Introduction of IPV

Guidance for Country Managers

 The Polio Eradication and Endgame
Strategic Plan 2013-2018

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

eradication to be a global public health emergency

 The plan was developed to eradicate both wild polioviruses and vaccine-derived
polioviruses (WPV and VDPV).

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

 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eradication – hence the type 2 containing OPV will be eventually withdrawn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

 OPV will be withdrawn in 2 phases beginning with type 2 OPV

2| Introduction to polio endgame rationale and IPV, Module 1 | 21 October 2019

 The Polio Eradication and Endgame
Strategic Plan 2013-2018 (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immunization schedule by the end of 2015, before type 2 OPV is withdrawn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:

– To reduce risks of an outbreak after type 2 OPV vaccine withdrawal
– To help stop outbreaks quickly if type 2 virus is reintroduced
– To boost immunity against polio types 1 & 3 to protect populations and
hasten eradication

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 tOPV bOPV

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4
 Comparison of OPV and IPV

Oral polio vaccine (OPV) Inactivated polio vaccine (IPV)

• Live, attenuated (weakened) virus • Killed virus
• Administered by drops • Administered by injection

• Highly successful in reducing transmission in • Highly effective

developing countries as part of eradication • Used commonly in developed countries
strategy
• Inexpensive • More expensive than OPV
• Easy to administer • Requires trained health workers
• Provides mucosal/gut immunity • Provides immunity through blood
• Protects close contacts who are unvaccinated • Carries no risk of VAPP or VDPV

5| Introduction to polio endgame rationale and IPV, Module 1 | 21 October 2019

 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 also helps us remind caretakers
about the importance of vaccinations overall, inform them about
missed and upcoming vaccinations.

6| Introduction to polio endgame rationale and IPV, Module 1 | 21 October 2019

 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 small 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

7| Introduction to polio endgame rationale and IPV, Module 1 | 21 October 2019

 What is the presentation of inactivated
poliovirus vaccine (IPV)?
 Liquid suspension providing protection against all 3 types of poliovirus
 Single-dose, and multi dose vials, of either 5-dose or10 doses per vial
 Does not require reconstitution
 Preservatives in multi-dose vials of IPV meets the WHO requirements to
preserve the vaccine for 28 days
 VVM
– If the VVM is on the label, multi-dose vials of this vaccine can be kept for
use in subsequent sessions providing that the meets all the 5 WHO
criteria for the MDVP
– If the VVM is on the cap the vial must be discarded at the end of the
immunization session or within 6 hours.

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October 2019
 VVM placement for IPV Vials
VVM on CAP 6 hour discard
Opened multi-dose vials with the VVM on the
cap should be discarded at the end of the
immunization session or within 6 hours after
opening, whichever comes first.

VVM on LABEL 28 day discard

Opened IPV multi-dose vialscan be kept and
used for up to 28 days after opening,
provided the expiry date has not passed, the
vaccine is appropriately handled and stored,
and the VVM indicates that vial can be used.
Remember: opened vials should be used first
before opening additional vials.

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October 2019
 Multi-dose vials of IPV
 If the VVM is on the label:
– Preservatives in multi-dose vials of IPV meet WHO requirements to preserve the vaccine
for 28 days

VVM on LABEL 28 day discard

Provided the expiry date has not passed
and the vaccine is appropriately handled
and stored, opened IPV multi-dose vials
with VVM on the label can be kept and
used in subsequent sessions for up to 28
days after opening.

10 | IPV vaccine administration, Module 4 | 21 October 2019

 How safe is IPV vaccine?

 IPV is one of the safest vaccines

 Infrequently reported side effects: swelling, redness and pain at injection

site, mild fever and discomfort

 IPV may be given with other vaccines in the infant Expanded Program on
Immunization (EPI) schedule without interfering with their effectiveness

 Incidence of Adverse Events does not increase when IPV is given in the
same session (either as stand-alone or in combination vaccines)

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October 2019
Philippines Immunization Schedule 2015

Age
Antigen At birth 1½ 2½ 3½ 9 months 12
months months months months
BCG vaccine
Hepatitis B vaccine
DPT-HepB-Hib
(Pentavalent vaccine)
Oral Polio vaccine
Inactivated Polio
vaccine
Pneumococcal
Conjugate vaccine
Rotavirus vaccine
Measles vaccine
Measles-Mumps-
Rubella vaccine

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 Absolute contraindications to IPV

Do not • Known or documented allergy to vaccine components, including:

vaccinate if - Streptomycin
recipient has: - Neomycin
- Polymyxin B
• History of an allergic reaction following a previous IPV injection
• Thrombocytopenia (insufficient blood platelets, which play an important
role in coagulation)
• Other bleeding disorder

Postpone • Taking temporary treatment that suppresses the immune response

vaccination if - Treatment could reduce immune response to the vaccine
recipient is: - Postpone vaccination until the end of the treatment to make sure
Wait! the infant is well protected by the vaccine

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Can IPV be administered on schedule to immunodeficient
infants or infants born prematurely?

 Yes!

