Inactivated Polio Vaccine

Inactivated Polio Vaccine (IPV) is a prescription medication belonging to the vaccine class.

Inactivated Polio vaccine is approved to prevent polio (poliomyelitis), a viral infectious disease caused by the poliovirus.

After being injected, the inactivated polio vaccine is absorbed into the circulation, circulated throughout the body, metabolized by the liver, and then excreted through the urine.

The common side effects of the Inactivated Polio vaccine include redness, pain, swelling, a lump at the administered site, or fever.

Inactivated Polio vaccine is available in the form of injectable suspension.

Inactivated Polio Vaccine (IPV) is available in the United States, the United Kingdom, India, Canada and Australia.

Inactivated Polio Vaccine (IPV), belonging to the vaccine class, acts as an inactivated poliovirus itself.

Inactivated Polio Vaccine (IPV) acts via Immune response against inactivated poliovirus.

The Inactivated Poliovirus Vaccine (IPV) delivers inactivated poliovirus strains (wild-types 1, 2, and 3) into the body to boost the immune system. It is administered typically through intramuscular or subcutaneous injection. Once administered, these inactivated viruses are processed and distributed by antigen-presenting cells, including B cells and macrophages, causing them to trigger an immune response. B-cell growth and differentiation are involved in this response, which results in a production of anti-poliovirus serum antibodies. These antibodies possess several functions, such as opsonization, neutralization, and complement activation, which help fight off poliovirus. IPV is effective in preventing systemic poliovirus disease. It helps lower the acquisition of poliovirus in the throat and, to some extent, in the intestines. Herd immunity, which benefits populations that only receive IPV vaccinations, is another advantage of IPV.

The length of disease protection is long-lasting (years), although the onset of it is relatively slow.

Inactivated Polio vaccine is available in the form of injectable suspension.

Injectable suspension: To be administered parenterally, as applicable

Inactivated Polio vaccine can be used as follows:

• Adults and children should be protected against polio.
• Programmes for routine immunization.
• Visitors to areas where polio is endemic.
• Immunity in populations at high risk.

Inactivated Polio vaccine can help support the following health benefits:

• Prevention: IPV provides serum immunity to all three poliovirus types, protecting against paralytic poliomyelitis. It offers robust immunity against polio infection, reducing the risk of transmission within communities.
• Global Polio Eradication: IPV is an essential vaccine to eradicate polio infection globally. Countries can contribute to the worldwide goal of eradicating polio by vaccinating populations with IPV.
• Herd Immunity: Herd immunity is considerably boosted by the inactivated polio vaccine (IPV). When enough of the population receives IPV vaccination, poliovirus transmission is reduced, protecting those who cannot accept the vaccine, such as people with compromised immune systems. IPV is essential in the ongoing fight against polio because the combination of immunity lowers the possibility of outbreaks and is essential to international efforts to eradicate polio.

• Low Risk of Vaccine-Associated Paralytic Polio (VAPP): When compared to the oral polio vaccine (OPV), the inactivated polio vaccine (IPV) offers a significant benefit by reducing the risk of vaccine-associated paralytic polio (VAPP). IPV is the preferred choice due to its improved safety profile, especially in areas with a low prevalence of wild poliovirus, which helps to maintain the effectiveness and safety of immunization programmes.

Inactivated Polio vaccine is used to prevent poliomyelitis, alone or in combination with oral poliomyelitis (bOPV).

Parenterally: Inactivated Polio vaccines (IPV) are available in injectable suspension and should be administered intramuscularly, intradermally or subcutaneously and not given intravenously. Injectable suspension IPV is typically injected into the muscles of the upper arm or thigh, depending on the patient’s age, as a single dose injection and can be only given by a healthcare professional in a hospital setting or during routine immunization programs.

The dosage and duration of treatment should be as per the clinical judgement of the treating physician

Injectable suspension: 5mL/vial

Inactivated Polio vaccine is available in the form of injectable suspension.

