A Guide To Introducing: Inactivated Polio Vaccine

A Guide to
Introducing
Inactivated
Polio Vaccine
Based on the Polio Eradication &
Endgame Strategic Plan 2013-2018
WHO Library Cataloguing-in-Publication Data
A guide to introducing Inactivated Poliomyelitis Vaccine based on the Polio Eradication & Endgame Strategic Plan 2013-2018
1.Poliovirus Vaccine, Inactivated. 2.Immunization Programs. 3.National Health Programs. I.World Health Organization.
ISBN 978 92 4 151141 4 (NLM classification: WC 556)
© World Health Organization 2016
All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be
purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264;
fax: +41 22 791 4857; email: bookorders@who.int).
Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution–
should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form).
The designations employed and the presentation of the material in this publication do not imply the expression of any opinion
whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or
of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent
approximate border lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or
recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and
omissions excepted, the names of proprietary products are distinguished by initial capital letters.
All reasonable precautions have been taken by the World Health Organization to verify the information contained in this
publication. However, the published material is being distributed without warranty of any kind, either expressed or implied.
The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health
Organization be liable for damages arising from its use.
Printed by the WHO Document Production Services, Geneva, Switzerland

Contents
Abbreviations................................................................................................................ 2
About this guide. . .......................................................................................................... 3
1 Introduction 5
1.1 Background ......................................................................................................... 5

1.2 Polio epidemiology.............................................................................................. 6
1.3 Polio vaccines...................................................................................................... 9
1.4 The rationale for IPV introduction.. ................................................................. 11
1.5 The switch from tOPV to bOPV........................................................................... 12
1.6 Strengthening routine immunization programmes ........................................ 13
2 Decision-making at country level 17
2.1 What is the process?........................................................................................... 17

2.2 WHO recommendations on the vaccination schedule..................................... 18
2.3 Safety of IPV and administration...................................................................... 19
2.4 Fractional doses of IPV via intradermal route.............................................. 20
2.5 Multiple injections in a single visit . . ............................................................... 21
3 Planning and managing IPV introduction 25
3.1 Planning for a successful introduction ........................................................ 25

3.2 Vaccine management and procurement considerations. . ............................... 27
3.3 Cold chain considerations . . ............................................................................. 30
3.4 Monitoring and evaluation............................................................................... 31
3.5 Communications and training........................................................................... 33
Resources 39
Online resources........................................................................................................ 39
Annex 1: IPV introduction plan checklist ............................................................. 40
Annex 2: Frequently asked questions about IPV..................................................... 41
Annex 3: AEFI Reporting Form. . ................................................................................ 42
Annex 4: Job aid on IPV for health workers. . .......................................................... 43
Abbreviations
AFP acute flaccid paralysis
AEFI adverse events following immunization
BCC behaviour change communication
bOPV bivalent oral poliomyelitis vaccine; containing types 1 and 3
CCL cold chain and logistics
cVDPV circulating vaccine-derived poliovirus
cMYP comprehensive multi-year plans for immunization
DTP Diphtheria tetanus pertussis vaccine
EPI Expanded Programme on Immunization
EVM Effective Vaccine Management
GPEI Global Polio Eradication Initiative
ICC Inter-agency Coordinating Committee
IM intramuscular
IPV inactivated poliomyelitis vaccine
MDVP multi-dose vial policy
mOPV monovalent oral poliomyelitis vaccine
NITAG National Immunization Technical Advisory Group
OPV oral poliomyelitis vaccine
PCV pneumococcal conjugate vaccine
SAGE Strategic Advisory Group of Experts on Immunization
SC subcutaneous
SIA supplementary immunization activity
tOPV trivalent oral poliomyelitis vaccine
VAPP vaccine-associated paralytic poliomyelitis
UNICEF United Nations Children’s Fund
VDPV vaccine-derived poliovirus
VVM vaccine vial monitor
WHA World Health Assembly
WHO World Health Organization
WPV wild poliovirus
2 a guide to introducing inactivated polio vaccine

About this guide
This document is intended for use by national immunization programme managers and immunization partners
involved in planning, implementing, and supporting the introduction of the inactivated poliomyelitis vaccine (IPV),
either as a full or fractional dose.
General guidance about planning for the introduction of a vaccine into a national routine immunization programme
is provided in the document “Principles and considerations for adding a vaccine to a national immunization
programme: from decision to implementation and monitoring” published by the World Health Organization (WHO)
in 2014 and available online1.
The specific objectives of this guide are to:
›› P rovide up-to-date references on the global policy, technical rationale and strategic issues related to
the introduction of IPV.
›› Inform the policy discussions and planning activities for the introduction of IPV into a national routine
immunization programme.
Section 1 of this guide provides background information on polioviruses, polio vaccines, and the rationale for
the introduction of IPV. Section 2 outlines the decision-making process and WHO recommendations to consider
on schedules and administration of IPV, leading into section 3, which covers planning and operational topics such
as cold chain management, monitoring and evaluation, and communications and training. In the Annexes,
practical and adaptable tools are provided, including a planning checklist, and sample questions and answers
for health workers.
1 http://www.who.int/immunization/programmes_systems/policies_strategies/vaccine_intro_resources/nvi_guidelines/en/
3
1 Introduction
1.1 Background
In May 2012, the World Health Assembly (WHA) declared
the completion of poliovirus eradication to be a
“programmatic emergency for global public health” and
called on the Director General of the World Health
Organization (WHO) to develop a comprehensive polio
endgame strategy.
The Polio Eradication and Endgame Strategic Plan 2013-20181 was endorsed by Member States at the Sixty-sixth
World Health Assembly in May 2013, approving the targets, goals, and timelines to secure a lasting polio-free world.
The four objectives of the Strategic Plan are to:

1. Detect and interrupt poliovirus transmission
2. Strengthen immunization programmes, introduce at
least one dose of inactivated poliomyelitis vaccine (IPV), Polio Eradication & Endgame
Strategic Plan 2013-2018
and withdraw oral poliomyelitis vaccine (OPV), starting
with the type 2 component
3. Contain poliovirus and certify the interruption of
transmission
4. Plan for the legacy of the polio programme
The Plan seeks to simultaneously eradicate wild poliovirus and eliminate vaccine-derived poliovirus.
The withdrawal of OPV commenced in April 2016 with the globally synchronized “switch” from trivalent OPV (tOPV;
containing types 1, 2, 3) to bivalent OPV (bOPV; containing only types 1 and 3).
Type 2 wild poliovirus was last detected in 1999, and the continued use of tOPV in areas where routine immunization
coverage is inadequate contributes to the emergence of rare circulating vaccine-derived poliovirus (cVDPV) cases.
In preparation for the switch, an updated WHO Position Paper on polio vaccines was published in February
20142. WHO recommended that all countries using OPV only should add at least one dose of IPV to the national
immunization schedule at or after 14 weeks of age.
1
The Polio Eradication and Endgame Strategic Plan 2013-2018 can be found at: http://polioeradication.org/who-we-are/strategy/
2
WHO. Polio vaccines: WHO Position Paper, January 2014. Weekly Epid. Record, 89. (February 2014). Available at: http://www.who.int/wer/2014/wer8909.pdf
5
A revised version of the polio Position Paper was published in March 20163 , replacing the 2014 version. It
reiterates the WHO recommendations and summarizes recent developments in the field. The latest paper
also reflects the global OPV switch as planned for April 2016.
The primary purpose of the IPV dose is to ensure that new birth cohorts have some protection against the type 2
poliovirus, either wild or vaccine-derived, hence mitigating the potential consequences of any re-emergence of
type 2 poliovirus following the switch. Adding at least one IPV dose will also boost immunity against poliovirus
types 1 and 3, and may contribute to hastening their eradication.
IPV can be safely administered with OPV during the same visit and should be given in addition to the 3 or 4 doses
of OPV in the primary series.
1.2 Polio epidemiology

Poliomyelitis is an acute communicable disease caused by
any one of three poliovirus serotypes (types 1, 2, or 3).
Polioviruses are human enteroviruses of the
Picornaviridae family. In the pre-vaccine era when Pol io
poliovirus was the leading cause of permanent disability E p id e miology
in children, virtually all children became infected by
R e se r vo ir
polioviruses, with on average 1 in 200 susceptible
individuals developing paralytic poliomyelitis4. ›› Human
Tr a n sm issio n :
Polioviruses are spread by faecal-to-oral and oral-to-oral
transmission. Where sanitation is poor, faecal-to-oral ›› Faecal-oral
transmission predominates, but in most settings, mixed ›› Oral-oral possible
patterns of transmission are likely to occur. If sanitation
and personal hygiene are inadequate, others can be C o m m u n ic a b ilit y:
infected through dirty hands or food and contaminated
›› Most infectious 7-10 days before and after
water. Thus, intestinal immunity is important in order to onset of symptoms
prevent transmission. ›› Virus present in stool for 3-6 weeks
›› Infected persons without symptoms shed virus
No specific anti-viral drugs are available for in the stool and are able to transmit the virus to
poliomyelitis. Treatment consists of supportive, others
symptomatic care during the acute phase.
Infection occurs without symptoms in approximately 72% of cases. In about 24% of cases it causes mild disease
with transitory fever, discomfort, somnolence, headache, nausea, vomiting, constipation, and sore throat, in various
combinations. In approximately 4% of cases, it presents as aseptic meningitis, and on rare occasions (< 1%) it
presents as paralytic poliomyelitis5.
3 WHO. Polio vaccines: WHO Position Paper, March 2016. Weekly Epid. Record, 91. (March 2016). Available at: http://www.who.int/wer/2016/wer9112.pdf
4 Ibid.
5 Sutter RW, Kew OM, Cochi SL, Aylward RB. Poliovirus vaccine - live. In: Plotkin SA, Orenstein WA, Offit PA, eds. Vaccines. 6th ed. Philadelphia: Elsevier; 2013.

