Measles, mumps and rubella (MMR) are three very dangerous infectious diseases which cause

severe morbidity, disability and death in low-income countries.

Based on the evidence provided by three cohort studies (3104 participants), vaccination with

one dose of MMR vaccine is at least 95% effective in preventing clinical measles among

preschool children; in schoolchildren and adolescents at least one dose of MMR vaccine was

98% effective in preventing laboratory-confirmed measles cases; one or two MMR doses were

respectively 92% and 95% effective in preventing secondary measles cases.

At least one dose of MMR vaccine is effective in preventing clinical mumps among children and

adolescents when prepared with Jeryl Lynn strains (vaccine effectiveness = 69% to 81%,

one cohort and one case-control study, 1656 participants), as well as when prepared with

Urabe strain (vaccine effectiveness = 70% to 75%, one cohort and one case-control study,

1964 participants). Effectiveness against laboratory-confirmed mumps in children and

adolescents was estimated to be between 64% to 66% for one and 83% to 88% for two doses of

Jeryl Lynn MMR (two case-control studies, 1664 participants) and 87% for Urabe-containing

MMR (one cohort study, 48 participants). Vaccination with Urabe MMR confers protection

against secondary mumps infection (vaccine effectiveness = 73%, one cohort study, 147

participants).

We identified no studies assessing the effectiveness of MMR vaccine against clinical or

laboratory-confirmed rubella.

Results from two very large case series studies involving about 1,500,000 children who were

given the MMR vaccine containing Urabe or Leningrad-Zagreb strains show this vaccine to be

associated with aseptic meningitis; whereas administration of the vaccine containing Moraten,

Jeryl Lynn, Wistar RA, RIT 4385 strains is associated with febrile convulsion in children aged

below five years (one person-time cohort study, 537,171 participants; two self controlled case

series studies, 1001 participants). The MMR vaccine could also be associated with idiopathic

thrombocytopaenic purpura (two case-controls, 2450 participants, one self controlled case

series, 63 participants).

We could assess no significant association between MMR immunisation and the following

conditions: autism, asthma, leukaemia, hay fever, type 1 diabetes, gait disturbance, Crohn's

disease, demyelinating diseases, or bacterial or viral infections. The methodological quality of

many of the included studies made it difficult to generalise their results.

The glossary of study designs is available in the full-text review.- See more at: http://summaries.cochrane.org/CD004407/ARI_using-the-combined-vaccine-for-protection-of-children-against-measles-mumps-and-rubella#sthash.3l22t2Sd.dpuf

Children (< 16 years old) and the elderly (above 65 years old) are the two age groups that

appear to have the most complications following an influenza infection. Influenza has a viral

origin and often results in an acute respiratory illness affecting the lower or upper parts of the

respiratory tract, or both. Viruses are mainly of two subtypes (A or B) and spread periodically

during the autumn-winter months. However, many other viruses can also cause respiratory tract

illnesses.

Diffusion and severity of the disease could be very different during different epidemics. Efforts to

contain epidemic diffusion rely mainly on widespread vaccination. Recent policy from several

internationally-recognised institutions, recommend immunisation of healthy children between 6

and 23 months of age (together with their contacts) as a public health measure.

The review authors found that in children aged from two years, nasal spray vaccines made from

weakened influenza viruses were better at preventing illness caused by the influenza virus than

injected vaccines made from the killed virus. Neither type was particularly good at preventing 'flu-

like illness' caused by other types of viruses. In children under the age of two, the efficacy of

inactivated vaccine was similar to placebo. It was not possible to analyse the safety of vaccines

from the studies due to the lack of standardisation in the information given, but very little

information was found on the safety of inactivated vaccines, the most commonly used vaccine in

young children.- See more at: http://summaries.cochrane.org/CD004879/ARI_vaccines-for-preventing-influenza-in-healthy-children#sthash.1LRVTOCG.dpuf

Japanese encephalitis is a viral disease of the central nervous system with general

symptoms of headache, fever, vomiting, and diarrhoea. Most people recover within a

week without further complications, but approximately 1 in 300 suffers additional

and severe symptoms such as disorientation, seizures, paralysis, and coma. Around

thirty per cent of the severe cases are fatal and most survivors are left with serious

and often chronic disabilities such as mental impairment, limb paralysis, and

blindness. In thisreview of randomized controlled trials, a commercially available

inactivated vaccine given in two doses was shown to provide disease protection for

at least one year after vaccination, but with some adverse events. Disease

protection by two vaccines, widely used in China but presently commercially

unavailable, has not been investigated in randomized controlled trials.

Further research is needed on all currently used as well as newly developed

vaccines.Background: Vaccination is recognized as the only practical measure for preventing Japanese encephalitis. Production shortage, costs, and issues of licensure impair vaccination programmes in many affected countries. Concerns over vaccine effectiveness and safety also have a negative impact on acceptance and uptake.Objectives: To evaluate vaccines for preventing Japanese encephalitis in terms of effectiveness, adverse events, and immunogenicity.Search strategy: In March 2007, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2007, Issue 1), MEDLINE, EMBASE, LILACS, BIOSIS, and reference lists. We also attempted to contact corresponding authors and vaccine companies.Selection criteria: Randomized controlled trials (RCTs), including cluster-RCTs, comparing Japanese encephalitis vaccines with placebo (inert agent or unrelated vaccine), no intervention, or alternative Japanese encephalitis vaccine.

Data collection and analysis: Authors independently extracted data and assessed methodological quality. Dichotomous data were compared with risk ratios and a 95% confidence interval (CI), and converted into percentage vaccine efficacy.Main results: Eight RCTs involving 358,750 participants were included. These trials investigated two available and three pre-licensure vaccines. Two RCTs assessing efficacy of the commercially available inactivated Nakayama vaccine were identified. A two-dose schedule of the licensed vaccine provided significant protection of 95% (95% CI 10% to 100%) for one year only, while two doses of an unpurified precursor vaccine protected children by 81% (95% CI 45% to 94%) in year one and by 59% (95% CI 2% to 83%) in year two. Serious adverse events were not observed. Mild and moderate episodes of injection site soreness, fever, headache, and nausea were reported in less than 6% of children receiving inactivated vaccine compared to 0.6% of unvaccinated controls. One cluster-RCT compared the live-attenuated SA14-14-2 vaccine (widely used in China) with no intervention measuring adverse events. Fever was reported in 2.7% of vaccinees compared to 3.1% of controls, while 0.1% of both groups suffered diarrhoea or seizures. Four small pre-licensure RCTs assessing a genetically engineered vaccine and two cell culture-derived inactivated vaccines revealed high immunogenicity and relative safety.Authors' conclusions: Only one of the three currently used vaccines has been assessed for efficacy in a RCT. Other RCTs have assessed their safety, however, and they appear to cause only occasional mild or moderate adverse events. Further trials of effectiveness and safety are needed for the currently used vaccines, especially concerning dose levels and schedules. Trials investigating several new vaccines are planned or in progress.- See more at: http://summaries.cochrane.org/CD004263/INFECTN_two-doses-of-an-inactivated-vaccine-can-help-prevent-japanese-encephalitis-disease-for-at-least-one-year-however-comparisons-with-other-widely-used-vaccines-are-not-available#sthash.qNwvWE13.dpuf

Polio eradication-lessons from the past and future perspective.Jain S1, P B2, Singh S3, Singla A3, Kundu H1, Singh K1.Author information

1Tutor, D.J College of Dental Sciences and Research , Modinagar, District Ghaziabad, Uttar Pradesh, India .

2Professor & Head Department, Department of Public Health Dentistry, D.J College of Dental Sciences and Research , Modinagar, District Ghaziabad, Uttar Pradesh, India .

3Senior Lecturer, Department of Public Health Dentistry, D.J College of Dental Sciences and Research , Modinagar, District Ghaziabad, Uttar Pradesh, India .

BACKGROUND:India has recently achieved the "Polio free status" by WHO with stringent efforts of the Health Ministry to control its spread. However, we should not forget the lessons learnt from the failure of National

malaria eradication Programme and National Tuberculosis control Programme which creates a need to assess the probable barriers for the various National Health Programmes. The present article presents an overview of the Polio Eradication programme in India highlighting the lessons learnt from the past. Also, it evaluates the reality behind full participation of Pulse Polio Programme.

MATERIALS AND METHODS:The study results of a cross-sectional survey conducted with an aim to assess the probable reasons and barriers behind non compliance of Pulse Polio Programme among parents of children (1-5 yr of age) of Modinagar area have also been discussed. The survey instrument was a structured, 10 item, closed ended questionnaire.

STATISTICAL ANALYSIS USED:Chi-square test was used to analyze the difference between proportions of individual responses for each question and multiple logistic regression was used to assess relation between socio demographic parameter and absence from Polio Ravivaar.

RESULTS:The study reveals a surprising 68% attendance of Pulse Polio programme which is far behind the desired goal. Most of the parents who did not attend polio ravivaar considered that there was no need for the repetition of Polio vaccine (76.9%) followed by their fear that the vaccine might get contaminated during transportation (74.5%). A significant positive association was found between older age group of the eligible children (4-5 yr, O.R.1.52), female gender, illiterate parents, distance of more than one km from residence to vaccination and lack of source of information (O.R. 1.47).

