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Who is at highest risk for complications from Polio vaccine?


There is a gap in medical knowledge in terms of doctors being able to predict who will have an adverse reaction to polio vaccination, and who will not.

In the U.S. today, the polio vaccine is usually administered in a combination shot that also contain vaccines for diphtheria (D), tetanus (T), and pertussis (whooping cough) (P). Additional vaccines may also include Haemophilus influenzae Type B (HIB) and/or hepatitis B vaccine. 

Pediarix (Diphtheria and tetanus toxoids and acellular pertussis, hepatitis B recombinant and inactivated poliovirus vaccine manufactured by GlaxoSmithKline.)

Children most at risk for complications from Pediarix include:

  • Premature infantsApnea following intramuscular vaccination has been observed in some infants born prematurely. Pediarix vaccine product insert warns that the decision to vaccinate an infant born prematurely should take into consideration both the potential risks and possible benefits of vaccination.
  • Children with latex allergies - The tip caps of prefilled Pediarix syringes contain latex and may cause an allergic reaction in persons sensitive to latex;
  • Previous health history of Guillain-Barré syndrome (GBS) occurring within 6 weeks of receiving a tetanus containing vaccine. Pediarix vaccine package insert states that assessment of the possible risks and potential benefits of receiving Pediarix should be carefully considered prior to vaccination.
  • Children with a progressive neurologic disorder (such as infantile spasms, uncontrolled epilepsy, or progressive encephalopathy);
  • Allergy or sensitivity to any component of Pediarix, including yeast or neomycin and polymyxin (antibiotics);
  • Having a temperature of 105 F or higher within 48 hours of a previous pertussis vaccination, not attributable to another identifiable cause;
  • Collapse or shock-like state within 48 hours of a previous pertussis vaccination;
  • Persistent crying lasting 3 hours or more within 48 hours of a previous pertussis vaccination;
  • Convulsions with or without fever, occurring within 3 days of a previous pertussis vaccination;
  • Serious allergic reaction to a previous pertussis vaccination;
  • Encephalopathy (coma, decreased level of consciousness, prolonged convulsions) within 7 days of a previous pertussis vaccination not attributable to another identifiable cause;

Kinrix (Diphtheria and tetanus toxoids, acellular pertussis and inactivated poliovirus vaccine manufactured by GlaxoSmithKline.)

Children most at risk for complications from Kinrix include:

  • Children with latex allergies - The tip caps of prefilled Kinrix syringes contain latex and may cause an allergic reaction in persons sensitive to latex;
  • Previous health history of Guillain-Barré syndrome GBS) occurring within 6 weeks of receiving a tetanus containing vaccine. Kinrix vaccine package insert states that assessment of the possible risks and potential benefits of receiving Kinrix should be carefully considered prior to vaccination.
  • Severe allergic reaction to any component of Kinrix, including neomycin and polymyxin B (antibiotics);
  • Serious allergic reaction to a previous pertussis vaccination;
  • Temperature of 105 F. or higher within 48 hours of a previous pertussis vaccination, not attributable to another identifiable cause;
  • Collapse or shock-like state (hypotonic-hyporesponsive episodes) within 48 hours of a previous pertussis vaccination;
  • Persistent crying lasting 3 hours or more within 48 hours of a previous pertussis vaccination;
  • Convulsions with or without fever, occurring within 3 days of a previous pertussis vaccination;
  • Encephalopathy (coma, decreased level of consciousness, prolonged convulsions) within 7 days of a previous pertussis vaccination not attributable to another identifiable cause;
  • Children with a progressive neurologic disorder (such as infantile spasms, uncontrolled epilepsy, or progressive encephalopathy);

Quadracel (Diphtheria and tetanus toxoid, acellular pertussis and inactivated poliovirus vaccine manufactured by Sanofi Pasteur.)

Children most at risk for complications from Quadracel include:

  • Serious allergic reaction following administration of a pertussis, tetanus, diphtheria, or polio containing vaccine or any ingredient of Quadracel vaccine;
  • Previous history of Guillain-Barré syndrome (GBS) occurring within 6 weeks of receiving a tetanus containing vaccine. The Quadracel package insert states that assessment of the possible risks and potential benefits of receiving Quadracel should be carefully considered prior to vaccination. 
  • Encephalopathy (coma, decreased level of consciousness, prolonged convulsions) within 7 days of a previous pertussis vaccination not attributable to another identifiable cause;
  • Children with a progressive neurologic disorder (such as infantile spasms, uncontrolled epilepsy, or progressive encephalopathy);
  • Seizures within 3 days of a previous pertussis vaccination;
  • Temperature of 105 F. or higher within 48 hours of a previous pertussis vaccination, not attributable to another identifiable cause;

Pentacel (Diphtheria and tetanus toxoids and acellular pertussis, inactivated poliovirus and Haemophilus b conjugate (tetanus toxoid conjugate) vaccine manufactured by Sanofi Pasteur.)

