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Poliovirus vaccination

Author
John F Modlin, MD
Section Editors
Martin S Hirsch, MD
Morven S Edwards, MD
Deputy Editor
Elinor L Baron, MD, DTMH

INTRODUCTION

Immunization against poliovirus infection represents one of the world's great medical achievements. The last cases of naturally occurring wild type paralytic poliomyelitis in the United States occurred during a small outbreak due to type 1 poliovirus in an unvaccinated religious community in 1978 to 1979 [1]. All nations in the Western Hemisphere, Europe, Southeast Asia, and the Pacific Region are now free of poliomyelitis. As of February 2017, wild type 1 poliovirus remains endemic in Nigeria, Pakistan, and Afghanistan.

Issues related to paralytic poliomyelitis, the post-polio syndrome, and global eradication of poliomyelitis are discussed separately. (See "Polio and infectious diseases of the anterior horn" and "Post-polio syndrome" and "Global poliomyelitis eradication".)

POLIOVIRUS VACCINES

Both inactivated poliovirus vaccine (IPV) and live attenuated oral poliovirus vaccine (OPV) were developed in the 1950s and have since been used worldwide [2-4]:

IPV is the only vaccine available for routine infant and childhood immunization in the United States and is the preferred vaccine in most middle- and upper-income countries because it does not cause vaccine-associated paralytic poliomyelitis (VAPP).

A combination of type 1 and 3 bivalent OPV (bOPV) vaccine and IPV is now recommended by the World Health Organization (WHO) Expanded Program on Immunization (EPI) for routine infant immunization in low-income countries; both OPV and IPV continue to be administered through supplementary immunization activities in countries at increased risk of poliovirus transmission. Advantages of OPV include low cost, ease of administration, induction of mucosal immunity, and transmission of vaccine virus to unimmunized contacts; the major disadvantage is that OPV can cause VAPP in rare cases (see 'Adverse effects' below). In this context, IPV provides protection against disease caused by type 2 polioviruses and a boost in immunity to types 1 and 3.

                

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Literature review current through: Aug 2017. | This topic last updated: Mar 22, 2017.
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