Polio Vaccine (IPV) Schedule
Standard Recommended Schedule
All children should receive four doses of IPV at 2 months, 4 months, 6-18 months, and 4-6 years of age. 1, 2
Detailed Dosing Timeline
Primary Series
- First dose: 2 months of age (minimum age 6 weeks) 1, 3, 2
- Second dose: 4 months of age (minimum 4-week interval from first dose) 1, 3, 2
- Third dose: 6-18 months of age (minimum 4-week interval from second dose, though 2-month interval preferred) 1, 3
- Fourth dose (booster): 4-6 years of age (minimum 6-month interval from third dose) 1, 3
Important Scheduling Considerations
The fourth dose is not needed if the third dose is administered on or after the fourth birthday. 1 This is a critical point that prevents unnecessary vaccination in children who received their third dose late.
If accelerated protection is needed due to imminent poliovirus exposure (travel to endemic areas or outbreak situations), the minimum 4-week intervals between all doses can be used, though 2-month intervals between doses 2 and 3 are preferred for optimal immunogenicity. 1, 3 The evidence shows that shorter intervals (1-month) in the first 6 months of life produce lower antibody levels compared to 2-month intervals. 1, 4
Special Populations
Premature Infants
Premature infants should receive IPV at the standard chronological ages (2,4,6-18 months, 4-6 years) regardless of birth weight. 3 Unlike hepatitis B vaccine, there is no weight-based delay for IPV in premature infants. 3
Incompletely Vaccinated Children
Children who received fewer than four doses should complete the series without restarting, regardless of time elapsed between doses. 1 If a child received three doses before age 4 years, they need a fourth dose before or at school entry unless the third dose was given on or after the fourth birthday. 1
Adults
Routine poliovirus vaccination is not recommended for adults residing in the United States. 1, 2 However, unvaccinated or incompletely vaccinated adults at increased risk should receive vaccination, including:
- Travelers to polio-endemic or epidemic regions 1, 2
- Healthcare workers in close contact with patients potentially excreting poliovirus 2
- Laboratory workers handling poliovirus specimens 2
- Members of communities with wild poliovirus disease 2
Immunocompromised Patients
IPV should be used (never OPV) in all immunocompromised patients and their household contacts when vaccination is indicated. 2 This includes patients with HIV/AIDS, severe combined immunodeficiency, hypogammaglobulinemia, malignancy, or those receiving immunosuppressive therapy. 2 Note that immunogenicity may be impaired in these patients. 2
Available Formulations
Four IPV preparations are available in the United States: 1
- Stand-alone IPV (Ipol)
- DTaP-HepB-IPV (Pediarix) - licensed for first 3 doses through 6 years
- DTaP-IPV/Hib (Pentacel) - licensed for 4 doses through 4 years
- DTaP-IPV (Kinrix) - licensed for booster dose at 4-6 years
Common Pitfalls to Avoid
Do not delay vaccination in premature infants based on weight - this applies only to hepatitis B vaccine in specific circumstances, not IPV. 3
Do not restart the series if doses are delayed - simply continue with the next dose in the sequence. 1
Do not use minimum 4-week intervals routinely - reserve this accelerated schedule only for imminent exposure risk, as longer intervals produce better antibody responses. 1, 3, 4
Do not administer the fourth dose if the third dose was given at age 4 years or older - this prevents unnecessary vaccination. 1
Contraindications
IPV is contraindicated only in persons with hypersensitivity to vaccine components (2-phenoxyethanol, formaldehyde, neomycin, streptomycin, polymyxin B). 3
Interchangeability
IPV can be administered simultaneously with other routinely recommended childhood vaccines including DTaP, Hib, hepatitis B, varicella, and MMR. 1 Children who initiated vaccination with OPV should complete the series with IPV, maintaining a minimum 4-week interval if switching from OPV to IPV. 1