Pediatric Updates
Revised Recommendations for Routine Poliomyelitis Vaccination: All IPV Schedule

On June 17, 1999, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) recommended an all-IPV schedule for routine childhood polio vaccination in the United States. As of January 1, 2000, all children should receive four doses of IPV at ages 2 months, 4 months, 6-18 months, and 4-6 years.

OPV should be used only for the following special circumstances:

1. Mass vaccination campaigns to control outbreaks of paralytic polio.
2. Unvaccinated children who will be traveling in less than 4 weeks to areas where polio is endemic.
3. Children of parents who do not accept the recommended number of vaccine injections. These children may receive OPV only for the third or fourth dose or both; in this situation, health-care providers should administer OPV only after discussing the risk for VAPP with parents or caregivers.

This recommendation changes the one from 1997 when ACIP recommended a sequential schedule of inactivated poliovirus vaccine (IPV) followed by OPV to decrease the risk for vaccine-associated paralytic polio (VAPP) while maintaining the benefits of OPV. The change to an all IPV schedule is intended to eliminate the 4 to 5 cases of OPV-VAPP that occur in the US each year (Grabenstein, 1999). ACIP reaffirms its support for the global polio eradication initiative and use of OPV as the vaccine of choice to eradicate polio from the remaining countries where polio is endemic.

Because this change will increase the number of injections for immunization of children, nurses and other health professionals need to make every effort to decrease injection pain (Reis and others, 1998).

References

Grabenstein JD: IPV shift approved, Booster Shots: A Quarterly Supplement of ImmunoFacts, August 1999, p. 2.

Recommendations of the Advisory Committee on Immunization Practices: Revised Recommendations for Routine Poliomyelitis Vaccination, MMWR 48(27):590, July 16, 1999.

Reis EC and others: Taking the Sting Out of Shots: Control of Vaccination-Associated Pain and Adverse Reactions, Pediatric Annals 27(6):375-386, 1998.

Additional Information

A Cooling Spray (Fluori-Methane) Reduces Immunization Injection Pain

Guidelines for Atraumatic Skin/Vessel Punctures

Guidelines for Using EMLA

Keeping Current on Vaccine Recommendations

See Chapter 10 in Essentials of Pediatric Nursing, 5th edition.

See Chapter 12 in Nursing Care of Infants and Children, 6th edition.

March 15, 2002

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