Vaccine Academy › Vaccine School › Childhood and adolescent
Content current as of October 11, 2026. AI-assisted draft; not yet reviewed by a licensed pharmacist. Current CDC schedules: immunization schedules.
- The disease and why it matters
- Video and figures
- Get CE credit
- Products available
- Who should get it
- Dosing and schedule, including catch-up
- Administration
- Storage and handling
- Contraindications and precautions
- Safety and adverse events
- Special populations
- Counseling pearls for the pharmacy counter
- Common patient questions
- References
The disease and why it matters
Poliovirus is highly contagious and causes polio (poliomyelitis), a serious and debilitating disease; infection is more common in infants and young children, and there are three poliovirus serotypes with minimal heterotypic immunity between them. [1]
Most people infected with poliovirus have no visible symptoms; about 1 in 4 have flu-like symptoms lasting 2 to 5 days, and fewer than 1% have weakness or paralysis of the arms or legs, which can lead to permanent disability and death. The onset of paralysis usually occurs 7 to 21 days after infection. [1]
There has not been a case of wild polio acquired in the United States since 1979, and the last imported case of wild polio was in 1993; polio has been eliminated from the United States but still occurs in other parts of the world. Adults who had paralytic polio in childhood may develop post-polio syndrome 15 to 40 years later. [1] [2]
Video and figures
Video
Get CE credit
- CDC You Call the Shots: Poliomyelitis module (CDC TRAIN course WB4719) — CDC · Free (CDC states no fees for its CE activities) · accredited by CDC, jointly accredited by ACCME, ACPE and ANCC; pharmacy UAN JA4008229-0000-23-065-H06-P. CDC's listing shows credit expiring 10/3/2025, so confirm on CDC TRAIN that credit is still available · link confirmed October 11, 2026
RxEvidence is not an accredited continuing education provider and does not award CE credit. These are links to activities offered by others.
Products available
CDC states that inactivated polio vaccine (IPV) is the only polio vaccine that has been given in the United States since 2000, and that IPOL is the single-antigen vaccine licensed in the United States; combination vaccines containing IPV are Pentacel (DTaP-IPV/Hib), Pediarix (DTaP-IPV-HepB), Kinrix (DTaP-IPV), Vaxelis (DTaP-IPV-Hib-HepB) and Quadracel (DTaP-IPV). [3]
| Vaccine | FDA list entry | Manufacturer (FDA page) | FDA-approved use |
|---|---|---|---|
| IPOL | Poliovirus Vaccine Inactivated (Monkey Kidney Cell) [4] | Sanofi Pasteur, SA [5] | Active immunization of infants (as young as 6 weeks of age), children and adults for the prevention of poliomyelitis caused by poliovirus types 1, 2 and 3 [6] |
| Poliovax | Poliovirus Vaccine Inactivated (Human Diploid Cell) [4] | No FDA product page or label link is shown for this entry on the FDA list | Not stated; no label was available from FDA's list |
The FDA licensed-vaccine list names Poliovax but links no product page or prescribing information for it, and CDC's page names only IPOL as the single-antigen vaccine licensed in the United States; this lesson therefore does not describe Poliovax. The IPOL label posted by FDA is an older-format label (FDA page content current as of 06/03/2022) with no revision date in the posted document. [4] [3] [5]
IPOL is supplied as a 5-mL multi-dose vial; neomycin, streptomycin, polymyxin B, 2-phenoxyethanol and formaldehyde are used in production and traces may be present, so allergic reactions may occur in persons sensitive to these substances. [6]
Who should get it
CDC / ACIP (polio vaccine recommendations page, September 6, 2024)
As of September 6, 2024
CDC recommends that children in the United States receive IPV as part of their routine immunizations: 4 doses, one at each of 2 months, 4 months, 6 through 18 months, and 4 through 6 years. Most adults born and raised in the United States can assume they were vaccinated; adults known or suspected to be unvaccinated or incompletely vaccinated should receive and complete the series, and adults at increased risk of exposure who completed the series may receive one lifetime IPV booster. [3]
FDA label (IPOL)
As of June 3, 2022
The IPOL label says all children should receive four doses of IPV at ages 2, 4, 6 to 18 months, and 4 to 6 years, and that OPV is no longer available in the US and is not recommended for routine immunization. [6]
Situations that put adults at increased risk of exposure include travelers to countries where polio is epidemic or endemic, laboratory and healthcare workers who handle specimens that might contain polioviruses, healthcare workers or caregivers with close contact with a person who could be infected, and adults identified by public health authorities as part of a group at increased risk because of an outbreak. [3]
