Other Vaccines

Overview

In the 1970s, you could count the number of routinely recommended childhood vaccines on the fingers of one hand — polio, DTP (diphtheria, tetanus, pertussis), MMR (measles, mumps, rubella). Even influenza (flu) vaccine was not routinely and universally recommended for children, adolescents, and adults until the first decade of the 21st century.

Today the recommended schedules for both children and adults list nearly 2 dozen vaccines for prevention of some 20 infectious diseases, including several combination vaccines covering anywhere from 2 to 6 diseases in one shot.1,2

Vaccination is widely regarded as one of the epic achievements in public health. Vaccination has reduced the incidence of debilitating and often fatal diseases such as polio, diphtheria, tetanus, measles, rubella and Haemophilus influenzae type b disease (Hib) to negligible levels in the United States. Immunization has also achieved a greater than 90% reduction in the incidence of 10 other diseases included in the childhood immunization schedule.3

Worldwide, the picture is not as bright, as many vaccine-preventable infectious diseases continue to cause millions of hospitalizations and hundreds of thousands of deaths every year. Progress is coming slowly but steadily amid efforts to improve access to vaccines while implementing other prevention measures. Such as ensuring clean water and proper sanitation. From a global perspective, vaccines prevent an estimated 4 million deaths a year, but 1 in 5 children do not have access to essential immunizations.4

References

  1. Centers for Disease Control and Prevention (CDC). Child and adolescent immunization schedule by age. https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html. Reviewed April 27, 2023. Accessed June 20, 2023.
  2. CDC. Adult immunization schedule. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult-compliant.html. Reviewed February 10, 2023. Accessed June 20, 2023.
  3. Talbird SE, Carrico J, La EM, et al. Impact of routine childhood immunization in reducing vaccine-preventable diseases in the United States. Pediatrics. 2022;150(3):e2021056013. doi:10.1542/peds.2021-056013
  4. CDC. Fast facts on global immunization. https://www.cdc.gov/globalhealth/immunization/
    data/fast-facts.html    . Updated April 20, 2023. Accessed June 25, 2023.

Diphtheria, Tetanus, and Pertussis1-3

Vaccines for three potentially life-threatening bacterial infections—diphtheria, tetanus (lockjaw), and pertussis (whooping cough)—were developed during the first half of the 20th century and combined into a single vaccine starting in 1948. There is a time and place for immunization against these diseases  at virtually every age throughout life, starting in infancy.

Infants and children need 5 doses of diphtheria, tetanus and acellular pertussis (DTaP) vaccine: at 2 months, 4 months, 6 months, 15 to 18 months, and 4 to 6 years of age.

Vaccines with DTaP include Daptacel and Infanrix and the combination vaccines Pediarix (DTaP-polio-hepatitis B), Pentacel (DTaP-polio-Hib), Kinrix and Quadracel (each with DTaP and polio) and Vaxelis (DTaP-polio-Hib-hepatitis B). Children who cannot receive acellular pertussis vaccine should receive DT (diphtheria toxin) instead.

For adolescents, a single dose of a different formulation, Tdap (tetanus, diphtheria and acellular pertussis vaccine; Adacel, Boostrix), is recommended, preferably at 11 to 12 years of age.

Women should receive a dose of Tdap during every pregnancy in the early part of the period from 27 through 36 weeks of gestation. If a woman has not received Tdap during a current pregnancy and has never received Tdap at any time, a dose of Tdap is recommended in the immediate postpartum period.

Adults who have never received Tdap need a single dose, followed by a booster of either Td (tetanus and diphtheria vaccine) or Tdap every 10 years.

References

  1. CDC. Diphtheria, tetanus and pertussis vaccine recommendations. https://www.cdc.gov/
    vaccines/vpd/dtap-tdap-td/hcp/recommendations.html    . Reviewed March 10, 2023. Accessed June 25, 2023.
  2. Havers FP, Moro PL, Hunter P, Hariri S, Bernstein H. Use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccines: updated recommendations of the Advisory Committee on Immunization Practices—United States, 2019. MMWR Morb Mortal Wkly Rep. 2020;69(3):77-83. doi:10.15585/mmwr.mm6903a5
  3. Liang JL, Tiwari T, Moro P, et al. Prevention of pertussis, tetanus, and diphtheria with vaccines in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2018;67(2):1-44. doi:10.15585/mmwr.rr6702a1

Rotavirus

Rotavirus is a gastrointestinal disease that causes severe watery diarrhea, mostly in infants and young children, along with fever, abdominal pain and vomiting. Dehydration can be serious enough to require hospitalization.