CONCLUSION:Efforts should be done to investigate the probable reasons behind non compliance for various immunization programmes to analyse the current situation in detail and formulate appropriate programs for coming years so that the efforts so far don't go in vain and we secure a healthyPolio free nation for our future generations.

Effect of multiple, simultaneous vaccines on polio seroresponse and associated health outcomes.Broderick MP1, Oberste MS2, Moore D2, Romero-Steiner S2, Hansen CJ3, Faix DJ3.

Author informationAbstractBACKGROUND:Administration of multiple simultaneous vaccines to infants, children, and military recruits is not uncommon. However, little research exists to examine associated serological and health effects, especially in adults.

METHOD:We retrospectively examined 416 paired serum specimens from U.S. military subjects who had received the inactivated polio vaccine (IPV) alone or in combination with either 1 other vaccine (<3 group) or 4 other vaccines (>4 group). Each of the 2 groups was subdivided into 2 subgroups in which Tdap was present or absent.

RESULTS:The >4 group was associated with a higher proportion of polio seroconversions than the <3 group (95% vs. 58%, respectively, p<0.01). Analysis of the <3 subgroup that excluded Tdap vs. the >4 subgroup that excluded Tdap showed no difference between them (p>0.1). However, the >4 subgroup that included Tdap had significantly more seroconversions than either the <3 subgroup that excluded Tdap or the >4 subgroup that excluded Tdap (p<0.01). Overall, at least 98% of subjects were at or above the putative level of seroprotection both pre- and post-vaccination, yet at least 81% of subjects

seroconverted. In an analysis of 400 of the subjects in which clinic in- and outpatient encounters were counted over the course of 1 year following vaccinations, there was no significant difference between the 2 groups (p>0.1).

CONCLUSION:A combination of >4 vaccines including IPV appeared to have an immunopotentiation effect on polio seroconversion, and Tdap in particular was a strong candidate for an important role. The dose of IPV we studied in our subjects, who already had a high level of seroprotection, acted as a booster. In addition, there appear to be no negative health consequences from receiving few versus more multiple simultaneous vaccinations.

Published by Elsevier Ltd.

Polio is an infectious disease caused by a virus. The virus lives in an infected person's throat and

intestines. It is most often spread by contact with the stool of an infected person. You can also get it

from droplets if an infected person sneezes or coughs. It can contaminate food and water if people do

not wash their hands.

Most people have no symptoms. If you have symptoms, they may include fever, fatigue, nausea,

headache, flu-like symptoms, stiff neck and back, and pain in the limbs. A few people will become

paralyzed. There is no treatment to reverse the paralysis of polio.

Some people who've had polio develop post-polio syndrome (PPS) years later. Symptoms include

tiredness, new muscle weakness, and muscle and joint pain. There is no way to prevent or cure PPS.

The polio vaccine has wiped out polio in the United States and most other countries.

Centers for Disease Control and Prevention

http://www.nlm.nih.gov/medlineplus/polioandpostpoliosyndrome.html

The virusPolio is caused by a human enterovirus called the poliovirus. Wild polioviruses are those that occur naturally. 

The poliovirus consists of an RNA genome enclosed in a protein shell called a capsid. There are three serotypes of wild poliovirus – type 1, type 2, and type 3 – each with a slightly different capsid protein.

The wild poliovirus as seen through a microscope. The virus invades the nervous system, causing

paralysis in one out of every 200 children.

From GPEI site photo gallery

Type 2 poliovirus has been eliminated in the wild – the last wild type 2 poliovirus was detected in India in 1999. 

In this final stage of polio eradication, only type 1 and type 3 wild poliovirus continue to circulate in endemic areas. Both are highly infectious and both cause paralytic polio. Type 1 is the most pervasive strain of poliovirus and type 3 is at very low levels.- See more at: http://www.polioeradication.org/Polioandprevention/Thevirus.aspx#sthash.gmkMGYIN.dpuf

Polio and preventionPolio is a crippling and potentially fatal infectious disease. There is no cure, but there are safe and effective vaccines. The strategy to eradicate polio is therefore based on preventing infection by immunizing every child until transmission stops and the world is polio-free.

The disease

Polio (poliomyelitis) is a highly infectious disease caused by a virus. It invades the nervous system and can cause irreversible paralysis in a matter of hours.

An Indian boy’s legs are shrunken from paralysis caused by polio

WHO/T. Moran

Who is at risk?

Polio can strike at any age, but it mainly affects children under five years old.

Transmission

Polio is spread through person-to-person contact. When a child is infected with wild poliovirus, the virus enters the body through the mouth and multiplies in the intestine. It is then shed into the environment through the faeces where it can spread rapidly through a community, especially in situations of poor hygiene and sanitation. If a sufficient number of children are fully immunized against polio, the virus is unable to find susceptible children to infect, and dies out.

Young children who are not yet toilet-trained are a ready source of transmission, regardless of their environment. Polio can be spread when food or drink is contaminated by faeces. There is also evidence that flies can passively transfer poliovirus from faeces to food.

Most people infected with the poliovirus have no signs of illness and are never aware they have been infected. These symptomless people carry the virus in their intestines and can “silently” spread the infection to thousands of others before the first case of polio paralysis emerges.

For this reason, WHO considers a single confirmed case of polio paralysis to be evidence of an epidemic – particularly in countries where very few cases occur.

Symptoms

Most infected people (90%) have no symptoms or very mild symptoms and usually go unrecognized. In others, initial symptoms include fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs.

Acute flaccid paralysis (AFP)

One in 200 infections leads to irreversible paralysis, usually in the legs. This is caused by the virus entering the blood stream and invading the central nervous system. As it multiplies, the virus destroys the nerve cells that activate muscles. The affected muscles are no longer functional and the limb becomes floppy and lifeless – a condition known as acute flaccid paralysis (AFP).

All cases of acute flaccid paralysis (AFP) among children under fifteen years of age are reported and tested for poliovirus within 48 hours of onset.

Bulbar polio

More extensive paralysis, involving the trunk and muscles of the thorax and abdomen, can result in quadriplegia. In the most severe cases (bulbar polio), poliovirus attacks the nerve cells of the brain stem, reducing breathing capacity and causing difficulty in swallowing and speaking. Among those paralysed, 5% to 10% die when their breathing muscles become immobilized.

In the 1940s and 1950s, people with bulbar polio were immobilized inside "iron lungs" – huge metal cylinders that operated like a pair of bellows to regulate their breathing and keep them alive. Today, the iron lung has largely been replaced by the positive pressure ventilator, but it is still in use in some countries.

Post-polio syndrome

Around 40% of people who survive paralytic polio may develop additional symptoms 15–40 years after the original illness. These symptoms – called post-polio syndrome – include new progressive muscle weakness, severe fatigue and pain in the muscles and joints.

Risk factors for paralysis

No one knows why only a small percentage of infections lead to paralysis. Several key risk factors have been identified as increasing the likelihood of paralysis in a person infected with polio. These include:

immune deficiency pregnancy

removal of the tonsils (tonsillectomy) intramuscular injections, e.g. medications strenuous exercise injury.

Treatment and prevention

There is no cure for polio, only treatment to alleviate the symptoms.  Heat and physical therapy is used to stimulate the muscles and antispasmodic drugs are given to relax the muscles. While this can improve mobility, it cannot reverse permanent polio paralysis.

Polio can be prevented through immunization. Polio vaccine, given multiple times, almost always protects a child for life.- See more at: http://www.polioeradication.org/Polioandprevention.aspx#sthash.4WRN6uyM.dpuf

The vaccinesThe development of effective vaccines to prevent paralytic polio was one of the major medical breakthroughs of the 20th century. With the development and evaluation of bivalent oral polio vaccine in 2009, the Global Polio Eradication Initiative now has an armoury of five different vaccines to stop polio transmission:

Four different oral polio vaccines are available to stop polio transmission. From left to right: mOPV3, mOPV1, bOPV and OPV

WHO/Rod Curtis

  • Oral polio vaccine (OPV)  • Monovalent oral polio vaccines (mOPV1 and mOPV3)  • Bivalent oral polio vaccine (bOPV)  • Inactivated polio vaccine (IPV)

If enough people in a community are immunized, the virus will be deprived of susceptible hosts and will die out. High levels of vaccination coverage must be maintained to stop transmission and prevent outbreaks occurring. The Global Polio Eradication Initiative is constantly assessing the optimal use of the different vaccines to prevent paralytic polio and stop poliovirus transmission in different areas of the world.- See more at: http://www.polioeradication.org/Polioandprevention/Thevaccines.aspx#sthash.aBImyfQl.dpuf

Oral polio vaccine (OPV)

The oral polio vaccine (OPV) was developed in 1961 by Albert Sabin. Also called “trivalent oral polio vaccine” or “Sabin vaccine”, OPV consists of a mixture of live, attenuated (weakened) poliovirus strains of all three poliovirus types.

The oral polio vaccine is simple to administer. A few drops, given multiple times, can protect a child for life. 