Dosage Adjustment for Adult Patients

Poliovirus Prophylaxis

Unvaccinated previously:

Administer 0.5 mL/dose for 3 doses as follows: Two 0.5 mL doses are administered at 1 to 2-month intervals, followed by a third dose 6 to 12 months later. If below 3 months, but at least 2 months are available before protection is needed, 3 doses may be administered at least 1 month apart. Give two doses at least one month apart if the administration must be completed within 1 to 2 months. Give 1 dose if less than 1 month is available.

Incompletely vaccinated:

Adults who have received less than three doses of IPV, at least one dose of OPV, or a combination of OPV and IPV, totalling fewer than three doses, should provide at least one 0.5 mL of IPV. Additional amounts to complete the series may be given if time permits.

Completely vaccinated:

Adults can receive 1 booster dose (0.5 mL dose) intramuscularly or subcutaneously if travelling to polio-endemic areas or areas where the risk of exposure is very high.

Inactivated Polio vaccine (IPV) should be used to prevent poliomyelitis along with no appropriate dietary restrictions. IPV usually has little effect on dietary or food substances when administered. Consuming regular foods and drinks before and after receiving the vaccine is safe.

It is commonly advised to stay well hydrated by drinking water or other fluids after vaccination so as to reduce the risk of any side effects.

The dietary restriction should be individualized as per patient requirements.

Inactivated Polio vaccine (IPV) may be contraindicated in the following conditions:-

• Anaphylaxis (previous dose of IPV or any of its components)
• Hypersensitivity to neomycin, streptomycin, polymixin B
• Acute febrile illness
• Concomitant use of methotrexate
• Immunodeficiency disorders like HIV infection.

The treating physician must closely monitor the patient and keep pharmacovigilance as follows.

Those who intend to receive any live virus vaccinations, such as those for measles, mumps, rotavirus, smallpox, etc., must consult with a healthcare professional within a month of taking IPV.

IPV should not be administered to patients receiving immunosuppressive medication (such as chemotherapy or high-dose corticosteroids) as it might not work in such cases and could increase the risk of vaccine-related complications.

IPV is not typically recommended during pregnancy unless there is a specific risk of exposure to the poliovirus.

Caution is advised when consuming alcohol with an Inactivated Polio Vaccine.

There is no sufficient scientific evidence traceable regarding the use and safety of Inactivated Polio Vaccine in breast feeding population.

Safe to use during pregnancy.

There is no sufficient scientific evidence traceable regarding use and safety of Inactivated Polio Vaccine in concurrent use with any particular food.

The adverse reactions related to Inactivated polio vaccine can be categorized as

• Common: Pain, redness, swelling at the injection site and low-grade fever.
• Less Common: Fatigue and GI symptoms like nausea or diarrhoea.
• Rare: Allergic Reactions and neurological issues.

The clinically relevant drug interactions of the Inactivated polio vaccine are briefly summarized here:

• Immunosuppressants- Drugs like prednisone or cyclosporine suppresses the immune system and may reduce the effectiveness of IPV when used.
• Immunoglobulins: Immunological globulins, such as intravenous immunoglobulin (IVIG), can interfere with the immunological response to IPV when administered concurrently. The vaccination may need to be administered more often or in greater doses for optimal outcomes.
• Other Vaccines: Multiple vaccinations, including IPV, given at the same time may increase the risk of adverse reactions. To reduce such a risk, medical professionals frequently adhere to vaccination regimens considering the time and space of vaccines.

The common side of Inactivated Polio Vaccine (IPV) includes the following-

• Redness, pain, swelling, or a lump at the site where the shot was given
• Low or high fever
• Joint pain, body aches
• Drowsiness
• Vomiting
• Problems with breathing
• Extreme behavioural changes
• Continuous crying for three hours or longer in case of infants and children
• Seizures
• Unexpected weakness or fatigue

The use of Inactivated Polio Vaccine (IPV) should be prudent in the following group of special populations

• Pregnancy:

Pregnancy Category: C. Safe during pregnancy, but when taken in high doses, use with caution if the benefits outweigh the risks.