Before the introduction of the rotavirus vaccine in 2006, virtually every child had a rotavirus infection before their fifth birthday. Rotavirus was the leading cause of severe diarrhea in this age group, causing more than 200,000 emergency department visits, 55,000 to 70,000 hospitalizations, and 20 to 60 deaths a year in the United States.1,2

A study of the impact of the vaccine in its first decade of use reported an 80% drop in hospitalizations and a 57% drop in emergency department visits for rotavirus disease.3 Vaccination coverage among young children is lower for rotavirus than it is for many other infectious diseases: 77% for children born during 2018-2019, compared with more than 90% for Hib, polio, and MMR.4

Two rotavirus vaccines are available for infants in the United States:1,5

  • RotaTeq (RV5), a pentavalent vaccine given at 2 months, 4 months, and 6 months of age
  • Rotarix (RV1) a monovalent vaccine given at 2 months and 4 months of age.

Both vaccines come in the form of oral drops. With either vaccine, the first dose should be given before 15 weeks of age and the final dose before 8 months of age. About 90% of vaccinated children are protected against rotavirus severe enough to require emergency department or inpatient care.1,3,6 Both vaccines offer sustained protection against moderate to severe rotavirus (>80% vaccine effectiveness) beyond the first 2 years of life.7

References

  1. CDC. Rotavirus vaccination: what everyone should know. https://www.cdc.gov/vaccines/vpd/rotavirus/public/index.html. Reviewed March 25, 2021. Accessed June 24, 2023.
  2. CDC. Rotavirus in the U.S. https://www.cdc.gov/rotavirus/surveillance.html. Reviewed March 25, 2021. Accessed June 25, 2023.
  3. Pindyck T, Tate JE, Parashar UD. A decade of experience with rotavirus vaccination in the United States—vaccine uptake, effectiveness, and impact. Expert Rev Vaccines. 2018;17(7):593-606. doi:10.1080/14760584.2018.1489724 
  4. Hill HA, Chen M, Elam-Evans LD, et al. Vaccination coverage by age 24 months among children born during 2018-2019—National Immunization Survey-Child, United States, 2019-2021. MMWR Morb Mortal Wkly Rep. 2023;72(2):33-38. doi: 10.15585/mmwr.mm7202a3
  5. Cortese MM, Parashar UD. Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2009;58(RR-2):1-25.
  6. Cortese MM, Immergluck LC, Held M, et al. Effectiveness of monovalent and pentavalent rotavirus vaccine. Pediatrics. 2013;132(1):e25-e33. doi:10.1542/peds.2012-38047. Immergluck LC, Parker TC, Jain S, et al. Sustained effectiveness of monovalent and pentavalent rotavirus vaccines in children. J Pediatr. 2016;172:116-120.e1. doi:10.1016/j.jpeds.2016.01.042

Chickenpox

Chickenpox (varicella) was once thought of as a nearly universal but essentially benign childhood illness. The reality is that chickenpox, while following a mild to moderate course in most cases, is capable of causing serious illness and death in previously healthy as well as immunocompromised individuals.1

Chickenpox is highly contagious; about 90% of susceptible close contacts will become infected after being exposed to someone with this viral disease. An itchy rash typically appears 2 weeks after exposure (range of 10 to 21 days), accompanied by malaise and fever that may reach 102° to 103°F.  Most healthy children experience mild illness. The risk of severe varicella disease and complications is higher among infants, adolescents, adults, pregnant women, and people with compromised immune systems.1

Since its introduction in the United States in 1995, the varicella vaccine has prevented more than 91 million infections, 238,000 hospitalizations, and nearly 2000 deaths. Before the vaccine, annual cases in the United States exceeded 4 million; today that number is less than 150,000. Over the same period, annual hospitalizations have dropped from more than 10,000 to less than 1400, and deaths have gone from 150 to less than 30.2,3

