Fractional IPV (fIPV) eligibility Training for the introduction of Inactivated Poliovirus Vaccine, Fractional Dose (fIPV) Module 3 Fractional IPV (fIPV) eligibility

Learning objectives At the end of the module, the participant will be able to: Describe the recommended immunization schedule for inactivated poliovirus vaccine (IPV) Determine when an infant is and is not eligible to receive IPV Describe ways to determine a child's eligibility for IPV when a written record is unavailable Describe the absolute contraindications for vaccination Duration 30 minutes

Key issues What is the recommended schedule for fractional dose IPV (fIPV)? 1 How to determine if a child is eligible to receive fIPV? 2 What are the contraindications to vaccination? 3 To the facilitator: Explain the key issues raised in this module to the participants. Caretakers bring their infants for immunization but before vaccinating the infant you have to be sure that he or she is eligible for inactivated poliovirus vaccine. This module will teach you to ask the right questions to determine the eligibility of a child for inactivated poliovirus vaccine: What is the inactivated poliovirus vaccine schedule? What to do when the immunization card is missing? What are the contraindications for vaccination?

At what age should fractional doses of IPV be administered? 2 fractional doses of IPV are needed Give first dose at or after 6 weeks, with a minimum interval of 4 weeks, e.g. at 6 and 14 weeks with OPV1+Penta1and OPV3+Penta3 IPV should be given in addition to OPV OPV is still the primary vaccine required to achieve eradication Vaccine Birth 6 wks 10 wks 14 wks BCG Pentavalent PCV Rotavirus* OPV fIPV Example EPI schedule using DTP-Hib-Hep B (Pentavalent), pneumococcal conjugate (PCV) and rotavirus vaccines IPV fractional doses should be given at 6 weeks and 14 weeks *rotavirus vaccine may be 2 or 3 doses, depending upon the vaccine used To the facilitator: Explain to the participants the IPV schedule – age at administration IPV should be administered at 6 and 14 weeks of age, the same time as OPV1+Penta1 and OPV3+Penta3 IPV is given in addition to OPV. Both vaccines together provide the strongest immunity necessary for polio until polio is eradicated. IPV may be given with other injectable vaccines 4

What should you do in this scenario? A child's immunization card shows that he/she is now 10 weeks old and has only received BCG and one dose of OPV. What should you do? To the facilitator: Read the situation and question to participants. The question will test if participants understand that, like other new vaccine introductions, inactivated poliovirus vaccine should be given at 6 and 14 weeks of age to the new cohort of children beginning the vaccination schedule. Other vaccines can be given as appropriate. Response: The child will get oral polio vaccine (OPV2) and other vaccines according to national schedule The child will not get the first fractional dose of IPV . Like for other new vaccine introductions, fIPV should only be given to the new cohort of children beginning the schedule (i.e. along with OPV1 and Penta1) Make an appointment for the next doses according to the schedule Explain to the caretaker the importance of coming for vaccination on time and completing the immunization schedule 5

What should you do in this scenario? A child's immunization card shows that he/she is now 18 weeks old and has only received BCG and 2 doses of OPV. What should you do? To the facilitator: Read the situation and question to participants. The question will test if participants understand that the like other new vaccine introductions, inactivated poliovirus vaccine should be only to the new cohort of children beginning the vaccination schedule. Other vaccines can be given as appropriate. Response: The child will get the third dose of oral polio vaccine (OPV3) and other vaccines according to national schedule The child will not get IPV . Like for other new vaccine introductions, fIPV should only be given to the new cohort of children beginning the schedule (i.e. along with OPV1 and Penta1) Make an appointment for the next doses according to the schedule Explain to the caretaker the importance of coming for vaccination on time and completing the immunization schedule 6

What should you do in this scenario? A child comes in at 6 months of age and has had no vaccines. What should you do? To the facilitator: Read the situation and question to participants. The question will test if participants understand that the first dose of inactivated poliovirus vaccine should be given at 6 weeks of age, or at first opportunity thereafter, provided the child hasn’t already begun the OPV-Penta schedule. Other vaccines can be given as appropriate. Response: The child is starting a new schedule now, therefore is eligible for fIPV The child will get fIPV1 and other vaccines according to national schedule Explain to the caretaker the importance of coming for vaccination on time and completing the immunization schedule Make an appointment for the next doses according to the schedule Prepare/update the immunization card 7

