Part 1, Chapter 12: Manual Appendix VI
IMPORTANT INFORMATION ABOUT POLIOMYELITIS AND BOTH LIVE-VIRUS AND INACTIVATED-VIRUS VACCINES
POLIOMYELITIS:
The risk of poliomyelitis Is very small in the United States; however, epidemics could occur if the high immunity level of the general population is not maintained by immunizing children routinely or If wild poliovirus is introduced into susceptible populations in communities with low immunization levels. In the United States inapparent Infection with wild poliovirus strains no longer contributes significantly to establishing or maintaining immunity. Most adults are already Immune.
POLIOVIRUS VACCINES:
Two types of poliovirus vaccines are currently licensed in the United States: oral poliovirus vaccine (OPV) and Inactivated poliovirus vaccine (IPV). A primary vaccination series with either vaccine produces immunity to all three types of poliovirus in more than 95 percent of recipients. The primary series of OPV consists of three doses: two doses given 6 to 8 weeks apart and a third dose given at least 6 weeks and customarily 6 to 12 months after the second. The primary series for IPV consists of four doses: three doses each given 4-8 weeks apart and a fourth dose given 6 to 12 months after the third. In general, it 1s not necessary to give a primary vaccine series to adults 1iving in the United States who have not had a primary series as children. However, for adults who have not had a primary series and are at greater- risk than the general population of exposure to wild polioviruses because of foreign travel or health occupation, IPV Is preferred since the risk of OPV-associated paralysis is slightly higher In adults than in children.
The OPV vaccine is not routinely recommended for persons older than high school age (18-19 years old).
VACCINE INDICATIONS:
Travelers to areas where wild poliovirus is epidemic or endemic should have completed a primary series of poliovirus vaccine. For previously immunized persons, IPV Is indicated. However, if less than 4 weeks are available before protection is needed, a single dose of OPV is recommended. Travelers who have previously received less than a full primary course of OPV or IPV should be given the remaining required doses of either vaccine, regardless of the interval since the last dose and the type of vaccine previously received. Travelers to developing countries who have previously completed a primary series of OPV should receive a single dose of OPV. Additional booster doses of OPV are probably not necessary. Those who have previously received a primary series of IPV should receive a dose of either OPV or IPV. If IPV is used exclusively, an additional dose may be given every 5 years if exposure continues or recurs, although the need for these boosters has not been established.
PNEUMOCOCCAL VACCINE:
The pneumococcal vaccine is made from the polysaccharide capsules of 23 different bacteria strains. The vaccine has been shown to be about 80 percent protective against pneumococcal pneumonia and bacteremia. One injection of the vaccine is necessary; it has not yet been determined if and when a booster dose may be needed.
Individuals for whom pneumococcal vaccine is indicated include:
Those with spleen dysfunction or absence.
Those with chronic heart, lung, liver and kidney diseases.
Persons over 65 years of age.
Persons who are alcoholic. Persons with diabetes mellitus. Persons with immune system dysfunction.
VACCINE SIDE EFFECTS AND CONTRAINDICATIONS:
Persons who are hypersensitive to any of the vaccine components should not receive the vaccine. Revaccination is contraindicated. Vaccination should be delayed in individuals who have an acute febrile respiratory. The vaccine should be administered to a pregnant woman only if protection against pneumococcal disease is clearly needed.
Local redness and soreness at the injection site is common and usually lasts less than 48 hours. Rash and painful joints have been reported rarely. Mild fever (less than 100.9 degrees F) occurs occasionally. Health-care personnel in close contact with patients who may be excreting wild polioviruses, and laboratory personnel handling specimens that may contain wild polioviruses, should have completed a primary series of poliovirus vaccine. The IPV is indicated because of the slightly increased risk to adults of vaccine-associated paralysis after OPV administration. Also, virus may be shed after receipt of OPV vaccine and inadvertently expose susceptible immunocompromised contacts to live virus.
VACCINE ADVERSE REACTIONS
Inactivated Poliovirus Vaccine (IPV):
No serious effects of currently available IPV have been documented. Since IPV contains trace amounts of streptomycin and neomycin, hypersensitive reactions are possible in individuals sensitive to these antibiotics. Persons with signs and symptoms of anaphylactic reaction (i.e., hives, swelling of mouth and throat, difficulty in breathing, hypotension, or shock) following receipt of streptomycin or neomycin should not receive IPV. Persons with reactions that are not anaphylactic are not at an increased risk and can be vaccinated.
Oral Poliovirus Vaccine (OPV):
In rare instances, administration of OPV has been associated with paralysis in healthy recipients and their contacts. Although the risk of vaccine-associated paralytic poliomyelitis is extremely small for immunologically normal vaccinees (approximately one case per nine million doses distributed) and their susceptible, immunologically normal household contacts (approximately one case per seven million doses distributed), vaccinees should be informed of this risk.
VACCINE PRECAUTIONS AND CONTRAINDICATIONS
Inactivated Poliovirus Vaccine:
There is no convincing evidence of adverse effects of IPV for the pregnant woman or developing fetus; regardless, it is prudent on theoretical grounds to avoid vaccinating pregnant women. However, if immediate protection against poliomyelitis is needed, OPV, not IPV, is recommended.
Oral Poliovirus Vaccine:
Unlike other live-virus vaccines, which are administered parenterally, OPV is administered orally. The OPV should not be given to persons who are or may be immunocompromised. The OPV should not be used for immunizing household contacts of patients immunocompromised as a result of immune deficiency disease, leukemia, lymphoma, or generalized malignancy or immunosuppressed as a result of therapy with corticosteroids, alkylating drugs, antimetabolites, or radiation. If protection is indicated, IPV should be used for immunizing household contacts of such patients. The OPV should not be given to anyone in a family with a known family history of immunodeficiency until the immune status of all family members is documented. When children in the household are given OPV, adults who are not adequately immunized against poliomyelitis are at a very small risk of contracting OPV-associated paralytic poliomyelitis. Because of the overriding importance of ensuring prompt and complete immunization of the child and the extreme rarity of OPV-associated disease in contacts of vaccines, the ACIP recommends the administration of OPV to a child regardless of the poliovirus-vaccine status of adult household contacts. This is the usual practice in the United States. The responsible adult should be informed of the small risk involved and of precautions to be taken, such as handwashing after changing a diaper. An acceptable alternative if there is strong assurance that ultimate, full immunization of the child will not be jeopardized or unduly delayed, is to immunize adults with IPV or OPV, as appropriate to their immunity status before giving OPV to the child.