The CDC currently recommends 2 doses of varicella vaccine, the first dose at 12 to 15 months of age and the second at 4 to 6 years of age. Vaccination is also recommended for older children, adolescents, and adults who do not have evidence of immunity.1,4 People aged 13 and older who never had a case of chickenpox or received chickenpox vaccine will need 2 doses at least 28 days apart.1,5

There are two varicella vaccines in use in the United States—Varivax (varicella only), approved for individuals 12 months of age and older; and ProQuad, a combination measles-mumps-rubella-varicella (MMRV) vaccine, approved only for  children 12 months through 12 years of age.1,5

Chickenpox is caused by varicella zoster virus, the same virus that causes shingles (herpes zoster) later in life.

References

  1. CDC. Varicella vaccination information for healthcare professionals. https://www.cdc.gov/vaccines/vpd/varicella/hcp/index.html. Reviewed April 28, 2021. Accessed June 24, 2023.
  2. Marin M, Seward JF, Gershon A. 25 years of varicella vaccination in the United States. J Infect Dis. 2022;226(Suppl4):S375-S379. doi:10.1093/infdis/jiac251
  3. CDC. Chickenpox vaccine saves lives and prevents serious illness infographic. https://www.cdc.gov/chickenpox/vaccine-infographic.html. Reviewed October 20, 2022. Accessed June 24, 2023.
  4. Marin M, Guris D, Chaves SS, Schmid S, Seward JF.  Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2007;56(RR-4):1-40.5. CDC.
  5. Chickenpox vaccination: what everyone should know. https://www.cdc.gov/vaccines/vpd/varicella/public/index.html. Reviewed April 28, 2021. Accessed July 2, 2023.

Meningococcal Disease

Meningococcal disease, caused by the bacterium Neisseria meningitidis, can be severe, spreading rapidly and turning deadly within hours. Bacteria may infect the lining of the brain and spinal cord (meningococcal meningitis) or invade the bloodstream (meningococcal septicemia or meningococcemia). People at greatest risk include infants less than 1 year of age, adolescents and young adults aged 16 to 23 years, and adults aged 65 years and older.1-3

Meningococcal disease is rare (282 reported cases in the United States in 2022),4 but potentially lethal: 10% to 15% of people infected will die, and up to 20% who survive will suffer lifelong disabilities, including loss of limbs, deafness, and neurologic deficits.1

The most common serotypes of N meningitidis in the United States are groups B, C, and Y. Vaccines licensed in the United States to protect against meningococcal  disease include meningococcal conjugate vaccines (MenACWY: Menactra, Menveo, MenQuadfi) and serogroup B vaccines (MenB: Bexsero, Trumenba).

The CDC recommends a primary dose of MenACWY vaccine for all preteens and teens, preferably at 11 to 12 years of age with a booster dose at age 16.2, 5 About half the states have implemented a  MenACWY vaccination mandate for incoming college students.6

Meningococcal vaccine is also recommended for any children and adults who are at increased risk for meningococcal disease — such as people with certain medical conditions (sickle cell disease, HIV, damaged or removed spleen), new military recruits, unvaccinated or incompletely vaccinated college freshmen living in dormitories, and people traveling to countries where meningococcal disease is common.5

The CDC recommends MenB vaccination for anyone aged 10 years or older at increased risk for meningococcal disease in the same categories mentioned above. The preferred timing for MenB vaccine is 16 to 18 years of age.2,3,5

Developing vaccines for the many serotypes of N meningitidis is an ongoing global challenge.7