Paralytic poliomyelitis is manifest as acute flaccid paralysis (AFP), of sudden onset, with maximum progression
within a few days (< 4 days). It is usually asymmetrical, with the reduction or absence of tendon reflexes, without
alterations of the sensory system.
Pol i o Er a d i cat i o n as of J un e 2 016

Before the WHA launched the Global Polio Eradication Initiative (GPEI) in 1988, the wild virus caused more
than 350,000 cases of paralysis per year across more than 125 countries.
›› Today, polio has been eradicated in the regions of the Americas, Europe, South East Asia, and the Western Pacific.
›› The global eradication of wild poliovirus type 2 was declared in September 2015.
›› Polio remains endemic in two countries: Afghanistan and Pakistan.
Reg ula r up d a tes avai l ab l e o n : w w w.p o l i o e rad i c ati o n .o r g
Vaccines that contain live attenuated viruses, such as oral polio vaccine (OPV), are extremely safe and effective for
immunizing children against polio. On very rare occasions, however, OPV can lead to vaccine-associated paralytic
polio or vaccine-derived poliovirus outbreaks.
Vaccine-associated paralytic polio (VAPP):

›› VAPP is caused by a strain of poliovirus that has genetically changed in the intestine from the original
attenuated vaccine strain contained in OPV.
›› It is associated with a single dose of OPV administered to a child or can occur in an unvaccinated or
non-immune contact who is close to the vaccine recipient excreting the mutated virus.
›› There are no outbreaks associated with VAPP. The weakened virus may paralyze the child or his or her
contact, but it does not spread to cause other cases of paralysis.
›› Globally, the estimated risk of VAPP in vaccine recipients or in close contacts is 1 in 2.4 million doses
administered. A recent review found that 26% of recipient VAPP and 31% of contact VAPP cases were
associated with type 2 vaccine virus6.
Vaccine-derived polioviruses (VDPDs):

›› On very rare occasions, where immunization coverage is low, a strain of the weakened poliovirus originally
contained in OPV may genetically change and revert to a form (a VDPV) that can regain the strength to cause
paralysis in humans. If undetected by “environmental surveillance” activities, a VDPV has the capacity for
sustained circulation, and is thereby known as a circulating VDPV (cVDPV).
›› Low vaccination coverage is a major risk factor for cVDPV emergence. Circulating VDPVs occur when a
significant proportion of the population is left susceptible to poliovirus, enabling the sustained transmission
of the VDPV and circulation in the environment.
›› “Persistent cVDPVs” refer to cVDPVs known to have circulated for more than six months.
›› In addition to cVDPVs, there are two other categories of VDPVs:
• Immune-deficiency associated VDPV (iVDPV): when a VDPV is isolated from persons with proven
immunodeficiencies;
• Ambiguous VDPV (aVDPV): when a VDPV is isolated from persons with or without AFP and with no known
immunodeficiency, or from environmental samples, and when there is no evidence of circulation.
6 Platt LR, Estivariz CF, Sutter RW. J Infect Dis. 2014 Nov 1;201 Suppl 1:S380-9
7
table
1. Ty p e s o f p o l i ov irus
Circ ul atin g vac c in e -

d e riv e d p ol iov irus
W i l d p o l i ov irus ( WP V ) ( c V DP V )
A very rare, circulating infectious virus
Infectious virus that invades the nervous mutated from the weakened strain
Definition
system. Can cause paralysis or death. of poliovirus in OPV. Under certain
conditions, may cause paralysis or death.
Risk factors Low immunization coverage rates, poor sanitation, high population densities.
To stop
Increase immunization coverage rates with OPV
transmission
Type 1: Caused 100% of 2014 cases Until April 2016, the type 2 virus was
Strains Type 2: Eradicated, last seen in 1999 responsible for up to 90% of all cVDPV
Type 3: Last seen in 2012 cases.
Total cases
359 56
in 2014
Total cases
74 32
in 2015⁸
Eradicating polio for good requires eliminating both wild and vaccine-derived polioviruses.
78
7 Reference: http://polioeradication.org/polio-today/polio-now/this-week/circulating-vaccine-derived-poliovirus/
8 Reference: http://polioeradication.org/polio-today/polio-now/this-week/

1.3 Polio vaccines
To date, two types of polio vaccines have been used
throughout the world and are available on the
international market: OPV and IPV.
Thanks to its immunological characteristics, the use of OPV has made it possible to eradicate polio in the regions
of the Americas, Europe, South East Asia, and Western Pacific. When OPV is administered, the virus in the vaccine
is ingested orally, replicates in the intestines, and can generate various immune responses.
›› Humoral immunity: presence of antibodies in the blood, which protects the organism by preventing the
virus from invading the nervous system and causing paralysis.
›› Oral mucosal immunity: prevents excretion of the virus in oral secretions and its transmission through
this route.
›› Intestinal mucosal immunity: prevents excretion of the poliovirus in faeces, which means that children
previously vaccinated with OPV coming into contact with this virus are less likely than unvaccinated children
to excrete it in their faeces.
It should be noted that children vaccinated with OPV who have not yet developed intestinal mucosal immunity
to poliovirus can excrete the vaccine virus in faeces, spreading it into the environment, which serves to immunize
others who have not been vaccinated. Due to its low cost and ease of administration by untrained health
workers, OPV has been used by many low and middle income countries where the risk of polio outbreaks has
been the greatest.
Unlike OPV, IPV cannot cause VAPP or cVDPVs. IPV stimulates a good humoral response and is as effective as
OPV in blocking oral transmission. However, IPV on its own it does not induce the same level of intestinal immunity
as OPV, which means that IPV does not prevent wild polio virus from being excreted in faeces and spreading in
the environment.
Polio vaccines generate immune responses to the types of poliovirus they contain. A polio vaccine that contains
only types 1 and 3 polioviruses generates immune responses to only those types (i.e. immunity to one type of
poliovirus does not guarantee immunity to the other two).
9
table
2. Ty p e s o f p o l i o vac c in e
O r a l p o l i o vac c in e I n ac tivate d p ol io
(OPV) vac c in e ( I P V )
Mixture of live, weakened poliovirus
strains.
Trivalent OPV (tOPV): All 3 poliovirus types Mixture of inactivated, killed strains of all
Contains
Bivalent OPV (bOPV): Types 1 and 3 three poliovirus types.
Monovalent OPV (mOPV): Any one
individual type
In response to the weakened virus, the In response to the inactivated virus, the
body produces antibodies in the blood body produces antibodies in the blood.
How it works and gut. Helps stop transmission by Protects the individual, but the virus may
limiting the virus’ ability to replicate in the still replicate in the gut and could spread to
gut and spread to infect others. infect others.
Easy, oral administration through drops

Vaccine injection is administered primarily
can be given by volunteers. Is used in
through routine immunization programmes
Administration many countries’ routine immunization
by trained health workers. Cost is higher,
and cost programmes and extensively in
currently starting at US$1 per dose for low-
immunization campaigns. Costs less than
income countries.
US$0.15 per dose.
Extremely effective in protecting

children from WPV and cVDPV. Nearly
Extremely effective in protecting children
every country has used OPV to stop
from polio disease due to WPV and cVDPV,
Use wild poliovirus transmission because it
but cannot stop spread of virus in a
prevents person-to-person spread of the
community.
virus, protecting both the individual and
the community.
In extremely rare cases, can cause cVDPV

in under-immunized populations.
cVDPV risk For this reason the global eradication of Cannot cause cVDPV.
polio will require the eventual cessation of
all OPV.
Due to their important but distinct advantages, both OPV and IPV are necessary to eradicate polio.
Because OPV protects both the individual and the community, it has been an essential tool for countries
working to stop wild poliovirus transmission. IPV protects against paralytic polio and cannot cause cVDPVs,
and thus is vital to ending polio.

