Public Health Agency of Canada
Symbol of the Government of Canada

Share this page

Canadian Immunization Guide

[Previous page] [Table of Contents] [Next page]

Part 4
Active Vaccines

Poliomyelitis Vaccine

Key Information (Refer to text for details)

What

  • Polio remains endemic in three countries - Afghanistan, Nigeria and Pakistan; additional countries are known or suspected of having re-established transmission of poliovirus. Several other countries have ongoing outbreaks due to importations of poliovirus.
  • Children less than five years of age are more susceptible to polio infection.
  • Inactivated poliomyelitis vaccine (IPV)-containing vaccines produce immunity in over 95% of vaccinees after three doses and in close to 100% following a booster dose.
  • Adverse events following IPV vaccine are usually limited to mild injection site reactions.

Who

  • IPV-containing vaccine is recommended for:
    • routine immunization of infants and children
    • children who missed polio immunization on the routine schedule
    • unimmunized adults
    • as a booster dose for adults previously immunized against polio and at increased risk of polio exposure

How

  • Routine polio immunization of infants and children: administer DTaP-IPV-Hib vaccine at 2, 4, 6 and 12 to 23 months of age (generally given at 18 months of age). If infant immunization for hepatitis B is undertaken, DTaP-HB-IPV-Hib vaccine may be used.  Subsequently, administer a booster dose of either DTaP-IPV or Tdap-IPV vaccine at 4 to 6 years of age (school entry).
  • Adults previously unimmunizedwith polio vaccine: administer a primary series of IPV-containing vaccine if a primary series of tetanus toxoid-containing vaccine is being given or if the adult is at increased risk for exposure to poliovirus; otherwise, administer polio with routine tetanus and diphtheria booster doses.
  • Adults previously immunized with polio vaccine: for those at increased risk of exposure to polio (e.g., those travelling to, or planning to work in areas that have wild polio or vaccine-derived polio outbreaks), a single lifetime booster dose of IPV-containing vaccine is recommended.
  • IPV-containing vaccines may be administered concomitantly with routine vaccines at different injection sites using separate needles and syringes.

Why

  • Until polio eradication has been achieved globally, there remains a small risk of contracting polio with travel to polio-endemic countries and importation of polio into Canada.
  • The case fatality rate for paralytic polio is 2% to 5% among children and 15% to 30% for adults.

Significant revisions since the last chapter update are highlighted in the Canadian Immunization Guide (CIG) Table of Updates which is available on the Public Health Agency of Canada (the Agency) website.

For additional information, refer to previously published National Advisory Committee on Immunization (NACI) Statements and Statement Updates.

Epidemiology

Disease description

Infectious agent
Polio is caused by poliovirus, a member of the enterovirus subgroup of the Picornaviridae family.

Reservoir
Humans

Transmission
Transmission of poliovirus occurs predominantly through the fecal-oral route. Respiratory spread may rarely occur. The incubation period for polio is generally 6 to 20 days (range, 3 to 35 days). Communicability is greatest around the onset of illness when the virus is present in high concentrations in the throat and feces. Poliovirus can remain in feces for 3 to 6 weeks. In persons who have received oral polio vaccine (OPV), poliovirus can be present in the throat for 1 to 2 weeks following immunization and can remain in feces for several weeks. In rare cases, including immunocompromised persons, poliovirus (from natural infection or OPV vaccine) can be excreted for prolonged periods of time (from greater than 6 months to a number of years).

Risk factors
Polio infections are more common in children less than five years of age; however, any person who is not immune to poliovirus, regardless of age, can become infected.

Seasonal and temporal patterns
In temperate climates, polio infection generally increases in the late summer and autumn months.

Spectrum of clinical illness
Most polio infections (90% to 95%) are asymptomatic. In symptomatic persons, initial symptoms occur on average 7 to 14 days after infection and include fever, fatigue, headache and vomiting. With increased disease severity, severe muscle pain and stiffness of the neck and back with or without paralysis may occur. Although paralysis is the most visible sign of polio infection, less than 1% of cases result in paralysis. The case fatality ratio for paralytic polio ranges from 2% to 5% among children and 15% to 30% for adults.

