BQ Journal Vol 54 - Q1 2024 - 33

Morbidity and Mortality Weekly Report
Summary
What is already known about this topic?
Previously, inactivated polio vaccine (IPV) recommendations for
U.S. adults addressed adults known to be at increased risk for
poliovirus exposure.
What is added by this report?
On June 21, 2023, the Advisory Committee on Immunization
Practices issued an IPV recommendation for all adults known or
suspected to be unvaccinated or incompletely vaccinated
against polio. Risk-based recommendations for IPV boosters
have not changed.
What are the implications for public health practice?
Adults aged ≥18 years who are known or suspected to be
unvaccinated or incompletely vaccinated against polio should
complete a primary polio vaccination series with IPV. Fully
vaccinated adults at increased risk for poliovirus exposure may
receive a single lifetime booster dose of IPV.
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,
¶ If >8 weeks are available before protection is needed, 3 doses of IPV should be
administered ≥4 weeks apart. If <8 weeks but >4 weeks are available before
protection is needed, 2 doses of IPV should be administered ≥4 weeks apart.
If <4 weeks are available before protection is needed, a single dose of IPV is
recommended. The remaining doses of vaccine should be administered later,
at the recommended intervals.
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US Department of Health and Human Services | Centers for Disease Control and Prevention | MMWR | December 8, 2023 | Vol. 72 | No. 49
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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.
Acknowledgments
Advisory Committee on Immunization Practices Polio Vaccination
Work Group members (in addition to listed authors): Consultants:
Edwin Asturias, University of Colorado School of Medicine and
Center for Global Health; Emily Lutterloh, Eli Rosenberg, New York
State Department of Health; Walter Orenstein, Emory University
School of Medicine; Jennifer Rosen, New York City Department
of Health and Mental Hygiene; Liaison Representatives: Lynn
Fisher, American Academy of Family Physicians; Chandy John,
American Academy of Pediatrics; Sandra Fryhofer, American Medical
Association; Kathy Kudish, Association of Immunization Managers;
Marcus Plescia, Association of State and Territorial Health Officials;
Paul Cieslak, Christine Hahn, Council of State and Territorial
Epidemiologists; Adenike Shoyinka, Tina Q. Tan, Infectious Diseases
Society of America; Mary Wilson, International Society of Travel
Medicine; Jaqueline Lawler, National Association of County and
City Health Officials; Kathy Edwards, Pediatric Infectious Diseases

https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html http://vaers.hhs.gov

BQ Journal Vol 54 - Q1 2024

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