1.4 The rationale for IPV introduction
As naturally occurring polio cases decrease, paralysis
induced by vaccine-related viruses in OPV will continue to
occur, although in extremely small numbers.
The sustained use of OPV is therefore inconsistent with the goal of eradicating all paralytic polio disease. For this
reason, all OPV use will eventually be stopped, after types 1 and 3 are certified as eradicated worldwide.
While wild poliovirus type 2 (WPV2) has been eradicated worldwide and is no longer a naturally occurring threat,
the type 2 component of OPV has caused the majority of vaccine-related cases since 2000. As a result, in this final
phase of global polio eradication, the type 2 component of tOPV presents greater risks than benefits, thus hindering
eradication efforts.
Accordingly, WHO called for the withdrawal of tOPV in April 2016 through a globally synchronized switch to bOPV,
targeting types 1 and 3 viruses.
To help mitigate the risks of the switch from tOPV to bOPV, WHO recommended that all countries currently using
only tOPV in their vaccination programmes introduce at least one dose of IPV into their routine immunization
schedules before the end of 2015 (pending available supply). This is to help address the gap in population immunity
against the type 2 virus following the switch from tOPV to bOPV.
Vaccination with IPV also reduces the risk of sustained transmission. If type 2 poliovirus is reintroduced post-
eradication, it can be more rapidly controlled using monovalent OPV type 2 (or IPV) because the population would
have already received at least one IPV dose and will therefore be primed or have some degree of immunity.
Wh y s h o u l d co u n t r i e s in trod uc e I P V ?
WHO recommends the introduction of at least one dose IPV by the end of 2015 (pending available
supply) for all countries that use only OPV. IPV is a key element of the Polio Eradication and
Endgame Strategic Plan 2013-2018 and the global readiness to manage risks associated with OPV
type 2 withdrawal:
›› To reduce risks: Once tOPV is withdrawn from the global market in April 2016, there will be an increase
in the population susceptible to the type 2 poliovirus. The use of IPV will help to maintain immunity
and prevent the reappearance of the disease in the event of the reintroduction or emergence of this
type of virus.
›› To help maintain immunity to type 2: Once the type 2 component of OPV is withdrawn globally,
there will be a gradual accumulation of infants susceptible to type 2 poliovirus, and IPV will help to
address this gap in immunity.
›› To interrupt transmission in the event of outbreaks: If the use of mOPV type 2 is required to
control a future outbreak, it will be easier to reach the immunity levels needed to stop transmission in a
population previously vaccinated with IPV. Introducing IPV can help to facilitate future outbreak control.
11
table
3. Ti me l i n e l e a d i n g to I P V in trod uc tion
The Strategic Advisory Group of Experts on Immunization (SAGE)

April 2012:
recommended the eventual cessation of OPV type 2
The World Health Assembly (WHA) declared the completion of poliovirus
May 2012:
eradication to be a “programmatic emergency for global public health”
January 2013: The WHO Executive Board approved the Endgame Strategic Plan 2013-2018.
November 2013: SAGE recommended the schedule for at least one dose of IPV
WHO Position Paper on polio is published, confirming that WHO no longer

February 2014:
recommends an OPV-only schedule
WHA resolution urges all Member States to prepare for the global
May 2015:
withdrawal of the type 2 component of OPV, expected in April 2016
Deadline for countries to have introduced IPV into national immunization
December 2015:
schedules (pending available supply)
March 2016: An updated WHO Position Paper on polio is published
April 2016: Globally coordinated switch from tOPV to bOPV, from 17 April to 1 May
1.5 The switch from tOPV to bOPV

Why switch from tOPV to bOPV?
There are three types of wild poliovirus, types 1, 2 and 3, each of which is targeted by a different component of the
trivalent oral polio vaccine (tOPV).
OPV consists of a weakened (attenuated) version of the polio virus, administered orally through two drops, and has
the advantage of immunizing the intestine, where the virus reproduces. OPV is very effective against the wild virus,
but in extremely rare cases can lead to paralysis through VAPP or cVDPV (see Section 1.2, Polio epidemiology).
Even though wild poliovirus type 2 has been declared as eradicated worldwide, vaccine-related type 2 viruses are
responsible for the majority of cVDPV outbreaks and VAPP cases.
As a result, there were more risks than benefits associated with the use of tOPV. Therefore, it was necessary to
replace tOPV with bOPV, which continues to protect against types 1 and 3. Once these two types are eradicated,
bOPV will also be withdrawn and replaced completely with IPV.
Why was it necessary for the switch to be implemented in a

globally synchronised manner?
All programmes using tOPV were required to switch to bOPV in a globally coordinated manner, between 17 April
and 1 May 2016, during the “low” season for poliovirus transmission.

If all countries had not switched at the same time, those using bOPV would have some decline in population
immunity to type 2, putting them at risk from the countries that continued to use tOPV and could generate and
export type 2 cVDPVs.
The highly synchronized nature of the switch during the “low” polio season was important to reduce the risk of the
re-emergence of type 2 cVDPVs. A globally coordinated switch was therefore the best way for countries to limit the
risk of cVDPV type 2 emergence and spread.
What happens if an outbreak of type 2 polio occurs

after the switch from tOPV to bOPV?
Following the switch, mOPV type 2 (mOPV2) and IPV will be the two vaccines of choice for responding to any type 2
outbreak or accidental wild poliovirus type 2 (WPV2) release from a laboratory or facility. A global stockpile of mOPV2
and IPV have been procured and will be available for outbreak response.
More information on the rationale and timelines for the OPV switch, including
guidance for planning and implementation, is available on a dedicated website:
www.who.int/immunization/diseases/poliomyelitis/
endgame_objective2/oral_polio_vaccine/en/
Strengthening routine
1.6 immunization programmes
Given that IPV will be administered primarily through
routine immunization programmes, it is essential that the
system be sufficiently robust.
High routine immunization coverage establishes adequate population immunity over time to prevent polio
outbreaks, and builds a sustainable platform for the delivery of lifesaving vaccines.
Many activities that are carried out to prepare for, implement, and monitor the introduction of IPV, offer
opportunities to make improvements in routine immunization programmes. Countries have found that new
vaccines tend to perform only as well as the underlying programme, so efforts to make use of the IPV introduction
to reinforce and improve the immunization programme should not be neglected.
Routine immunization strengthening and polio eradication efforts can amplify each other’s impact and together
more effectively achieve disease prevention targets. Strong routine immunization programmes will also help
to sustain the gains already made by polio resources and help ensure that children who are at a greater risk of
contracting polio have access to immunization.
While a strong routine immunization system helps maintain population immunity to prevent outbreaks, vaccination
campaigns will remain important strategies, for example, in reaching hard-to-access populations and responding
to outbreaks. As much as possible, such supplementary campaign activities – and any efforts to add a vaccine to
an immunization programme – should allow for adequate planning in a way that complements and augments the
routine programme.
13
table W h at t r a n s f o r m ativ e in v e stme n ts c an he l p to
4. ach i e v e b e t t e r immun iz ation outc ome s?
The Global Routine Immunization Strategies and Practices (GRISP) document9 calls on national
Governments, global partners and donors to take the following steps to achieving better immunization
outcomes:
Invest in a capable and sufficiently resourced national programme management team in

1.
each country.
Invest in tailored vaccination strategies that will identify the under-vaccinated and the
2.
unvaccinated and provide them with all needed vaccinations regularly.
Invest in a coherent planning cycle, from comprehensive multi-year plans to operational annual
3.
EPI plans to the quarterly monitoring of implementation of these plans.
4. Invest in assuring that sufficient funds reach the operational level of the programme regularly.
Invest in vaccinators and district managers by regularly and systematically building their capacity,
5.
strengthening their performance and providing supportive supervision.
Invest in modernizing vaccine management and supply chains to make sure that each
6.
vaccination session has sufficient amounts of the right and potent vaccines available.
Invest in an information system that identifies and tracks the vaccination status of
7.
everyone targeted.
8. Invest in sustainably expanding the routine vaccination schedules to cover the full life course.
Invest in sharing responsibility on immunization with the community to help reach

9.
uniformly high coverage through high demand and quality services.
How to strengthen immunization programmes and health systems

during a new vaccine introduction
Suggestions on how different aspects of an immunization programme and the overall health system can be
improved in the process of planning and implementing a vaccine introduction are outlined in Annex 1 of the
document Principles and considerations for adding a vaccine to a national immunization programme (WHO 2014)10.
This provides a list of opportunities during the vaccine introduction, organized by the six building blocks of a health
system (see diagram below), derived from the WHO Health System Framework11, and is based on a body of research
conducted in this area.
9 Available on the WHO web site: http://www.who.int/immunization/programmes_systems/policies_strategies/GRISP/en/

10
Available at: http://www.who.int/immunization/programmes_systems/policies_strategies/vaccine_intro_resources/nvi_guidelines/en/
11
WHO. Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes – WHO’s Framework for Action. World Health Organization, 2007.
Available (PDF): http://www.who.int/healthsystems/strategy/everybodys_business.pdf

Figure
1. Th e W H O syste m frame work
The six building blocks of a health system: aims and desirable attributes
System Overall goals /

building blocks outcomes
S e r v i ce d e l i v e r y Ac c e ss I mp rov e d he alth
(lev el and equit y)
Cov e rage
H e a lt h w o r k f o r ce Re sp on siv e n e ss
I n f o r mat i o n Soc ial an d

fin an c ial risk
p rote c ion
M e d i ca l p r o d u cts , Q ual it y
vacci n e s &
t e ch n o lo g i e s I mp rov e d e ffic e ncy
S afe t y
fi n a n ci n g
L e a d e r s h i p/
g ov e r n a n ce
15
Decision-making at
2 country level
2.1 What is the process?