Disease distribution

The incidence of polio in Canada was dramatically reduced by the introduction of immunization programs in the 1950s. In Canada, after using the live attenuated oral polio vaccine (OPV) for many years, its use was replaced with an inactivated poliomyelitis vaccine (IPV) in 1995/1996. The last indigenous case of wild poliovirus in Canada was in 1977. In 1994, Canada was certified as being free of wild poliovirus by the World Health Organization. More recent cases of paralytic polio in Canada have been associated with importations of wild poliovirus and the use of OPV. The last nationally reported case of paralytic polio occurred in 1995 and was related to OPV receipt. More information on polio and polio surveillance in Canada can be found on the Agency’s website.

Preparations Authorized For Use In Canada

Poliomyelitis-containing vaccines
  • ADACEL®-POLIO (adsorbed vaccine containing tetanus toxoid, reduced diphtheria toxoid and reduced acellular pertussis vaccine combined with inactivated poliomyelitis vaccine), sanofi pasteur Ltd. (Tdap-IPV)
  • BOOSTRIX®-POLIO (adsorbed vaccine containing tetanus toxoid, reduced diphtheria toxoid and reduced acellular pertussis vaccine combined with inactivated poliomyelitis vaccine), GlaxoSmithKline Inc. (Tdap-IPV)
  • IMOVAX® Polio (inactivated poliomyelitis vaccine (vero cell origin), sanofi pasteur SA (manufacturer), Sanofi Pasteur Ltd. (distributor). (IPV)
  • INFANRIX®-IPV (adsorbed vaccine containing diphtheria and tetanus toxoids, acellular pertussis, inactivated poliomyelitis), GlaxoSmithKline Inc. (DTaP-IPV)
  • INFANRIX®-IPV/Hib (adsorbed vaccine containing diphtheria and tetanus toxoids, acellular pertussis, inactivated poliomyelitis and conjugated Haemophilus influenzae type b vaccine), GlaxoSmithKline Inc. (DTaP-IPV-Hib)
  • INFANRIX hexa™ (adsorbed vaccine containing diphtheria and tetanus toxoids, acellular pertussis, hepatitis B (recombinant), inactivated poliomyelitis and conjugated Haemophilus influenzae type b vaccine), GlaxoSmithKline Inc. (DTaP-HB-IPV-Hib)
  • PEDIACEL® (adsorbed vaccine containing diphtheria and tetanus toxoids and acellular pertussis vaccine combined with inactivated poliomyelitis vaccine and Haemophilus influenzae type b conjugate vaccine), Sanofi Pasteur Ltd. (DTaP-IPV-Hib)
  • QUADRACEL® (adsorbed vaccine containing diphtheria and tetanus toxoids and acellular pertussis vaccine combined with inactivated poliomyelitis vaccine), Sanofi Pasteur Ltd. (DTaP-IPV)
  • Td POLIO ADSORBED (adsorbed vaccine containing tetanus and reduced diphtheria toxoids and inactivated poliomyelitis vaccine), Sanofi Pasteur Ltd. (Td-IPV)

Poliomyelitis vaccine contains three types of wild poliovirus and is available as trivalent inactivated polio vaccine (IPV) or in a combination vaccine. Live attenuated oral polio vaccine (OPV) is no longer recommended or available in Canada because most cases of paralytic polio from 1980 to 1995 were associated with OPV vaccine. OPV vaccine continues to be widely used internationally.

For complete prescribing information, consult the product leaflet or information contained within Health Canada’s authorized product monographs available through the Drug Product DatabaseExternal Link. Refer to Table 1 in Contents of Immunizing Agents Available for Use in Canada in Part 1 for a list of all vaccines available for use in Canada and their contents.

Efficacy, Effectiveness and Immunogenicity

IPV-containing vaccines produce immunity to all three types of poliovirus in over 95% of vaccinees following three doses of vaccine, and in close to 100% following a booster dose. Seroconversion rates are lower if the minimum age and minimum intervals for vaccine administration are used in infants less than 6 months of age.

