Polio Vaccine: Oral vs. Injectable Options for Children

Polio vaccine

Doctor: Hello! Is it necessary to administer two doses of the oral polio vaccine? My child received the first dose orally at two months, but I opted for injections for the second and third doses, considering that the oral Sabin vaccine is a live attenuated vaccine with a risk of paralysis of one in three million.
For the fourth dose, which is given at 18 months, can I still administer it via injection?

cynthia, 30~39 year old female. Ask Date: 2007/09/20

Dr. Pei Rensheng reply Pediatrics

Dear Cynthia,
Currently, the Department of Health is considering administering only injectable vaccines (including the inactivated polio vaccine or the pentavalent or hexavalent vaccines), as the antibody response generated is relatively low.
Additionally, since injectable vaccines are inactivated, they cannot provide herd immunity.
Therefore, before starting elementary school, at least two doses of the oral Sabin vaccine should be administered.
The fourth dose, which can be given at one and a half years of age, can still be an injectable vaccine (including the inactivated polio vaccine or the pentavalent or hexavalent vaccines).
However, please remember to administer the second dose of the Sabin vaccine before starting elementary school.
Wishing you health and happiness!
Sincerely,
Dr.
Pei Ren-Sheng
Director of Pediatrics, Taoyuan Hospital, Department of Health

Reply Date: 2007/09/20

More Info

The question regarding the polio vaccine, specifically the choice between oral and injectable forms, is an important one for parents and healthcare providers alike. The polio vaccine can be administered in two forms: the oral polio vaccine (OPV) and the inactivated polio vaccine (IPV). Each has its own benefits and considerations.

The oral polio vaccine (OPV), which contains live attenuated (weakened) virus, is effective in inducing both systemic and mucosal immunity. This means it not only protects the vaccinated individual but also helps in reducing the transmission of the virus within the community, contributing to herd immunity. However, there is a very small risk associated with OPV; in rare cases (approximately 1 in 2.4 million doses), it can lead to vaccine-derived poliovirus, which can cause paralysis. This is particularly a concern in areas where polio is still endemic or in populations with low vaccination coverage.

On the other hand, the injectable polio vaccine (IPV) contains inactivated virus and does not carry the risk of vaccine-derived poliovirus. IPV is administered via injection and is effective in providing systemic immunity. However, it does not induce the same level of mucosal immunity as OPV, which means that while it protects the individual, it does not significantly contribute to herd immunity.

In many countries, including the United States, the current recommendation is to use IPV exclusively for routine immunization against polio. The Centers for Disease Control and Prevention (CDC) recommends a series of IPV doses during infancy and early childhood, typically at 2 months, 4 months, 6-18 months, and a booster dose at 4-6 years of age.
In your case, since your child received the first dose of OPV at 2 months and subsequent doses as IPV, this is acceptable. The key point is to ensure that the child receives the complete series of vaccinations as recommended by health authorities. If you are considering administering IPV for the fourth dose, it is indeed permissible and safe. The important aspect is to follow the vaccination schedule and ensure that your child is protected against polio.

It is also crucial to note that while OPV was historically used widely, many health authorities have shifted towards IPV due to the associated risks with OPV. In regions where polio has been eradicated, IPV is preferred to maintain immunity without the risk of vaccine-derived cases.

In summary, both OPV and IPV have their roles in polio vaccination, but IPV is the safer option in terms of preventing vaccine-related complications. If you have concerns about your child's vaccination schedule or the type of vaccine administered, it is always best to consult with your pediatrician or healthcare provider for personalized advice and to ensure that your child is adequately protected against polio.

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