Version May 2024
Primary immunization:
IM, SUBQ: Administer 0.5 mL per dose for a total of 3 doses given as follows: Two 0.5 mL doses administered at a 1- to 2-month interval, followed by a third dose 6 to 12 months later. If <3 months, but at least 2 months are available before protection is needed, 3 doses may be administered at least 1 month apart. If administration must be completed within 1 to 2 months, give 2 doses at least 1 month apart. If <1 month is available, give 1 dose.
Incomplete vaccination: IM, SUBQ: Adults at an increased risk of exposure and who have had at least 1 previous dose of trivalent OPV (tOPV), <3 doses of IPV, or a combination of tOPV and IPV equaling <3 doses, administer at least one 0.5 mL dose of IPV. Additional doses to complete the series should be given if time permits.
Booster dose: IM, SUBQ: 0.5 mL as a single dose for persons at increased risk of exposure.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
(For additional information see "Poliovirus vaccine (inactivated) (IPV): Pediatric drug information")
Primary immunization: Note: Use of the minimum age and minimum intervals (4 weeks) during the first 6 months of life should only be done when the vaccine recipient is at risk for imminent exposure to circulating poliovirus (shorter intervals and earlier start dates may lead to lower seroconversion) (CDC/ACIP 2009). Refer to CDC/ACIP for guidance on schedules and interval for individuals who received polio vaccination(s) (including oral formulation) outside of the United States (CDC/ACIP [Marin 2017]).
Infants and Children 6 weeks to 47 months: IM, SUBQ: 0.5 mL per dose for a total of 3 doses administered as follows: 2 months, 4 months, and 6 to 18 months of age.
Booster immunization:
Children 4 to 6 years: IM, SUBQ: 0.5 mL as a single dose administered at least 6 months after the previous dose.
Adolescents ≥18 years at increased risk of exposure to poliovirus: IM, SUBQ: 0.5 mL as a single dose (ACIP/CDC [Wodi 2023]).
Catch-up immunization: Infants, Children, and Adolescents 4 months to 18 years: Note: Do not restart the series if doses have been given (OPV and/or IPV); refer to current immunization guidelines for specific schedule and timing of dose based on patient age and date and number of previous doses. IM, SUBQ: 0.5 mL per dose for a total of 1 to 4 doses.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Reported adverse reactions are for infants and children. Percentages noted with concomitant administration of DTP or DTaP vaccine and observed within 48 hours of injection, unless otherwise noted.
>10%:
Gastrointestinal: Anorexia (1% to 17%)
Local: Swelling at injection site (≤11%), tenderness at injection site (1% to 29%)
Nervous system: Fatigue (4% to 61%), irritability (7% to 65%)
1% to 10%:
Gastrointestinal: Vomiting (1% to 3%)
Local: Erythema at injection site (≤1%)
Nervous system: Excessive crying (1%; reported within 72 hours)
Miscellaneous: Fever (>39°C: ≤4%)
Postmarketing:
Cardiovascular: Syncope
Dermatologic: Skin rash, urticaria
Hematologic & oncologic: Lymphadenopathy
Hypersensitivity: Anaphylactic shock, anaphylaxis, hypersensitivity reaction, type 1 hypersensitivity reaction
Local: Rash at injection site, residual mass at injection site
Nervous system: Agitation, drowsiness, febrile seizure, headache, paresthesia, seizure
Neuromuscular & skeletal: Arthralgia, myalgia
Hypersensitivity to any component of the vaccine, including 2-phenoxyethanol, formaldehyde, neomycin, streptomycin and polymyxin B; anaphylaxis or anaphylactic shock occurring within 24 hours of administration of 1 dose of vaccine; acute, febrile illness (excluding minor illness with or without low-grade fever).
Concerns related to adverse effects:
• Anaphylactoid/hypersensitivity reactions: Immediate treatment (including epinephrine 1 mg/mL) for anaphylactoid and/or hypersensitivity reactions should be available during vaccine use (ACIP [Kroger 2021]).