It is important to have a systematic and transparent process
for making a decision about introducing any vaccine into
the national immunization programme.
Ideally, the national immunization technical advisory group (NITAG12) or an equivalent independent advisory body
should be requested to undertake a rigorous review of the evidence and global WHO recommendations, and present
their independent guidance to the national government.
A review of background, evidence and WHO recommendations should also include reference to GPEI’s Polio
Eradication and Endgame Strategic Plan 2013-2018 – endorsed by Member States at the Sixty-sixth session of
the World Health Assembly in May 2013 – as well as the latest WHO Position Paper on polio. Additional guidance
is available on the WHO IVB website (www.who.int/immunization/) and includes the document Principles and
considerations for adding a new vaccine13.
After making a decision, the Inter-agency Coordinating Committee (ICC14) or equivalent should serve to coordinate
partner support and funding for the immunization programme activities.
12
NITAGs should consist of national experts in a broad range of disciplines – such as senior paediatricians, immunization and vaccine experts,
epidemiologists, public health experts, health economists, health system experts and social scientists – who are capable of analyzing the different types
of evidence and issues that should be considered in making an informed decision.
13
14
A committee made up of representatives of the Ministry of Health (MOH), WHO, UNICEF and other domestic and external partners to improve
coordination among partners for the support of immunization programmes.
17
WHO recommendations on the
2.2 IPV vaccination schedule
As of February 2014, WHO no longer recommends an OPV-
only vaccination schedule. For all countries using only OPV,
at least one dose of IPV should be added to the national
immunization schedule 15 .
The primary purpose of the IPV dose is to help maintain immunity against type 2 poliovirus during and after the
planned global withdrawal of OPV2 and switch from tOPV to bOPV.
The primary series consisting of 3 OPV doses plus 1 IPV dose can be initiated from the age of 6
weeks with a minimum interval of 4 weeks between the OPV doses.
If one dose of IPV is used, it should be administered at 14 weeks of age or the nearest immunization visit
(when maternal antibodies have diminished and immunogenicity is significantly higher). IPV can be co-
administered with an OPV dose, and should be given in addition to all other scheduled vaccine doses.
For infants starting the routine immunization schedule late (e.g. older than 3 months), the IPV dose should be
administered at the first immunization contact.
table
5. E xa mp l e s o f w he n to ad min iste r I P V
Schedule Ti mi n g o f I P V
6, 10, 14 weeks At 14 weeks, with the third dose of pentavalent/OPV: OPV1, OPV2, OPV3+IPV
2, 3, 4 months At 4 months, with the third dose of pentavalent/OPV: OPV1, OPV2, OPV3+IPV
At 4 months, with the second dose of pentavalent/OPV: OPV1, OPV2+IPV, OPV3

2, 4, 6 months or;
at 6 months, with the third dose of pentavalent/OPV: OPV1, OPV2, OPV3+IPV
For countries that experience any delays or interruptions to IPV supply due to the global shortage in 2016 and 2017,
guidance about any potential need to “catch-up” children who missed receiving IPV is under review at the time of
writing. Once available supply is confirmed, WHO and UNICEF will facilitate discussions with countries to help
assist in planning.
WHO recommendations on polio vaccines also include other schedule options such as sequential IPV-OPV and IPV-only. For details please see the WHO
15
Position Paper, March 2016. Weekly Epid. Record, 91. Available at: http://www.who.int/wer/2016/wer9112.pdf

2.3 Safety of IPV and administration
IPV is considered very safe, whether given alone or in
combination with other vaccines.
There is no proven or causal relationship to any adverse events other than minor local erythema (0.5%-1%),
induration (3%-11%), and tenderness (14%-29%)16.
A full dose of IPV (non adjuvanted) can be given as an intramuscular (IM; in the thigh) or subcutaneous (SC)
injection, although IM administration for IPV has been shown to provide equal immunogenicity and have fewer
local reactions than SC. The SC route is a viable alternative for vaccines where this is indicated on the label.
The thigh is the site generally recommended for IM injections. Injection into the deltoid muscle is not
recommended for infants due to inadequate muscle mass17.
IPV can be safely administered to children with immunodeficiencies (e.g. congenital or acquired
immunodeficiency, or sickle cell disease). In fact, because of the elevated risk of VAPP after the use of OPV
in patients with immunodeficiencies, IPV is universally recommended in these children.
IPV should not be administered to infants with known or documented allergy to streptomycin, neomycin, or
polymyxin B, or with a history of an allergic reaction following a previous vaccine injection.
WHO. Polio vaccines: WHO Position Paper, March 2016. Weekly Epid. Record, 91. (March 2016). Available at: http://www.who.int/wer/2016/wer9112.pdf
16
Meeting of the Strategic Advisory Group of Experts on immunization, April 2015: conclusions and recommendations. Weekly Epid. Record, 90. (May 2015).
17
Available at: http://www.who.int/wer/2015/wer9022.pdf
19
Fractional doses of IPV via
2.4 the intradermal route
As an alternative to the intramuscular injection of a full
IPV dose, countries may consider using fractional doses
(one-fifth of the full dose), via the intradermal route.
In the context of an IPV shortage, countries may consider a 2-dose fractional dose schedule, which could ensure
that all eligible infants receive IPV. Such a strategy is dose-sparing and results in better immunogenicity than a
single full dose of IPV.
A schedule of fractional intradermal doses administered at 6 and 14 weeks ensures early and appropriately-timed
protection. The 2 fractional doses should be separated by a minimum interval of 4 weeks. One fractional dose of
IPV may be suitable for outbreak response if supplies are limited.
If considering a two-dose fractional dose schedule for IPV, the following programmatic and operational challenges
should be carefully assessed:
›› The two-dose schedule, which may add time and complexity to existing contacts
›› The procurement of appropriate 0.1ml syringes and devices
›› The need for added training and supervision of health workers to address the demands of intradermal
administration
›› The necessary adjustments to registers and home-based records to support tracking and follow up
›› The communications strategies and messaging to reassure caregivers and communities about the new practice
Further details on the intradermal administration of IPV and a summary of studies to date comparing
seroconversion rates are presented in the WHO Position Paper on polio vaccines published in March 201618. In
addition, to support countries in considering and implementing a fractional dose schedule of IPV, a range of
background papers and adaptable training materials are available on a dedicated web page19.
WHO. Polio vaccines: WHO Position Paper, March 2016. Weekly Epid. Record, 91. (March 2016). Available at: http://www.who.int/wer/2016/wer9112.pdf
18
Available here: http://www.who.int/immunization/diseases/poliomyelitis/endgame_objective2/inactivated_polio_vaccine/fractional_dose/en/

19

2.5 Multiple injections in a single visit
Many countries administer multiple vaccine injections
(including more than three injections) to infants in a single
visit and achieve high vaccine coverage and acceptability.
Other countries, particularly lower- and middle-income
countries, are in the process of introducing additional National vaccination schedules that administer
injectable vaccines into their routine schedule (including multiple injections in the same visit are widely
pneumococcal conjugate vaccine (PCV) and IPV) which used and enable the timely and efficient
will make receiving three injections during a single visit a vaccination of children.
common occurrence.
In 2015, a systematic review of evidence on the safety of administering multiple injectable vaccines during a single
visit (specifically for IPV, PCV and pentavalent vaccines) showed that when given together these vaccines are safe
and generally well tolerated by infants. Data supports co-administration of these vaccines, and no increase in
reactogenicity was found when compared with vaccines injected in separate visits20.
A dva n tag e s o f g i v i n g a c hil d

t wo o r mo r e vacci n at ion s d urin g the same v isit:
›› Protects children at the earliest opportunity: Immunizing children as soon as possible provides
protection during the vulnerable early months of their lives
›› Fewer vaccination visits: Giving several vaccinations at the same time means parents and caregivers
do not need to make as many visits to their health facility
›› More effective use of health resources and workers: Giving multiple vaccine injections at
the same visit means health workers are able to be more efficient in providing and delivering other
health services
Studies of health worker and caregiver attitudes indicate that both have concerns about infant pain, potential
vaccine side effects, and uncertainty about vaccine effectiveness when multiple vaccines are given. Findings also
demonstrate that health workers should make a positive recommendation to the caregiver and not overestimate
caregiver concerns about multiple injections.
WHO. Meeting of the Strategic Advisory Group of Experts on immunization, April 2015: conclusions and recommendations. Weekly Epid. Record, 90. (May
20
2015). Available at: http://www.who.int/wer/2015/wer9022.pdf
21
When three injections are given, one injection should be
administered in one limb, and two injections in the other
limb, separated sufficiently to differentiate local reactions.
A common acceptable practice is to separate injections in
the same limb by 2.5 cm (approximately 1 inch)21.
Countries should not make modifications to recommended

immunization schedules with the aim of avoiding multiple
injections during the same visit when such changes are not
evidence-based.
To support health worker training on multiple injections

that include IPV, please refer to the materials available If giving three or more vaccines, make sure vaccines
on the Polio Endgame objective 2 website22, specifically in the same thigh are separated by at least 2.5 cm.
training module 8, “Multiple injections and IPV”, and a
related adaptable job aid (also available in Annex 4 of this
document) for health workers on IPV administration.
23
Studies and experience have demonstrated that caregiver concerns about multiple injections can
be addressed with effective communication and immunization practices.
Health worker training should therefore include:

›› Vaccine co-administration policy and practices
›› Techniques to mitigate pain and distress at the time of vaccination (see below box: “Reducing pain at the
time of vaccination”)
›› Information about safety and effectiveness of vaccines when co-administered
›› Information about the likely overestimation of concerns by parents or caregivers
›› Improved communication strategies to provide reassurance of the safety, effectiveness and value of
multiple vaccine injections
21
Weekly Epid. Record, 90. (May 2015). Available at: http://www.who.int/wer/2015/wer9022.pdf
22
Health worker training materials on multiple injections are available: http://www.who.int/immunization/diseases/poliomyelitis/endgame_objective2/
inactivated_polio_vaccine/implementation/en/
23
In the absence of specified grading of painfulness, healthcare professionals are encouraged to use their practical experience on the painfulness of specific
vaccines to determine accordingly the best sequencing of the injections.

