Inactivated polio vaccine(IPV)

Polio vaccines are vaccines used to prevent poliomyelitis. Two types are used: an inactivated poliovirus and a weakened poliovirus .

1. INACTIVATED POLIO VACCINE BY: Dr.Aishwarya.R.G 1 st year MPH RGIPH & CDC

2. CONTENTS INTRODUCTION TO IPV ADMINISTRATION AND DOSAGE IMMUNITY ADVANTAGES DISADVANTAGES RISKS REFRENCES INTRODUCTION TO OPV NATIONAL IMMUNIZATION SCHEDULE DEVELOPMENT OF IMMUNITY ADVANTAGES COMPLICATION CONTRAINDICATION STORAGE COMPARISON BETWEEN OPV AND IPV PULSE POLIO IMMUNIZATION

3. Introduction Inactivated polio vaccine (IPV) was developed in 1955 by Dr Jonas Salk. Also called the Salk vaccine IPV consists of inactivated (killed) poliovirus strains of all three poliovirus types. IPV is given by intramuscular or intradermal injection and needs to be administered by a trained health worker. IVP produces antibodies in the blood to all three types of poliovirus. In the event of infection, these antibodies prevent the spread of the virus to the central nervous system and protect against paralysis.

4. Introduction IPV is usually made from selected WPV strains - namely, Mahoney (Salk type-1), MEF-1 (Salk type-2) and Saukett (Salk type-3) that are grown in Vero cell culture or in human diploid cells. The final vaccine mixture is formulated to contain at least 40 units of type-1, 8 units of type-2 and 32 units of type-3 D-antigen (D-antigen, which is expressed only on intact poliovirus particles, is used to adjust the concentration of the individual viruses included in the trivalent IPV) IPV is available either as a stand-alone product or in combination with >1 other vaccine antigens including diphtheria, tetanus, whole-cell or acellular pertussis, hepatitis B, or Haemophilus influenzae type b. IPV induces, humoral antibodies (IgM, IgG and IgA serum antibodies) but does not induce intestinal or local immunity

5. Introduction Generally three spaced doses are administered to generate adequate levels of seroconversion, and most countries, a booster dose is added during late childhood.  IPV provides serum immunity to all three types of poliovirus, resulting in protection against paralytic poliomyelitis.  Adverse events following administration of IPV are very mild and transient. CDC recommends that children get four doses of polio vaccine. They should get one dose at each of the following ages: 2 months old, 4 months old, 6 through 18 months old, and 4 through 6 years old.

6. Polio vaccine Administration and Dosage Single-antigen IPV is distributed in single-dose syringes or in 10-dose vials. The recommended dose for both children and adults is 0.5 mL.   It can be administered by the intramuscular or subcutaneous route, using a needle length appropriate for the age and size of the person receiving the vaccine. Preferred injection sites: Infants and small children: anterolateral aspect of the thigh. Older children and adults: deltoid muscle for intramuscular injection or the posterior aspect of the upper arm for subcutaneous injection.

7. Immunity The circulating antibodies protect the individual against paralytic polio, but do not prevent reinfection of the gut by wild viruses. For the individual, it gives protection from paralysis and nothing more; for the community, it offers nothing because the wild viruses can still multiply in the gut and be a source of infection to others. This is a major drawback of IPV.

8. Advantages Advantages: As IPV is not a ‘live’ vaccine, it carries no risk of  Vaccine-associated paralytic poliomyelitis( VAPP). IPV triggers an excellent protective immune response in most people. is safe to administer to persons with immune deficiency diseases (ii) to persons undergoing corticosteroid and radiation therapy (iii) to those over 50 years who are receiving vaccine for the first time, and (iv) During pregnancy.

9. Disadvantages IPV induces very low levels of immunity in the intestine. As a result, when a person immunized with IPV is infected with wild poliovirus, the virus can still multiply inside the intestines and be shed in the faeces, risking continued circulation. IPV is over five times more expensive than OPV. Administering the vaccine requires trained health workers, as well as sterile injection equipment and procedures. Further, in the case of an epidemic, IPV is unsuitable because : ( i ) immunity is not rapidly achieved, as more than one dose is required to induce immunity, and (ii) injections are to be avoided during epidemic times as they are likely to precipitate paralysis. Therefore, IPV is not efficacious in combating epidemics of polio.

10. Efficacy IPV is highly effective in preventing paralytic disease caused by all three types of poliovirus. Recommended use An increasing number of industrialized, polio-free countries are using IPV as the vaccine of choice. This is because the risk of paralytic polio associated with continued routine use of OPV is deemed greater than the risk of imported wild virus. However, as IPV does not stop transmission of the virus, OPV is used wherever a polio outbreak needs to be contained, even in countries which rely exclusively on IPV for their routine immunization programme. Once polio has been eradicated, use of all OPV will need to be stopped to prevent re-establishment of transmission due to vaccine derive polio-virus (VDPVs).

