Use of Inactivated Polio Vaccine Among U.S. Adults: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2023

Clinical Considerations

Polio vaccination has been part of routine childhood immunization since the late 1950s. Adults who received any childhood vaccines almost certainly were vaccinated against polio. Thus, most adults who were born and raised in the United States can assume they were vaccinated against polio as children, even if they do not have written documentation of vaccination, unless they have specific reasons to believe they were not vaccinated. The current definition of a complete primary polio vaccination series is receipt of ≥3 appropriately spaced doses of tOPV or IPV in any combination, with the final dose in the series administered on or after the fourth birthday.^§

Persons at Increased Risk for Poliovirus Exposure

Adults who might be at increased risk for exposure to poliovirus include travelers to countries where polio is epidemic or endemic, laboratory and health care workers who handle specimens that might contain polioviruses, health care workers or other caregivers who have close contact with patients in a community with a polio outbreak, and other adults who are identified by public health authorities as being part of a group or population at increased risk for exposure to poliovirus because of an outbreak.

Dosing Schedule

Adults requiring a primary polio vaccination series should receive 2 doses of IPV administered at an interval of 4–8 weeks; a third dose should be administered 6–12 months after the second dose. There is no need to restart the series if the interval between doses exceeds the recommended interval. If 3 doses of IPV cannot be administered within the recommended interval before protection is needed (e.g., before travel to a country with endemic polio), an accelerated schedule is recommended based on the amount of time available.^¶

Considerations for Persons with Altered Immunocompetence

IPV is an inactivated vaccine and is safe to administer to persons who are immunocompromised or who have close contact with other persons who are immunocompromised. However, IPV might be less effective when administered during periods of altered immunocompetence. For this reason, when feasible, IPV should be administered before initiation of immunosuppressive therapy or anticipated period of altered immunocompetence. Specifically, for persons anticipated to be eligible for an IPV booster in the future (e.g., before travel to a country with endemic polio), administration of the booster dose before the period of altered immunocompetence should be considered. Additional guidance regarding immunization in persons with specific conditions is available at https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html.

Contraindications and Precautions

Contraindications and precautions are unchanged from previous recommendations. Severe allergic reaction (e.g., anaphylaxis) to IPV or to antibiotics contained in trace amounts in IPV (streptomycin, polymyxin B, or neomycin) is the only contraindication to administration of IPV. Pregnancy is a precaution to administration of IPV. Although there is no evidence that IPV vaccine causes harm to pregnant persons or their fetuses, out of an abundance of caution IPV should not be given during pregnancy if there is not an increased risk for exposure. However, if a pregnant person is at increased risk for exposure and requires immediate protection against polio, IPV can be administered in accordance with the recommended schedule for adults (2).

Reporting of Vaccine Adverse Reactions

Adverse events occurring after administration of any vaccine should be reported to the Vaccine Adverse Event Reporting System (VAERS). Reports can be submitted to VAERS online, by fax, or by mail. Additional information about VAERS is available by telephone (1-800-822-7967) or online at vaers.hhs.gov.