• Shoulder injury related to vaccine administration: Vaccine administration that is too high on the upper arm may cause shoulder injury (eg, shoulder bursitis, tendinopathy) resulting in shoulder pain and reduced range of motion following injection. Use proper injection technique for vaccines administered in the deltoid muscle (eg, injecting in the central, thickest part of the muscle) to reduce the risk of shoulder injury related to vaccine administration (Cross 2016; Foster 2013).
• Syncope: Syncope has been reported with use of injectable vaccines and may result in serious secondary injury (eg, skull fracture, cerebral hemorrhage); more often reported in adolescents and young adults and typically within 15 minutes after vaccination. Procedures should be in place to avoid injuries from falling and to restore cerebral perfusion if syncope occurs (ACIP [Kroger 2021]).
Disease-related concerns:
• Acute illness: The decision to administer or delay vaccination because of current or recent febrile illness depends on the severity of symptoms and the etiology of the disease. Defer administration in patients with moderate or severe acute illness (with or without fever); vaccination should not be delayed for patients with mild acute illness (with or without fever) (ACIP [Kroger 2021]).
• Bleeding disorders: Use with caution in patients with bleeding disorders (including thrombocytopenia); bleeding/hematoma may occur from IM administration; if the patient receives antihemophilia or other similar therapy, IM injection can be scheduled shortly after such therapy is administered (ACIP [Kroger 2021]).
• Polio infection: Patients with prior clinical poliomyelitis or incomplete vaccination with oral poliovirus vaccine (OPV) may receive inactivated poliovirus vaccine (IPV).
Concurrent drug therapy issues:
• Anticoagulant therapy: Use with caution in patients receiving anticoagulant therapy; bleeding/hematoma may occur from IM administration (ACIP [Kroger 2021]).
• Immune globulin: Immune response may be decreased in patients receiving immune globulin.
• Vaccines: In order to maximize vaccination rates, the ACIP recommends simultaneous administration of all age-appropriate vaccines (live or inactivated) for which a person is eligible at a single clinic visit, unless contraindications exist. The use of combination vaccines is generally preferred over separate injections, taking into consideration provider assessment, patient preference, and adverse events. When using combination vaccines, the minimum age for administration is the oldest minimum age for any individual component; the minimum interval between dosing is the greatest minimum interval between any individual components. The ACIP prefers each dose of a specific vaccine in a series come from the same manufacturer when possible; however, vaccination should not be deferred because a specific product is unavailable (ACIP [Kroger 2021]).
Special populations:
• Altered immunocompetence: Consider deferring vaccination during periods of severe immunosuppression; may have a reduced response to vaccination. According to the manufacturer, patients with HIV infection, severe combined immunodeficiency, hypogammaglobulinemia, agammaglobulinemia, or altered immunity (due to corticosteroids, alkylating agents, antimetabolites, or radiation) may receive inactivated poliovirus vaccine (IPV). In general, household and close contacts of persons with altered immunocompetence may receive all age-appropriate vaccines. Inactivated vaccines should be administered ≥2 weeks prior to planned immunosuppression when feasible; inactivated vaccines administered during chemotherapy should be readministered after immune competence is regained (ACIP [Kroger 2021]; IDSA [Rubin 2014]).
• Pediatric: Use of the minimum age and minimum intervals during the first 6 months of life should only be done when the vaccine recipient is at risk for imminent exposure to circulating poliovirus (shorter intervals and earlier start dates may lead to lower seroconversion). Apnea has occurred following intramuscular vaccine administration in premature infants; consider clinical status implications. In general, preterm infants should be vaccinated at the same chronological age as full-term infants (ACIP [Kroger 2021]).
Dosage form specific issues:
• 2-phenoxyethanol: Products may contain 2-phenoxyethanol.
• Calf serum protein: Products may contain calf serum protein.
• Formaldehyde: Products may contain formaldehyde.
• Neomycin: Products may contain neomycin.
