Polio Disease Awareness and Prevention Campaign for

Healthcare Practitioners
September 23, 2019

A Joint Statement of the Philippine College of Physicians (PCP) and the Philippine Society for
Microbiology and Infectious Diseases (PSMID)

The polio viruses (type 1, type 2 , and type 3) invade the nervous system and cause
poliomyelitis which presents as fever, fatigue, headache, vomiting, stiffness in the neck, and
pain and weakness in the limbs. The polio virus is highly infectious, spreads from person-to-
person, through the fecal-oral route. The incubation period for polio is commonly 6–20 days,
with a range of 3–35 days. Children under the age of five (5) are most commonly infected, and
around 70% of infected children will remain asymptomatic but continue to shed the virus that
may infect others. There is no cure, but poliomyelitis is a vaccine-preventable disease
(VPD).

Vaccination coverage in the country has been steadily declining over the past few years.
Estimated polio vaccination coverage for children aged < 1 year with the required 3 doses of
bivalent OPV (bOPV) for 2018 was 66% (compared to the recommended 95%), while that for
IPV has been below 50% since its introduction in 2016, and is at a low of 23% for 2019.

The oral polio vaccine (OPV) is very effective against the wild polio virus, but in VERY RARE
cases the vaccine can lead to paralysis (known as vaccine-associated paralytic poliomyelitis
[VAPP]). The overall risk of VAPP is estimated at 1 case per 2.4 million doses administered. In
addition, another form of vaccine-associated polio is the circulating vaccine derived poliovirus
(cVDPV); the strain of poliovirus changed and reverted to a form that is able to cause paralysis
in humans, and has the ability to circulate. These are mutated versions of OPV. Almost all
cVDPV outbreaks in recent years have been caused by a type 2 vaccine-derived virus. The
strain of polio virus in VAPP has genetically changed in the intestine from the original attenuated
vaccine strain contained in OPV; associated with a single dose of OPV administered in a child,
or can occur in a close unvaccinated or non-immune contact of the vaccine recipient who is
excreting the mutated virus. There are no outbreaks associated with VAPP.
Meanwhile cVDPV outbreaks have a tendency to become endemic and can spread in any
undervaccinated community, and can be imported to other countries.
LOW VACCINATION coverage is a major risk factor for cVDPV emergence. A fully immunized
population will be protected against both vaccine-derived and wild polioviruses. The
immunization of every child under the age of 5 years several times with OPV will stop the
transmission of the cVDPVs.

A programmatic emergency for global public health for the eradication of the polio virus was
declared in 2012 by the World Health Assembly of the World Health Organization (WHO). For
this polio-free goal, the recommendations were as follows: 1) use of OPV must eventually be
stopped worldwide, starting with OPV containing type 2 poliovirus (OPV type 2), and 2) at least
one dose of inactivated poliovirus vaccine (IPV) must be introduced, given in addition to OPV, to
protect against type 2 poliovirus and to boost population immunity. The switch from trivalent
(tOPV) to bivalent (bOPV) will reduce the risk of vaccine-associated polio and increase
protection from types 1 and 3 polioviruses.

After the switch from tOPV to bOPV, IPV use will help maintain immunity to poliovirus type 2 to
help prevent re-emergence or reintroduction of wild or vaccine-derived poliovirus. IPV does not
cause either VAPP or cVDPV because it contains killed virus only. However, until polio is
eradicated globally, OPV vaccination is still the main PREVENTIVE measure against polio. IPV
is recommended in addition to OPV and does not replace OPV.

For adults, vaccination with OPV and IPV is not routinely recommended largely because most
adults have been vaccinated during childhood.

Vaccination in adults is only recommended in situations where there is a HIGHER RISK of

exposure such as:
● Those who will travel to endemic areas
● Those with occupational exposure [e.g. laboratory workers handling possibly
contaminated specimen and healthcare workers in close contact with patients
who might be excreting wild polioviruses in their stool]
● Those with close contact to persons likely or suspected to have been infected
with the poliovirus.

