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

2. 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

3. 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?

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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.

13. 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!