Re d u ci n g pa i n at t h e time of vac c in ation : WHO p osition
Better pain management during vaccination is possible and does not decrease the efficacy of the
vaccine. There are effective, feasible, non-costly, culturally acceptable, and age-specific evidence-
based strategies to mitigate pain at the time of vaccination.
Recommendations for measures that can be taken to reduce pain and anxiety during vaccination, which can
be applied in high, middle and low income countries, are summarized below.
›› Healthcare personnel carrying out vaccination should be calm, collaborative, and well-informed.
They should use neutral words.
›› Proper positioning of the vaccine recipient should be ensured, according to age. Infants and young
children should be held by their caregiver. Older children should be sitting upright.
›› No aspiration (or pulling back of the plunger of a syringe) should be done during intramuscular injections,
as this may increase pain.
›› When multiple vaccines are scheduled to be injected at the same session, they should be given in
order of painfulness, ending with the most painful23.
Further details are available in the Position Paper: Reducing pain at the time of vaccination –
September 2015. Weekly Epid. Record, 90.
Available at: http://www.who.int/wer/2015/wer9039.pdf
23
Planning and managing
3 IPV introduction
3.1 Planning for a successful introduction

For the most part, the
K e y Re ad in g
addition of IPV to routine
immunization programmes
involves the same planning Principles and
considerations for adding
a vaccine to a national
and implementation process immunization programme

FROM DECISION TO IMPLEMENTATION AND MONITORING
as for other new vaccine

introductions.
General guidance for making decisions about and
planning the introduction of a vaccine into a national
immunization programme is available in the document
Principles and considerations for adding a vaccine to a
national immunization programme24 and is recommended
reading when planning for IPV introduction. Principles and considerations for adding a
vaccine to a national immunization programme
There are, however, some important factors specific to (WHO 2014)
the introduction of IPV that need to be considered.
A generic guide for countries explaining the
These include: principles and issues to be considered when
›› Unprecedented timelines – in which all countries introducing a new vaccine into a national
that use only OPV should add at least one dose of IPV immunization programme.
before the end of 2015 (pending available supply).
›› Impact indicators – the evaluation of IPV will be It describes the process and latest references
based on whether it reaches the same level of and tools/checklists on topics such as decision-
coverage as for routine DTP-containing vaccines. making, introduction planning, vaccine safety,
This is in contrast to indicators used to measure the communications and monitoring.
impact of other vaccines, e.g. reduced mortality or
disease rates. Importantly, this guide highlights ways to use
the opportunity of adding a new vaccine to
strengthen immunization and health systems.

24
25
Once the decision to introduce IPV has been made by the national authorities, the first step will be to develop a
plan for IPV introduction. This should be incorporated into the country’s comprehensive multi-year action plan for
the immunization programme.
The plan for IPV introduction should take into account the following:
›› IPV-specific planning – ensuring that the vaccine is licensed, training is scheduled and corresponding
materials available, immunization records and registers updated, and logistics plans prepared.
›› Programme management and coordination – including the formation of a technical and administrative
committee, use of accountability frameworks, data management, evidence-based planning, training and supply
chain management.
›› M icroplanning – including population mapping, harmonization of routine immunization microplans with
those from polio campaigns to enable more complete session planning, vaccine supply management and cold
chain logistics.
›› I mmunization service delivery – including monitoring and supervision of immunization sessions, local
community coverage and vaccine acceptance, availability of health workers, vaccine delivery and other
immunization session logistics.
›› A dvocacy and briefings – including high level advocacy, the engagement of journalists, paediatricians and
local community leaders, and house-hold level outreach.
›› A calculation of the costs of the plan – including the unit cost per activity, the total cost, and the
sources of financing. Fixed costs of activities that form part of the regular programme should be defined to see
whether further investment will be required.
Annex 1 of this document includes a checklist of core components of an IPV introduction plan. The list can be easily
adapted to reflect any country-specific considerations.
Managing the impact on other immunization programme plans

Many countries may be planning to introduce other new vaccines around the same time as IPV. There are potential
benefits to introducing IPV at the same time as other new vaccines, especially if they share the same target
population. Studies in Ghana and Tanzania showed that efficiencies in cost and time can be gained by introducing
two vaccines at once.
Countries planning to introduce another new vaccine and IPV may wish to consider a joint introduction. This option
should be discussed with regional immunization staff, NITAGs and Ministries of Health as soon as possible, in order
to ensure adequate time for planning. Reviews of lessons learned from vaccine introduction experiences to date25
have identified the importance of early planning as a critical factor for success.
Lessons learned from vaccine introduction experiences: opportunities for inactivated poliovirus vaccine (pdf). Available at: http://www.who.int/
25
immunization/diseases/poliomyelitis/endgame_objective2/inactivated_polio_vaccine/lessons-learned-vaccine-introduction-ri-strengthening-dec2014_
en.pdf?ua=1

Vaccine management and
3.2 procurement considerations
For the successful introduction of IPV, the characteristics
of the vaccine and the technical aspects relating to its
administration need to be taken into account (Table 6).
table Ch a r act e r i st ic s of I P V an d te c hn ic al asp e c ts

6. r e l at e d to i ts ad min istration
C h a r act e r i st i c D e s c rip tion

Type of vaccine Inactivated (killed) vaccine with types 1, 2 and 3 antigens
Route of
Intramuscular is preferred. (For more information, see section 2.3.)
administration
WHO recommends at least one dose of IPV with the third dose of DTP and
Immunization
OPV, typically administered at 14 weeks of age (or 4 months, or the nearest
schedule
immunization visit). (For more information, see section 2.2.)
Target age group Infants under 12 months of age
Volume per dose Each dose is 0.5ml
Store between 2°C and 8°C. DO NOT FREEZE. Discard if known or suspected to
have been frozen. The shake test does not work to determine if IPV was frozen.
Storage conditions
IPV is also damaged by accumulated exposure to heat and light (level of heat
exposure can be determined by the VVM).
IPV multi-dose vials may be used for up to 28 days after opening, provided that
Open vial policy
the criteria for the multi-dose vial policy outlined on the next page are fully met.
The WHO prequalified vaccine comes in 1, 2, 5 and 10-dose liquid presentations.

Presentation and
IPV is also available26 in combined pentavalent and hexavalent presentations with
dosage form
DTP, hepatitis B and Hib antigens.
Vaccine vial monitor

VVM7 or VVM14, depending on the product
(VVM)
Co-administration IPV may be safely co-administered with other vaccines. (For more information, see
with other vaccines section 2.4.)
27
Vaccine management
It is essential to handle the vaccines properly from the moment they arrive in country until the moment they
are used. Good vaccine management includes:
›› Sufficient storage volumes
›› Efficient arrival and acceptance procedures
›› Effective stock management
›› Appropriate temperature monitoring
›› Maintaining standards of buildings, storage rooms, equipment and vehicles
›› Vaccine delivery systems, including vaccine handling, transporting people and vaccines
›› Effective use of policies such as the multi-dose vial policy (MDVP) and the use of vaccine vial monitors (VVMs)
Effective vaccine management requires adequately trained staff at all levels from national and subnational
programme managers, district health management teams, cold chain technicians, logisticians, drivers, and health
facility team. These individuals deal with all aspects of vaccine management, cold chain system and logistics.
Application of the WHO multi-dose vial policy for IPV

When properly handled and stored, multi-dose vials of IPV (presented in 5 and 10 dose vials; produced by two
manufacturers) are approved for use for up to 28 days after opening, based on preservative efficacy data26.
The WHO Policy Statement: Multi-dose Vial Policy (MDVP),

Revision 201427, on the use of opened multi-dose vaccine WHO Policy Statement:
Multi-dose Vial Policy (MDVP)
vials specifies the criteria under which opened multi-dose
Revision 2014
vials can be kept and used for up to 28 days after opening.

