IPV (polio) Vaccine

Summary

Although there have been no recent cases in the U.S., polio still exists in other parts of the world and could travel here.
The disease is highly contagious and can cause paralysis and death.
There are no known risks to the vaccine, and for now the risks of the disease outweigh the risk of the vaccine.
RECOMMENDED

Polio is one of the most dreaded childhood diseases. As late as the 1950’s, parents were terrified that polio would make their children unable to walk, or worse, unable to breathe and forced to spend the rest of their lives in an iron lung. Many parents in the 1950’s refused to let their children go swimming in the summer for fear of catching polio. Of the thousands of cases every year, about 13,000-20,000 people developed paralytic polio; only 1 in 10 people would recover from the disease. President Franklin Delano Roosevelt was paralyzed by polio when he was in his 30’s. About 2%-5% of children who contracted polio died from the disease itself; many more whose respiratory muscles were paralyzed would die later from complications such as pneumonia while living in an iron lung.

The Disease

Polio is a viral disease, which means that there is no effective antibiotic or other medication to kill the germ. The polio virus, in fact, is a member of the Enterovirus family, a group of viruses that is a common cause of disease in children and adults today. These viruses infect the gastrointestinal tract, usually causing vomiting and diarrhea. They can go on to spread to the nervous system and sometimes cause damage there. Perhaps the most well known enterovirus today are the ones that cause hand-foot-mouth disease in toddlers. Many other mild cases of diarrhea are also caused by enteroviruses. These viruses spread rapidly and easily, especially among children, and they tend to be summertime viruses. That is why so many children caught polio while swimming; diarrhea viruses can spread rapidly in swimming pools (and in daycares as well). Polio itself can cause diarrhea, but more commonly causes mild stomachache, sore throat, low grade fever and/or upper respiratory tract symptoms; these symptoms are indistinguishable from other common viral diseases. There is no treatment to prevent progression to paralysis.

The virus is very contagious; almost 100% of those exposed catch the disease. Most have no symptoms at all; some have upper respiratory or gastrointestinal symptoms. About 1-2% develop meningitis, and less than 1% develop paralysis. The paralysis may be temporary or permanent.

The last case transmitted in the United States was in 1979; however, polio continued to be imported into the United States from other countries until 1993. Polio infection continues to occur in other countries.

The Vaccine

The first vaccine developed was the injectable, inactivated Salk vaccine in 1955 and was considered a major breakthrough. An live virus oral vaccine was developed in 1961 that was more effective than the injectable vaccine. The oral vaccine replaced the IPV until the year 2000. The oral vaccine had the side effect of occasionally causing a mild infection with the vaccine strains. When an enhanced inactivated vaccine became available in 1988, the use of the oral vaccine was gradually phased out. Currently in the United States, only the IPV vaccine is used.

There is no way to catch any disease or illness from the IPV vaccine.

Schedule

The IPV vaccine is given at ages 2 and 4 months. A third dose is given anywhere from 6 to 18 months; a booster is given between ages 4 and 6 years. A total of four doses are given (unless the 3rd dose is given after the child turns 4 years old; then a 4th dose is not necessary). Immunity is lifelong; however, sometimes people traveling to countries where polio is common need an additional booster.

How it is given

The vaccine is injected into the thigh or arm muscle or subcutaneous tissue (we give it in the muscle), either alone or as part of another combination vaccine (see below). It is safe and effective to give IPV along with other vaccines the same day, and it is safe and effective to give multiple injections in the same arm or leg.

Side effects

The vaccine causes virtually no side effects. Occasionally there is slight soreness and/or redness near the injection site.

Extremely rarely (1 in a million doses), an allergic reaction to any vaccine can occur causing hives and difficulty breathing, which can be treated with medications. The reaction occurs 15-30 minutes after the shot. There are no known deaths in children from an allergic reaction to a vaccine.

Risks vs. benefits

The risks of the vaccine are small, with the side effects noted above, and no one has ever died from the vaccine. While natural polio infection has been eliminated from the United States, outbreaks are still occurring in Africa, India, and Asia. Children have returned from overseas travel to the Western Hemisphere with polio, so the potential for infection still exists. For these reasons, the benefits of the vaccine outweigh the risks; to put it another way, the risks of disease outweigh the risks of the vaccine.

Contraindications & Precautions

A person should not receive the vaccine if there has been a severe allergic reaction to a component of the IPV vaccine, including streptomycin, neomycin, or polymyxin B, or a severe reaction following a prior dose of the vaccine. Persons with moderate or severe acute illness should consider postponing the vaccine.

My Recommendations

Polio vaccine is an amazing success story, almost wiping polio disease off the planet. Polio is a horrible disease, and the current vaccine has no known risks or side effects. Polio still exists in other parts of the world and can return to the U.S. at any time. The risks of disease outweigh any possible risk of the vaccine.