recommended. In addition, children completing the accelerated schedule should still receive a dose of IPV at 4 years old or older, as long as it has been at least 6 months after the last dose.

Recommendations for adults

Most adults residing in the United States are presumed to be protected against polio because they received routine childhood immunization and have only a small risk of exposure to poliovirus in the United States. In general, unless there are specific reasons to believe they were not vaccinated, most adults who were born and raised in the United States can assume they were vaccinated for polio as children.

Polio vaccination has been part of the routine childhood immunization schedule for decades and is still part of the routine childhood immunization schedule. Adults who received any childhood vaccines almost certainly were vaccinated for polio.

Adults that should receive polio vaccination

Adults who are known or suspected to be unvaccinated or incompletely vaccinated against polio should receive and complete the polio vaccination series with IPV. Adults who completed their polio vaccination but who are at increased risk of exposure to poliovirus may receive one lifetime IPV booster.

Situations that put adults at increased risk of exposure to poliovirus include:

• Travelers who are going to countries where polio is epidemic or endemic.
• Laboratory and healthcare workers who handle specimens that might contain polioviruses.
• Healthcare workers or other caregivers who have close contact with a person who could be infected with poliovirus.
• Adults who are identified by public health authorities as being part of a group or population at increased risk of exposure because of an outbreak.

Fully vaccinated adults

Adults who have had 3 or more doses of polio vaccine in the past and are at increased risk of exposure to poliovirus may receive one lifetime booster dose of IPV.

Unvaccinated adults

Unvaccinated adults should be given three doses of IPV at these recommended intervals:

• The first dose at any time
• The second dose 1 or 2 months later
• A third dose 6 to 12 months after the second dose

Incompletely vaccinated adults

Adults who are incompletely vaccinated (previously received 1 or 2 doses of either IPV or tOPV) should receive the remaining doses of IPV to complete the three-dose series at the recommended intervals:

If the adult has received dose 1 and

• It's been ≥4 weeks since dose 1, then give dose 2 today. Dose 3 (final) should be given at least 6 months after dose 2.
• It's been <4 weeks since Dose 1, then wait to give dose 2 at least 4 weeks after dose 1.

If the adult has received dose 2 and

• It's been ≥6 months since dose 2—then give final dose 3 today. This will complete the person's primary polio vaccination series.
• It's been <6 months since dose 2—then wait to give final dose 3 at least 6 months after dose 2.

Accelerated vaccination schedule

In some circumstances, when there is not enough time to give three doses of IPV according to the above recommended intervals, then an accelerated schedule can be used:

• If protection is needed in ≥8 weeks—3 doses of IPV can be administered at least 4 weeks apart (e.g., at weeks 0, 4, and 8).
• If protection is needed in ≥4 but <8 weeks—2 doses of IPV should be administered at least 4 weeks apart (e.g., at weeks 0 and 4).
• If protection is needed in fewer than 4 weeks—a single dose of IPV should be administered.

If the accelerated schedule cannot be completed before a situation that puts someone at increased risk of exposure to poliovirus, the remaining doses should be given as soon as possible. This can occur in the visited country or upon returning home. The patient should complete the primary series at the recommended intervals; the third dose should be given at least 6–12 months after the second dose if that is possible.

There are no known risks to getting IPV at the same time as other vaccines.

Children & adults vaccinated outside the U.S.

CDC recommends that children and adults who may have received poliovirus vaccination outside the U.S. should meet the U.S. recommendation for poliovirus vaccination that includes protection against all three poliovirus types.

Notes about OPV doses

In April 2016, all countries that were still using OPV stopped using trivalent OPV (tOPV) and switched to using bivalent OPV (bOPV) in routine immunization. If a person only received bOPV, they are not vaccinated against type 2 poliovirus, and they need to complete an IPV 3-dose or 4-dose series depending on their age to be fully protected. OPV doses administered after April 1, 2016 should not be counted as tOPV doses unless written documentation specifies that the dose was tOPV.

Notes about fractional IPV doses

For people who received fractional (1/5 full dose) IPV administered intradermally outside of the U.S., 2 fractional doses of IPV (fIPV) should be considered valid and counted as 1 full intramuscular dose of IPV towards the U.S. vaccination schedule. If a person received only 1 dose of fIPV, this dose should not be considered valid or counted towards the U.S. vaccination schedule. The following countries include 2 fractional doses of IPV as part of their routine immunization schedule:

• Bangladesh
• Cuba
• Ecuador
• India
• Nepal
• Sri Lanka

IPV doses administered in these countries and recorded as "IPV" should be assumed to be fractional IPV doses, not full IPV doses.

Children & adolescents

If documentation is available and shows administration of age-appropriate vaccination with either IPV or trivalent OPV (tOPV), then the person is considered fully vaccinated. Children with no or questionable documentation of poliovirus vaccination should be revaccinated according to the U.S. schedule with the age appropriate IPV.

Adults

For people age 18 years and older, verbal reports of previous polio vaccination administered outside the U.S. can be accepted unless the clinician has specific reasons to believe the patient was not vaccinated such as they did not receive consistent medical care as an infant, parents were against vaccination, or the person has other reason to doubt their vaccination status.

Contraindications and precautions

Contraindications and precautions to vaccination generally dictate circumstances when vaccines will not be given.

Resources

• Polio Vaccine Safety
• Polio Vaccine Information Statement
• Travelers Health: Yellow Book
  
• Vaccines Web-based Training Course
• Immunization schedules (Child and adolescent | Adult)
• Vaccines For Children Program Information for Providers

Clinical information

• Polio | Vaccine Preventable Diseases Surveillance Manual
• Pink Book: Poliomyelitis
• Clinical Overview of Poliomyelitis