Recommendations For Use

Infants and children (2 months to 17 years of age)

An IPV-containing vaccine is recommended for routine infant immunization beginning at 2 months of age. DTaP-IPV (with or without Hib) vaccine is authorized for use in children less than 7 years of age. DTaP-HB-IPV-Hib vaccine is authorized for use in children 6 weeks to 23 months of age and may be given to children aged 24 months to less than 7 years, if necessary. DTaP-IPV or Tdap-IPV vaccine should be used as the booster dose for children at 4 to 6 years of age. Children 7 years of age and older should receive IPV vaccine or the adolescent/adult formulation of the diphtheria-tetanus-pertussis-polio-containing vaccine (Tdap-IPV). Tdap-IPV vaccine contains less diphtheria toxoid than vaccines given to younger children and is less likely to cause reactions in older children. Tdap vaccine is generally administered to adolescents at 14 to 16 years of age as the first 10-year booster dose; however, Tdap-IPV vaccine should be used if IPV vaccine is also indicated.

Adults (18 years of age and older)

Similar to vaccination of children, vaccination of adults is recommended to prevent the introduction and circulation of polio. A complete series of IPV-containing vaccine is recommended for previously unimmunized adults who are also receiving a primary series of tetanus toxoid-containing vaccine. For other adults who are unvaccinated against polio, vaccination efforts should be focused on those who are at increased risk of exposure to polioviruses (refer to Table 1). Adults who are unvaccinated against polio but who do not need a primary series of tetanus and diphtheria toxoid-containing vaccine and who are not at increased risk of exposure can be provided with polio vaccinations when tetanus and diphtheria toxoid-containing vaccine booster doses are due.

Adults previously immunized with polio vaccine: for those at increased risk of exposure to polio (e.g., those travelling to, or planning to work in areas that have wild polio or vaccine-derived polio outbreaks) a single lifetime booster dose of IPV-containing vaccine is recommended (refer to Table 1).

Table 1: Persons at increased risk of exposure to poliovirus

Travellers to, or persons receiving travellers from, areas where poliovirus is known or suspected to be circulating

Members of communities or specific population groups with disease caused by polio

Health care workers who have close contact with patients who might be excreting wild type or vaccine type poliovirus

People who come in close contact with those who may be excreting poliovirus (e.g., people working with refugees, or the military and people on humanitarian missions in endemic countries)

Laboratory workers handling specimens that may contain poliovirus

Family or close contacts of internationally adopted infants who may have been or will be vaccinated with OPV vaccine

Refer to Schedule, Travellers and Booster doses and re-immunization. Refer to Diphtheria Toxoid, Tetanus Toxoid, Pertussis Toxoid, Haemophilus influenzae type b Vaccine, and Hepatitis B Vaccine in Part 4 for additional information.

Persons with inadequate immunization records

Children and adults lacking adequate documentation of immunization should be considered unimmunized and started on an immunization schedule appropriate for their age and risk factors. IPV vaccine can be given, if indicated, without concern about prior receipt of the vaccine, because adverse events associated with repeated immunization with the vaccine have not been demonstrated. Refer to Diphtheria Toxoid in Part 4 for additional information. Refer to Immunization of Persons with Inadequate Immunization Records in Part 3 for additional general information.

Pregnancy and breastfeeding

IPV vaccine may be considered for pregnant women who require immediate protection and are at increased risk of exposure to wild poliovirus (refer to Table 1). There is no evidence to suggest a risk to the fetus or to the pregnancy from maternal immunization with inactivated vaccines, such as IPV vaccine. Refer to Immunization in Pregnancy and Breastfeeding in Part 3 for additional general information.

Infants born prematurely

Premature infants in stable clinical condition should be immunized with an IPV-containing vaccine at the same chronological age and according to the same schedule as full-term infants. Infants born prematurely (especially those weighing less than 1,500 grams at birth) are at higher risk of apnea and bradycardia following vaccination. Hospitalized premature infants should have continuous cardiac and respiratory monitoring for 48 hours after their first immunization. Refer to Immunization of Infants Born Prematurely in Part 3 for additional general information.

Persons/residents in health care institutions

Residents of long-term care facilities should receive all routine immunizations appropriate for their age and risk factors, including IPV-containing vaccine. Refer to Immunization of Persons/Residents in Health Care Institutions in Part 3 for additional general information.

