19 August 2004: New Polio Vaccine for Travellers

Changes to vaccinations for the childhood immunisation programme have been announced by the Department of Health in the CMO letter of 10 August 2004. These changes also have implications for travellers. They include switching from a whole cell pertussis vaccine to an acellular product, removal of thiomersal (a mercury containing preservative) from the vaccines, and switching from oral polio vaccine (OPV) to inactivated polio vaccine (IPV).

IPV will now be incorporated into three new vaccines and replaces the use of OPV. OPV will only be available for use in control of an outbreak of poliomyelitis. Distribution of the new vaccines will be via Farillon and begin the week commencing 27 th September; all surgeries are expected to have one month's stock by 8 th October.

The three new vaccines are for primary immunisation, pre school boosting and teenage boosting. The teenage vaccine contains tetanus, low dose diphtheria and IPV [Td/IPV, trade name 'Revaxis', Aventis Pasteur MSD) and is recommended in the childhood schedule for those aged 13-18 years old. It replaces the separate Td and OPV vaccines currently given in this age group and can be used for primary immunisation in unvaccinated individuals aged 10 years and over.

Revaxis is the vaccine that will be most used in travellers to update any one of the three antigens (tetanus, diphtheria or polio) in order to provide comprehensive long-term protection against all three diseases. This vaccine can also be used to complete courses commenced with OPV. When travellers are being evaluated for vaccination prior to travel, health practitioners should insure that all travellers are fully immunised according to the UK schedule (www.immunisation.nhs.uk/article.php?id=97 ). When it has been more than 10 years since the last tetanus, diphtheria or polio-containing vaccine, and the traveller is considered at risk for any one of these diseases, a booster dose of Td/IPV should be given.

If polio protection is not required, existing stocks of Td (Diftavax, Aventis Pasteur MSD) can be given in adolescent and adult travellers. Single antigen IPV (Aventis Pasteur MSD) will also be available.

The rationale for replacement of OPV with IPV-containing vaccines is twofold. First, there is no risk of vaccine associated paralytic polio (VAPP) with IPV. VAPP rarely followed administration of OPV (about 1 case per million doses). Second, the Department of Health states that due to the progress of the Global Polio Eradication Initiative (www.polioeradication.org/ ) that has decreased the risk of imported polio, the benefit to the community through acquisition of vaccine virus by contacts of persons recently immunised with OPV is no longer needed. Therefore, the excellent individual immunity conferred by IPV is sufficient.

Further information for health professionals is available at www.immunisation.nhs.uk . This site includes the new Green Book chapters on the relevant diseases, sample Patient Group Directions ( PGDs ) for the new vaccines, and questions and answers for parents of children undertaking the routine childhood schedule.

For updated advice on geographical areas for which polio vaccine is recommended, please see the NaTHNaC clinical update: Poliomyelitis and changes to recommendations for travellers.