CDC: January 2026 schedule revision and its legal status (polio vaccine)
As of June 11, 2026
On January 5, 2026 the CDC Acting Director approved a revised childhood and adolescent schedule whose first category (recommended for all children) lists measles, mumps, rubella, polio, pertussis, tetanus, diphtheria, Hib, pneumococcal disease, HPV and varicella, so polio vaccine stayed in the all-children category. A federal district court stayed that schedule on March 16, 2026 and reverted it to the version as of May 2025, and CDC's schedule page continues to show the July 2, 2025 addendum edition. [7] [8] [9]
American Academy of Pediatrics 2026 schedule (endorsed by AAFP, ACOG, AMA, IDSA, APhA and others)
As of January 26, 2026
The AAP published its own 2026 schedule on January 26, 2026, which continues to recommend routine immunization for protection against 18 diseases, including RSV, hepatitis A, hepatitis B, rotavirus, influenza and meningococcal disease, and differs from the schedule recently issued by CDC; the AAP schedule is formally endorsed by 12 organizations, including AAFP, ACOG, AMA, IDSA and the American Pharmacists Association. [10]
Dosing and schedule, including catch-up
CDC schedule notes (July 2, 2025): minimum age 6 weeks; 4-dose series at ages 2, 4, 6 to 18 months and 4 to 6 years, with the final dose given on or after age 4 years and at least 6 months after the previous dose; 4 or more doses may be given before age 4 years when a combination vaccine containing IPV is used, but a dose is still recommended on or after age 4 years and at least 6 months after the previous dose. [11]
The IPOL label says the primary series consists of three 0.5 mL doses given intramuscularly or subcutaneously, preferably 8 or more weeks apart and usually at 2, 4 and 6 to 18 months, and under no circumstances more frequently than 4 weeks apart; the first immunization may be given as early as 6 weeks of age, with a booster at 4 to 6 years. [6]
Accelerated schedule for children traveling outside the United States (CDC): one dose at age 6 weeks or older, a second dose 4 or more weeks after the first, a third dose 4 or more weeks after the second, and a fourth dose 6 or more months after the third; children completing the accelerated schedule should still receive an IPV dose at 4 years or older, at least 6 months after the last dose. [3]
| Situation | Recommendation |
|---|---|
| Unvaccinated adults | Three doses of IPV: the first dose at any time, the second 1 or 2 months later, and a third 6 to 12 months after the second. [3] |
| Accelerated adult schedule | Protection needed in 8 weeks or more: 3 doses at least 4 weeks apart; in 4 to less than 8 weeks: 2 doses at least 4 weeks apart; in fewer than 4 weeks: a single dose. [3] |
| Fully vaccinated adults at increased risk | Adults who have had 3 or more doses of polio vaccine and are at increased risk of exposure may receive one lifetime booster dose of IPV. [3] |
| Adolescents 18 years and adults, schedule notes (July 2, 2025) | Known or suspected to be unvaccinated or incompletely vaccinated: administer remaining doses (1, 2 or 3 IPV doses) to complete a 3-dose primary series; adults at increased risk who completed the primary series (at least 3 doses of IPV or trivalent OPV in any combination) may have one lifetime IPV booster. [12] |
- Oral polio vaccine (OPV) doses: only trivalent OPV (tOPV) counts toward U.S. requirements; OPV doses given before April 1, 2016 should be counted (unless given during a campaign) and doses given on or after April 1, 2016 should not be counted. [11]
- Since April 2016 countries still using OPV switched from trivalent to bivalent OPV; a person who received only bivalent OPV is not vaccinated against type 2 poliovirus and needs to complete an IPV 3-dose or 4-dose series depending on age. [3]
- Fractional IPV (1/5 full dose, intradermal) given outside the United States: 2 fractional doses count as 1 full intramuscular IPV dose, and a single fractional dose should not be counted; doses recorded as "IPV" in Bangladesh, Cuba, Ecuador, India, Nepal and Sri Lanka should be assumed to be fractional doses. [3]
- Children with no or questionable documentation of poliovirus vaccination should be revaccinated according to the U.S. schedule with age-appropriate IPV; documented age-appropriate IPV or tOPV means fully vaccinated. [3]
Administration
- IPOL is given intramuscularly or subcutaneously; in infants and small children the mid-lateral aspect of the thigh is the preferred site, and in older children and adults the deltoid area; do not administer intravenously. [6]