WHO/Rod Curtis

OPV produces antibodies in the blood to all three types of poliovirus. In the event of infection, these antibodies protect against paralysis by preventing the spread of wild poliovirus to the nervous system. 

OPV also produces a local, mucosal immune response in the mucous membrane of the intestines. In the event of infection, these mucosal antibodies limit the replication of the wild poliovirus inside the intestine. This intestinal immune response to OPV is thought to be the main reason why mass campaigns with OPV can rapidly stop person-to-person transmission of wild poliovirus.

Advantages

OPV is administered orally. It can be given by volunteers and does not require trained health workers or sterile injection equipment.

The vaccine is relatively inexpensive. In 2011, the cost of a single dose for public health programmes in developing countries was between 11 and 14 US cents. 

OPV is safe, effective, and induces long-lasting immunity to all three types of poliovirus.

For several weeks after vaccination, the vaccine virus replicates in the intestine, is excreted in the faeces, and can be spread to others in close contact. This means that in areas where hygiene and sanitation are poor, immunization with OPV can result in the “passive” immunization of people who have not been directly vaccinated.

Disadvantages

Although OPV is safe and effective, in extremely rare cases (approx. 1 in every 2.7 million first doses of the vaccine) the live attenuated vaccine virus in OPV can cause paralysis. In some cases it is believed that this vaccine-associated paralytic polio (VAPP) may be triggered by immune deficiency. 

The extremely low risk of VAPP is well known and accepted by most public health programmes in the world because without OPV, hundreds of thousands of children would be crippled every year. 

A second disadvantage is that very rarely the virus in the vaccine may genetically change and start to circulate among a population. These viruses are known as circulating vaccine-derived polioviruses (cVDPV).

Safety

OPV is an extremely safe vaccine. All OPV used in supplementary immunization activities for the Global Polio Eradication Initiative is pre-qualified by WHO and procured through UNICEF. In 2006, WHO issued a statement to affirm the quality and safety of OPV.

Oral polio vaccine is usually provided in vials containing 10–20 doses of vaccine. A single dose is usually two drops

Efficacy

OPV is highly effective against all three types of wild poliovirus. When this vaccine is used however, there is competition among the three viruses to cause immunity, which results in protection but not with equal efficiency for each type: it is most effective against type 2.

One dose of OPV produces immunity to all three poliovirus serotypes in approximately 50% of recipients. Three doses produce immunity in more than 95% of recipients. Immunity is long-lasting and probably life-long.

Recommended use

In most countries, OPV remains the vaccine of choice in routine immunization schedules and supplementary immunization activities. 

Where more than one type of wild poliovirus is circulating, OPV is epidemiologically and operationally the best vaccine to use because protection develops to each of the three types of polio virus.- See more at: http://www.polioeradication.org/Polioandprevention/Thevaccines/Oralpoliovaccine(OPV).aspx#sthash.uoXSGtV4.dpuf

Monovalent oral polio vaccines (mOPV)Monovalent oral polio vaccines (mOPV) consist of live, attenuated (weakened) poliovirus strains of either type 1 (mOPV1) or type 3 (mOPV3) poliovirus only. Unlike OPV, it does not contain the other two types of poliovirus. The vaccine gives protection against one type of poliovirus only (either type 1 or type 3 depending on the vaccine).

Monovalent oral polio vaccine type 1 provides a much stronger immunity to type 1 poliovirus compared with OPV

Monovalent oral polio vaccines were used extensively in the early days of polio vaccination in the late 1950s and early 1960s. However, from 1963, mOPVs were replaced by OPV, where protection against all three types of wild poliovirus could be given at the same time – an important consideration when more than one type of wild poliovirus was circulating.

In 2005, new mOPVs were introduced to more rapidly interrupt the final strains of poliovirus transmission around the world. 

Monovalent oral polio vaccine type 1 was first used in India in April 2005, and has subsequently been used in many areas since the adoption of a strategy to primarily target type 1 poliovirus, the type which is the more paralytic and spreads more easily than type 3.

Monovalent oral polio vaccine type 3 was introduced in India and Afghanistan in 2005 to interrupt endemic strains of polio type 3 in targeted areas. Experience in western Uttar Pradesh and in parts of Bihar demonstrated that rapid, large-scale mOPV3 campaigns had a significant impact on type 3 transmission. The vaccine has subsequently been used in Nigeria and Pakistan and to tackle an outbreak of imported poliovirus in Chad.

Advantages

Monovalent oral polio vaccines offer the same advantages as OPV. In addition:

In children being immunized for the first time, mOPV1 (or mOPV3) provides a much stronger immunity to type 1 (or type 3) poliovirus compared with OPV.

For the same number of doses, mOPV1 (or mOPV3) provides increased immunity to type 1 (or type 3) poliovirus compared to OPV. This is because there is no competition from the other two virus types in the vaccine.

If children immunized with mOPV1 (or mOPV3) are subsequently exposed to wild poliovirus type 1 (or type 3), they will excrete less virus and for a shorter period of time, limiting the possibility of further transmission.

Safety

Based both on years of use and the administration of tens of millions of doses, monovalent oral polio vaccines are known to be a safe, with safety records similar to trivalent OPV.

Efficacy

Approximately twice as many children develop immunity to poliovirus type 1 after the first dose of mOPV1 compared with the first dose of OPV. With three doses of mOPV1, over 90% of children will develop immunity; the same of tOPV will confer immunity on only 70–75% of children.

Approximately 70% of children develop immunity to poliovirus type 3 after the first dose of mOPV3 compared with approximately 30% of children after the first dose of OPV.

Monovalent oral polio vaccine type 1 efficacy study1

Results of an Indian study published in The Lancet in 2007, showed increased efficacy of monovalent oral polio vaccine type 1 (mOPV1) over the traditionally-used trivalent OPV against paralytic polio due to type 1 poliovirus. 

The study showed that:

mOPV1 was three times as effective as trivalent OPV against type 1 polio wide-scale use of mOPV1 can raise population immunity to levels necessary to

stop indigenous type 1 polio in India.The implications for the remaining polio-endemic states of India are to vaccinate all children multiple times with mOPV1 and sustain these levels until transmission has been successfully interrupted.

1Grassly NC et al, Protective efficacy of a monovalent oral type 1 poliovirus vaccine: a case-control study, The Lancet, 12 April 2007.

 

Recommended use

Monovalent oral polio vaccines are recommended for use in supplementary immunization campaigns in areas where only wild poliovirus type 1 or type 3 alone is circulating. It is not recommended as a substitute for OPV in routine immunization programmes.

Two doses of mOPV administered within two weeks forms the basis of the new Short Interval Additional Dose (SIAD) approach, which is intended to rapidly boost population immunity in Asia.- See more at: http://www.polioeradication.org/Polioandprevention/Thevaccines/MonovalentOPV.aspx#sthash.srUejKdG.dpuf

Bivalent oral polio vaccine (bOPV)

Bivalent oral polio vaccine was used for the first time in December 2009 to vaccinate 2.8 million children in Afghanistan

Photo:UNICEF/Cornelia Walther

The bivalent vaccine is more effective than the traditional oral polio vaccine

Bivalent oral polio vaccine (bOPV) consists of live, attenuated (weakened) poliovirus strains of type 1 and type 3. It simultaneously targets the two remaining types of wild poliovirus (type 1 and type 3) and was developed to improve the efficiency and impact of vaccination campaigns in areas where both types of poliovirus co-circulate.

Bivalent oral polio vaccine was first used in Afghanistan in December 2009, when 2.8 million children under five years old received the vaccine.

Advantages

Bivalent oral polio vaccine offers the same advantages as OPV. In addition: For both types 1 and 3 polio, bOPV is more effective than OPV and almost as good

as the monovalent vaccines, yet in a package that delivers both at once. bOPV allows countries to simplify vaccine logistics and optimize protection. In areas where access to children is limited, using bOPV helps maximise the

impact of each contact with a child.

Efficacy

Bivalent OPV is at least 30% more effective than trivalent OPV and almost as good as the respective monovalent OPVs.Recommended useIt is recommended that bOPV is introduced as rapidly as possible into supplementary immunization activities (SIAs) of all endemic countries and in some outbreak settings. The vaccine is recommended for use in SIAs to complement the ongoing large-scale use of trivalent OPV for routine immunization and SIAs, and the use of monovalent OPVs for SIAs. 

Related links

Sutter R. et al. Immunogenicity of bivalent type 1 and 3 oral vaccine: a randomised, double-blind, controlled trial, November 2010.

Conclusions and recommendations of the Advisory Committee on Poliomyelitis Eradication, November 2009

Advisory Committee on Poliomyelitis Eradication: recommendations on the use of bivalent oral poliovirus vaccine types 1 and 3

Afghanistan first in world to use new vaccine against polio. WHO press release 2009.

- See more at: http://www.polioeradication.org/Polioandprevention/Thevaccines/BivalentOPV.aspx#sthash.3sDfHTzZ.dpuf

Inactivated polio vaccine (IPV)Inactivated polio vaccine (IPV) was developed in 1955 by Dr Jonas Salk. Also called the “Salk vaccine”, IPV consists of inactivated (killed) poliovirus strains of all three poliovirus types. IPV is given by intramuscular injection and needs to be administered by a trained health worker.