References

  1. CDC. Meningococcal disease. https://www.cdc.gov/meningococcal/index.html. Reviewed February 7, 2022. Accessed June 20, 2023.
  2. CDC. Meningococcal vaccination for preteens and teens: information for parents. https://www.cdc.gov/vaccines/vpd/mening/public/adolescent-vaccine.html. Reviewed October 12, 2021. Accessed June 24, 2023.
  3. CDC. Meningococcal vaccination. https://www.cdc.gov/meningococcal/vaccine-info.html. Reviewed September 12, 2022. Accessed June 25, 2023.
  4. CDC. National Notifiable Diseases Surveillance System, Weekly Tables of Infectious Disease Data. Atlanta, GA. CDC Division of Health Informatics and Surveillance. Available at: https://www.cdc.gov/nndss/data-statistics/index.html. Reviewed October 19, 2022. Accessed June 30, 2023.
  5. Mbaeyi SA, Bozio CH, Duffy J, et al. Meningococcal vaccination: recommendations of the Advisory Committee on Immunization Practices, United States, 2020. MMWR Recomm Rep. 2020;69(9):1-41. doi: 10.15585/mmwr.rr6909a1
  6. Immunization Action Coalition. MenACWY vaccine mandates for colleges and universities. https://www.immunize.org/laws/menin.asp. Updated February 19, 2020. Accessed July 2, 2023.
  7. Parikh SR, Campbell H, Bettinger JA, et al. The everchanging epidemiology of meningococcal disease worldwide and the potential for prevention through vaccination. J Infect. 2020;81(4):483-498. doi:10.1016/j.jinf.2020.05.079

Measles, Mumps, and Rubella

Measles is a highly contagious viral disease, easily spread by coughing and sneezing.1,2 The CDC notes that the measles virus “is so contagious that if one person has it, up to 90% of the people close to that person who are not immune will also become infected.”3 The virus can live for 2 hours in a room after an infected person leaves. People with measles can transmit the infection from 4 days before until 4 days after the rash appears. Possible complications include pneumonia and encephalitis.1-3

Globally, measles caused an estimated 128,000 deaths in 2021, according to the World Health Organization, mostly in unvaccinated or undervaccinated children less than 5 years of age.1 Before the measles vaccination program began in the United States in 1963, the disease affected 3 to 4 million people every year, causing 48,000 hospitalizations and 400 to 500 deaths. Although measles was declared eradicated in the United States in 2000, unvaccinated people who are traveling abroad may get infected and bring it back to this country and infect others.2

Mumps is a normally mild infection that causes swelling of the parotid salivary glands;  complications may include encephalitis, deafness, and inflammation of the testes.4 Rubella is also a typically mild infection but may lead to miscarriage or birth defects if a woman becomes infected while pregnant.5

The CDC recommends 2 doses of measles-containing vaccine (MMR or MMRV), with the first dose at 12 to 15 months of age and the second at 4 to 6 years of age before starting school.6,7

MMR vaccines (M-M-R II and PRIORIX) help protect against measles, mumps, and rubella. One dose is 93% effective at preventing measles, 78% effective against mumps, and 97% effective against rubella. Two doses of MMR vaccine are 97% effective against measles and 88% effective against mumps.2,6 M-M-R II and PRIORIX are “fully interchangeable for all indications for which MMR vaccine is recommended,” according to the CDC.6,7

MMRV vaccine (ProQuad) helps protect against measles, mumps, rubella, and varicella (chickenpox) and is licensed only for use in children aged 12 months through 12 years.

Adults should be up-to-date with either 1 or 2 doses of MMR vaccine, depending on their risk factors, unless they have presumptive evidence of immunity to measles, mumps and rubella.

All women of childbearing age should receive a single dose of MMR vaccine or have other acceptable presumptive evidence of rubella immunity (positive serologic test for rubella antibody or documentation of appropriate vaccination).

References

  1. World Health Organization. Measles. https://www.who.int/news-room/fact-sheets/detail/measles. Published May 31, 2023. Accessed June 25, 2023.
  2. CDC. Measles (rubeola). https://www.cdc.gov/measles/index.html. Reviewed November 5, 2020. Accessed June 25, 2023.
  3. CDC. Transmission of measles. https://www.cdc.gov/measles/transmission.html. Reviewed November 5, 2020. Accessed July 2, 2023.
  4. CDC. Mumps.  https://www.cdc.gov/mumps/index.html. Reviewed March 8, 2021. Accessed June 26, 2023.
  5. CDC. Rubella (German measles, 3-day measles). https://www.cdc.gov/rubella/index.html. Reviewed December 31, 2020. Accessed June 30, 2023.
  6. CDC. Measles, mumps, and rubella vaccination: what everyone should know. https://www.cdc.gov/vaccines/vpd/mmr/public/index.html. Reviewed January 26, 2021. Accessed June 25, 2023.
  7. Krow-Lucal E, Marin M, Shepersky L, et al. Measles, mumps, rubella vaccine (PRIORIX): recommendations of the Advisory Committee on Immunization Practices—United States, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(46):1465-1470. doi:10.15585/mmwr.mm7146a1

