Is there an age cutoff for Inactivated Poliovirus Vaccine (IPV)?

Age Cutoff for Inactivated Poliovirus Vaccine (IPV)

There is no specific age cutoff for IPV vaccination in adults, but routine vaccination is not recommended for adults aged ≥18 years unless they are at increased risk for exposure to polioviruses. 1

General Recommendations for IPV

Children

• All children should receive four doses of IPV at ages 2,4,6-18 months, and 4-6 years 1
• The final dose should be administered at age ≥4 years regardless of the number of previous doses 1
• Minimum intervals between doses:
  • Dose 1 to dose 2: 4 weeks
  • Dose 2 to dose 3: 4 weeks
  • Dose 3 to dose 4: 6 months 1

Adults

• Routine poliovirus vaccination is not necessary for most adults residing in the United States 1
• Most adults have minimal risk for exposure to polioviruses in the US and most are already immune from childhood vaccination 1
• However, recent ACIP recommendations (2023) state that all US adults who are known or suspected to be unvaccinated or incompletely vaccinated against polio should complete a primary vaccination series with IPV 2

Adults Who Should Receive IPV

IPV vaccination is specifically recommended for certain adults at increased risk for exposure to polioviruses:

• Travelers to areas or countries where polio is epidemic or endemic 1
• Members of communities or specific population groups with disease caused by wild polioviruses 1
• Laboratory workers who handle specimens that might contain polioviruses 1
• Healthcare workers who have close contact with patients who might be excreting wild polioviruses 1
• Unvaccinated adults whose children will be receiving oral poliovirus vaccine (though OPV is no longer available in the US) 1

IPV Vaccination Schedule for Unvaccinated Adults

For unvaccinated adults who need protection:

• Primary series consists of three doses of IPV 1
• First two doses should be administered at intervals of 4-8 weeks 1
• Third dose should be administered 6-12 months after the second dose 1

If accelerated protection is needed:

• If more than 8 weeks are available: three doses of IPV at least 4 weeks apart 1
• If fewer than 8 weeks but more than 4 weeks are available: two doses of IPV at least 4 weeks apart 1
• If fewer than 4 weeks are available: a single dose of IPV 1

Safety Considerations

• IPV is well tolerated with no serious adverse events associated with its use 1
• IPV is contraindicated in persons with a history of hypersensitivity to any component of the vaccine, including 2-phenoxyethanol, formaldehyde, neomycin, streptomycin, and polymyxin B 1

Clinical Pearls and Pitfalls

• There is no need to restart a vaccine series regardless of the time that has elapsed between doses 1
• Adults without documentation of vaccination status should be considered unvaccinated 1
• The risk of vaccine-associated paralytic poliomyelitis (VAPP) has been eliminated in the US with the transition from OPV to IPV 1
• Despite the elimination of indigenous wild poliovirus in the Western Hemisphere, the risk of importation remains, as demonstrated by a case of paralytic polio caused by vaccine-derived poliovirus type 2 identified in an unvaccinated young adult in New York in 2022 2

Conclusion

While there is no specific upper age cutoff for IPV administration, the need for vaccination should be based on risk factors rather than age alone. Most adults in the US are already immune from childhood vaccination, but those at increased risk should receive appropriate IPV vaccination regardless of age.