• Polymyxin B: Products may contain polymyxin B.
• Streptomycin: Products may contain streptomycin.
Other warnings/precautions:
• Antipyretics: Antipyretics have not been shown to prevent febrile seizures; antipyretics may be used to treat fever or discomfort following vaccination (ACIP [Kroger 2021]). One study reported that routine prophylactic administration of acetaminophen to prevent fever prior to vaccination decreased the immune response of some vaccines; the clinical significance of this reduction in immune response has not been established (Prymula 2009).
• Appropriate use: Use of this vaccine for specific medical and/or other indications (eg, immunocompromising conditions, hepatic or kidney disease, diabetes) is also addressed in the annual ACIP Recommended Immunization Schedules (refer to CDC schedule for detailed information). Specific recommendations for vaccination in immunocompromised patients with asplenia, cancer, HIV infection, cerebrospinal fluid leaks, cochlear implants, hematopoietic stem cell transplant (prior to or after), sickle cell disease, solid organ transplant (prior to or after), or those receiving immunosuppressive therapy for chronic conditions as well as contacts of immunocompromised patients are available from the IDSA (Rubin 2014).
• Effective immunity: Vaccination may not result in effective immunity in all patients. Response depends upon multiple factors (eg, type of vaccine, age of patient) and may be improved by administering the vaccine at the recommended dose, route, and interval. Vaccines may not be effective if administered during periods of altered immune competence (ACIP [Kroger 2021]).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Injection, suspension:
IPOL: Type 1 poliovirus 40 D-antigen units, type 2 poliovirus 8 D-antigen units, and type 3 poliovirus 32 D-antigen units per 0.5 mL (0.5 mL, 5 mL) [contains 2-phenoxyethanol, formaldehyde, calf serum protein, neomycin (may have trace amounts), streptomycin (may have trace amounts), and polymyxin B (may have trace amounts)]
No
IM, SUBQ: For IM or SUBQ administration in the deltoid area; do not administer IV. Use proper injection technique for IM injection into the deltoid muscle (eg, injecting in the central, thickest part of the muscle) to reduce the risk of shoulder injury related to vaccine administration (Cross 2016; Foster 2013). Do not mix with other vaccines or injections; separate needles and syringes should be used for each injection. To prevent syncope related injuries, patients should be vaccinated while seated or lying down (ACIP [Kroger 2021]). US law requires that the date of administration, the vaccine manufacturer, lot number of vaccine, Vaccine Information Statement (VIS) edition date and date it was provided, and the administering person's name, title, and address be recorded. Imovax Polio (Canadian product) should be shaken well before use.
For patients at risk of hemorrhage following IM injection, the vaccine should be administered IM if, in the opinion of the physician familiar with the patient's bleeding risk, the vaccine can be administered by this route with reasonable safety. If the patient receives antihemophilia or other similar therapy, IM vaccination can be scheduled shortly after such therapy is administered. A fine needle (23-gauge or smaller) should be used for the vaccination and firm pressure on the site (without rubbing) for at least 2 minutes. The patient should be instructed concerning the risk of hematoma from the injection. Patients on anticoagulant therapy should be considered to have the same bleeding risks and treated as those with clotting factor disorders (ACIP [Kroger 2021]).
IM, SUBQ: Administer IM or SUBQ into midlateral aspect of the thigh in infants and small children; administer in the deltoid area in older children and adolescents; not for IV administration. Do not mix with other vaccines or injections; separate needles and syringes should be used for each injection (ACIP [Kroger 2021]). To prevent syncope-related injuries, adolescents should be vaccinated while seated or lying down (ACIP [Kroger 2021]). US law requires that the date of administration, the vaccine manufacturer, lot number of vaccine, Vaccine Information Statement (VIS) edition date and date it was provided, and the administering person's name, title, and address be recorded.