A baby receives the inactivated polio vaccine from a qualified nurse

CDC/Judy Schmidt

The inactivated polio vaccine produces antibodies in the blood to all three types of poliovirus. In the event of infection, these antibodies prevent the spread of the virus to the central nervous system and protect against paralysis.

Advantages

As IPV is not a 'live' vaccine, it carries no risk of vaccine-associated polio paralysis. IPV triggers an excellent protective immune response in most people.

Disadvantages

IPV induces very low levels of immunity in the intestine. As a result, when a person immunized with IPV is infected with wild poliovirus, the virus can still multiply inside the intestines and be shed in the faeces, risking continued circulation.

IPV is over five times more expensive than oral polio vaccine. Administering the vaccine requires trained health workers and sterile injection

equipment and procedures.

Safety

IPV is one of the safest vaccines in use. No serious systemic adverse reactions have been shown to follow vaccination.

Efficacy

IPV is highly effective in preventing paralytic disease caused by all three types of poliovirus.

Recommended use

An increasing number of industrialized, polio-free countries are using IPV as the vaccine of choice. This is because the risk of paralytic polio associated with continued routine use of oral polio vaccine (OPV) is deemed greater than the risk of imported wild virus. 

However, as IPV does not stop transmission of the virus, oral polio vaccine is used

wherever a polio outbreak needs to be contained, even in countries which rely exclusively on IPV for their routine immunization programme (e.g. the polio outbreak in the Netherlands in 1992). 

IPV is not recommended for routine use in polio-endemic countries or in developing countries at risk of poliovirus importations. In these countries, oral polio vaccines – either trivalent, bivalent or monovalent, depending on local epidemiology – are used.

Once polio has been eradicated, use of the oral polio vaccine will need to be stopped to prevent re-establishment of transmission due to vaccine-derived polioviruses. Switching to IPV is one option for this post-OPV era.

Related links

Developing affordable inactivated polio vaccine

Introduction of inactivated poliovirus vaccine into oral poliovirus vaccine-using countries [pdf 400kb] 

Inactivated poliovirus vaccine following oral poliovirus vaccine cessation [pdf 163.9kb]

- See more at: http://www.polioeradication.org/Polioandprevention/Thevaccines/Inactivatedpoliovaccine(IPV).aspx#sthash.dJ1KucsT.dpuf

History of polioIn the early 20th century, polio was one of the most feared diseases in industrialized countries, paralysing hundreds of thousands of children every year. Soon after the introduction of effective vaccines in the 1950s and 1960s however, polio was brought under control and practically eliminated as a public health problem in these countries. 

It took somewhat longer for polio to be recognized as a major problem in developing countries. Lameness surveys during the 1970s revealed that the disease was also prevalent in developing countries. As a result, during the 1970s routine immunization was introduced worldwide as part of national immunization programmes, helping to control the disease in many developing countries. 

In 1988, when the Global Polio Eradication Initiative began, polio paralysed more than 1000 children worldwide every day. Since then, more than 2.5 billion children have been immunized against polio thanks to the cooperation of more than 200 countries and 20 million volunteers, backed by an international investment of more than US$ 9 billion. There are now only 3 countries that have never stopped polio transmission and global incidence of polio cases has decreased by 99% - in 2013, 416 cases were reported for the entire year as opposed to over 350,000 in 1988. 

In February 2012, India, long-regarded as the nation facing the greatest challenges to eradication, was removed from the list of polio-endemic countries, convincing doubters that global polio eradication is feasible. 

There has also been success in eradicating certain strains of the virus; of the three types of wild polioviruses (WPVs), the last case of type 2 was reported in 1999 and the last case of type 3 in November 2012. 

However, tackling the last 1% of polio cases has still proved to be difficult. Conflict, political instability, hard-to-reach populations, and poor infrastructure continue to pose challenges to eradicating the disease. Each country offers a unique set of challenges which require local solutions. Thus, in 2013 the Global Polio Eradication Initiative launched its most comprehensive and ambitious plan for completely eradicating polio. It is a 5 year all-encompassing strategic plan that clearly outlines measures for eliminating polio in its last strongholds and for maintaining a polio-free world.- See more at: http://www.polioeradication.org/Polioandprevention/Historyofpolio.aspx#sthash.IeWEhg9i.dpuf

Polio this week as of 3 September 2014

  Protecting west Africa: Even as polio programme staff across west Africa

support efforts to control the Ebola outbreak affecting the region, preparations are going ahead for large scale multi-country vaccination campaigns in those countries not affected by Ebola, in mid-September.

In Nigeria, inactivated polio vaccine (IPV) has been used in early August during supplementary immunization activities in Borno and Yobe, reaching 0.6 million children. Further campaigns will integrate IPV, aiming to reach more than a million children by April 2015.

Polio vaccination activities have resumed in parts of Helmand Province in the Southern Region of Afghanistan for the first time in five months.  Upcoming immunization campaigns in September will cover the entire province. 

   

Wild Poliovirus (WPV) cases

Total cases Year-to-date 2014 Year-to-date 2013 Total in 2013

Globally 149 250 416

- in endemic countries 131 76 160

- in non-endemic countries 18 174 256

  

Case breakdown by country

CountriesYear-to-date 2014 Year-to-date 2013

Total in

 2013

Date of most   recent

case

 WPV1

 WPV3

 W1W3

 Total

 WPV1

 WPV3

 W1W3

 Total

Pakistan 117 117 27 27 93 30-Jul-14

Afghanistan 8 8 4 4 14 17-Jun-14

Nigeria 6 6 45 45 53 24-Jul-14

Somalia 4 4 160 160 194 03-Jun-14

Equatorial Guinea 5 5 0 0 03-May-14

Iraq 2 2 0 0 07-Apr-14

Cameroon 5 5 0 4 09-Jul-14

Syria 1 1 0 35 21-Jan-14

Ethiopia      1 1 1 1 9 05-Jan-14

Kenya 0 13 13 14 14-Jul-13

Total 149 0 0 149 250 0 250 416

Total in endemic countries

131 0 0 131 76 0 76 160

Total outbreak 18    0 0 18 174 0 0 174 256

Data in WHO as of 03 September 2013 for 2013 data and 02 September 2014 for 2014 data.

Afghanistan No new wild poliovirus type 1 (WPV1) cases were reported in the past week. The

total number of WPV1 cases in 2014 remains eight. The most recent WPV1 case had onset of paralysis on 17 June, from Khost province (linked to virus circulating in adjacent North Waziristan, Pakistan).

Polio vaccination activities have resumed in parts of Helmand Province in the Southern Region of Afghanistan for the first time in five months. The 21-23 September activity will cover the entire province using bivalent OPV.

Nigeria No new cases of wild poliovirus type 1 (WPV1) were reported in the past week.

Nigeria’s total case count for 2014 is now six. The most recent case, which had onset of paralysis in Sumaila Local Government

Area (LGA), southern Kano, on 24 July, was the second to be reported in the LGA this year. Kano is the only state with cases of WPV since April.

No new cases of type 2 circulating vaccine-derived poliovirus (cVDPV2) were reported in the past week. The total number of cVDPV2 cases for 2014 is 19. The most recent cVDPV2 case had onset of paralysis on 22 June, also in Kano.

The next subnational immunization days are planned for 20-23 September using bivalent OPV. 

Pakistan No new wild poliovirus type 1 (WPV1) cases were reported in the past week. The

most recent case, which had onset of paralysis in Khyber Agency in the Federally Administered Tribal Areas (FATA) on 30 July, was the 117th to be reported this year.

Two new circulating vaccine-derived poliovirus (cVDPV2) cases were reported in the past week. One was in the Lakki Marwat district with onset of paralysis on 8 May and the other in Bannu district, Khyber Pakhtunkhwa on 3 May. The country has reported 18 cases of cVDPV2 in 2014 and the most recent case had onset of paralysis on 27 May in FR Bannu, FATA.

Immunization activities are continuing with particular focus on known high-risk areas.

Central Africa No new wild poliovirus type 1 (WPV1) cases were reported this week. In 2014, ten

cases have been reported in central Africa: five in Cameroon and five in Equatorial Guinea.

The outbreak in Cameroon has been ongoing since at least October 2013, with international spread to Equatorial Guinea in 2014. In March 2014, WHO elevated the risk assessment of international spread of polio from Cameroon to very high, due to expanding circulation and influx of vulnerable refugee populations from Central African Republic (CAR).

Vaccination activities are planned in high-risk areas of Cameroon on 4-7 September, in Equatorial Guinea on 4-7 September and in CAR on 12-14 September, all using bivalent OPV.

Between 18-23 September, campaigns will be held across Cameroon, the Democratic Republic of the Congo, Congo, Gabon, Chad, the Central African Republic and Equatorial Guinea and in Angola on 22 September - 5 October.

