What are the recommendations for Inactivated Poliovirus Vaccine (IPV) administration in adults?

IPV Vaccination for Adults

Routine poliovirus vaccination is not necessary for most adults residing in the United States, but specific high-risk groups require IPV vaccination, and as of 2023, all unvaccinated or incompletely vaccinated U.S. adults should complete a primary IPV series. 1, 2

Who Needs IPV Vaccination

High-Risk Adults Requiring Vaccination

The following adults are at increased risk and should receive IPV:

• Travelers to polio-endemic or epidemic areas 1, 3
• Laboratory workers handling specimens potentially containing polioviruses 1, 3
• Healthcare workers with close contact to patients who may be excreting wild polioviruses 1, 3
• Members of communities with active wild poliovirus circulation 1, 3
• Unvaccinated adults whose children will receive oral poliovirus vaccine (OPV) 1, 3

Updated 2023 Recommendation

All U.S. adults aged ≥18 years who are known or suspected to be unvaccinated or incompletely vaccinated should complete a primary polio vaccination series with IPV. 2 This expanded recommendation followed the 2022 detection of vaccine-derived poliovirus type 2 causing paralytic polio in an unvaccinated New York adult and subsequent community transmission. 2

Primary Vaccination Series for Unvaccinated Adults

Standard Schedule

The recommended primary series consists of three 0.5 mL doses of IPV:

• First two doses: 4-8 weeks apart (minimum 4 weeks) 1, 3, 4
• Third dose: 6-12 months after the second dose 1, 3, 4

Adults without documentation of vaccination status should be considered unvaccinated. 1, 3

Accelerated Schedules When Time is Limited

When standard intervals cannot be met before protection is needed:

• If >8 weeks available: Three doses at least 4 weeks apart 1, 3
• If 4-8 weeks available: Two doses at least 4 weeks apart 1, 3
• If <4 weeks available: Single dose of IPV 1, 3

The remaining doses should be administered later at recommended intervals if the person remains at increased risk. 1

FDA-Labeled Alternative for Adults

The FDA label provides a slightly different accelerated option: if less than 3 months but more than 2 months are available, give three doses at least 1 month apart; if only 1-2 months available, give two doses at least 1 month apart. 4 However, the CDC guideline recommendations above should take precedence as they are more recent and specific.

Previously Vaccinated Adults

Incompletely Vaccinated Adults

Adults at increased risk who received fewer than three doses of any polio vaccine (OPV, conventional IPV, or combination) should receive at least one 0.5 mL dose of IPV. 4 Additional doses should be given to complete the primary series if time permits. 4

Completely Vaccinated Adults

Adults who completed a primary series and are at increased risk can receive a single lifetime booster dose of IPV. 1, 3 Available data indicate no need for more than one lifetime booster. 1, 3

Why IPV is Preferred Over OPV for Adults

IPV is strongly preferred over OPV for adult vaccination due to safety concerns:

• OPV carries a higher risk of vaccine-associated paralytic poliomyelitis (VAPP) in adults compared to children (approximately 1 case per 1.4 million first doses for immunologically normal vaccinees) 1
• IPV has no serious documented adverse effects and cannot cause VAPP 1
• OPV can shed virus and potentially expose immunocompromised contacts to live vaccine virus 1

Note: OPV is no longer routinely used in the United States as of 2000. 1

Administration Details

Route and Site

• Intramuscular or subcutaneous administration 4
• Preferred site for adults: Deltoid area 4
• Do NOT administer intravenously 4

Concurrent Vaccination

IPV can be administered simultaneously with other vaccines using separate syringes at separate sites. 1

Safety Profile and Contraindications

Contraindications

IPV should NOT be given to persons with:

• History of anaphylactic reaction to previous IPV dose 1, 3, 4
• Anaphylactic reaction to streptomycin, polymyxin B, or neomycin (trace amounts present in IPV) 1, 3

Signs of anaphylaxis include hives, swelling of mouth/throat, difficulty breathing, hypotension, or shock. 1

Non-Contraindications

The following are NOT contraindications:

• Minor illnesses with or without fever 3
• Mild to moderate local reactions to previous dose 3
• Current antimicrobial therapy 3
• Convalescent phase of acute illness 3
• Non-anaphylactic reactions to antibiotics 1

Pregnancy

Vaccination during pregnancy should be avoided on theoretical grounds, though no adverse effects have been documented. 1, 3 However, if a pregnant woman is at increased risk and requires immediate protection, IPV can be administered. 3

Immunocompromised Persons

IPV is safe for immunodeficient persons and is the only polio vaccine recommended for this population and their household contacts. 3 However, protective immune response cannot be ensured in immunocompromised individuals. 3

Key Clinical Pitfalls to Avoid

• Do not assume immunity without documentation: Most U.S. adults are immune from childhood vaccination, but those without documentation should be considered unvaccinated 1, 3
• Do not delay vaccination for minor illnesses: These are not contraindications 3
• Do not give OPV to immunocompromised persons or their contacts: Always use IPV 1
• Do not restart the series: If the schedule is interrupted, continue where left off regardless of time elapsed 1
• Do not give multiple lifetime boosters: Only one booster is needed for previously vaccinated adults at increased risk 1, 3