For patients at risk of hemorrhage following IM injection, the vaccine should be administered IM if, in the opinion of the physician familiar with the patient's bleeding risk, the vaccine can be administered by this route with reasonable safety. If the patient receives antihemophilia or other similar therapy, IM vaccination can be scheduled shortly after such therapy is administered. A fine needle (23 gauge or smaller) should be used for the vaccination and firm pressure applied to the site (without rubbing) for at least 2 minutes. The patient should be instructed concerning the risk of hematoma from the injection. Patients on anticoagulant therapy should be considered to have the same bleeding risks and treated as those with clotting factor disorders (ACIP [Kroger 2021]).
In the U.S, the appropriate CDC-approved Vaccine Information Statement (VIS) must be provided to the patient prior to administering each dose of this vaccine; VIS is available at http://www.cdc.gov/vaccines/hcp/vis/vis-statements/ipv.html.
Poliovirus prevention:
Active immunization for prevention of poliomyelitis caused by poliovirus types 1, 2, and 3 in the following persons:
US labeling: Infants (≥6 weeks), children, adolescents, and adults
Canadian labeling: Infants (≥2 months), children, adolescents, and adults
The Advisory Committee on Immunization Practices (ACIP) and Canada's National Advisory Committee on Immunization (NACI) recommend routine vaccination for the following:
• All infants and children (CDC/ACIP 2009; PHAC 2015)
Routine vaccination of adults in the United States and Canada is generally not recommended. Adults with previous wild poliovirus disease, who have never been vaccinated, or those who are incompletely vaccinated may receive inactivated poliovirus vaccine if they fall into one of the following categories (CDC/ACIP [Prevots 2000]; PHAC 2015):
• Travelers to regions or countries where poliomyelitis is endemic or epidemic
• Healthcare workers in close contact with patients who may be excreting poliovirus
• Laboratory workers handling specimens that may contain poliovirus
• Members of communities or specific population groups with diseases caused by wild poliovirus
• Incompletely vaccinated or unvaccinated adults in a household or with other close contact with children receiving oral poliovirus (may be at increased risk of vaccine associated paralytic poliomyelitis)
IPV (inactivated poliovirus vaccine) may be confused with HPV (human papilloma virus vaccine)
IPV (inactivated poliovirus vaccine) may be confused with PPD (purified protein derivative tuberculin test).
IPV (inactivated poliovirus vaccine), a trivalent product, may be confused with OPV (oral poliovirus vaccine [live/bivalent]), which is no longer licensed in the United States, but still used in some other countries.
Poliovirus vaccine (inactivated) may be confused with tuberculin products. Medication errors have occurred when poliovirus vaccine (IPV) has been inadvertently administered instead of tuberculin skin tests (PPD). Both of these products are refrigerated and often stored in close proximity to each other.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Acetaminophen: May diminish the therapeutic effect of Vaccines. Management: Consider avoiding routine prophylactic use of acetaminophen before or during vaccine administration when possible. Acetaminophen is still recommended to treat fevers and/or pain that occurs after vaccination. Risk D: Consider therapy modification
Anti-CD20 B-Cell Depleting Therapies: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation or 6 months after anti-CD20 B-cell depleting therapies. If vaccinated prior to B cell recovery, consider assessing immune response to vaccination. Risk D: Consider therapy modification
Cladribine: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation of cladribine when possible. Patients vaccinated less than 14 days before initiating or during cladribine should be revaccinated at least 3 months after therapy is complete. Risk D: Consider therapy modification
Corticosteroids (Systemic): May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Administer vaccines at least 2 weeks prior to immunosuppressive corticosteroids if possible. If patients are vaccinated less than 14 days prior to or during such therapy, repeat vaccination at least 3 months after therapy if immunocompetence restored. Risk D: Consider therapy modification
Elivaldogene Autotemcel: May enhance the adverse/toxic effect of Vaccines. Specifically, there may be a greater risk for contracting an infection from any live vaccine. Elivaldogene Autotemcel may diminish the therapeutic effect of Vaccines. Management: Administration of vaccines is not recommended in the 6 weeks before myeloablative conditioning, and until hematologic recovery after elivaldogene autotemcel treatment. Risk X: Avoid combination