Horn of Africa No new wild poliovirus type 1 (WPV1) cases were reported in the past week. Five

cases have been reported in the Horn of Africa to date in 2014: one WPV1 in Ethiopia (date of onset of paralysis on 14 January) and four WPV1s in Somalia (the most recent date of onset of paralysis on 3 June in Mudug, Puntland).

The Polio Technical Advisory Group (TAG) for the Horn of Africa has warned that the outbreak is likely to continue in Somalia and possibly the Somali region of Ethiopia unless urgent improvements are made in SIA operations and surveillance, and improved vaccination outreach is focused on pastoral communities.

Immunization campaigns are planned for September in Yemen using trivalent OPV and in Ethiopia and Somalia using bivalent.

Israel and West Bank and Gaza Wild poliovirus type 1 (WPV1) is not being detected in environmental samples in

Israel, the West Bank and Gaza Strip in recent months; the most recent positive sample was collected in southern Israel on 30 March. Environmental samples collected since April have been negative.

Middle East No new cases of wild poliovirus type 1 (WPV1) were reported in the past week.

Three cases of WPV1 have been reported in the Middle East in 2014 - two in Iraq

and one in Syria. The most recent case reported from Iraq occurred in Mada'in district, Baghdad-Resafa province, with onset of paralysis on 7 April. Syria’s most recent case had onset of paralysis on 21 January.

Immunization campaigns are planned for 14-18 September in Iraq using bivalent OPV; Turkey, Syria, Jordan, Iraq, Egypt, Lebanon and the West Bank and Gaza are planning activities for October.

On 6-7 September, WHO and UNICEF will review Phase II of the outbreak response in the Middle East and make the necessary tactical adjustments.  

West Africa No wild poliovirus type 1 (WPV1) cases have been reported in West Africa in 2014.

The most recent WPV1 case in the region occurred in Tahoua province, Niger, with onset of paralysis on 15 November 2012. In addition, a single case of circulating vaccine-derived poliovirus (cVDPV2) was reported in Niger on 11 July 2013.

Even as polio programme staff across West Africa support efforts to control the Ebola outbreak affecting the region, preparations are going ahead for large scale multi-country vaccination campaigns in those countries not affected by Ebola, in mid-September.

A trivalent OPV campaign is planned for the entire region, in Mali on 19-22 September and in Benin, Burkina Faso, Cote d’Ivoire, Gambia, Ghana, Guinea-Bissau, Mauritania, Niger, Senegal and Togo on 20-23 September.

- See more at: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx#sthash.kfqDjqAX.dpuf

Vaccine Information

A person is considered to be fully immunized if he or she has received a primary series of at least

three doses of inactivated poliovirus vaccine (IPV), live oral poliovirus vaccine (OPV), or four doses

of any combination of IPV and OPV. Until recently, the benefits of OPV use (i.e. intestinal immunity,

secondary spread) outweighed the risk for vaccine-associated paralytic poliomyelitis (VAPP) which

occurred in one child out of every 2.4 million OPV doses distributed. To eliminate the risk of

vaccine-associated paralytic poliomyelitis (VAPP), as of January 1, 2000, OPV was no longer

recommended for routine immunization in the United States. However, OPV continues to be used in

the countries where polio is endemic or the risk of importation and transmission is high. OPV is

recommended for global polio eradication activities in polio-endemic countries due to its

advantages over IPV in providing intestinal immunity and providing secondary spread of the

vaccine to unprotected contacts.

Polio VaccinationAt a Glance

Polio is an infectious disease caused by a virus that lives in the throat and intestinal tract. It is most

often spread through person-to-person contact with the stool of an infected person and may also

be spread through oral/nasal secretions. Polio used to be very common in the United States and

caused severe illness in thousands of people each year before polio vaccine was introduced in

1955. Most people infected with the polio virus have no symptoms; however, for the less than 1%

who develop paralysis it may result in permanent disability and even death.

There are two types of vaccine that protect against polio: inactivated polio vaccine (IPV) and oral

polio vaccine (OPV). IPV is given as an injection in the leg or arm, depending on the patient's age.

Polio vaccine may be given at the same time as other vaccines. Most people should get polio

vaccine when they are children. Children get 4 doses of IPV at these ages: 2 months, 4 months, 6-

18 months, and a booster dose at 4-6 years. OPV has not been used in the United States since

2000 but is still used in many parts of the world.

What Would Happen If We Stopped Vaccinations?

On this Page Vaccines don’t just protect yourself Diseases haven’t disappeared A final example: what could happen

Before the middle of the last century, diseases like whooping cough, polio,

measles, Haemophilus influenzae, and rubella struck hundreds of thousands of infants, children

and adults in the U.S.. Thousands died every year from them. As vaccines were developed and

became widely used, rates of these diseases declined until today most of them are nearly gone

from our country.  

Nearly everyone in the U.S. got measles before there was a vaccine, and hundreds died from it each year. Today, most doctors have never seen a case of measles. 

More than 15,000 Americans died from diphtheria in 1921, before there was a vaccine. Only one case of diphtheria has been reported to CDC since 2004.

An epidemic of rubella (German measles) in 1964-65 infected 12½ million Americans, killed 2,000 babies, and caused 11,000 miscarriages. In 2012, 9 cases of rubella were reported to CDC.

Given successes like these, it might seem reasonable to ask, “Why should we keep vaccinating

against diseases that we will probably never see?”  Here is why:

 

Vaccines don’t just protect yourself.

Most vaccine-preventable diseases are spread from person to person. If one person in a

community gets an infectious disease, he can spread it to others who are not immune. But a

person who is immune to a disease because she has been vaccinated can’t get that disease and

can’t spread it to others. The more people who are vaccinated, the fewer opportunities a

disease has to spread.

If one or two cases of disease are introduced into a community where most people are not

vaccinated, outbreaks will occur. In 2013, for example, several measles outbreaks occurred

around the country, including large outbreaks in New York City and Texas – mainly among

groups with low vaccination rates. If vaccination rates dropped to low levels nationally, diseases

could become as common as they were before vaccines.

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Diseases haven’t disappeared.

The United States has very low rates of vaccine-preventable diseases, but this isn’t true

everywhere in the world. Only one disease — smallpox — has been totally erased from the

planet. Polio no longer occurs in the U.S., but it is still paralyzing children in several African

countries. More than 350,000 cases of measles were reported from around the world in 2011,

with outbreaks in the Pacific, Asia, Africa, and Europe. In that same year, 90% of measles cases

in the U.S. were associated with cases imported from another country. Only the fact that most

Americans are vaccinated against measles prevented these clusters of cases from becoming

epidemics.

Disease rates are low in the United States today. But

if we let ourselves become vulnerable by not vaccinating, a case that could touch off an

outbreak of some disease that is currently under control is just a plane ride away.

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A final example: what could happen.

We know that a disease that is apparently under control can suddenly return, because we have

seen it happen, in countries like Japan, Australia, and Sweden. Here is an example from Japan.

In 1974, about 80% of Japanese children were getting pertussis (whooping cough) vaccine. That

year there were only 393 cases of whooping cough in the entire country, and not a single

pertussis-related death. Then immunization rates began to drop, until only about 10% of

children were being vaccinated. In 1979, more than 13,000 people got whooping cough and 41

died. When routine vaccination was resumed, the disease numbers dropped again.

The chances of your child getting a case of measles or chickenpox or whooping cough might be

quite low today. But vaccinations are not just for protecting ourselves, and are not just for

today. They also protect the people around us (some of whom may be unable to get certain

vaccines, or might have failed to respond to a vaccine, or might be susceptible for other

reasons). And they also protect our children’s children and their children by keeping diseases

that we have almostdefeated from making a comeback.  What would happen if we stopped

vaccinations?  We could soon find ourselves battling epidemics of diseases we thought we had

conquered decades ago.

References CDC. Measles — United States, January 1-August 24, 2013.  MMWR   2013; 62(36);741-43. Updates on CDC’s Polio Eradication Efforts Reported Cases and Deaths from Vaccine Preventable Diseases, United States, 1950-

2011     [6 pages] Gangarosa EJ, et al. Impact of anti-vaccine movements on pertussis control: the untold

story.Lancet 1998;351:356-61.

Polio Disease In-ShortOn this PageDescription

Poliomyelitis (polio) is a highly infectious disease caused by a virus that invades the nervous

system.

Symptoms

Approximately 72% of persons infected with polio will have no symptoms. About 24% of infected

persons have minor symptoms, such as fever, fatigue, nausea, headache, flu-like symptoms,

stiffness in the neck and back, and pain in the limbs, which often resolve completely. Fewer than

1% of polio cases result in permanent paralysis of the limbs (usually the legs). Of those paralyzed,

5-10% die when the paralysis strikes the respiratory muscles. The death rate increases with

increasing age.

Complications

Paralysis that can lead to permanent disability and death.

Transmission

Polio is spread by person-to-person contact and only affects humans.

Vaccine

There are two types of vaccine that can prevent polio: inactivated polio vaccine (IPV) and oral polio

vaccine (OPV). Only IPV has been used in the United States since 2000; however OPV is still used

throughout much of the world.

Who Needs to be Vaccinated?

