Which adults need a polio (poliomyelitis) vaccine?

Polio Vaccination Recommendations for Adults

Most adults in the United States do not need routine polio vaccination, but specific high-risk groups should receive inactivated poliovirus vaccine (IPV). 1

Who Needs Polio Vaccination

Adults who should receive polio vaccination include:

• Travelers to areas where polio is epidemic or endemic 1
• Members of communities with active wild poliovirus circulation 1
• Laboratory workers who handle specimens that might contain polioviruses 1
• Healthcare workers who have close contact with patients potentially excreting wild polioviruses 1
• Unvaccinated adults whose children will be receiving oral poliovirus vaccine (OPV) 1
• Adults who are known or suspected to be unvaccinated or incompletely vaccinated against polio 2

Vaccination Schedule for Unvaccinated Adults

For unvaccinated adults at increased risk, the recommended IPV schedule is:

• Primary series of three doses of IPV:

  • Two doses given 4-8 weeks apart 1
  • Third dose given 6-12 months after the second dose 1

• For accelerated protection when time is limited:

  • If >8 weeks available: Three doses of IPV at least 4 weeks apart 1
  • If 4-8 weeks available: Two doses of IPV at least 4 weeks apart 1
  • If <4 weeks available: A single dose of IPV 1

• Complete the series later at recommended intervals if the person remains at increased risk 1

Previously Vaccinated Adults

• Adults who have completed a primary series of OPV or IPV and are at increased risk can receive a single lifetime booster dose of IPV 1
• No need for more than one lifetime booster dose 1

Precautions and Contraindications

• IPV should not be administered to persons with history of anaphylactic reaction to:

  • Previous dose of IPV 1
  • Streptomycin, polymyxin B, or neomycin (trace amounts in vaccine) 1

• Pregnancy:

  • Vaccination should be avoided during pregnancy on theoretical grounds 1
  • If a pregnant woman is at increased risk and requires immediate protection, IPV can be administered 1

• Immunodeficiency:

  • IPV is the only vaccine recommended for immunodeficient persons and their household contacts 1
  • IPV is safe for immunodeficient persons, though protective immune response cannot be ensured 1

Clinical Considerations

• Adults without documentation of vaccination status should be considered unvaccinated 1
• IPV can be administered simultaneously with other vaccines 1
• IPV is preferred over OPV for adults due to the slightly higher risk of vaccine-associated paralysis with OPV in adults 1
• Minor illnesses with or without fever, mild to moderate local reactions to a previous dose, current antimicrobial therapy, and the convalescent phase of an acute illness are not contraindications for vaccination 1

Recent Developments

• In 2022, a case of paralytic polio caused by vaccine-derived poliovirus was identified in an unvaccinated young adult in New York, highlighting the ongoing risk of poliovirus importation 2
• In June 2023, ACIP updated recommendations to include that all U.S. adults who are known or suspected to be unvaccinated or incompletely vaccinated against polio should complete a primary vaccination series with IPV 2

Importance of Polio Vaccination

• IPV is safe and effective in preventing paralytic poliomyelitis 3, 4
• Although wild poliovirus has been eliminated from the Western Hemisphere, the risk of importation remains from countries where poliovirus still circulates 5, 6
• IPV reduces replication of poliovirus and can provide community protection when coverage is high 3, 4