ACIP Updates Recommendations for Poliovirus Vaccinations

By David Mitchell
8/11/2009

The CDC's Advisory Committee on Immunization Practices, or ACIP, has updated its recommendations for poliovirus vaccination to help clarify how to use combination vaccines and timing of the vaccine.

This historical image depicts workers creating a billboard in downtown Atlanta. Billboards were used to promote public health awareness about polio vaccinations within communities. In the early 1950s, there were more than 20,000 cases of polio each year. After polio vaccination began in 1955, the number of cases dropped significantly.

The ACIP recommended in 1999 that all poliovirus vaccine administered in the United States be an inactivated poliovirus vaccine, or IPV, starting in January 2000. The agency implemented the policy to eliminate the risk for paralytic poliomyelitis, a rare condition associated with use of the live oral poliovirus vaccine.

In the decade since that recommendation, three different combination vaccines containing inactivated poliovirus have been licensed.

"The new combination vaccines may be adding some confusion," said Doug Campos-Outcalt, M.D., M.P.A., the AAFP's liaison to the ACIP and head of the department of family and community medicine at the University of Arizona College of Medicine, Phoenix.

The potential for confusion led the ACIP to issue the following recommendations and clarifications:

the four-dose IPV series should continue to be administered at ages 2 months, 4 months, 6-18 months, and 4-6 years;
the final dose in the series should be administered at ages 4-6 years, regardless of the number of previous doses;
the minimum interval between the third dose and the fourth dose was extended from four weeks to six months, but the minimum interval between the first and second dose and the second and third dose remains at 4 weeks; and
the minimum age for the first dose is still 6 weeks.

The ACIP said use of the minimum age and minimum intervals for administration during the first six months of life should be used only if a child is at risk for imminent exposure to poliovirus, such as during an outbreak or because of travel to an area where the disease is endemic.

The advisory committee said it made that precaution because shorter intervals and earlier start dates lead to lower seroconversion rates.

ACIP members also clarified the vaccination schedule for use with combination vaccines. The combination vaccine for diphtheria, tetanus and pertussis, or DTaP; IPV; and Haemophilus influenzae type b (i.e., Pentacel) is not indicated for use as a booster dose at age 4-6 years. If the product is used to provide four doses at ages 2, 4, and 6 months and at 15-18 months, a dose of age-appropriate IPV-containing vaccine should be administered at age 4-6 years. This will result in a five-dose series, which the ACIP said is acceptable.

"Clinicians need to be aware of combination vaccines containing IPV and plan accordingly," said Jonathan Temte, M.D., Ph.D., associate professor in the department of family medicine at the University of Wisconsin School of Medicine and Public Health, Madison, and a member of the ACIP.

The ACIP recommends that the minimum interval between dose four and dose five should be at least six months to provide an optimum booster response. If a child does not receive an IPV dose at age 4-6 years, a booster dose should be administered as soon as feasible.

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