IPV is a shot, given in the leg or arm, depending on age. Polio vaccine may be given at the same

time as other vaccines.

Does my infant or child need this vaccine?

Children should be vaccinated with 4 doses of inactivated polio vaccine (IPV) at the following ages:

A dose at 2 months

A dose at 4 months

A dose at 6-18 months

A booster dose at 4-6 years

For additional details, consult the Polio Vaccine Information Statement and the Childhood

Immunization Schedule.

As an adult, do I need this vaccine?

Most adults do not need polio vaccine because they were already vaccinated as children. But three

groups of adults are at higher risk and should consider polio vaccination in the following situations:

You are traveling to polio-endemic or high-risk areas of the world. Ask your healthcare provider for specific information on whether you need to be vaccinated.

You are working in a laboratory and handling specimens that might contain polioviruses.

You are a healthcare worker treating patients who could have polio or have close contact with a person who could be infected with poliovirus.

Adults in these three groups who have never been vaccinated against polio should get 3 doses of

IPV:

The first dose at any time,

The second dose 1 to 2 months later,

The third dose 6 to 12 months after the second.

Adults in these three groups who have had 1 or 2 doses of polio vaccine in the past should get the

remaining 1 or 2 doses. It doesn’t matter how long it has been since the

earlier dose(s).

Adults who are at increased risk of exposure to poliovirus and who have previously completed a

routine series of polio vaccine (IPV or OPV) can receive one lifetime booster dose of IPV.

For additional details, consult the Polio Vaccine Information Statement and the Adult Immunization

Schedule.

Who Should NOT Get Vaccinated with these Vaccines?Because of age, health conditions, or other factors, some people should not get certain vaccines or

should wait before getting them. Read the guidelines below for each vaccine.

On this Page Adenovirus Anthrax DTaP Hep A Hep B Hib HPV-Cerarix HPV-Gardasil Influenza JE Ixiaro MMR MMRV Meningococcal PCV13 PPV23 Polio Rabies Rotavirus Shingles Smallpox Td Tdap Typhoid Varicella (chickenpox) Yellow Fever

Adenovirus vaccineSome people should not get adenovirus vaccine.

Anyone with a severe (life-threatening) allergy to any component of the vaccine. Tell the doctor if you have any severe allergies.

Pregnant women or nursing mothers.

Anyone who is unable to swallow the vaccine tablets whole without chewing them.

Anyone younger than 17 or older than 50 years of age.

A woman who learns she was pregnant when she got the vaccine, or becomes pregnant within 6

weeks after vaccination, should contact the Adenovirus Vaccine Pregnancy Registry at 1-866-

790-4549. This will help us learn how pregnant women and their babies respond to the vaccine.

Note: Adenovirus vaccine is approved for use only among military personnel.

This information was taken directly from the Adenovirus VIS 

(This information taken from Adenovirus VIS dated 7/14/11. If the actual VIS is more recent than this date, the

information on this page needs to be updated.)

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Anthrax vaccine

Some people should not get anthrax vaccine.

Anyone who has had a serious allergic reaction to a previous dose of anthrax vaccine should not get another dose.

Anyone who has a severe allergy to any vaccine component should not get a dose. Tell your provider if you have any severe allergies, including latex.

If you have ever had Guillain Barré syndrome (GBS), your provider might recommend not getting anthrax vaccine.

If you have a moderate or severe illness your provider might ask you to wait until you recover to get the vaccine. People with mild illness can usually be vaccinated.

Vaccination may be recommended for pregnant women who have been exposed to anthrax and are at risk of developing inhalation disease. Nursing mothers may safely be given anthrax vaccine.

This information was taken directly from the Anthrax VIS

(This information taken from Anthrax VIS dated 3/10/10. If the actual VIS is more recent than this date, the information

on this page needs to be updated.)

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DTaP vaccine (Diphtheria, Tetanus, & acellular Pertussis)

Some children should not get DTaP vaccine or should wait.

Children with minor illnesses, such as a cold, may be vaccinated. But children who are moderately or severely ill should usually wait until they recover before getting DTaP vaccine.

Any child who had a life-threatening allergic reaction after a dose of DTaP should not get another dose.

Any child who suffered a brain or nervous system disease within 7 days after a dose of DTaP should not get another dose.

Talk with your doctor if your child:

o had a seizure or collapsed after a dose of DTaP

o cried non-stop for 3 hours or more after a dose of DTaP

o had a fever over 105 degrees Fahrenheit after a dose of DTaP.

Ask your health care provider for more information. Some of these children should not get another

dose of pertussis vaccine, but may get a vaccine without pertussis, called DT. DTaP should not be

given to anyone 7 years of age or older.

This information was taken directly from the DTaP VIS 

(This information taken from DTaP VIS dated 5/17/07. If the actual VIS is more recent than this date, the information on

this page needs to be updated.)

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Hepatitis A vaccine

Some people should not get hepatitis A vaccine or should wait.

Anyone who has ever had a severe (life-threatening) allergic reaction to a previous dose of hepatitis A vaccine should not get another dose.

Anyone who has a severe (life-threatening) allergy to any vaccine component should not get the vaccine. Tell your doctor if you have any severe allergies, including a severe allergy to latex. All hepatitis A vaccines contain alum and some hepatitis A vaccines contain 2-phenoxyethanol.

Anyone who is moderately or severely ill at the time the shot is scheduled should probably wait until they recover. Ask your doctor. People with a mild illness can usually get the vaccine.

Tell your doctor if you are pregnant. Because hepatitis A vaccine is inactivated (killed), the risk to a pregnant woman or her unborn baby is believed to be very low. But your doctor can weigh any theoretical risk from the vaccine against the need for protection.

This information was taken directly from the Hepatitis A VIS 

(This information taken from Hepatitis A VIS dated 10/25/11. If the actual VIS is more recent than this date, the

information on this page needs to be updated.)

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Hepatitis B vaccine

Who should not get hepatitis B vaccine?

Anyone with a life-threatening allergy to yeast, or to any other component of the vaccine, should not get hepatitis B vaccine. Tell your provider if you have any severe allergies.

Anyone who has had a life-threatening allergic reaction to a previous dose of hepatitis B vaccine should not get another dose.

Anyone who is moderately or severely ill when a dose of vaccine is scheduled should probably wait until they recover before getting the vaccine.

Your doctor can give you more information about these precautions.

Note: You might be asked to wait 28 days before donating blood after getting hepatitis B vaccine.

This is because the screening test could mistake vaccine in the bloodstream (which is not

infectious) for hepatitis B infection.

This information was taken directly from the Hepatitis B VIS 

(This information taken from Hepatitis B VIS dated 2/2/12. If the actual VIS is more recent than this date, the

information on this page needs to be updated.)

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Hib vaccine

Hib vaccine should not be given to infants younger than 6 weeks of age.

Tell your doctor: If the patient has any severe (life-threatening) allergies. If the patient has ever had a

life-threatening allergic reaction after a dose of Hib vaccine, or has a severe allergy to any part of this vaccine, he or she may be advised not to get a dose.

If the patient is not feeling well. Your doctor might suggest waiting until the patient feels better. But you should come back.

This information was taken directly from the Hib VIS 

(This information taken from Hib VIS dated 02/04/14. If the actual VIS is more recent than this date, the information on

this page needs to be updated.)

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HPV-Cervarix (Human Papillomavirus) vaccine

Some people should not get HPV vaccine or should wait.

Anyone who has ever had a life-threatening allergic reaction to any component of HPV vaccine, or to a previous dose of HPV vaccine, should not get the vaccine. Tell your doctor if the person getting vaccinated has any severe allergies, including an allergy to latex.

HPV vaccine is not recommended for pregnant women. However, receiving HPV vaccine when pregnant is not a reason to consider terminating the pregnancy. Women who are breast feeding may get the vaccine.

Any woman who learns she was pregnant when she got this HPV vaccine is encouraged to

contact the manufacturer’s HPV in pregnancy registry at 888-452-9622. This will help us

learn how pregnant women respond to the vaccine. People who are mildly ill when a dose of HPV vaccine is planned can still be vaccinated.

People with a moderate or severe illness should wait until they are better.

This information was taken directly from the HPV-Cervarix VIS 

(This information taken from HPV VIS dated 5/3/11. If the actual VIS is more recent than this date, the information on

this page needs to be updated.)

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HPV-Gardasil (Human Papillomavirus) vaccine

Some people should not get HPV vaccine or should wait.

Anyone who has ever had a life-threatening allergic reaction to any component of HPV vaccine, or to a previous dose of HPV vaccine, should not get the vaccine. Tell your doctor if the person getting vaccinated has any severe allergies, including an allergy to yeast.

HPV vaccine is not recommended for pregnant women. However, receiving HPV vaccine when pregnant is not a reason to consider terminating the pregnancy. Women who are breast feeding may get the vaccine.

People who are mildly ill when a dose of HPV vaccine is planned can still be vaccinated. People with a moderate or severe illness should wait until they are better.

This information was taken directly from the HPV-Gardasil VIS 

(This information taken from HPV VIS dated 5/17/13. If the actual VIS is more recent than this date, the information on

this page needs to be updated.)