IPV is usually considered safe during pregnancy; it is mostly advised when there is a significant risk of polio exposure. Unless the risk of exposure is very high, routine vaccinations are normally not recommended during pregnancy.

• Paediatrics:

Paediatric patients are given IPV (Inactivated Polio Vaccine) to protect them from poliovirus infections. To protect childrens health and wellbeing, it is an integral part of routine childhood immunization programmes.

The dosage of IPV is given along with the first dose of bOPV in children who begin regular vaccinations later (after the age of 3 months). Then 2 doses of bOPV alone are given 4 weeks apart after that, keeping in mind that vaccination needs to be provided in a fixed schedule.

Dosage Adjustment for Paediatric Patients

Poliovirus Prophylaxis

Less than 6 weeks old: Safety and efficacy not established

0.5 mL SC/IM; 2 doses 1-2 months apart (at 2 and 4 months old), 3rd dose 18 months later; and 4th dose (also known as booster immunization) at age 4-6 years old before entering school. The booster immunization should be administered at least 6 months from the previous dose.

• Geriatrics:

For older individuals travelling to endemic areas or those with insufficient vaccination records, a single dose of 0.5 ml of the inactivated polio vaccine (IPV) as a booster dose administered intramuscularly or subcutaneously may provide a reliable and safe option for polio prevention.

• Lactating mothers:

There is no sufficient scientific evidence traceable regarding the use and safety of histidine for lactating mothers populations.

Dosage Adjustment in Kidney Impairment

There are no specific dosage adjustments provided.

Dosage Adjustment in Hepatic Impairment

There are no specific dosage adjustments provided.

Overdosage of IPV (Inactivated Polio Vaccine) suspension rarely occurs because healthcare professionals administer it according to specific or precise dosing guidelines.

There is no specific antidote or treatment for excessive intake of IPV. Medical attention should be sought immediately when an overdose is suspected, followed by monitoring any adverse effects or allergic reactions. Supportive therapy should also be given, addressing any symptoms that persist or worsen. Physical treatment might be added if necessary.

Pharmacodynamics of IPV:

The inactivated polio vaccine (IPV) has a physiological mechanism that plays a role in its pharmacodynamics. The immune system is stimulated by IPV to develop poliovirus-blocking antibodies. The inactivated poliovirus antigens in the vaccination cause an immunological reaction when given. These antigens are recognized and processed by immune cells, including B cells and macrophages. As a result of this processing, B cells get activated and grow more numerous, producing anti-poliovirus antibodies. These antibodies serve several purposes, such as opsonization (marking the virus for destruction), neutralization (making the virus inert), and complement system activation (improving immune response). In conclusion, the pharmacodynamics of IPV include the production of particular antibody-mediated immunity against the poliovirus, preventing people from acquiring the disease.

Pharmacokinetics of IPV:

Absorption: The drug enters the bloodstream from its injection site after administration.

Distribution: Drugs are transported throughout the body through the bloodstream after absorption. The drug molecules enter various tissues and organs, and the concentration of the molecules varies depending on the area of the body.

Metabolism: The chemical processes a medication goes through in the body to be broken down into various components are called metabolism. The primary site for drug metabolism is the liver, and this transformation can make the drug more water-soluble, which helps in its elimination.

Elimination: Once metabolized or in its original form, the drug leaves the body mainly through the kidneys in the form of urine, although it can also leave the body through other channels such as bile, sweat, saliva, and even exhaled air.

• https://www.pdr.net/drug-summary/?drugLabelId=Ipol-poliovirus-vaccine-inactivated-973#
• https://medicalguidelines.msf.org/
• Adams J. Francke E, Lillestol M. Poliomyelitis vaccination (letter). New England Journal of Medicine 1977; 297:1290-1291.
• ttps://www.cdc.gov/vaccines/vpd/polio/hcp/