Immunocompromised persons

Diphtheria-tetanus-pertussis-polio-Hib-containing vaccines may be administered to immunocompromised persons. When considering immunization of an immunocompromised person, consultation with the individual’s attending physician may be of assistance in addition to the guidance provided in Immunocompromised persons in Diphtheria Toxoid and Haemophilus influenza type b Vaccine in Part 4. For complex cases, referral to a physician with expertise in immunization or immunodeficiency is advised.

Refer to Immunization of Immunocompromised Persons in Part 3 for additional general information.

Persons with chronic diseases

Neurologic disorders
Refer to Tetanus Toxoid and Pertussis Vaccine in Part 4 for information regarding other components in IPV-containing combination vaccines. Refer to Immunization of Persons with Chronic Diseases in Part 3 for additional general information.

Travellers

Unimmunized or incompletely immunized travellers should receive an IPV-containing vaccine as appropriate for age, particularly if they are children, or if they are adults and are travelling to areas where poliovirus is known or suspected to be circulating. Previously unimmunized children travelling to areas where poliovirus is known or suspected to be circulating should start a primary series of an IPV-containing vaccine, with consideration given to an accelerated schedule (refer to Schedule). For infants embarking on travel, the first dose of DTaP-IPV-Hib or DTaP-HB-IPV-Hib vaccine can be given at 6 weeks of age. If IPV vaccine is not available in the region to which the child is travelling, children may complete their series with OPV vaccine while travelling. Parents of children receiving OPV vaccine should be informed that infants can excrete poliovirus for up to 5 days following vaccination, so household contacts and caregivers of these infant should have up-to-date polio immunization. People should be instructed to wash their hands carefully after changing diapers. There is also a small risk of OPV vaccine-associated paralytic polio (approximately 1 per 2.4 million doses distributed).

Children with a complete primary series do not require additional doses of IPV vaccine before travelling. For adults previously immunized against polio, a single lifetime dose of polio-containing vaccine is recommended for travellers at increased risk of exposure to polio (e.g., military personnel, workers in refugee camps in endemic areas, or travellers to areas where there are polio epidemics) (refer to Table 1). Refer to the Committee to Advise on Tropical Medicine and Travel (CATMAT) Poliomyelitis vaccination for International Travellers for more information.

Refer to Diphtheria Toxoid in Part 4 for additional information. Refer to Immunization of Travellers in Part 3 for additional general information.

Persons new to Canada

Health care providers who see people newly arrived in Canada should review the immunization status and update immunization for these individuals. Children who have received one or more doses of polio vaccine before arriving in Canada should have their vaccine series completed with IPV-containing vaccine as appropriate for age. Refer to Immunization of Persons New to Canada in Part 3 for additional general information.

Workers

Workers who need a primary series of tetanus and diphtheria toxoid-containing vaccine should also receive IPV-containing vaccine if unvaccinated against polio. For other workers who are unvaccinated against polio, vaccination efforts should be focused on those who are at increased risk of exposure to polioviruses as identified in Table 1. If previously vaccinated with a primary series of tetanus and diphtheria toxoid-containing vaccine and not in an increased risk group (refer to Table 1), adults unvaccinated against polio can receive IPV-containing vaccine when due for their next tetanus and diphtheria booster. Refer to Immunization of Workers in Part 3 for additional general information.

Vaccine Administration

Dose, route of administration, and schedule

Dose
Each dose of IPV-containing vaccine is 0.5 mL.

Route of administration
Combination vaccines containing IPV vaccine must be administered intramuscularly. IPV vaccine when given as a separate vaccine, should be administered subcutaneously. Refer to Vaccine Administration Practices in Part 1 for additional information.

Schedule

Infants and children (2 months to 6 years of age)

Routine polio immunization of infants: DTaP-IPV-Hib vaccine should be given at 2, 4, 6 and 12 to 23 months of age (generally given at 18 months of age).

If infant immunization for hepatitis B is undertaken, DTaP-HB-IPV-Hib vaccine may be used as an alternative to separately administered hepatitis B and DTaP-IPV-Hib vaccines. DTaP-HB-IPV-Hib vaccine is authorized for use in children 6 weeks to 23 months of age and may be given to children aged 24 months to less than 7 years, if necessary. DTaP-HB-IPV-Hib vaccine may be given at 2, 4, 6 and 12 to 23 months of age, but the fourth dose is unlikely to provide significant additional hepatitis B protection and will increase cost. Alternative schedules may be used as follow:

  • DTaP-HB-IPV-Hib vaccine (2, 4 and 6 months of age) with DTaP-IPV-Hib vaccine at 12 to 23 months of age
  • DTaP-HB-IPV-Hib vaccine (2, 4 and 12 to 23 months of age) with DTaP-IPV-Hib vaccine at 6 months of age.

