Guidelines for Adult Immunisation

Available Vaccines

Poliomyelitis

Updated in November 2023

 

Introduction

Poliomyelitis is an acute communicable disease caused by one of the three poliovirus serotypes (poliovirus type 1, 2 or 3) and is spread mainly by the faecal-oral route. The last cases of Wild poliovirus type 2 (WPV2) were reported in October 1999 (India) and global eradication of WPV2 was certified in 2015. The last case of Wild poliovirus type 3  (WPV3) was reported in November 2012 (Nigeria) and global eradication of WPV3 was certified in 2019. In 2021, only 6 WPV type 1 (WPV1) cases were reported in Afghanistan and Pakistan. These 2 countries continue to report cases of wild poliovirus type 1 (Polio endemic countries).  Besides these 2 countries, circulating vaccine-derived poliovirus (cVDPV) has been reported in 35 other countries in 2023 (visit www.polioeradication.org for updated list of countries).

In 2000, WHO certified Malaysia as polio-free. However, in December 2019, the Ministry of Health of Malaysia announced the country’s first case of polio since 1992. Testing had confirmed that the vaccine derived polioviruses (cVDPV1 and cVDPV2) were genetically linked to the virus circulating in the Philippines. However, after extensive public health measures, Malaysia was declared polio-free again since 11 Sept 2021.

On an average, about 1 in 75 adults who are infected, will develop paralytic poliomyelitis. The case fatality rate among paralytic cases is higher in adults (15-30%) compared to children (5-10%) predominantly due to bulbar involvement. Outbreaks of vaccine associated paralytic poliomyelitis (VAPP) occur in regions with low immunisation rates and poor sanitation. The low immunisation rates result in long term circulation of the vaccine-derived poliovirus in the population and thus allowing the virus to mutate and acquire back biologic properties similar to naturally occurring wild-type poliovirus. This results in VAPP among the unvaccinated.

Vaccines

Two types of poliovirus vaccines are currently available: oral poliovirus vaccine (OPV) and inactivated poliovirus vaccine (IPV). Until 2015, over 90% of vaccine derived poliomyelitis were due to the type 2 component of OPV. In 2016 trivalent OPV was switched to bivalent OPV (bOPV) in the routine immunisation program in countries with high risk of transmission. Type 2 poliovirus was removed from the vaccine because it was eradicated in 1999 and ongoing burden of VAPP due to circulating vaccine derived poliovirus type 2. In November 2020, WHO has recommended the use of type 2 novel oral poliovirus (nOPV2) in outbreaks due to circulating vaccine derived poliovirus 2 (cVDPV2).  The strains contained in the vaccine are modified versions of original OPV strain with enhanced genetic stability.

In Malaysia, OPV has been completely switched to IPV in the national immunisation program since 2010. IPV has mixture of inactivated, killed strains of all three poliovirus types.

Vaccines Available in Malaysia


1. Imovax Polio® (Inactivated polio vaccine)
Sanofi Aventis (Malaysia) Sdn Bhd/Sanofi Pasteur, France

Note:
IPV is also available in combination with DTP

Mode of Administration

  • Inactivated poliovirus vaccine (IPV)
    1. Adult dosage: 2 doses at an interval of two months. Booster to be given 8 to 12 months after the second injection.

    2. Given into the deltoid muscle for intramuscular injection or the posterior aspect of the upper arm for subcutaneous injection.

Target Groups in Malaysia

 
    • Travelers to polio-affected countries (refer to polioeradication.org for the list of countries) should have completed the primary vaccination schedule. If unvaccinated or if vaccination status is not documented should receive the primary vaccination series with IPV.  This includes two doses of IPV 4-8 weeks apart and a third dose 6-12 months after the second dose.
    • Residents or long-term visitors (i.e.,> four weeks) from polio-affected countries (refer to polioeradication.org for the list of countries) should complete the full course of polio vaccination according to their national schedule and in addition receive 1 dose of IPV or bOPV 4 weeks to 12 months before departure, if they have not had a booster vaccination in the preceding 12 months.
    • All health care workers should have completed a full course of primary vaccination.

Contraindications and Adverse Events

 
    • In general, vaccination of pregnant women and immunocompromised persons should be avoided. However, if immediate protection is needed, IPV is recommended.
    • Reported adverse events include transient minor local erythema (0.5-1.5%), induration (3-11%), and tenderness (14-29%)
    • To date, the most frequently reported adverse event for OPV received by the National Pharmaceutical Regulatory Agency (NPRA) is fever. Cases of febrile seizure and convulsions had also been reported in children.

References

  1. WHO (2022). Weekly Epidemiological Record, No 25, 24 June 2022; Polio vaccines; WHO position paper
  2. The Malaysian National Centre of Adverse Drug Reactions Database [Accessed: October 10, 2019].
  3. National Pharmaceutical Regulatory Agency (NPRA), Ministry of Health Malaysia. Senarai Produk Vaksin Berdaftar Dengan Pihak Berkuasa Kawalan Dadah. Updated September 5, 2019.