Children most at risk for complications from Pentacel include:

  • Premature infants - Apnea following intramuscular vaccination has been observed in some infants born prematurely. The Pentacel vaccine product insert warns that the decision to vaccinate an infant born prematurely should take into consideration both the potential risks and possible benefits of vaccination;
  • Severe allergic reaction to any component of Pentacel, including neomycin and polymyxin B (antibiotics);
  • Serious allergic reaction to a previous pertussis vaccination;
  • Previous history of Guillain-Barré syndrome (GBS) occurring within 6 weeks of receiving a tetanus containing vaccine. The Pentacel package insert states that assessment of the possible risks and potential benefits of receiving Pentacel should be carefully considered prior to vaccination. 
  • Children with a progressive neurologic disorder (such as infantile spasms, uncontrolled epilepsy, or progressive encephalopathy)
  • Encephalopathy (coma, decreased level of consciousness, prolonged convulsions) within 7 days of a previous pertussis vaccination not attributable to another identifiable cause;
  • Temperature of 105 F. or higher within 48 hours of a previous pertussis vaccination, not attributable to another identifiable cause;
  • Collapse or shock-like state (hypotonic-hyporesponsive episodes) within 48 hours of a previous pertussis vaccination;
  • Persistent crying lasting 3 hours or more within 48 hours of a previous pertussis vaccination;
  • Convulsions with or without fever, occurring within 3 days of a previous pertussis vaccination;

VAXELIS (Diphtheria and tetanus toxoids and acellular pertussis, inactivated poliovirus, Haemophilus b conjugate, and hepatitis B recombinant vaccine manufactured by MCM Vaccine Company.)

Children most at risk for complications from VAXELIS include:

  • Premature infants - Apneafollowing intramuscular vaccination has been observed in some infants born prematurely. The VAXELIS vaccine product insert warns that the decision to vaccinate an infant born prematurely should take into consideration both the potential risks and possible benefits of vaccination;
  • Previous history ofGuillain-Barré syndrome (GBS) occurring within 6 weeks of receiving a tetanus containing vaccine. The VAXELIS vaccine product insert warns that the decision to vaccinate an infant born prematurely should take into consideration both the potential risks and possible benefits of vaccination;
  • Serious allergic reaction to a previous dose of VAXELIS, any ingredient found in VAXELIS, or any other tetanus toxoid, diphtheria toxoid, pertussis-containing vaccine, hepatitis B vaccine, inactivated poliovirus vaccine, or influenzae type b vaccine;
  • Children with a progressive neurologic disorder (such as infantile spasms, uncontrolled epilepsy, or progressive encephalopathy);
  • Temperature of 105 F. or higher within 48 hours of a previous pertussis vaccination, not attributable to another identifiable cause;
  • Collapse or shock-like state (hypotonic-hyporesponsive episodes) within 48 hours of a previous pertussis vaccination;
  • Persistent crying lasting 3 hours or more within 48 hours of a previous pertussis vaccination;
  • Convulsions with or without fever, occurring within 3 days of a previous pertussis vaccination;
  • Encephalopathy (coma, decreased level of consciousness, prolonged convulsions) within 7 days of a previous pertussis vaccination not attributable to another identifiable cause;

IPOL (inactive poliovirus (Monkey Kidney Cell) manufactured by Sanofi Pasteur)

Persons most at risk for complications from IPOL include:

  • Persons with an allergy or hypersensitivity to any ingredient found within the vaccine, including polymyxin B, neomycin, streptomycin, formaldehyde, and 2-phenoxyethanol;
  • Persons who experience anaphylaxis or anaphylactic shock occurring within 24 hours of vaccine administration;
  • Persons who receive the vaccine when they are experiencing an acute febrile illness.

Oral Poliovirus Vaccine

While not in use in the United States, the oral poliovirus vaccine (OPV) can cause complications, which include paralytic polio. Persons most at risk for developing vaccine-acquired paralytic polio (VAPP) are those who are immunosuppressed with B-cell deficiencies. In this population, the risk is reported to be 3200-times greater than that of the general population. Vaccine-strain type 3 poliovirus is most frequently found in previously healthy individuals who develop VAPP. VAPP in persons with immunosuppression is commonly attributed to vaccine-strain type 2 poliovirus;1 however, OPV containing type 2 poliovirus are no longer in use globally.2

Children who receive intramuscular (IM) injections, usually within 30 days of receiving OPV, are at a greater risk of developing VAPP. This risk also extends to children within the community who have received IM injections and who are exposed to vaccine-strain poliovirus through shedding from OPV recipients.3 4 5

Household contacts and members of the community are also at risk for complications from OPV if they come into contact with the vaccine-strain poliovirus through direct or indirect vaccine-strain shedding and transmission.6 7

IMPORTANT NOTE: NVIC encourages you to become fully informed about Polio and the Polio vaccine by reading all sections in the Table of Contents, which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.

« Return to Vaccines & Diseases Table of Contents

References

1 Bandyopadhyay AS, Garon J, Seib K, Orenstein WA Polio vaccination: past, present and future. Future Microbiol. 2015;10(5):791-808.

2 CDC Cessation of Trivalent Oral Poliovirus Vaccine and Introduction of Inactivated Poliovirus Vaccine — Worldwide, 2016 MMWR Sep 9, 2016; 65(35);934–938

3 Strebel PM, Ion-Nedelcu N, Baughman AL Intramuscular injections within 30 days of immunization with oral poliovirus vaccine--a risk factor for vaccine-associated paralytic poliomyelitis. N Engl J Med. 1995 Feb 23;332(8):500-6.

4 Wyatt HV Injections and poliomyelitis: what are the risks of vaccine associated paralysis? Dev Biol Stand. 1986;65:123-6.

5 Gromeier M, Wimmer E. Mechanism of injury-provoked poliomyelitis. J Virol. 1998 Jun;72(6):5056-60.

6 Strebel PM, Aubert-Combiescu A, Ion-Nedelcu N et al.  Paralytic poliomyelitis in Romania, 1984-1992. Evidence for a high risk of vaccine-associated disease and reintroduction of wild-virus infection. Am J Epidemiol. 1994 Dec 15;140(12):1111-24.

7 Örstavik I, Flugsrud LB, Lahelle O Paralytic poliomyelitis in Norway since the introduction of trivalent oral vaccine: an epidemiological and virological study Bull World Health Organ. 1971; 45(6): 733–739.


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