 Immunodeficiency does not prevent

administration of IPV

 Vaccination of infants with immunodeficiency,

such as HIV infection, is recommended

 Infants born prematurely should receive IPV

on schedule (at or after 14 weeks of age)

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 Contraindication Checklist

Do I still give IPV if recipient has….? Yes No Postpone

… mild illness
… malnutrition
… HIV
… prematurity
… allergy to streptomycin, neomycin or
polymyxin B
… bleeding disorder
… had a previous reaction to IPV

… taking treatment that suppresses immune

response

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 Key messages

 First IPV dose should be given at 3 ½ months of age together

with OPV3 and Penta 3
 It is safe to give IPV at the same time as other injectable
vaccines like pentavalent and pneumococcal vaccine
 Do not replace OPV with IPV; the dose of IPV should be
added to the schedule
 IPV can be administered to children with immunodeficiency
disorders and those born prematurely

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Checking the Vaccine Vial Monitor (VVM)
 IPV vial has a VVM on the vial label
 The VVM registers cumulative heat exposure, and
changes from light to dark
 Check the VVM on each vaccine vial
 If inside square is the same color, or darker than the circle
(stage 3 or 4), do not use the vaccine
Stage 1: Vaccine OK
Stage 2: Vaccine OK but use first
Stage 3: Do not use the vaccine
Stage 4: Do not use the vaccine

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 How to successfully administer multiple injections?

Pentavalent IPV and PCV

(or other) given in the outer
in the Right thigh aspect of the Left
upper thigh.

Injection sites
separated by at
least 2.5 cm --
about two fingers
apart.

http://www.who.int/vaccine_safety/initiative/tech_support/Vaccine-safety-E-course-manual.pdf 18
 Sequence of Injections

1. Give OPV 2. Penta R thigh 3. PCV L thigh 4. IPV L thigh

Separate the two i.m. injections in the Left thigh by about two
fingers width
 How to administer IPV

 Location
– IPV is administered as a 0.5 ml dose into the
muscle in the outer part of the Left thigh
 Procedure
– Wash your hands well for 15 seconds
– Hold the muscle firmly between your thumb
and index finger
– Hold the syringe like a pencil
– Quickly insert the needle through the skin at
a 90-degree angle
– Depress the plunger
Remember to record both OPV and IPV
separately
 Both IPV and OPV will be administered simultaneously

 Therefore, both IPV and OPV should be recorded and

monitored separately, not as “polio vaccines”

Vaccine Date Given

Penta3 May 15, 2015
Record separately OPV3 May 15, 2015
as “OPV3” and
“IPV”, not “polio” IPV May 15, 2015

21 | Recording and monitoring uptake of IPV vaccine, Module 5 | 21 October 2019

 How likely is an AEFI after IPV?

 IPV is a very safe vaccine

 Not associated with serious systemic AEFIs
 Inactivated vaccine – therefore, no risk of vaccine-associate
polio

 Can safely be administered with other

recommended childhood vaccines, including
OPV and other injectable vaccines

22 | Inactivated poliovirus vaccine AEFI monitoring, Module 6 I 21 October

2019
 How to communicate with caregivers?

 Provide reassurance
– Explain to parents and caregivers that IPV is
important and safe.
– Reassure them that multiple injections are safe.
– Remind them that it is better for the child to
experience one, brief moment of discomfort than
pain on two separate days.
– Reinforce the importance of immunization overall

23 | Multiple Vaccine Injections, Module 6 | 21 October 2019

 How to explain the benefits of IPV
Health workers can tell parents and caregivers:

“Combining IPV and OPV provides stronger protection against polio. The
dose of IPV will help protect your children against polio disease even more –
and will give your child the benefits of both vaccines.”

“IPV strengthens immunity in the blood, while OPV strengthens immunity in

the gut”

“Using both vaccines together provides the best form of protection from
polio – it protects your child and helps protect our community.”

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 Safety of IPV 1

 IPV has been used in over 60 countries worldwide, over

decades
 IPV is a very safe vaccine, whether used alone or in combination
vaccines
 No serious side effects have been reported, only minor side
effects
 Minor local reactions may occur following IPV, as can sometimes
happen with other vaccines. But a child will recover

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 Safety of IPV 2
 IPV is one of the safest vaccines used for routine immunization, alone or in
combination; there is no proven causal relationship to adverse events except
minor local erythema (0.5–1%), induration (3–11%) and tenderness (14–29%)

 Local reactions are usually mild and transient in nature.

 Systemic adverse reactions reported in infants receiving IPV concomitantly at

separate sites or combined with DTP-containing vaccines have been similar
to those associated with administration of DTP-containing vaccines alone.

26 | Multiple Vaccine Injections, Module 6 | 21 October 2019

 Module 8: Multiple Injections

Common questions from caregivers about

multiple injections:
Wouldn’t it be safer to separate vaccine injections and spread them out?
No, it is safer for your child to receive all of his vaccinations at once. Spreading
out vaccinations leaves babies unprotected for a longer time.

If my child receives multiple injections at the same visit, will the vaccines
be as effective if given alone?
Yes. IPV does not interfere with other vaccines and IPV is equally effective when
given alone or with other vaccines.

Can multiple vaccines given at once “overwhelm” a child’s immune

system?
No. Children are exposed to numerous bacteria and viruses on a daily basis
through eating and playing. Vaccines do not add a significant burden to the
immune system.
 Key Messages on Multiple Injections

 It is safe to give multiple vaccine injections at one visit. Many countries

have successfully introduced multiple vaccine injections into their routine
immunization schedule.
 Multiple injections are better than spacing injections because they protect
children, increase efficiency and lead to fewer overall vaccination visits.
 Parental concerns about multiple injections can be addressed through
reassurance, clear communication and pain reducing techniques.
 Health workers need to listen, encourage and effectively communicate with
caregivers to ensure that they receive their vaccines and return for future
vaccinations.

28 | Multiple Vaccine Injections, Module 8 | 21 October 2019