Haemophilus Influenzae Type b (Hib)

Before Hib vaccine became available in the late 1980s, Hib was a leading cause of bacterial meningitis in children, most of them under age 5 years. Every year, nearly 20,000 children in the United States developed serious Hib infection; 1000 of them died and 6000 suffered intellectual disabilities, deafness, seizures, or brain damage.Vaccination has virtually eliminated Hib meningitis in young children in the United States; fewer than 50 infections are now reported annually, most of them in unvaccinated or undervaccinated children .1-4

Hib vaccination is recommended for all children under 5 years of age, for older children and adults who have certain medical conditions, and people who have received a bone marrow transplant.

Vaccination is a 4-dose series with ActHIB, Hiberix, Pentacel, or Vaxelis at 2, 4 and 6 months of age, followed by a booster dose (with a vaccine other than Vaxelis) at 12 to 15 months.5,6 Another Hib vaccine is PedvaxHIB, with doses at 2 and 4 months and a booster at 12 to 15 months. Pentacel is a combination vaccine for immunization against Hib disease as well as diphtheria, tetanus, pertussis, and polio. Vaxelis combines protection against Hib, hepatitis B, diphtheria, tetanus, pertussis, and polio.

Hib vaccines will not protect against diseases caused by H influenzae other than type b. A separate schedule applies to catch-up vaccination and to primary vaccination of people with compromised immune systems.5

References

  1. CDC. Haemophilus influenzae disease (including Hib). https://www.cdc.gov/hi-disease/index.html. Reviewed March 4, 2022. Accessed June 21, 2023.
  2. CDC. Hib vaccination: what everyone should know. https://www.cdc.gov/vaccines/
    vpd/hib/public/index.html    . Reviewed April 13, 2021. Accessed June 20, 2023.
  3. National Institutes of Health.Childhood Hib vaccines: nearly eliminating the threat of bacterial meningitis.  https://www.nih.gov/sites/default/files/about-nih/impact/childhood-hib-vaccines-case-study.pdf. Accessed June 21, 2023.
  4. Gilsdorf JR. Hib vaccines: their impact on Haemophilus influenzae type b disease. J Infect Dis. 2021;224(S4):S321-S330. doi:10.1093/infdis/jiaa537
  5. Briere EC. Food and Drug Administration approval for use of Hiberix as a 3-dose primary Haemophilus influenzae type b (Hib) vaccination series. MMWR Morb Mortal Wkly Rep. 2016;65(16):418-419. doi:10.15585/mmwr.mm6516a3
  6. Briere EC, Rubin L, Moro Pl, et al. Prevention and control of Haemophilus influenzae type b disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2014;63(RR-01):1-14.

Hepatitis A

Hepatitis A is an acute viral infection of the liver transmitted (via the fecal-oral route) through close contact with an infected person (including sexual contact) or through ingestion of contaminated food or water.1,2

Hepatitis A vaccine is part of the routine immunization schedule, recommended for all children from 12 to 23 months of age (2 doses at least 6 months apart). The recommendation for this age group was implemented in 2006; by 2011, reported hepatitis A infections had dropped by 95.5% from their 1996 level.2 Even so,  “hepatitis A outbreaks frequently occur among high-risk populations and those who have not been covered by universal childhood vaccination programs in recent years.”3

Hepatitis A vaccine is also recommended for unvaccinated children and adolescents aged 2 to 18 years. Hepatitis A vaccines include Vaqta and Havrix, both indicated for use in individuals 12 months of age and older. A combination hepatitis A and hepatitis B vaccine (Twinrix) is available for people aged 18 years and older.1,2

People at particular risk of hepatitis A should get immunized. This group includes international travelers (see the separate section of this website for travel vaccines), men who have sex with men, people who use illegal drugs (injection or non-injection), those whose jobs expose them to the virus, people who expect to have close personal contact with an adoptee from abroad, and the homeless.1,2

Hepatitis A vaccination is also recommended for people with chronic liver disease or HIV infection, pregnant women at risk for hepatitis A infection or a severe outcome from infection, and people without a specific risk factor who request the vaccine.1,2