Fingolimod: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Vaccine efficacy may be reduced. Complete all age-appropriate vaccinations at least 2 weeks prior to starting fingolimod. If vaccinated during fingolimod therapy, revaccinate 2 to 3 months after fingolimod discontinuation. Risk D: Consider therapy modification
Immunosuppressants (Cytotoxic Chemotherapy): May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation of chemotherapy when possible. Patients vaccinated less than 14 days before initiating or during chemotherapy should be revaccinated at least 3 months after therapy is complete. Risk D: Consider therapy modification
Immunosuppressants (Miscellaneous Oncologic Agents): May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation of immunosuppressants when possible. Patients vaccinated less than 14 days before initiating or during therapy should be revaccinated at least 3 after therapy is complete. Risk D: Consider therapy modification
Immunosuppressants (Therapeutic Immunosuppressant Agents): May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation of immunosuppressants when possible. Patients vaccinated less than 14 days before initiating or during therapy should be revaccinated at least 2 to 3 months after therapy is complete. Risk D: Consider therapy modification
Methotrexate: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Administer vaccines at least 2 weeks prior to methotrexate initiation, if possible. If patients are vaccinated less than 14 days prior to or during methotrexate therapy, repeat vaccination at least 3 months after therapy if immunocompetence restored. Risk D: Consider therapy modification
Propacetamol: May diminish the therapeutic effect of Vaccines. Management: Consider avoiding routine prophylactic use of propacetamol before or during vaccine administration when possible. Propacetamol is still recommended to treat fevers and/or pain that occurs after vaccination. Risk D: Consider therapy modification
Siponimod: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Avoid administration of vaccines (inactivated) during treatment with siponimod and for 1 month after discontinuation due to potential decreased vaccine efficacy. Risk D: Consider therapy modification
Teplizumab: May diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Vaccination with inactivated or non-replicating vaccines is not recommended in the 2 weeks prior to teplizumab therapy, during treatment, or for 6 weeks following completion of therapy. Risk D: Consider therapy modification
Animal reproduction studies have not been conducted with the inactivated poliovirus vaccine (IPV).
Pregnancy may be a risk factor for paralytic disease following poliomyelitis infection (CDC/ACIP [Prevots 2000]). Patients previously diagnosed with polio may have an increased risk of adverse pregnancy outcomes (Veiby 2007).
Although vaccination of pregnant patients may be avoided on theoretical grounds, previously unvaccinated pregnant patients at increased risk for infection may be administered IPV; this includes pregnant patients who are traveling to countries where polio is epidemic or endemic, those in communities with disease caused by wild polioviruses, laboratory workers handling poliovirus specimens, health care personnel in close contact with infected patients, and unvaccinated persons whose children may be receiving an oral poliovirus vaccine (ACIP [Kroger 2021]; CDC/ACIP [Prevots 2000]).
It is not known if the components of this vaccine are present in breast milk.
Breastfeeding patients may be administered IPV (CDC/ACIP [Prevots 2000]). Administration does not affect the safety of breastfeeding for the mother or the infant. Breastfeeding infants should be vaccinated according to recommended schedules (ACIP [Kroger 2021]).
Monitor for anaphylaxis and syncope for 15 minutes following administration (ACIP [Kroger 2021]). If seizure-like activity associated with syncope occurs, maintain patient in supine or Trendelenburg position to reestablish adequate cerebral perfusion.
As an inactivated virus vaccine, poliovirus vaccine induces active immunity against poliovirus types 1, 2, and 3 infection
Onset of action: In the United States, ≥95% of infants and children 2 to 18 months of age who received 2 doses of the vaccine developed seroconversion to all 3 serotypes. A full 3-dose primary regimen is needed for optimal immunity.
Duration: Immunity typically persists for decades or possibly lifelong after a 3-dose primary series (WHO 2022).
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