What are the side effects of polio (poliomyelitis) vaccines?

Side Effects of Polio Vaccines

Polio vaccines have distinct safety profiles with IPV (inactivated poliovirus vaccine) having no serious side effects, while OPV (oral poliovirus vaccine) carries a rare but serious risk of vaccine-associated paralytic poliomyelitis (VAPP). 1

Inactivated Poliovirus Vaccine (IPV) Side Effects

IPV is the currently recommended polio vaccine in the United States and has an excellent safety profile:

• No serious side effects documented 1, 2
• Minor side effects may include:
  • Local reactions at injection site (redness, swelling) 3
  • Hypersensitivity reactions in persons allergic to vaccine components 1

Potential allergens in IPV:

• Contains trace amounts of streptomycin, neomycin, and polymyxin B 1
• Persons with history of anaphylactic reactions to these antibiotics should not receive IPV 1
• Non-anaphylactic reactions to these antibiotics are not contraindications 1

Oral Poliovirus Vaccine (OPV) Side Effects

OPV is no longer routinely used in the United States but remains important in global polio eradication efforts:

Major side effect:

• Vaccine-Associated Paralytic Poliomyelitis (VAPP) - rare but serious 1, 4
  • Risk for immunologically normal recipients: approximately 1 case per 1.4 million first doses and 1 case per 41.5 million subsequent doses 1
  • Risk for susceptible household contacts: approximately 1 case per 1.9 million first doses and 1 case per 13.8 million subsequent doses 1
  • Risk increases with age (about tenfold higher in adults compared to children) 5
  • Can rarely be fatal 1

Other considerations with OPV:

• Vaccine virus can be shed for up to 4-6 weeks after vaccination 1, 2
• No evidence of increased risk for Guillain-Barré Syndrome (GBS) 1, 2
• Contains trace amounts of streptomycin, bacitracin, and neomycin 1

Special Populations and Contraindications

Immunocompromised individuals:

• OPV is contraindicated in persons with:

  • Immune deficiency diseases
  • HIV infection
  • Leukemia, lymphoma, or generalized malignancy
  • Those receiving immunosuppressive therapy 1

• IPV is the only polio vaccine recommended for:

  • Immunodeficient persons
  • Household contacts of immunodeficient individuals 1, 2

Pregnancy:

• Theoretically, vaccination of pregnant women should be avoided with IPV 1
• If immediate protection is needed during pregnancy, IPV can be administered 1

Surveillance Data

Surveillance through the Vaccine Adverse Event Reporting System (VAERS) has shown:

• Similar reporting rates for IPV compared to OPV across severity categories 4
• No concerning adverse event patterns following the switch from OPV to IPV in the United States 4
• Elimination of VAPP cases with the transition to an all-IPV schedule 4, 6

Clinical Implications

1. For routine vaccination in the United States:

   • IPV is the only recommended vaccine, eliminating the risk of VAPP 1
   • No special precautions needed for contacts of IPV recipients 2

2. For travelers to polio-endemic areas:

   • IPV is recommended for previously unvaccinated adults 1
   • A single booster dose may be sufficient for those previously vaccinated 1

3. For healthcare workers:

   • Those in contact with patients who may excrete polioviruses should complete a primary series of IPV 1

By understanding these side effects and contraindications, clinicians can appropriately counsel patients about the safety profile of polio vaccines and select the appropriate vaccine for specific populations.