A dose of IPV-containing vaccine is not required at 6 months of age for a complete primary series of polio vaccine; however, it is acceptable to give the additional dose of IPV vaccine in a combination vaccine for convenience of administration.

If rapid protection is required for an infant, the first dose of DTaP-IPV-Hib or DTaP-HB-IPV-Hib vaccine can be given at 6 weeks of age. The first three doses may be administered at intervals of 4 weeks and, optimally, the fourth dose given 12 months after the third dose. The fourth dose may be given at a minimum interval of 6 months after the third dose in certain situations (e.g., travel) but must be administered at or after 12 months of age for sustained immunity.

Children less than 7 years of age, not immunized in infancy: should receive three doses of DTaP-IPV (with or without Hib) vaccine with an interval of 8 weeks between doses, followed by a dose of DTaP-IPV vaccine 6 to 12 months after the third dose. A booster dose of either DTaP-IPV or Tdap-IPV vaccine should be administered at 4 to 6 years of age (school entry). The booster dose at 4 to 6 years of age is not required if the fourth dose of tetanus-toxoid containing vaccine was administered after the fourth birthday.

If rapid protection is required for a child less than 7 years of age not immunized in infancy, with imminent exposure to circulating poliovirus (e.g., during an outbreak or because of travel), the first three doses of vaccine may be administered at intervals of 4 weeks and, optimally, the fourth dose given 12 months after the third dose. The fourth dose may be given at a minimum interval of 6 months after the third dose in certain situations (e.g., travel).

Children (4 years of age and older) not immunized against polio in infancy and not requiring the additional antigens in combination vaccine should receive two doses of IPV vaccine, given 4 to 8 weeks apart, followed by a third dose administered 6 to 12 months after the second dose.

Children who received a primary series of IPV-containing vaccine and a booster dose 6-12 months later as outlined above, should receive a booster dose of either DTaP-IPV or Tdap-IPV vaccine at 4 to 6 years of age (school entry). The booster dose at 4 to 6 years of age is not required if the third dose of IPV-containing vaccine was administered after the fourth birthday. A dose of IPV-containing vaccine should be administered at 4 to 6 years of age, regardless of the number doses of IPV and OPV vaccine administered prior to 4 years of age.

Children and adolescents (7 years to 17 years of age)

For children and adolescents not previously immunized with tetanus, diphtheria and polio, refer to Tetanus Toxoid or Diphtheria Toxoid in Part 4. Children 7 years of age and older needing only polio protection, should receive two doses of IPV-containing vaccine, given 4 to 8 weeks apart, followed by a third dose administered 6 to 12 months after the second dose.

Adults (18 years of age and older)

For adults not previously immunized with tetanus, diphtheria and polio, refer to Tetanus Toxoid or Diphtheria Toxoid in Part 4. Adults at increased risk for polio who only need polio protection, should receive two doses of IPV-containing vaccine, given 4 to 8 weeks apart, followed by a third dose 6 to 12 months after the second dose. Adults who are unimmunized against polio but are not at increased risk and have had a primary series of tetanus and diphtheria containing vaccine, should receive polio containing vaccine as part of their next tetanus and diphtheria booster.

Booster doses and re-immunization

The preschool booster dose of either DTaP-IPV or Tdap-IPV vaccine should be administered at 4 to 6 years of age. For adults previously immunized against polio, a single lifetime booster dose of polio-containing vaccine is recommended for those at increased risk of exposure to polio (e.g., military personnel, workers in refugee camps in endemic areas, travellers to areas where there are polio epidemics) (refer to Table 1).

Serologic Testing

Serologic testing is not recommended before or after receiving IPV vaccine.

Storage Requirements

IPV-containing vaccines should be stored in a refrigerator at +2°C to +8°C and not frozen. Refer to Storage and Handling of Immunizing Agents in Part 1 for additional general information.