- IPOL should not be combined through reconstitution or mixed with any other vaccine; inspect the vial and packaging for leakage or a faulty seal and do not use if defects are observed; do not remove the vial stopper or the metal seal. [6]
- IPV can be given at the same time as other vaccines, and there are no known risks to getting IPV at the same time as other vaccines. [3]
- If the third dose of IPOL is given between 12 and 18 months of age it may be desirable to give it with MMR and/or other vaccines using separate syringes at separate sites, though no data on immunological interference exist. [6]
Storage and handling
- IPOL: the vaccine is stable if stored in the refrigerator at 2 to 8 °C (35 to 46 °F); it must not be frozen; protect from light. [6]
Contraindications and precautions
| Source | Contraindications | Precautions |
|---|---|---|
| CDC appendix (July 2, 2025 edition) | Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component. [13] | Pregnancy; moderate or severe acute illness with or without fever. [13] |
| IPOL label | History of hypersensitivity to any component of the vaccine, including 2-phenoxyethanol, formaldehyde, neomycin, streptomycin and polymyxin B; no further doses should be given if anaphylaxis or anaphylactic shock occurs within 24 hours of a dose. [6] | Vaccination of persons with an acute, febrile illness should be deferred until after recovery; minor illness such as mild upper respiratory infection with or without low-grade fever is not a reason for postponing vaccination. [6] |
Safety and adverse events
CDC's VIS says a sore spot with redness, swelling or pain where the shot is given can happen after polio vaccination, people sometimes faint after medical procedures including vaccination, and there is a very remote chance of a severe allergic reaction, other serious injury or death. [2]
The IPOL label reports that in earlier studies with the vaccine grown in primary monkey kidney cells, erythema, induration and pain occurred in 3.2%, 1% and 13% of vaccinees within 48 hours; temperatures of 39 °C (102 °F) or higher were reported in 38% of vaccinees; these systemic reactions could not be attributed to a specific vaccine because IPV was given concurrently with DTP at a different site, and were comparable in frequency and severity to DTP given alone. [6]
Although no causal relationship between IPOL and Guillain-Barré syndrome (GBS) has been established, GBS has been temporally related to administration of another inactivated poliovirus vaccine, and deaths have been reported in temporal association with IPV administration in infants, though no causal relationship has been established. [6]
CDC says 90% or more of vaccine recipients are immune after 2 doses of poliovirus vaccine and at least 99% are immune after 3 doses. [3]
Special populations
Pregnancy and breastfeeding: not much is known about the risks of polio vaccine for pregnant or breastfeeding women, but it can be given if a pregnant woman is at increased risk of infection and requires immediate protection. [2]
Immunodeficiency: the IPOL label says IPOL should be used in all patients with immunodeficiency diseases and members of such patients' households when vaccination of such persons is indicated, including patients with asymptomatic HIV infection, AIDS or AIDS-related complex, severe combined immunodeficiency and hypogammaglobulinemia. [6]
Previous clinical poliomyelitis or incomplete immunization with OPV are not contraindications to completing the series with IPOL, and persons with previous wild poliovirus disease who are incompletely immunized should be given additional doses if they fall into one or more of the adult at-risk categories. [6]
Counseling pearls for the pharmacy counter
- Children should usually get 4 doses of polio vaccine at 2 months, 4 months, 6 to 18 months and 4 to 6 years; most adults do not need polio vaccine because they were vaccinated as children, but some adults at higher risk (for example travelers to certain parts of the world and laboratory workers who might handle poliovirus) should consider it. [2]
- Tell the provider about an allergic reaction after a previous dose or severe, life-threatening allergies; people with minor illnesses may be vaccinated, while moderately or severely ill people should usually wait. [2]
- Signs of a severe allergic reaction (hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness or weakness) warrant calling 9-1-1; adverse reactions should be reported to the Vaccine Adverse Event Reporting System (VAERS). [2]
Common patient questions
A 5-year-old had 4 doses of a DTaP-IPV-containing combination, with dose 4 at 15 months. Does the child need another IPV dose?