Anyone who has not been vaccinated against hepatitis A and comes in direct contact with a person infected with the virus should receive hepatitis A vaccine as soon as possible, and no later than 2 weeks after the exposure.1,2,4

References

  1. CDC. Hepatitis A. https://www.cdc.gov/hepatitis/hav/index.htm. Reviewed June 22, 2020. Accessed June 19, 2023.
  2. Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep. 2020;69(5):1-38. doi:10.15585/mmwr.rr6905a1
  3. Zhang L. Hepatitis A vaccination. Hum Vaccin Immunother. 2020;16(7):1565-1573. doi: 10.1080/21645515.2020.1769389
  4. Nelson NP, Link-Gelles R, Hofmeister MC, et al. Update: recommendations of the Advisory Committee on Immunization Practices for use of hepatitis A vaccine for postexposure prophylaxis and for preexposure prophylaxis for international travel. MMWR Morb Mortal Wkly Rep. 2018;67(43):1216-1220. doi:10.15585/mmwr.mm6743a5

Hepatitis B

The hepatitis B virus can cause both acute and chronic liver disease. Chronic hepatitis can lead to cirrhosis, liver cancer and liver failure. Hepatitis B is the leading cause of liver cancer in the world.1,2

The disease spreads through contact with blood, semen and other body fluids; it can be transmitted by sexual activity, sharing of needles, sharing razors or toothbrushes, or by direct contact with the blood or open sores of an infected person. The virus can also be transmitted from mother to child at birth.1,2

The CDC recommends 3 doses of hepatitis B vaccine: at birth, age 1 to 2 months, and age 6-18 months.3,4 Monovalent hepatitis B vaccine rather than combination vaccine should be used for any doses administered before 6 weeks of age.

The first dose should be given within 24 hours of birth (if birthweight is 2000 g or more and the child is medically stable) or at a chronological age of 1 month or at hospital discharge (if birthweight is less than 2000 g).3,4 If a birth dose is not given — birth dose coverage is about 80%5 — vaccination should begin as soon as possible. A 4-dose series is permitted if a combination vaccine is used after the birth dose.

A different schedule applies if the mother is positive for the hepatitis B surface antigen (HBsAg) or if the maternal HBsAg status is not known.

As of 2022, hepatitis B vaccine is also recommended for all adults aged 19 to 59 years—a 2-, 3- or 4-dose series.3 In addition, adults 60 and older with risk factors for hepatitis B should receive hepatitis B vaccine, while those 60 and older without risk factors may receive the vaccine.3,4

Risk factors calling for vaccination include chronic liver disease, HIV infection, certain sexual exposure risks, current or recent injection drug use, incarceration, travel to countries with high or intermediate endemic hepatitis B, and situations carrying a risk of exposure to the skin or mucous membranes.3,4

Hepatitis B vaccines include:

  • Engerix-B and Recombivax (pediatric and adult formulations)
  • Pediarix, a combination vaccine for children 6 weeks through 6 years of age that also helps protect against diphtheria, tetanus, pertussis, and polio
  • Vaxelis, for children 6 weeks through 4 years of age, a combination vaccine for HepB, Hib, DTaP and polio
  • Heplisav-B, for adults 18 and older
  • PreHevbrio, for adults 18 and older
  • Twinrix, a combination vaccine for adults 18 and older that helps protect against both hepatitis A and hepatitis B. 

References

  1. WHO. Hepatitis B. https://www.who.int/news-room/fact-sheets/detail/hepatitis-b. Published June 24, 2022. Accessed June 26, 2023.
  2. CDC. Hepatitis B. https://www.cdc.gov/hepatitis/hbv/index.htm. Reviewed March 9, 2023. Accessed June 26, 2023.
  3. Weng MK, Doshani M, Khan MA, et al. Universal hepatitis B vaccination in adults aged 19-59 years: updated recommendations of the Advisory Committee on Immunization Practices—United States, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(13):477-483. doi: 10.15585/mmwr.mm7113a1
  4. Schillie S, Vellozzi C, Reingold A et al. Prevention of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2018;67(1):1-31. doi:10.15585/mmwr.rr6701a1
  5. Hill HA, Chen M, Elam-Evans LD, et al. Vaccination coverage by age 24 months among children born during 2018-2019—National Immunization Survey-Child, United States, 2019-2021. MMWR Morb Mortal Wkly Rep. 2023;72(2):33-38. doi:10.15585/mmwr.mm7202a3