HANDLING OF MULTI-DOSE VACCINE VIALS AFTER OPENING
If the criteria are not met, the multi-dose vials must be
C O N TA C T
discarded at the end of the immunization session, or within

W O R L D H E A LT H O R G A N I Z AT I O N
D E P A R T M E N T O F I M M U N I Z AT I O N , V A C C I N E S A N D B I O L O G I C A L S
20, AVENUE APPIA
CH-1211 GENEVA 27
SWITZERLAND
six hours of opening, whichever comes first. FA X : + 4 1 2 2 7 9 1 4 2 2 7

EMAIL: vaccines@who.int
The criteria are as follows:

1. The vaccine is currently pre-qualified by WHO
2. The vaccine is approved for use for up to 28 days after
opening, as determined by WHO
3. The expiry date of the vaccine has not passed
4. The vaccine vial has been, and will continue to be, WHO Policy Statement:
stored at WHO- or manufacturer-recommended Multi-dose Vial Policy (MDVP) Revision 2014
temperatures. Furthermore, the VVM, if attached, is
visible on the vaccine label and is not past its discard point and the vaccine has not been damaged by freezing.
For vials that can be kept for up to 28 days after opening, it is recommended that national programmes orient
vaccinators, where possible, to record on the vial the day and month when the vial was opened.
Materials for the training of health workers on vaccine handling practices corresponding to the MDVP and VVM are
available for countries and partners to adapt and use as needed28.
26
For a complete list of WHO prequalified vaccines for polio: http://www.who.int/immunization_standards/vaccine_quality/PQ_vaccine_list_en/en/
27
WHO policy on the use of opened multi-dose vaccine vials (2014 Revision). Available at: http://www.who.int/immunization/documents/general/WHO_
IVB_14.07/en/
28
Application of the WHO Multi-Dose Vial Policy for IPV: MDVP and IPV job aid, and modules 4A and 4B. Available at: http://www.who.int/immunization/
diseases/poliomyelitis/endgame_objective2/inactivated_polio_vaccine/implementation/en/

Estimating vaccine requirements
Immunization services depend on an adequate supply and quality of vaccine and injection equipment. Efficient
management of the vaccine stock is important for ensuring a balance between having too much vaccine for too
long in one part of the cold chain, thereby risking vaccine expiry, and having too little vaccine, whereby not all
children in the target population can be vaccinated.
To be sure that the appropriate amount of vaccine is available, vaccine stocks must be checked continuously, and
records kept of all movements of stock in and out of storage areas. Effective planning, management, and storage of
supplies is important for reducing programme costs, preventing stock-outs and high wastage rates, and ensuring
vaccine safety.
Vaccine wastage is the proportion of vaccine that is supplied but never administered due to a number of reasons.
Each country should calculate its wastage rate based on its experience with other vaccines, especially those
packaged in multiple-dose vials.
C a lcu l at i n g t h e n u mb e r of d ose s of I P V n e e d e d
The basic formula for calculating the annual number of IPV doses needed is:
N=
Surviving infants
x target coverage (%)
x number of doses in the schedule
x wastage factor
The formula to calculate the wastage rate is:
Wastage rate =
[(doses supplied - doses administered)/doses supplied]
x 100
Wastage factor =
100 / (100-wastage rate)
A proper application of the MDVP can decrease wastage while ensuring safety. Taking advantage of using a 28-day
discard on opened multi-dose vials, the indicative maximum wastage rate of 20% for 10-dose vials, and 15% for
5-dose vials, can be used in forecasting the estimated vaccine needs.
Each level of the supply chain should maintain a 25% buffer (or reserve) stock, which is a quantity of vaccine that can
be used if new supplies are delayed or if there is a sudden increase in demand. Constraints in the global supply of
IPV may mean that initially this level of buffer stock is not possible.

29
3.3 Cold chain considerations
The introduction of any new vaccine offers a good
opportunity to critically review the cold chain and logistics
(CCL) system and to improve its performance.
Countries may conduct an Effective Vaccine Management (EVM)29 assessment and develop a CCL improvement
plan to guide enhancements. For each vaccine storage site, an assessment is needed to ensure that sufficient
capacity is available.
C a lc ul at i n g vacci n e sto rage re quire me n ts
To calculate the net volume for vaccine storage, the following factors should be considered: target
population; number of doses in the immunization schedule; wastage factor; expected reserve, and; storage
volume per dose according to presentation. In order to precisely determine the specific cold chain capacity
needs for the introduction of IPV into the national immunization schedule, programme managers are advised
to use the Excel-based WHO Vaccine Volume Calculator 201231.
30
Once the cold chain storage capacity required for IPV has been calculated, the manager of the immunization
programme should decide if any adjustments are warranted, for example, changes to the frequency of vaccine
deliveries, or additional refrigeration equipment. Those responsible for procuring refrigeration equipment can select
the most appropriate, depending on the capacity and infrastructure of the storage spaces. Any decision should
be taken in the context of other planned vaccine introductions or campaigns that will be implemented over the
coming years.
IPV loses its potency when exposed to temperatures outside the range recommended by the manufacturer. Its
capacity to produce neutralizing antibodies is destroyed by both heat and freezing. The heat impact on vaccines
is cumulative. Proper storage of vaccines and maintenance of the cold chain during storage and distribution are
essential to prevent the loss of potency. Damaged vaccines should be discarded according to current national
guidelines on good practices in injection safety.
Proper management and handling of vaccines requires that they be properly packed and stored. In general, the same
principles that apply to other vaccines also apply to IPV, for example, inventory control systems should ensure that
units with the nearest expiry date are used first in a system known as “first-expired, first-out” (FEFO). The expiry date
and VVM status should always be checked whenever a vial is opened.
Waste management
In preparing for the introduction of IPV, waste management plans should also be updated, to describe the ultimate
destruction of the increased volume of used needles and syringes. Strengthening of the vaccine/healthcare waste
management plan can be noted as an action within the vaccine introduction plan.
As a general guide, vaccinators should place all used needles (without recapping them) and syringes directly in
a safety box immediately after administering the vaccine. The container should be securely closed when full
29
Effective Vaccine Management initiative: http://www.who.int/immunization/programmes_systems/supply_chain/evm/en/
30
Vaccine volume calculator: http://www.who.int/immunization/programmes_systems/supply_chain/resources/tools/en/index4.html

(i.e. at up to 75% capacity) and stored in a safe place until it can be transported, according to national guidelines,
to its final destination for disposal.
No other waste should be put into the safety boxes. Instead, other waste should be disposed of in bins and collected
along with the safety boxes, or handled according to national guidelines.
3.4 Monitoring and evaluation

The introduction of any new vaccine can pose some
challenges that may benefit from tracking closely.
Monitoring, evaluation, and supervision are basic processes that facilitate the collection and analysis of data
required to verify whether planned activities are being implemented effectively, and to what extent the objectives
and targets have been achieved. In the first weeks after introduction, this can take the form of telephone calls
and/or visits to health facilities to identify and resolve potential bottlenecks linked to administration.
Monitoring and evaluation information systems need to be updated to facilitate collection of core indicators
related to IPV introduction. Monitoring and evaluation activities are not unique to IPV and are described in detail
in many other references31, 32.
Monitoring tools
The main recording tools used for immunization that should be adapted to include IPV at the service delivery
level are:
›› Immunization register
›› Tally sheet
›› Immunization card
›› Defaulter tracking system
›› Stock record
›› Integrated monthly report
Evaluation tools
A range of immunization programme evaluation tools are available and may be used to assess the implementation
of IPV. These tools include:
›› EPI reviews
An EPI review is the chief methodology for assessing the progress of a national immunization programme,
identifying challenges and corrective actions, and providing technical recommendations to strengthen the
programme. It is undertaken every 3 to 5 years. Tools to be used for the EPI review should be adapted to suit
local requirements and to include IPV and any other new vaccine that has been added to the programme.
31
Principles and considerations for adding a vaccine to a national immunization programme. Available at: http://www.who.int/immunization/programmes_
systems/policies_strategies/vaccine_intro_resources/nvi_guidelines/en/
32
Immunization in practice, module 6: Monitoring and surveillance (pdf). Available at: http://www.who.int/immunization/documents/IIP2014Mod6_19may.
pdf
31
›› Post-introduction evaluations (PIEs):
Now that most countries have extensive experience introducing new vaccines, WHO no longer recommends
that a PIE take place 6 to 12 months after the launch. Rather than conduct a stand-alone PIE, it is encouraged
that new vaccine introduction questions be combined with the next EPI review or surveillance review.
Following the introduction of a new vaccine, regular supervision and other ongoing monitoring activities should be
used to assess the impact on the immunization programme and rapidly identify any problems that require action.
›› Coverage surveys
National coverage monitoring is important to validate administrative data that is reported throughout the year
and allow for comparisons of coverage between vaccines and with the coverage achieved by other countries.
Estimates of coverage can be obtained through evaluation surveys using the standard sampling technique for
defined geographical areas. Other survey methods may be employed for larger areas.
The WHO Vaccination Coverage Survey Manual33, updated in 2015, focuses on methods to reduce bias and
improve the accuracy and precision of survey results.
Reporting on adverse events following immunization

