Training for Inactivated Poliovirus Vaccine (IPV)

introduction

Module 1

Introduction to the polio endgame

rationale and IPV vaccine
 Learning objectives
 At the end of the module, the participant will be able
to:
– Understand poliovirus transmission, poliomyelitis disease
and global progress toward polio eradication
– Recognize the vaccines available against polio and the risks
and benefits of each
– Describe the rationale for introducing IPV into the routine
immunization schedule

 Duration
– 25 minutes

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 Key issues

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 What is polio disease?
 Polio (also called Poliomyelitis) is a highly infectious
disease caused by a virus
 The virus invades the nervous system and can cause
permanent paralysis
 Polio is spread through person-to-person contact and
can spread rapidly through a community
 Most infected people (72%) have no symptoms

 However, one in 200 infections leads to permanent

paralysis (can’t move parts of the body) and even death
www.immune.org.nz

4| Introduction to polio endgame rationale and IPV, Module 1 | February 2015

 How does poliovirus spread?
 Poliovirus infection is highly contagious
 Poliovirus is spread mostly by the fecal-oral route
– Primary mode of transmission – passage of the virus in stool to the mouth
of another child
– Can also be spread through saliva or droplets from a sneeze or cough

Child excretes virus in Virus transferred to objects Virus transferred to Virus transferred ingested Next cycle of infection
stool and does not wash from hands another child’s hands
hands after using the
bathroom

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 Advances in Polio Eradication

1988 2013-2014
• 350,000 cases •416 cases reported in 2013
• 125 endemic countries •359 cases reported in 2014
• World Health Assembly resolved •3 endemic countries
to eradicate polio •2013-2014: 7 countries with re-established
transmission

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 Types of polioviruses
 3 Types of polioviruses
– Wild poliovirus (WPV) – 3 serotypes
• Type 1 – 359 cases in 2014 this is the only type of WPV in
circulation today)

• Type 2 – eliminated in 1999

• Type 3 – last case reported in Nov. 2012 (more time is

needed to certify eradication)

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 Types of Oral Polio Vaccines

 3 Types of Oral Polio vaccine

– Trivalent OPV (tOPV): types 1, 2 and 3
• most commonly used OPV in routine immunization globally
– Bivalent OPV (bOPV): types 1 and 3
• commonly used in supplementary immunization activities (SIAs)
– Monovalent OPV (mOPV): type 1, 2 or 3
• primarily used for SIAs in areas where only type 1 or type 3 is circulating

OPV is still the primary vaccine for eradication

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 Paralysis associated with OPV
 OPV offers effective protection against polio, but... in very rare cases it can lead to paralysis
 Vaccine Associated Paralytic Polio (VAPP)
– Vaccine virus spontaneously changes and becomes capable of causing disease
Globally
• 1 case per 2.4 million doses administered; (250-500 cases/year)
• 40% of VAPP are from type 2 OPV
Region of the Americas:
• One case of VAPP per 7.68 million doses administered
• 24% of VAPP cases are caused by the type 2 virus (28%- by type 1, and 31%-type 3)
 Circulating Vaccine Derived Poliovirus (cVDPV)
– Rare outbreaks caused by person-to-person spread of vaccine strain, which
mutates/changes to a highly transmissible form capable of causing disease to the nervous
system, in areas/countries with low coverage
– Low coverage is the main factor for the occurrence of cVDPVs
– 97% of cVDPVs are from type 2 OPV in recent years

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WPV and vaccine-related polio cases 2009-
2014*
Through the use
of OPV, polio
cases related to
the wild poliovirus
.have decreased

Today the number 359

of polio cases due

to OPV is greater
than those related Post-interruption of WPV
transmission
.to the wild virus

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 Polio eradication plan

 In May 2012 the World Health Assembly of WHO declared poliovirus

eradication to be a global public health emergency

 Under this plan to achieve a polio-free world, they recommend that the use of
OPV must eventually be stopped worldwide

 OPV will be withdrawn in 2 phases beginning with type 2 OPV

 Type 2 OPV has the two risks: VAPP and cVDPV – and is no longer needed for
eradication – hence the type 2 containing OPV will be eventually withdrawn
from use globally.

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 Polio eradication plan (continued)
 WHO’s Strategic Advisory Group of Experts (SAGE)
recommends that all countries introduce at least one dose of
IPV into their routine immunization schedule by the end of
2015, before type 2 OPV is withdrawn
 Rationale for this includes:
• Contribute to the final phase of polio eradication
• To reduce risks associated with type 2 OPV withdrawal
• Maintain immunity against polio type 2 during the global
withdrawal

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 Comparison of OPV and IPV?
Inactivated polio vaccine (IPV) Oral polio vaccine (OPV)
• Killed virus • Live, attenuated (weakened) virus
• Administered by injection • Administered by drops
• Highly effective and safe • Highly successful in reducing transmission
• Used commonly in developed countries in developing countries as part of
• More expensive than OPV eradication strategy
• Requires trained health workers • Inexpensive
• Provides humoral immunity • Easy to administer
• Carries no risk of VAPP or cVDPV • Provides humoral immunity and
mucosal/gut immunity
• Protects close contacts who are
unvaccinated

Both vaccines are

needed to fully
!eradicate polio

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 Why IPV?

 IPV introduction sets the stage for ending OPV use entirely after
WPV eradication has been achieved
 When use of OPV is eventually stopped, IPV will continue to
provide full protection
 Introducing IPV to our community is another opportunity to remind
caretakers about the importance of vaccinations
 IPV does not cause any paralysis and is a very safe vaccine

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 Key Messages

 Polio is a highly contagious viral disease that can spread rapidly through person-
to-person contact causing permanent paralysis

 There are 3 types of wild poliovirus but only type 1 remains in circulation today

 OPV is inexpensive and effective at reducing polio transmission in developing

countries, but carries a risk of VAPP and VDPV

 All use of OPV must stop for the world to be completely polio-free

 IPV is being introduced to provide protection against all 3 serotypes, while OPV
is being phased out, to help us make the world polio free

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 Inactivated Polio Vaccine (IPV)

 Our country is about to introduce IPV

 Next modules of this training will explain how to:

 Store the vaccine

 Determine vaccine eligibility
 Administer the vaccine
 Record the vaccine dose
 Monitor Events Supposedly Attributable to Vaccination or
Immunization
 Communicate with caregivers about the vaccine

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 End of module

Thank you
!for your attention

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