Simultaneous Administration with Other Vaccines

IPV-containing vaccines may be administered concomitantly with routine vaccines at different injection sites using separate needles and syringes. Refer to Timing of Vaccine Administration in Part 1 for additional general information.

Vaccine Safety and Adverse Events

Refer to Vaccine Safety Part 2 for additional general information. Refer to Diphtheria Toxoid, Tetanus Toxoid, Pertussis Vaccine, Haemophilus influenzae type b Vaccine and Hepatitis B Vaccine in Part 4 for additional information regarding other components in IPV-containing combination vaccines.

Common and local adverse events

Adverse events following IPV vaccine are usually limited to mild injection site reactions.

Less common and serious or severe adverse events

Serious adverse events are rare following immunization with IPV-containing vaccine and, in most cases, data are insufficient to determine a causal association. Anaphylaxis following vaccination with IPV-containing vaccine may occur, but is very rare.

Guidance on reporting Adverse Events Following Immunization (AEFI)

Vaccine providers are asked to report, through local public health officials, any serious or unexpected adverse event felt to be temporally related to vaccination. An unexpected AEFI is an event that is not listed in available product information but may be due to the immunization, or a change in the frequency of a known AEFI.

Refer to Reporting Adverse Events Following Immunization (AEFI) in Canada for additional information about AEFI reporting.

Contraindications and precautions

IPV-containing vaccines are contraindicated in persons with a history of anaphylaxis after previous administration of the vaccine and in persons with proven immediate or anaphylactic hypersensitivity to any component of the vaccine or its container (e.g. latex). Refer to Table 1 in Contents of Immunizing Agents Available for Use in Canada in Part 1 for a list of all vaccines available for use in Canada and their contents. For IPV-containing vaccines, potential allergens include:

  • ADACEL®-POLIO: neomycin, polymyxin B, streptomycin
  • BOOSTRIX®-POLIO: latex in plunger stopper of pre-filled syringe, neomycin, polymyxin B
  • IMOVAX®- POLIO: neomycin, polymyxin B, streptomycin
  • INFANRIX hexa™: latex in plunger stopper of pre-filled syringe, neomycin, polymyxin B, yeast
  • PEDIACEL®: neomycin, polymyxin B, streptomycin
  • QUADRACEL®: neomycin, polymyxin B
  • Td POLIO ADSORBED: neomycin, polymyxin B

Hypersensitivity to yeast is very rare and a personal history of yeast allergy is not generally reliable. In situations of suspected hypersensitivity or non-anaphylactic allergy to vaccine components, investigation is indicated, which may involve immunization in a controlled setting. Consultation with an allergist is advised.

Administration of IPV-containing vaccine should be postponed in persons with moderate or severe acute illness. Persons with minor acute illness (with or without fever) may be vaccinated.

Refer to General Contraindications and Precautions in Part 2 for additional general information.

Other Considerations

Interchangeability of vaccines

The primary series of three doses of IPV-containing vaccine should be completed with an appropriate vaccine from the same manufacturer whenever possible. However, if the original vaccine is unknown or unavailable, an alternative combination vaccine from a different manufacturer may be used to complete the primary series. On the basis of expert opinion, an appropriate product from any manufacturer can be used for all booster doses. Refer to Principles of Vaccine Interchangeability in Part 1 for additional general information.