An adverse event following immunization (AEFI) is any untoward medical occurrence which follows immunization
and which does not necessarily have a causal relationship with the usage of the vaccine. If not rapidly and effectively
dealt with, an AEFI can undermine confidence in a vaccine and immunization programme, and ultimately can have
dramatic consequences for coverage and disease incidence.
Vaccine-associated adverse events may affect healthy individuals and should be promptly identified to allow
additional investigation and appropriate action to take place. As for all vaccines, AEFIs should be reported according
to current national regulations.
Guidance from the WHO Global Vaccine Safety Initiative34 includes AEFI investigation, the communications
response, a sample AEFI
reporting form35 (also
Ke y R e sourc e
shown in Annex 3), and
other tools and trainings.
Vaccine Safety Events:
managing the
communications response
These resources are
designed to support the
strengthening of national Vaccine safety events: managing the
capacity to detect and communications response. A Guide for
respond to any event in a Ministry of Health, EPI Managers and
clear, factual, and timely Health Promotion Units.
manner.
WHO Regional Office for Europe, 2013.
A Guide for Ministry of
Health EPI Managers and
Health Promotion Units www.euro.who.int/__data/assets/pdf_file/
0007/187171/Vaccine-Safety-Events-managing-the-
communications-response-final.pdf
33
Coverage survey manual: http://www.who.int/immunization/monitoring_surveillance/Vaccination_coverage_cluster_survey_with_annexes.pdf
34
Resources are available through the Global Vaccine Safety Initiative: http://www.who.int/vaccine_safety/initiative/en/
35
AEFI reporting form: http://www.who.int/vaccine_safety/REPORTING_FORM_FOR_ADVERSE_EVENTS_FOLLOWING_IMMUNIZATION.pdf

3.5 Communications and training
Well-planned, adequately funded communications are vital
for the successful delivery of immunization services and are
particularly needed to achieve vaccination coverage goals
and maintain trust in vaccines.
A communications strategy and its activities should Core c ommun ic ation
all be guided by some degree of formative research, be ap p roac he s:
carefully planned, systematically implemented, and take
into account the context of the overall immunization ›› Advocacy – raising awareness and
programme or vaccine introduction plan. commitment among decision-makers
and key influencers so that they support
The benefits of a well-defined and executed and facilitate the introduction and
communication and advocacy strategy are many, and implementation of all vaccines
include generating demand for IPV and vaccination in ›› Community engagement – involving
general, fostering community support and trust in the community leaders, civil society, and the
immunization programme. relevant professional associations in activities
to ensure acceptance, and boost demand
A national communication and advocacy strategy and sustainability
targeted towards implementing partners, professional ›› Informational – targeting individuals via
associations, health workers, communities, civil society, information/dialogue on the change to the
traditional leaders, and caregivers (groups identified immunization schedule, promoting health
through appropriate mapping surveys), should aim to seeking behaviour and calling for the action
achieve the following objectives: of caregivers
›› R aise awareness and understanding by all parties on the importance of vaccination

›› Generate positive intentions and actions towards immunization in general
›› Promote trust and confidence in immunization, its safety and effectiveness
›› Prevent rumours and misinformation
›› Improve and maintain demand for immunization
›› Enhance detection, reporting and management of possible AEFIs
K e y R e s o u r ce s
To support the strategic planning process for communications and issues/crisis management,
two adaptable guides are available:
IPV Communications Planning Guide: IPV Issues Management Guide:

Includes a range of checklists, tools, Includes guidance on how to write a press release
templates, and best practices. and samples of frequently asked questions.
www.who.int/immunization/diseases/poliomyelitis/endgame_objective2/inactivated_polio_vaccine/implementation/en
33
Communication planning framework
To support the addition of IPV to a national immunization programme, a Communications Planning Guide36 is
available. This guide provides a range of checklists, tools, templates and best practices, to inform effective planning
and implementation of communication activities associated with IPV and any broader efforts to strengthen routine
services. Content and activities can be adapted to local contexts as needed.
Communications planning frameworks typically follow the series of steps shown in the alongside chart
“Communications planning framework”. This may be adapted and used for planning communications activities to
support the introduction of IPV, any other vaccine, or the overall routine immunization programme.
Figure
2. C o mmu n i cat i on s p l an n in g frame work
1 Coord in ation
an d p re paration
5 mo n i to r i n g
a n d e va l uat i o n 2 Commun ic ations
an alysis
4 Cr e at i v e st r ate gy
a n d mat e r i a l
d e v e lo p me n t
3 Strate gic
p l an n in g
an d d e sign
The IPV communications planning guide is available on this web page, under the heading “Communications planning guide”: http://www.who.int/
36
immunization/diseases/poliomyelitis/endgame_objective2/inactivated_polio_vaccine/implementation/en/

Recommended activities within each step:
Step 1: Coordination and preparation

›› Establish or reactivate a communication committee
›› Establish roles and responsibilities for partners and allies, including key community leaders and civil society
Step 2: Communications analysis

›› Identify target audiences, and conduct a problem or situation analysis, including formative research that
may consist of focus groups, interviews, and mixed methods assessments
›› Conduct studies of knowledge, attitudes, behaviours, and communication channels
Step 3: Strategic planning and design

›› Develop measurable and realistic objectives, and monitoring and evaluation indicators
›› Develop a strategy planning matrix, including activities, timelines, and budgets
Step 4: Creative strategy and material development

›› Develop messages and templates for materials
›› Test, revise, and if necessary, retest materials before finalization
›› Implement activities, including community consultations and engagement
Step 5: Monitoring and evaluation

›› Develop a plan for monitoring the implementation of communication interventions
›› Plan for evaluation and analysis of implications for subsequent planning
More details on the overall framework and each phase are available in the IPV Communications Planning Guide.
In addition to developing a communications plan to support the introduction of IPV, countries are also encouraged
to prepare for any unexpected situations that may arise. Created specifically to support IPV, an Issues Management
(or Crisis Communications) Guide37 can be used as a basis to establish a national issues/crisis management plan.
It can be used to help identify an unexpected event, evaluate its potential impact, and have ready in advance an
appropriate communications strategy to minimize potential consequences.
Further guidance on advocacy, communications, and social mobilization activities related to vaccine introductions
and immunization programmes can be found in a number of other resources38, 39.
37
The issues management guide is available under the heading of same name on this page: http://www.who.int/immunization/diseases/poliomyelitis/
endgame_objective2/inactivated_polio_vaccine/implementation/en/
38
Principles and considerations for adding a vaccine to a national immunization programme. Available at: http://www.who.int/immunization/programmes_
systems/policies_strategies/vaccine_intro_resources/nvi_guidelines/en/
39
Immunization in practice, module 7: Partnering with communities (pdf). Available at: http://www.who.int/immunization/documents/IIP2014Mod7_19may.
pdf
35
Training
One of the core success factors for the introduction of a vaccine is comprehensive, high-quality training about the
new vaccine and the disease it prevents. Such training should include all health workers with a role in immunization,
their supervisors and all immunization programme staff. The training should also include refreshing of the skills and
knowledge of important areas of the immunization programme, especially in areas that may have been previously
identified as weak.
If not already available from a recent evaluation, an initial step to plan and design an effective training programme
is to conduct an assessment of the knowledge, attitudes and practices (KAP) of health workers involved in
immunization. This information will highlight areas where refresher training may be needed and inform the
development of a training plan, budget, and the resulting training materials.
K ey co mmu n i cat i o n me ssage s to in c l ud e

i n h e a lt h w o r k e r t r a i n i n g
›› I PV is a very safe vaccine, whether given alone or in combination with other vaccines. It has been used
for many years in many countries.
›› Given together with OPV, IPV offers the best protection against polio.
›› IPV is generally given with the third dose of a DTP-containing vaccine, such as pentavalent. This enables
the child to be protected as soon as possible.
›› It is safe for a child to receive many vaccines at once, including two polio vaccines. Each vaccine is still
equally effective when given together.
Examples of frequently asked questions (FAQs) to support health workers to respond to caregivers
and communities are available in Annex 2.
When implementing the trainings, the number of levels through which the training is relayed (e.g. cascade training),
should be minimized to maintain the quality of the training content. If cascade training is unavoidable, it should be
supported by the use of videos and materials.
The training for IPV should not be conducted too far in advance of the vaccine introduction to ensure proper
recollection of learning. For frontline health workers, the training should ideally take place two or three weeks prior
to the vaccine launch. It is also important that the training be followed by supportive supervision to ensure that
health workers correctly apply their new skills.