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Influenza (inactivated) vaccineSome people should not get inactivated influenza vaccine or should wait.

Tell the person who gives you the vaccine: If you have any severe, life-threatening allergies. If you ever had a life-threatening

allergic reaction after a dose of flu vaccine, or have a severe allergy to any part of this vaccine, including (for example) an allergy to gelatin, antibiotics, or eggs, you may be advised not to get vaccinated. Most, but not all, types of flu vaccine contain a small amount of egg protein.

If you ever had Guillain-Barré Syndrome (a severe paralyzing illness, also called GBS). Some people with a history of GBS should not get this vaccine. This should be discussed with your doctor.

If you are not feeling well.  It is usually okay to get flu vaccine when you have a mild illness, but you might be advised to wait until you feel better.  You should come back when you are better.

This information was taken directly from the Inactivated Influenza VIS  

(This information taken from Inactivated Influenza VIS dated 8/19/14. If the actual VIS is more recent than this date,

the information on this page needs to be updated.)

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Influenza (live) vaccineSome people should not receive LAIV.

Tell the person who gives you the vaccine:

If you have any severe, life-threatening allergies, including (for example) an allergy to gelatin or antibiotics.  If you ever had a life-threatening allergic reaction after a dose of flu vaccine, or have a severe allergy to any part of this vaccine, you should not get vaccinated.

If you ever had Guillain-Barré Syndrome (a severe paralyzing illness, also called GBS). Some people with a history of GBS should not get this vaccine. This should be discussed with your doctor.

If you have long-term health problems, such as certain heart, breathing, kidney, liver, or nervous system problems, your doctor can help you decide if you should get LAIV.

If you have gotten any other vaccines in the past 4 weeks, or if you are not feeling well.  It is usually okay to get flu vaccine when you have a mild illness, but you might be advised to wait until you feel better.  You should come back when you are better.

You should get the flu shot instead of the nasal spray if you:

o are pregnant

o have a weakened immune system

o are allergic to eggs

o are a young child with asthma or wheezing problems

o are a child or adolescent on long-term aspirin therapy

o will provide care for, or visit someone, within the next 7 days who needs special care for an extremely weakened immune system (ask your health care provider)

o have taken influenza antiviral medications in the past 48 hours

The person giving you the vaccine can give you more information.

This information was taken directly from the Live Influenza VIS 

(This information taken from Live Influenza VIS dated 8/19/14. If the actual VIS is more recent than this date, the

information on this page needs to be updated.)

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JE Ixiaro (Japanese Encephalitis) vaccine

Some people should not get JE vaccine.

Anyone who has had a severe (life-threatening) allergic reaction to a dose of JE vaccine should not get another dose.

Anyone who has a severe (life threatening) allergy to any component of JE vaccine should

not get the vaccine.

Tell your doctor if you have any severe allergies that you know of.

Pregnant women should usually not get JE vaccine. If you are pregnant, check with your doctor.

If you will be traveling for fewer than 30 days, especially if you will be staying in urban areas, tell

your doctor. You might not need the vaccine.

This information was taken directly from the Japanese Encephalitis VIS 

(This information taken from Japanese Encephalitis VIS dated 1/24/14. If the actual VIS is more recent than this date,

the information on this page needs to be updated.)

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MMR (Measles, Mumps, and Rubella ) vaccine

Some people should not get MMR vaccine or should wait.

Anyone who has ever had a life-threatening allergic reaction to the antibiotic neomycin, or any other component of MMR vaccine, should not get the vaccine. Tell your doctor if you have any severe allergies.

Anyone who had a life-threatening allergic reaction to a previous dose of MMR or MMRV vaccine should not get another dose.

Some people who are sick at the time the shot is scheduled may be advised to wait until they recover before getting MMR vaccine.

Pregnant women should not get MMR vaccine. Pregnant women who need the vaccine should wait until after giving birth. Women should avoid getting pregnant for 4 weeks after vaccination with MMR vaccine.

Tell your doctor if the person getting the vaccine:

o Has HIV/AIDS, or another disease that affects the immune system

o Is being treated with drugs that affect the immune system, such as steroids

o Has any kind of cancer

o Is being treated for cancer with radiation or drugs

o Has ever had a low platelet count (a blood disorder)

o Has gotten another vaccine within the past 4 weeks

o Has recently had a transfusion or received otherblood products

Any of these might be a reason to not get the vaccine, or delay vaccination until later.

This information was taken directly from the MMR VIS 

(This information taken from MMR VIS dated 4/20/12. If the actual VIS is more recent than this date, the information on

this page needs to be updated.)

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MMRV (Measles, Mumps, Rubella, and Varicella) vaccine

Children should not get MMRV vaccine if they:

Have ever had a life-threatening allergic reaction to a previous dose of MMRV vaccine, or to either MMR or varicella vaccine.

Have ever had a life-threatening allergic reaction to any component of the vaccine, including gelatin or the antibiotic neomycin. Tell the doctor if your child has any severe allergies.

Have HIV/AIDS, or another disease that affects the immune system.

Are being treated with drugs that affect the immune system, including high doses of oral steroids for 2 weeks or longer.

Have any kind of cancer.

Are being treated for cancer with radiation or drugs.

Check with your doctor if the child:

Has a history of seizures, or has a parent, brother or sister with a history of seizures.

Has a parent, brother or sister with a history of immune system problems.

Has ever had a low platelet count, or another blood disorder.

Recently had a transfusion or received other blood products.

Might be pregnant.

Children who are moderately or severely ill at the time the shot is scheduled should usually wait

until they recover before getting MMRV vaccine. Children who are only mildly ill may usually get

the vaccine.

Ask your provider for more information.

This information was taken directly from the MMRV VIS 

(This information taken from MMRV VIS dated 5/21/10. If the actual VIS is more recent than this date, the information

on this page needs to be updated.)

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Meningococcal vaccine

Some people should not get meningococcal vaccine or should wait.

Anyone who has ever had a severe (life-threatening) allergic reaction to a previous dose of MCV4 or MPSV4 vaccine should not get another dose of either vaccine.

Anyone who has a severe (life-threatening) allergy to any vaccine component should not get the vaccine. Tell your doctor if you have any severe allergies.

Anyone who is moderately or severely ill at the time the shot is scheduled should probably wait until they recover. Ask your doctor. People with a mild illness can usually get the vaccine.

Meningococcal vaccines may be given to pregnant women. MCV4 is a fairly new vaccine and has not been studied in pregnant women as much as MPSV4 has. It should be used only if clearly needed. The manufacturers of MCV4 maintain pregnancy registries for women who are vaccinated while pregnant.

Except for children with sickle cell disease or without a working spleen, meningococcal vaccines

may be given at the same time as other vaccines.

This information was taken directly from the Meningococcal VIS 

(This information taken from Meningococcal VIS dated 10/14/11. If the actual VIS is more recent than this date, the

information on this page needs to be updated.)

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PCV13 (Pneumococcal Conjugate) vaccine

Some children should not get PCV13 or should wait.

Anyone who has had a life-threatening allergic reaction to a dose of this vaccine, to an early

pneumococcal vaccine called PCV7 (or Prevnar), or to any vaccine containing diphtheria toxoid (for

example, DTaP) should not get PCV13.

Anyone with a severe allergy to ay component of PCV13 should not get the vaccine. Tell your

doctor if the person being vaccinated has any severe allergies.

If the person scheduled for vaccination is sick, your doctor might decide to reschedule the shot on

another day.

This information was taken directly from the PCV13 VIS 

(This information taken from PCV13 VIS dated 2/27/2013. If the actual VIS is more recent than this date, the

information on this page needs to be updated.)

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PPV23 (Pneumococcal Polysaccharide) vaccine

Some people should not get PPSV or should wait:

Anyone who has had a life-threatening allergic reaction to PPSV should not get another dose.

Anyone who has a severe allergy to any component of a vaccine should not get that vaccine. Tell your provider if you have any severe allergies.

Anyone who is moderately or severely ill when the shot is scheduled may be asked to wait until they recover before getting the vaccine. Someone with a mild illness can usually be vaccinated.

Although there is no evidence that PPSV is harmful to either a pregnant woman or to her fetus, as a precaution, women with conditions that put them at risk for pneumococcal disease should be vaccinated before becoming pregnant, if possible.

This information was taken directly from the PPSV VIS 

(This information taken from PPSV VIS dated 10/6/09. If the actual VIS is more recent than this date, the information on

this page needs to be updated.)

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Polio vaccine

Some people should not get IPV or should wait.

These people should not get IPV:

Anyone with a life-threatening allergy to any component of IPV, including the antibiotics neomycin, streptomycin or polymyxin B, should not get polio vaccine. Tell your doctor if you have any severe allergies.

Anyone who has a severe allergic reaction to a polio shot should not get another one.

These people should wait:

Anyone who is moderately or severely ill at the time the shot is scheduled should usually wait until they recover before getting polio vaccine. People with minor illnesses, such as a cold, may be vaccinated.

Ask your health care provider for more information.