Selected References

  • American Academy of Pediatrics, Committee on Infectious Diseases. Prevention of poliomyelitis: recommendations for use of only inactivated poliovirus vaccine for routine immunization. Pediatrics 1999;104(6):1404-6.
  • Buck P, Herman S, Scott C et al. Health Canada Working Group on Polio Eradication. Protocol for the investigation of acute flaccid paralysis and suspected paralytic poliomyelitis. Can Comm Dis Rep 1998;24(4):25-32.
  • Caceres VM, Sutter RW. Sabin monovalent oral polio vaccines: review of past experiences and their potential use after polio eradication. Clin Infect Dis 2001;33(4):531-41.
  • Centers for Disease Control and Prevention. Epidemiologic notes and reports follow-up on poliomyelitis – United States, Canada, Netherlands. MMWR Morb Mortal Wkly Rep 1997;46(50):1195-99.
  • Centers for Disease Control and Prevention. Isolation of wild poliovirus type 3 among members of a religious community objecting to vaccination – Alberta, Canada, 1993. MMWR Morb Mortal Wkly Rep 1993;42(17):337-39.
  • Centers for Disease Control and Prevention. Poliomyelitis prevention in the United States: updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2000;49(RR-5):1-22.
  • Centers for Disease Control and Prevention. The Pink Book: Epidemiology and Prevention of Vaccine Preventable Diseases. Updated 11th ed.; May 2009.
  • Centers for Disease Control and Prevention. Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP) Regarding Routine Poliovirus Vaccination. MMWR Morb Mortal Wkly Rep. 2009;58(30):829-830.
  • Committee to Advise on Tropical Medicine and Travel (CATMAT). Poliomyelitis vaccination for international travellers. Can Comm Dis Rep 2003;29(ACS-10):1-7.
  • Gautret P, Wilder-Smith A. Vaccination against tetanus, diphtheria, pertussis and poliomyelitis in adult travellers. Travel Med Infect Dis 2010;8:155-60.
  • GlaxoSmithKline Inc. Product Monograph - BOOSTRIX®-POLIO, June 2008.
  • GlaxoSmithKline Inc. Product Monograph - INFANRIX hexa. July 2008.
  • Modlin J, Halsey N, Thomas M et al. Humoral and mucosal immunity in infants induced by three sequential inactivated poliovirus vaccine-live attenuated oral poliovirus vaccine immunization schedules. J Infect Dis 1997;175(Suppl 1):S228-34.
  • National Advisory Committee on Immunization. Statement on the recommended use of pentavalent and hexavalent vaccines. Can Comm Dis Rep 2007;33(ACS-1):1-15.
  • NVAC-ACIP Joint Working Group and Centers for Disease Control and Prevention. Ensuring preparedness for potential poliomyelitis outbreaks: recommendations for the US poliovirus vaccine stockpile from the National Vaccine Advisory Committee and the Advisory Committee on Immunization Practices. Arch Pediatr Adolesc Med 2004;158(12):1106-12.
  • Patriarca P, Sutter R, Oostvogel P. Outbreaks of paralytic poliomyelitis, 1976-1995. J Infect Dis 1997;175(Suppl 1):S165-72.
  • Plotkin S, Orenstein W. Vaccines. 3rd edition. Philadelphia: W.B. Saunders Company, 1999.
  • Rutty C, Barreto L, Van Exan R et al. Conquering the crippler: Canada and the eradication of polio. Can J Public Health 2005;96(2):I1-I24.
  • Sanofi Pasteur Ltd. Product Monograph - ADACEL®-POLIO, October 2010.
  • Sanofi Pasteur Ltd. Product Monograph - IMOVAX® Polio, January 2007.
  • Sanofi Pasteur Ltd. Product Monograph – PEDIACEL®, January 2009.
  • Sanofi Pasteur Ltd. Product Monograph - QUADRACEL®, July 2008.
  • Sanofi Pasteur Ltd. Product Monograph – Td POLIO ADSORBED, December 2010.
  • Varughese P and Canadian Paediatric Society. Acute flaccid paralysis. In: Canadian Paediatric Surveillance Program (CPSP): 2003 results. Ottawa: CPS, 2003.
  • Varughese P, Carter A, Acres S et al. Eradication of indigenous poliomyelitis in Canada: impact of immunization strategies. Can J Public Health 1989;80(5):363-68.
  • Vidor E, Meschievitz C, Plotkin S. Fifteen years of experience with Vero-produced enhanced potency inactivated poliovirus vaccine. Pediatr Infect Dis J 1997;16(3):312-22.
  • World Health Organization. Acute flaccid paralysis surveillance: a global platform for detecting and responding to priority infectious diseases. Wkly Epidemiol Rec 2004;79(48):425-32.
  • World Health Organization. Global polio eradication initiative, strategic plan 2004-2008. Wkly Epidemiol Rec 2004;79(6):55-7.
  • World Health Organization. Progress towards global eradication of poliomyelitis, 2003 and January-April 2004. Wkly Epidemiol Rec 2004;79(25):229-34.

[Previous page] [Table of Contents] [Next page]