What are the contraindications for Oral Poliovirus Vaccine (OPV) during a pulse polio campaign?

OPV Contraindications During Pulse Polio Campaign

OPV should NOT be administered to immunodeficient individuals, their household contacts, persons with previous anaphylactic reactions to OPV or its antibiotic components (neomycin/streptomycin), and should generally be avoided in pregnancy unless immediate protection is required. 1

Absolute Contraindications

Immunodeficiency States

The most critical contraindication is any form of immunodeficiency due to substantially increased risk of vaccine-associated paralytic poliomyelitis (VAPP). 1, 2

• Primary immunodeficiency disorders: severe combined immunodeficiency syndrome, agammaglobulinemia, hypogammaglobulinemia 1
• Malignant diseases: leukemia, lymphoma, generalized malignancy 1
• Immunosuppressive therapy: corticosteroids, alkylating drugs, antimetabolites, radiation therapy 1
• HIV infection: persons with HIV should not receive OPV due to theoretical risk of paralytic disease 1
• Household contacts of immunodeficient persons: IPV should be used instead to prevent transmission of vaccine virus 1

Hypersensitivity Reactions

• Previous anaphylactic reaction to OPV 1
• Hypersensitivity to neomycin or streptomycin (trace amounts present in OPV) 1

Precautions (Relative Contraindications)

Pregnancy

• Vaccination of pregnant women should be avoided on theoretical grounds 1
• Exception: If immediate protection against polio is required during outbreak control, OPV can be administered as no adverse effects have been documented in pregnant women or fetuses 1

NOT Contraindications (Common Pitfalls to Avoid)

Healthcare providers frequently delay vaccination unnecessarily for conditions that are NOT contraindications: 1

• Breastfeeding - does not interfere with immunization 1
• Mild diarrhea - OPV can be administered 1
• Minor upper respiratory illness with or without fever 1
• Mild to moderate local reactions to previous vaccine dose 1
• Current antimicrobial therapy 1
• Convalescent phase of acute illness 1

Critical Safety Considerations for Pulse Campaigns

Inadvertent Administration to Household Contacts

If OPV is accidentally given to a household contact of an immunodeficient person: 1

• The OPV recipient should avoid close contact with the immunodeficient person for 4-6 weeks after vaccination (period of maximum vaccine virus excretion) 1, 2
• If contact cannot be avoided: rigorous hand washing after fecal contact (diaper changing), avoid sharing food/utensils, avoid saliva contact 1

Risk Communication

Parents/caregivers must be informed about VAPP risk (rare paralysis in healthy recipients and contacts), though the risk is minimal in immunocompetent individuals 1

Special Populations During Campaigns

• Children with leukemia in remission: Should receive IPV instead; they can respond to IPV boosters but remain at risk for VAPP with OPV 3
• HIV-infected children: Should not receive OPV due to decreased immune response and theoretical VAPP risk, though prolonged viral shedding has not been consistently demonstrated 4

Practical Algorithm for Pulse Campaign Screening

Before administering OPV, screen for:

1. Any known immunodeficiency or HIV infection → Use IPV instead 1
2. Household contact of immunodeficient person → Use IPV instead 1
3. Cancer or immunosuppressive therapy → Use IPV instead 1
4. Previous anaphylaxis to OPV/neomycin/streptomycin → Contraindicated 1
5. Pregnancy → Avoid unless outbreak requires immediate protection 1
6. Mild illness, diarrhea, breastfeeding → Proceed with OPV 1

The key pitfall is unnecessarily withholding OPV for minor illnesses or breastfeeding, which reduces campaign coverage without safety benefit. 1