If an adult is at increased risk of exposure and has NEVER been vaccinated against polio, the
following are the recommendations:
● he or she should receive three doses of IPV - the first two doses given 1–2
months apart; the third dose 6–12 months after the second.
● In situations where time will not allow the completion of this schedule, a more
accelerated schedule is possible (e.g., each dose separated four weeks from the
previous dose).

If an adult at risk has PREVIOUSLY RECEIVED polio vaccine, BUT only one or two doses of
polio vaccine (either OPV or IPV):
 ● he or she should receive the remaining dose(s) of IPV, regardless of the interval
since the last dose

If an adult at increased risk has PREVIOUSLY COMPLETED a primary course of polio vaccine
(three or more doses of either OPV or IPV):
● he or she may have the OPTION to receive one dose of IPV to ensure protection.
● Only one “booster” dose of polio vaccine in a person’s life-time is recommended.
● It is NOT necessary to receive a booster dose each time a person travels to an
area where polio may still occur.

A completed polio vaccine series confers high levels of immunity. After three doses of the
standard four-dose series of IPV, efficacy stands at 99% to 100%. No long-term monitoring of
immunity is recommended.

In the Philippines, where polio morbidity is high and immunity is conferred mainly through the
OPV series, booster doses in addition to the four-dose series may be WARRANTED.

There is NO CURE for polio and vaccine is the primary intervention for prevention. The priority
for vaccination is the children < 5-year-old. We encourage ALL parents to coordinate with your
local health center regarding vaccination.

Polio is MAINLY transmitted via the fecal-oral route thus STRATEGIES to prevent its acquisition
is equally important, and as such we recommend the following:
● Improved environmental sanitation
● STRICTLY observe proper HAND HYGIENE at ALL times either with the use of
alcohol-based hand rubs or soap and water.
● Clean source of water should also be observed. If there is concern regarding the
cleanliness of the drinking water, boil it for a minute before drinking. ● Active
surveillance by the Department of Health should continue.

This is NOT the time to PANIC.

Correct information on the nature of the infection, how it is transmitted, and how it can be
prevented is an important tool to address the current situation.

PCP and PSMID will continue to be vigilant in bringing timely information and advisory to all
clinicians.
References:

Wallace, GS., Seward, JF., Pallansch, MA. (2014). Centers for Disease Control and
Prevention (CDC) Morbidity and mortality weekly report Interim CDC guidance
for polio vaccination for travel to and from countries affected by wild poliovirus.
July 11, 2014 / 63(27); 591-594. Retrieved from
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6327a4.htm.

Immunization Action Coalition (IAC) (2019). Ask the experts: polio.

Retrieved from https://www.immunize.org/askexperts/experts_pol.asp.

Immunization Action Coalition (IAC) (2018). Polio: questions and answers, information about
the disease and vaccines. (PDF).
Retrieved from https://www.immunize.rog/catg.d/p4215.pdf.

O'Grady M, Bruner PJ. Polio Vaccine. [Updated 2019 Jan 17]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2019 Jan-.

Polio Global Eradication Initiative (2014). Polio and the introduction of IPV. (PDF). Retrieved
from
https://www.who.int/immunization/diseases/poliomyelitis/inactivated_polio_vaccine/Key_
mess_FAQs.pdf.

Polio Global Eradication Initiative (2015). Vaccine-associated paralytic polio (VAPP) and
Vaccine-derived poliovirus (VDPV). (PDF). Retrieved from
https://www.who.int/immunization/diseases/poliomyelitis/endgame_objective2/oral_polio
_vaccine/VAPPandcVDPVFactSheet-Feb2015.pdf.

United Nations International Childrens’ Emergency Fund (UNICEF) and World Health
Organization (WHO). (2019). Philippines situation report 1: polio outbreak. Retrieved from
https://reliefweb.int/report/philippines/unicef-who-philippines-poliooutbreak-situation-report-
1-19-september-2019.

World Health Organization (WHO) (2019). International travel and health: poliomyelitis (polio).
Retrieved from https://www.who.int.