Polio

At its peak of activity in the United States, in the early 1950s, polio caused more than 20,000 cases of paralysis a year. That changed dramatically with the development of inactive polio vaccine in 1955 and an oral vaccine in 1963. No cases of wild poliovirus have been reported in the US since 1979.1,2 Meanwhile, a campaign to eliminate polio worldwide is on the verge of success; 2 of the 3 types of wild poliovirus have been declared eradicated, and the one remaining type is endemic in just 2 countries, Pakistan and Afghanistan.1,3,4

However, polio can also be spread by circulation of the virus that is included in the live oral polio vaccine. Known as vaccine-derived poliovirus, it can cause outbreaks in areas where vaccination rates are low. The virus can be brought into the United States by infections originating in other countries, putting unvaccinated individuals at risk.5

Most people infected with poliovirus either do not develop symptoms or experience mild illness with full recovery. Paralysis of more than one limb occurs in 1 to 200-2000 infections, depending on the type of virus involved. Residual paralysis is common; some people experience weakness or paralysis 20 or 30 years after recovering, a condition known as post-polio syndrome.2,6

The CDC recommends 4 doses of polio vaccine for children, at 2 months, 4 months 6 to18 months and 4 to6 years of age.6,7 Inactivated poliovirus vaccine is the only polio vaccine formulation in use in the United States. Other countries around the world may use both oral polio vaccine and IPV.

Polio vaccines include IPOL and several combination vaccines for infants and young children (Pediarix, Pentacel, Vaxelis, Quadracel, Kinrix).6

Most adults probably received polio vaccine when they were children. If, however, they are unvaccinated or only partially vaccinated, it is best to consult with a health care provider about the need for vaccination.

References

  1. World Health Organization: Poliomyelitis (polio). https://www.who.int/health-topics/poliomyelitis#tab=tab_1. Accessed June 20, 2023.
  2. CDC. Polio. https://www.cdc.gov/polio/index.htm. Updated June 28, 2023. Accessed June 30, 2023.
  3. Rachlin A, Patel JC, Burns CC, et al. Progress toward polio eradication—worldwide, January 20-April 2022. MMWR Morb Mortal Wkly Rep. 2022;71(19):650-655. doi:10.15585/mmwr.mm7119a2
  4. Global Polio Eradication Initiative. https://polioeradication.org/who-we-are/. Accessed June 25, 2023.
  5. Link-Gelles R, Lutterloh E, Ruppert PS, et al. Public health response to a case of paralytic poliomyelitis in an unvaccinated person and detection of poliovirus in wastewater—New York, June-August 2022. MMWR Morb Mortal Wkly Rep. 2022;71(33):1065-1068. doi: 10.15585/mmwr.mm7133e2  
  6. CDC. Polio vaccination: what everyone should know. https://www.cdc.gov/
    vaccines/vpd/polio/public/index.html    . Reviewed October 12, 2022. Accessed June 20, 2023.
  7. CDC. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding routine poliovirus vaccination. MMWR Morb Mortal Wkly Rep. 2009;58(30):829-830.

American Academy of Pediatrics. Red Book: 2021-2024 Report of the Committee on Infectious Diseases (32nd Edition). https://publications.aap.org/redbook.

CDC. Recommended child and adolescent immunization schedule for ages 18 years or younger, 2023. https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf. Accessed June 25, 2023.

CDC. Recommended adult immunization schedule for ages 19 years or older. 2023. https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf. Accessed June 25, 2023.

Immunization Action Coalition. https://www.immunize.org.

Vaccinate Your Family. https://vaccinateyourfamily.org/. Marshall GS. The Vaccine Handbook: A Practical Guide for Clinicians, 11th edition. Professional Communications, Inc., West Islip, NY, November 2022.

  • Latest News Your top articles for Wednesday

  • Haymarket Medical NetworkTop Picks

  • Loading...

    Continuing Medical Education (CME/CE) Courses

    Show More