Guidance for Assessment of Poliovirus Vaccination Status and Vaccination of Children Who Have Received Poliovirus Vaccine Outside the United States.

Mona Marin,Manisha Patel,Steve Oberste,Mark A Pallansch

doi:10.15585/mmwr.mm6601a6

Abstract

In 1988, the World Health Assembly resolved to eradicate poliomyelitis (polio). Since then, wild poliovirus (WPV) cases have declined by >99.9%, from an estimated 350,000 cases of polio each year to 74 cases in two countries in 2015 (1). This decrease was achieved primarily through the use of trivalent oral poliovirus vaccine (tOPV), which contains types 1, 2, and 3 live, attenuated polioviruses. Since 2000, the United States has exclusively used inactivated polio vaccine (IPV), which contains all three poliovirus types (2,3). In 2013, the World Health Organization (WHO) set a target of a polio-free world by 2018 (4). Of the three WPV types, type 2 was declared eradicated in September 2015. To remove the risk for infection with circulating type 2 vaccine-derived polioviruses (cVDPV), which can lead to paralysis similar to that caused by WPV, all OPV-using countries simultaneously switched in April 2016 from tOPV to bivalent OPV (bOPV), which contains only types 1 and 3 polioviruses (5). This report summarizes current Advisory Committee on Immunization Practices (ACIP) recommendations for poliovirus vaccination and provides CDC guidance, in the context of the switch from tOPV to bOPV, regarding assessment of vaccination status and vaccination of children who might have received poliovirus vaccine outside the United States, to ensure that children living in the United States (including immigrants and refugees) are protected against all three poliovirus types. This guidance is not new policy and does not change the recommendations of ACIP for poliovirus vaccination in the United States. Children living in the United States who might have received poliovirus vaccination outside the United States should meet ACIP recommendations for poliovirus vaccination, which require protection against all three poliovirus types by age-appropriate vaccination with IPV or tOPV. In the absence of vaccination records indicating receipt of these vaccines, only vaccination or revaccination in accordance with the age-appropriate U.S. IPV schedule is recommended. Serology to assess immunity for children with no or questionable documentation of poliovirus vaccination will no longer be an available option and therefore is no longer recommended, because of increasingly limited availability of antibody testing against type 2 poliovirus.

Highlights

In the United States, all infants and children should receive 4 doses of inactivated polio vaccine (IPV) at ages 2 months, 4 months, 6 through 18 months, and at 4 through 6 years [2,3]
Vaccines administered outside the United States generally can be accepted as valid doses if the schedule is similar to that recommended in the United States.* Vaccination against polio is valid for children from countries that use an accelerated schedule, with the first dose given as early as 6 weeks and the second and third doses administered at least 4 weeks after the previous doses
Documentation of vaccination with OPV outside the United States should specify vaccination against all three poliovirus types. If both trivalent oral poliovirus vaccine (tOPV) and IPV were administered as part of a series, the total number of doses needed to complete the series is the same as that recommended for the U.S IPV schedule

Summary

Introduction

In the United States, all infants and children should receive 4 doses of IPV at ages 2 months, 4 months, 6 through 18 months, and at 4 through 6 years [2,3]. Current ACIP Recommendations for Routine Poliovirus Vaccination in the United States A fourth dose in the routine IPV series is not necessary if the third dose was administered at age ≥4 years and ≥6 months after the previous dose.

Results

Conclusion