This information was taken directly from the IPV VIS 

(This information taken from IPV VIS dated 11/08/11. If the actual VIS is more recent than this date, the information on

this page needs to be updated.)

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Rabies vaccine

Talk with a doctor before getting rabies vaccine if you:

1. ever had a serious (life-threatening) allergic reaction to a previous dose of rabies vaccine, or to any component of the vaccine; tell your doctor if you have any severe allergies,

2. have a weakened immune system because of:

HIV/AIDS or another disease that affects the immune system,

treatment with drugs that affect the immune system, such as steroids,

cancer, or cancer treatment with radiation or drugs.

If you have a minor illness, such as a cold, you can be vaccinated. If you are moderately or

severely ill, you should probably wait until you recover before getting a routine (non-exposure)

dose of rabies vaccine.

If you have been exposed to rabies virus, you should get the vaccine regardless of any other

illnesses you may have.

This information was taken directly from the Rabies VIS 

(This information taken from Rabies VIS dated 10/6/09. If the actual VIS is more recent than this date, the information

on this page needs to be updated.)

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Rotavirus vaccine

Some people should not get this vaccine.

A baby who has had a severe (life-threatening) allergic reaction to a dose of rotavirus vaccine should not get another dose.

A baby who has a severe (life threatening) allergy to any component of rotavirus vaccine should not get the vaccine.

Tell your doctor if your baby has any severe  allergies that you know of, including a severe allergy to latex.

Babies with “severe combined immunodeficiency” (SCID) should not get rotavirus vaccine.

Babies who have had a type of bowel blockage called “intussusception” should not get rotavirus vaccine.

Babies who are mildly ill can probably get the vaccine today. Babies who are moderately or severely ill should probably wait until they recover. This includes babies with moderate or severe diarrhea or vomiting.

Check with your doctor if your baby’s immune system is weakened because of:

o HIV/AIDS, or any other disease that affects the immune system

o treatmentith drugs such as long-term steroids

o cancer, or cancer treatment with x-rays or drugs

This information was taken directly from the Rotavirus VIS

(This information taken from Rotavirus VIS dated 8/26/13. If the actual VIS is more recent than this date, the

information on this page needs to be updated.)

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Shingles (Herpes Zoster) vaccine

Some people should not get shingles vaccine or should wait.

A person should not get shingles vaccine who:

has ever had a life-threatening allergic reaction to gelatin, the antibiotic neomycin, or any other component of shingles vaccine. Tell your doctor if you have any severe allergies.

has a weakened immune system because of current:

o AIDS or another disease that affects the immune system,

o treatment with drugs that affect the immune system, such as prolonged use of high-dose steroids,

o cancer treatment such as radiation or chemotherapy,

o cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma.

is pregnant, or might be pregnant. Women should not become pregnant until at least 4 weeks after getting shingles vaccines.

Someone with a minor acute illness, such as a cold, may be vaccinated. But anyone with a

moderate or severe acute illness should usually wait until they recover before getting the vaccine.

This includes anyone with a temperature of 101.3° F or higher.

This information was taken directly from the Shingles VIS

(This information taken from Shingles VIS dated 10/6/09. If the actual VIS is more recent than this date, the information

on this page needs to be updated.)

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Smallpox (Vaccinia) vaccineThis medication guide replaces the Smallpox VIS. It is to be used before one receives the

vaccination. Medical Guide for vaccination with ACAM2000     [6 pages]  (10/1/09)

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Td (Adult Tetanus & Diphtheria) vaccine

Some people should not be vaccinated or should wait. If you ever had a life-threatening allergic reaction after a dose of any tetanus or diphtheria

containing vaccine, OR if you have a severe allergy to any part of this vaccine, you should not get Td. Tell your doctor if you have any severe allergies.

Talk to your doctor if you:

o have epilepsy or another nervous system problem,

o had severe pain or swelling after any vaccine containing diphtheria or tetanus,

o ever had Guillain Barré Syndrome (GBS),

o aren’t feeling well on the day the shot is scheduled.

This information was taken directly from the Td VIS

(This information taken from Td-Tdap VIS dated 2/4/14. If the actual VIS is more recent than this date, the information

on this page needs to be updated.)

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Tdap vaccine (Combined Tetanus, Diphtheria & Pertussis) If you ever had a life-threatening allergic reaction after a dose of any tetanus, diphtheria, or

pertussis containing vaccine, OR if you have a severe allergy to any part of this vaccine, you should not get Tdap. Tell your doctor if you have any severe allergies.

If you had a coma, or long or multiple seizures within 7 days after a childhood dose of DTP or DTaP, you should not get Tdap, unless a cause other than the vaccine was found. You can still get Td.

Talk to your doctor if you:

o have epilepsy or another nervous system problem,

o had severe pain or swelling after any vaccine containing diphtheria, tetanus or pertussis,

o ever had Guillain Barré Syndrome (GBS),

o aren't feeling well on the day the shot is scheduled.

This information was taken directly from the Tdap VIS

(This information taken from Td-Tdap VIS dated 5/9/13. If the actual VIS is more recent than this date, the information

on this page needs to be updated.)

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Typhoid vaccineSome people should not get typhoid vaccine or should wait.

Inactivated Typhoid Vaccine (Shot)

Should not be given to children younger than 2 years of age.

Anyone who has had a severe reaction to a previous dose of this vaccine should not get another dose.

Anyone who has a severe allergy to any component of this vaccine should not get it. Tell your doctor if you have any severe allergies.

Anyone who is moderately or severely ill at the time the shot is scheduled should usually wait until they recover before getting the vaccine.

Live Typhoid Vaccine (Oral)

Should not be given to children younger than 6 years of age.

Anyone who has had a severe reaction to a previous dose of this vaccine should not get another dose.

Anyone who has a severe allergy to any component of this vaccine should not get it. Tell your doctor if you have any severe allergies.

Anyone who is moderately or severely ill at the time the vaccine is scheduled should usually wait until they recover before getting it. Tell your doctor if you have an illness involving vomiting or diarrhea.

Anyone whose immune system is weakened should not get this vaccine. They should get the typhoid shot instead. This includes anyone who:

o has HIV/AIDS or another disease that affects the immune system,

o is being treated with drugs that affect the immune system, such as steroids, for 2 weeks or longer,

o has any kind of cancer,

o is taking cancer treatment with radiation or drugs.

Oral typhoid vaccine should not be given until at least 3 days after taking antibiotics.

Ask your doctor or nurse for more information.

This information was taken directly from the Typhoid VIS

(This information taken from Typhoid VIS dated 5/29/12. If the actual VIS is more recent than this date, the information

on this page needs to be updated.)

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Varicella (chickenpox) vaccine

Some people should not get chickenpox vaccine or should wait.

People should not get chickenpox vaccine if they have ever had a life-threatening allergic reaction to a previous dose of chickenpox vaccine or to gelatin or the antibiotic neomycin.

People who are moderately or severely ill at the time the shot is scheduled should usually wait until they recover before getting chickenpox vaccine.

Pregnant women should wait to get chickenpox vaccine until after they have given birth. Women should not get pregnant for 1 month after getting chickenpox vaccine.

Some people should check with their doctor about whether they should get chickenpox vaccine, including anyone who:

o Has HIV/AIDS or another disease that affects the immune system

o Is being treated with drugs that affect the immune system, such as steroids, for 2 weeks or longer

o Has any kind of cancer

o Is getting cancer treatment with radiation or drugs

People who recently had a transfusion or were given other blood products should ask their doctor when they may get chickenpox vaccine.

Ask your provider for more information.

This information was taken directly from the Varicella VIS

(This information taken from Varicella VIS dated 3/13/08. If the actual VIS is more recent than this date, the information

on this page needs to be updated.)

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Yellow Fever vaccine

Who should not get the yellow fever vaccine? Anyone with a severe (life-threatening) allergy to any component of the vaccine, including

eggs, chicken proteins, or gelatin, or who has had a severe allergic reaction to a previous dose of yellow fever vaccine should not get yellow fever vaccine. Tell your doctor if you have any severe allergies.

Infants younger than 6 months of age should not get the vaccine.

Tell your doctor if:

o You have HIV/AIDS or another disease that affects the immune system.

o Your immune system is weakened as a result of cancer or other medical conditions, a transplant, or radiation or drug treatment (such as steroids, cancer chemotherapy, or other drugs that affect immune cell function).

o Your thymus has been removed or you have a thymus disorder, such as myasthenia gravis, DiGeorge syndrome, or thymoma.

Your doctor will help you decide whether you can receive the vaccine.

Adults 60 years of age and older who cannot avoid travel to a yellow fever area should discuss vaccination with their doctor. They might be at increased risk for severe problems following vaccination.

Infants 6 through 8 months of age, pregnant women, and nursing mothers should avoid or postpone travel to an area where there is risk of yellow fever. If travel cannot be avoided, discuss vaccination with your doctor.

If you cannot get the vaccine for medical reasons but require proof of yellow fever vaccination for

travel, your doctor can give you a waiver letter if he considers the risk acceptably low. If you plan

to use a waiver, you should also contact the embassy of the countries you plan to visit for more

information.

This information was taken directly from the Yellow Fever VIS