CDC says a dose is still recommended on or after age 4 years and at least 6 months after the previous dose, even when 4 or more doses were given before age 4 years with combination vaccines. [11]
A U.S.-born adult is traveling to a polio-endemic country. What now?
If the adult is fully vaccinated (3 or more doses), CDC says one lifetime IPV booster may be given because travelers to countries where polio is epidemic or endemic are at increased risk; if unvaccinated or incompletely vaccinated, complete the series. [3]
A refugee child has records of 3 doses of "OPV" given in 2018. How are they counted?
CDC says OPV doses given on or after April 1, 2016 should not be counted as tOPV unless written documentation specifies the dose was tOPV; a person who received only bivalent OPV is not vaccinated against type 2 poliovirus and needs to complete an IPV series. [3]
References
- Centers for Disease Control and Prevention. Clinical overview of poliomyelitis. Page dated May 9, 2024. Accessed October 11, 2026. https://www.cdc.gov/polio/hcp/clinical-overview/index.html. Accessed October 11, 2026.
- Centers for Disease Control and Prevention. Polio vaccine: what you need to know. Vaccine Information Statement, January 31, 2025. Accessed October 11, 2026. https://www.cdc.gov/vaccines/hcp/current-vis/polio.html. Accessed October 11, 2026.
- Centers for Disease Control and Prevention. Polio vaccine recommendations (for health care providers). Page dated September 6, 2024. Accessed October 11, 2026. https://www.cdc.gov/polio/hcp/vaccine-considerations/index.html. Accessed October 11, 2026.
- U.S. Food and Drug Administration. Vaccines licensed for use in the United States (content current as of 10/08/2026). Accessed October 11, 2026. https://www.fda.gov/vaccines-blood-biologics/vaccines/vaccines-licensed-use-united-states. Accessed October 11, 2026.
- U.S. Food and Drug Administration. IPOL (poliovirus vaccine inactivated, monkey kidney cell) product page (content current as of 06/03/2022). Accessed October 11, 2026. https://www.fda.gov/vaccines-blood-biologics/vaccines/ipol-poliovirus-vaccine-inactivated-monkey-kidney-cell. Accessed October 11, 2026.
- IPOL (poliovirus vaccine inactivated [monkey kidney cell]): package insert as posted on FDA's product page (older-format label; no revision date appears in the posted document). Sanofi Pasteur. U.S. Food and Drug Administration. Accessed October 11, 2026. https://www.fda.gov/media/75695/download?attachment. Accessed October 11, 2026.
- Centers for Disease Control and Prevention. CDC acts on Presidential Memorandum to update childhood immunization schedule. News release, January 5, 2026. Accessed October 11, 2026. https://www.cdc.gov/media/releases/2026/2026-cdc-acts-on-presidential-memorandum-to-update-childhood-immunization-schedule.html. Accessed October 11, 2026.
- Congressional Research Service. The 2026 Childhood Immunization Schedule (R48982). June 11, 2026. Accessed October 11, 2026. https://www.congress.gov/crs_external_products/R/PDF/R48982/R48982.1.pdf. Accessed October 11, 2026.
- Centers for Disease Control and Prevention. Healthcare professionals: immunization schedules. Accessed October 11, 2026. https://www.cdc.gov/vaccines/hcp/imz-schedules/index.html. Accessed October 11, 2026.
- American Academy of Pediatrics. AAP releases recommended childhood and adolescent immunization schedule for 2026. HealthyChildren.org news. Accessed October 11, 2026. https://healthychildren.org/English/news/Pages/AAPs-recommended-childhood-and-adolescent-immunization-schedule-for-2026.aspx. Accessed October 11, 2026.
- Centers for Disease Control and Prevention. Child and adolescent immunization schedule notes: recommendations for ages 18 years or younger, United States, 2025. July 2, 2025. Accessed October 11, 2026. https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-notes.html. Accessed October 11, 2026.
- Centers for Disease Control and Prevention. Adult immunization schedule notes: recommendations for ages 19 years or older, United States, 2025. July 2, 2025. Accessed October 11, 2026. https://www.cdc.gov/vaccines/hcp/imz-schedules/adult-notes.html. Accessed October 11, 2026.
- Centers for Disease Control and Prevention. Child and adolescent immunization schedule appendix: guide to contraindications and precautions (July 2, 2025 edition). Accessed October 11, 2026. https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-appendix.html. Accessed October 11, 2026.
For professional education. Check current labeling and guidance before acting. Not medical advice.