11. Risks No serious adverse reactions to IPV vaccines currently in use have been reported except minor local erythema (0.5-1 per cent), induration (3-11 per cent) and tenderness (14-29 per cent).

12. Sequential administration of IPV and OPV Over the past decade, a number of countries in central and eastern Europe, the Middle East, the Far East, and southern Africa have adopted sequential schedules of 1-2 doses of IPV followed by > or ~ 2 doses of OPV. Combined schedules of IPV and OPV appear to reduce or prevent vaccine acquired paralytic poliomyelitis (VAPP) while maintaining the high levels of intestinal mucosal immunity conferred by OPV. In addition, such schedules economize on limited resources by reducing the number of doses of IPV, and may optimize both the humoral and mucosal immunogenicity of polio vaccination.

13. References https://www.nhp.gov.in/Launch-of-Inactivated-Polio-Vaccine(IPV)_pg National health portal https://www.who.int/biologicals/areas/vaccines/poliomyelitis/en/ World health organisation https://www.cdc.gov/cpr/polioviruscontainment/diseaseandvirus.htm#:~:text=There%20are%20three%20wild%20types,vaccination%20is%20the%20best%20protection. CDC - Centre of disease control and prevention http://polioeradication.org/polio-today/polio-prevention/the-vaccines/ipv/ Polio global eradication initiative Textbook of preventive and social medicine. By K.Park

14. Pulse Polio Immunization The Pulse Polio Initiative was started with an objective of achieving hundred per cent coverage under Oral Polio Vaccine. It aimed to immunize children through improved social mobilization, plan mop-up operations in areas where poliovirus has almost disappeared and maintain high level of morale among the public. With the global initiative of eradication of polio in 1988 following World Health Assembly resolution in 1988, Pulse Polio Immunization programme was launched in India in 1995. Government of India conducted the first round of PPI consisting of two immunization days 6 weeks apart on 9th December 1995 and 20th January 1996. The first PPI conducted targeted all children under 3 years of age irrespective of their immunization status. Later on, as recommended by WHO, it was decided to increase the age group from under 3 to under 5 years.

15. Continued.. The term "pulse" has been used to describe this sudden, simultaneous, mass administration of OPV on a single day to all children 0-5 years of age, regardless to previous immunization. PPIs occur as two rounds about 4 to 6 weeks apart during low transmission season of polio, i.e. between November to February. In India, the peak transmission is from June to September. The dose of OPV during PPIs are extra doses which supplement, and do not replace the doses received during routine immunization services. The children including 0-1 year old infants should receive all their scheduled doses and PPI doses. There is no minimum interval between PPI and scheduled OPV doses.

16. Steps taken by the Government to maintain polio free status in India Maintaining community immunity through high quality National and Sub National polio rounds each year. An extremely high level of vigilance through surveillance across the country for any importation or circulation of poliovirus and VDPV is being maintained. Environmental surveillance (sewage sampling) have been established to detect poliovirus transmission and as a surrogate indicator of the progress as well for any programmatic interventions strategically in Mumbai, Delhi, Patna, Kolkata Punjab and Gujarat. All States and Union Territories in the country have developed a Rapid Response Team (RRT) to respond to any polio outbreak in the country. An Emergency Preparedness and Response Plan (EPRP) has also been developed  by  all  States  indicating  steps  to  be  undertaken  in  case  of detection of a polio case. To reduce risk of importation from neighbouring countries, international border vaccination is being provided through continuous vaccination teams (CVT) to all eligible children round the clock. These are provided through special booths set up at the international borders that India shares with Pakistan, Bangladesh, Bhutan Nepal and Myanmar. Government of India has issued guidelines for mandatory requirement of polio vaccination to all international travelers before their departure from India to polio affected countries namely:  Afghanistan, Nigeria, Pakistan, Ethiopia, Kenya, Somalia, Syria and Cameroon. The mandatory requirement is effective for travellers from 1 st  March 2014. A rolling emergency stock of OPV is being maintained to respond to detection/importation of wild poliovirus (WPV) or emergence of circulating vaccine derived poliovirus ( cVDPV ). National Technical Advisory Group on Immunization (NTAGI) has recommended Injectable Polio Vaccine (IPV) introduction as an additional dose along with 3rd dose of DPT in the entire country in the last quarter of 2015 as a part of polio endgame strategy.

17. Last case of polio The last case of polio in the country was reported from Howrah of West Bengal with date of onset of disease on 13th January 2011. Thereafter no polio case has been reported in the country. On 27th March 2014, India was declared as non-endemic country for polio.