What should you do in this scenario? A child has received OPV1, Penta1 and fIPV-1. The child comes in for OPV3+Penta3 but is more than one year old. What should you do? To the facilitator: Read the situation and question to participants. The question will test if participants understand that the full fIPV schedule should be completed once started, even if the child comes in late for vaccination. Other vaccines can be given as appropriate. Response: The child should get the second fractional dose of IPV (fIPV2) and the other vaccines that they are past due for Explain to the caretaker the importance of coming for vaccination on time and completing the immunization schedule Prepare/update the immunization card 8

Absolute contraindications to IPV Do not vaccinate if recipient has: Known or documented allergy to vaccine components, including: Streptomycin Neomycin Polymyxin B History of an allergic reaction following a previous IPV injection Thrombocytopenia (insufficient blood platelets, which play an important role in coagulation) Other bleeding disorder Wait! Postpone vaccination if recipient is: Taking temporary treatment that suppresses the immune response Treatment could reduce immune response to the vaccine Postpone vaccination until the end of the treatment to make sure the infant is well protected by the vaccine To the facilitator: Explain to the participants the absolute contraindications. –Known or documented allergy to vaccine components, including: Streptomycin Neomycin Polymyxin B History of an allergic reaction following a previous IPV injection Have thrombocytopenia (insufficient blood platelets, which play an important role in coagulation) or a bleeding disorder, because of the bleeding that can occur during intramuscular administration of the vaccine. Other bleeding disorder Postpone Vaccination if taking a treatment that suppresses your immune response, in which case the immune response to the vaccine may be reduced. In such cases it is recommended to postpone vaccination until the end of the treatment or to make sure the subject is well protected. Vaccination of subjects with chronic immunodeficiency, such as HIV infection, is nevertheless recommended even if the immune response might be limited by the underlying illness. 9

Can IPV be administered on schedule to immunodeficient infants or infants born prematurely? Yes! Immunodeficiency does not prevent administration of IPV Vaccination of infants with immunodeficiency, such as HIV infection, is recommended Infants born prematurely should receive IPV on schedule via two fractional doses at 6 and 14 weeks To the facilitator: Explain to the participants that IPV can be administered to immunodeficient and infants born prematurely. Immunodeficiency is NOT a contraindication for IPV. Vaccination of subjects with chronic immunodeficiency, such as HIV infection, is recommended even if the immune response might be limited by the underlying illness. 10

Contraindication Checklist Do I still give IPV if recipient has….? Yes No Postpone mild illness malnutrition HIV prematurity allergy to streptomycin, neomycin or polymyxin B bleeding disorder had a previous reaction to IPV taking treatment that suppresses immune response To the facilitator: Explain to the participants the absolute contraindications. --Known or documented allergy to streptomycin, neomycin, or polymyxin B, which are inactive components of the vaccine, or a history of an allergic reaction following a previous injection of IPV. – Have thrombocytopenia (insufficient blood platelets, which play an important role in coagulation) or a bleeding disorder, because of the bleeding that can occur during intramuscular administration of the vaccine. – Are taking a treatment that suppresses your immune response, in which case the immune response to the vaccine may be reduced. In such cases it is recommended to postpone vaccination until the end of the treatment to make sure the subject receives the full benefit of the vaccine. Vaccination of subjects with chronic immunodeficiency, such as HIV infection, is nevertheless recommended even if the immune response might be limited by the underlying illness. 11

Key messages Two fractional doses of IPV should be given at 6 weeks, with a minimum interval of 4 weeks (e.g. at 6 and 14 weeks, with penta1 and penta3) IPV can be given and the same time as other injectable vaccines like pentavalent and pneumococcal vaccine If EPI schedule currently includes OPV, do not replace OPV with IPV; the fractional doses of IPV should be given in addition to OPV IPV can be administered to children with immunodeficiency disorders and those born prematurely To the facilitator: Explain to the participants that these messages are the main information to keep in mind.

Thank you for your attention! End of module Thank you for your attention! To the facilitator: This is the end of the module. You have been introduced to “Inactivated poliovirus vaccine eligibility” module. The following module is titled “Inactivated poliovirus vaccine administration”. Thank you for your attention!