Polio prophylaxis brief 2nd mbbs Microbiology
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WHO polio vaccines routine immunization IPV bOPV 2025
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Polio prophylaxis
Poliomyelitis prevention is mainly by immunization, supported by surveillance, sanitation, and rapid outbreak control.
1. Active immunization
| Feature | OPV | IPV |
|---|---|---|
| Full name | Oral polio vaccine | Inactivated polio vaccine |
| Type | Live attenuated virus | Killed/inactivated virus |
| Serotypes | bOPV: types 1 and 3 | Usually all 3 types |
| Route | Oral drops | Intramuscular/intradermal injection |
| Immunity | Good intestinal and humoral immunity | Predominantly humoral immunity |
| Advantages | Cheap, easy to give, interrupts intestinal transmission, useful in campaigns | No risk of vaccine-associated paralytic polio (VAPP) or vaccine-derived poliovirus |
| Important limitation | Rare VAPP and circulating vaccine-derived poliovirus in under-immunized populations | More costly; less intestinal immunity than OPV |
- OPV induces local intestinal IgA immunity and helps reduce fecal shedding and community transmission.
- IPV is safer in immunodeficient persons because it is non-live.
- Trivalent OPV was withdrawn globally in 2016 and replaced by bOPV, containing poliovirus types 1 and 3. WHO recommends that OPV-using programmes include at least one IPV dose. WHO polio immunization information
2. Immunization in India
National Immunization Schedule:
- OPV-0: at birth
- OPV doses: 6, 10, and 14 weeks
- OPV booster: 16-24 months
- IPV: given at 6 and 14 weeks, according to the current national schedule/programme formulation.
Pulse Polio Immunization (PPI):
- OPV is given to all children below 5 years on National/Sub-national Immunization Days.
- This is given irrespective of routine immunization status.
- Routine immunization must continue because PPI is supplementary, not a replacement.
3. Contraindications/precautions for OPV
Avoid OPV in:
- Primary immunodeficiency or severe immunosuppression
- Children receiving immunosuppressive therapy
- Household contacts of severely immunocompromised persons, where IPV is preferred
IPV can be used in such situations.
4. Other preventive measures
- High routine vaccine coverage, ideally above 90-95%
- Surveillance for acute flaccid paralysis and poliovirus in sewage
- Safe water, sanitary disposal of feces, hand hygiene
- Health education
- In an outbreak, rapid supplementary vaccination of the at-risk population with vaccine selected according to the detected poliovirus type.
Exam points
- No specific drug or immunoglobulin is used for routine post-exposure prophylaxis.
- Polio is prevented primarily by vaccination.
- OPV has the advantage of intestinal immunity, but may rarely cause VAPP/cVDPV.
- IPV is safe because it is inactivated but does not limit gut carriage as effectively as OPV.
Text reference: Park's Textbook of Preventive and Social Medicine, sections on Polio Eradication and Pulse Polio Immunization. Recent reviews continue to support good immunogenicity of IPV-containing and sequential schedules, though schedules are adapted to local epidemiology and programme needs (PMIDs 42060979 and 41163052).
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