Key subjects to address in the training are:
›› Updates on polio eradication and the rationale for IPV introduction
›› The immunization schedule incorporating the new vaccine, and how to handle infants who are “off-schedule”
and come late for vaccination
›› IPV presentation, safety and effectiveness, storage, and co-administration policy and practices
›› Interpretation of VVMs and implementation of the open vial policy (including writing date/time on
opened vials)
›› Recording data and reporting on doses administered using the appropriate forms
›› Monitoring of coverage, drop outs and vaccine wastage rates
›› Benefits of multiple injections and related co-administration practices, including:
• Safety and effectiveness of vaccines when co-administered
• The preferred order and placement of injections (see section 2.4. for more information on multiple
injection techniques and pain reduction)
• Information about the likely overestimation of parental concerns, and how to respond and reassure
›› Techniques for reducing pain and distress at the time of injection
›› Detection, handling and reporting of AEFIs
›› Interpersonal skills and improved communication strategies with parents and caregivers about the new
vaccine, the schedule, value of multiple injections, and possible side-effects
40 41 42
Tr a i n i n g mat e r i a l s o n I P V an d re l ate d re sourc e s

WHO and partners have developed a training package specifically for IPV, including modules on
different topics in an adaptable Powerpoint slide format, key messages and frequently asked
questions on IPV and polio, and a leave-behind job aid for reference 41.
A number of general immunization training resources are also available and include the Immunization in
Practice modules, a series of modules on immunization training for Mid-Level Managers (MLM)42, and a WHO
e-learning course on Vaccine Safety Basics43.
40
The IPV training package includes modules 1-8, a job aid, key messages and frequently asked questions, and review exercises. Available at: http://www.who.
int/immunization/diseases/poliomyelitis/endgame_objective2/inactivated_polio_vaccine/implementation/en/
41
The Mid-level Manager training modules can be found at: http://www.who.int/immunization/documents/training/en/
42
The WHO Vaccine Safety Basics course is available at: http://vaccine-safety-training.org/
37
Resources
Online resources
All materials last accessed August 2016.
Principles and considerations for adding a vaccine to a national immunization programme: From decision to
implementation and monitoring. Publication date: April 2014
http://www.who.int/immunization/programmes_systems/policies_strategies/vaccine_intro_resources/nvi_
guidelines/en/
World Health Assembly resolution: Completion of polio eradication a programmatic emergency for global public
health. May 2012. (pdf)
http://apps.who.int/gb/ebwha/pdf_files/WHA65/A65_R5-en.pdf
Polio Eradication and Endgame Strategic Plan 2013-2018

http://polioeradication.org/who-we-are/strategy/
World Health Organization. Immunization standards. WHO prequalified vaccines.

http://www.who.int/immunization_standards/vaccine_quality/PQ_vaccine_list_en/en/

World Health Organization. Department of immunization, vaccines and biologicals. WHO policy on the use of
opened multi-dose vaccine vials (2014 Revision)
http://www.who.int/immunization/documents/general/WHO_IVB_14.07/en/
World Health Organization. Global Polio Eradication Initiative. (web site)

http://www.polioeradication.org/
World Health Organization. Immunization, vaccines and biologicals. IPV introduction, OPV withdrawal and routine
immunization strengthening. (website)
http://www.who.int/immunization/diseases/poliomyelitis/endgame_objective2/en/
WHO papers
Polio vaccines: WHO position paper, March 2016. Weekly Epid. Record, 91. (March 2016)
http://www.who.int/wer/2016/wer9112.pdf
Reducing pain at the time of vaccination: WHO position paper, September 2015. Weekly Epid. Record, 90. (September
2015) http://www.who.int/wer/2015/wer9039.pdf
Administration of multiple injectable vaccines in a single visit. Meeting of the Strategic Advisory Group of Experts
on immunization, April 2015: conclusions and recommendations. Weekly Epid. Record, 90. (May 2015). http://www.
who.int/wer/2015/wer9022.pdf
39
Annex 1
IPV introduction plan checklist
Following is a check list of the core components that should be included in an IPV introduction plan. This may be
adapted depending on country-specific considerations.
Section Ke y c omp on e n ts
❏❏ enefits of introducing IPV
B
❏❏ Summary of the introduction plan activities
❏❏ Key programmatic considerations, e.g. capacity, cold chain, etc.
Executive summary ❏❏ Economic assessments, financial needs and sustainability
(2 pages)
❏❏ Monitoring and evaluation plan and indicators
❏❏ Timeline of activities from preparation to full roll-out
❏❏ Budget summary
Justification for ❏❏ Overview of the rationale for IPV introduction

introduction of IPV ❏❏ Technical and operational feasibility
and national decision-
making process ❏❏ Approaches to involve all key decision-makers
❏❏ V accine presentation preference and introduction date

Overview of IPV ❏❏ Licensing information and procurement obstacles
❏❏ ational coordination mechanism to oversee the introduction

N
Introduction and ❏❏ Policy considerations (e.g. schedule, doses, phased vs. national)
implementation ❏❏ Estimated target population for vaccination
considerations ❏❏ Affordability and sustainability plan
❏❏ Operational risks, challenges and mitigating strategies
❏❏ eneral country context, health system overview and priorities

G
❏❏ Barriers to immunization
❏❏ Summary findings from programme reviews
Situational analysis ❏❏ EVM assessment findings and improvement plan
❏❏ Description of vaccine stock management processes
❏❏ Description of health worker knowledge, attitudes, behaviours
❏❏ Immunization coverage for past two years
Procurement of ❏❏ alculation of vaccines required

C
vaccines, ❏❏ Estimation of any added cold chain requirements at all levels
cold chain, and ❏❏ Vaccine administration guidance including open vial policy
logistics ❏❏ Provision for waste management and injection safety
❏❏ P lans for updating monitoring tools and information systems

Monitoring and ❏❏ Adverse events following immunization (AEFI) reporting processes
evaluation ❏❏ Plan for monitoring of pre-introduction, introduction and post-
introduction follow up activities
❏❏ Overall communications plan for IPV introduction

❏❏ Messaging framework, including topics such as multiple injections
Communications and ❏❏ Plan for any additional resource mobilization or advocacy activities
training ❏❏ Crisis communications or issues management plan
❏❏ Plan for stakeholder engagement, e.g. media, paediatricians
❏❏ Plan for training health workers and supervision

Annex 2
Frequently asked questions about IPV
The following questions and answers may be a useful starting point for the development of materials to help health
workers to answer questions received from caregivers and the community.
C h a r act e r i st i c D esc rip tion

Why does my child need Using both vaccines together provides the best form of protection from polio.
two different vaccines The additional dose of IPV will help protect your child against polio disease even
for polio? more – and will give your child the benefits of both vaccines working together.
What is the benefit IPV provides important additional protection against polio, protecting both your
of IPV? child and children in our community.
How is IPV different IPV and OPV each provide a different kind of immunity, and are needed together
than OPV? to give you child the best protection against polio.
Is IPV safe? Does it have IPV is one of the safest vaccines in humans. After vaccination, there might be a
any side-effects? little bit of redness and the skin may feel tender.
Until polio is eradicated globally, OPV is still the main preventative measure
Why is OPV still against polio. IPV is recommended in addition to OPV and does not replace OPV.
needed? Is OPV safe? IPV and OPV are both safe vaccines, and together provide the best protection
against polio.
I only want my child It is important – and best – for your child to receive both IPV and OPV. Together,
to receive one polio these two vaccines provide safe and strong protection against polio. If your
vaccine, IPV or OPV,
but not both. child only receives one of the vaccines they will not be as well protected.
Giving a child several vaccinations during the same visit allows your child to be
Why does my child immunized as soon as possible. This provides protection during the vulnerable
need three injections
early months of your child’s life. In addition, giving many vaccines at one time
on one visit?
means fewer visits to the health centre.
It is safe for your child to receive three (or more) injections at once. Many
Is it safe to give three countries have immunization schedules where children receive multiple
injections at one visit?
vaccine injections at one visit.
Can multiple injections No. Numerous studies have shown that giving multiple vaccinations at the
of vaccines increase the same visit does not result in a higher rate of adverse events. Each of the
risk of adverse events? vaccines is still equally effective when given together.
While receiving multiple injections at once is painful, having to return for

Aren’t multiple additional vaccines forces the child to experience pain on two visits. It is better
injections painful
for the child to experience one, brief moment of discomfort than pain on two
for the child?
separate days.
41
Annex 3
AEFI Reporting Form
The form shown below is also available on the ‘Tools and methods’ page of the Global Vaccine Safety Initiative web
site: http://www.who.int/vaccine_safety/initiative/en/

Annex 4
Job aid on IPV for health workers
The following two-page job aid is an adaptable reference that may be shared with health workers during their
training on IPV. Standalone English and French versions are available: www.who.int/immunization/diseases/
poliomyelitis/endgame_objective2/inactivated_polio_vaccine/implementation/en/
IPV: Inactivated Polio Vaccine

Giving IPV in 3 easy steps
1 When to
give IPV OPV
drops
OPV
drops
OPV
drops
1
3
only only only
IPV
1
3
Birth 6 Weeks 10 Weeks 14 Weeks
14 weeks is the best time to give IPV because it gives the most protection at that time.
IPV should be given at the same time as Oral Polio Vaccine (OPV) drops. IPV is safe to give at 14
weeks even for babies born too early or who get sick often. For infants starting the routine
immunization schedule after 14 weeks, the IPV dose should be given the first time you
see them.
2 How to
give IPV
2
1
90˚
0
IPV
2nd injection
in same thigh
Check date 0.5 ml dose 2.5 cm apart Right angle

and VVM to thigh
Check the expiration Administer in a If giving 3 or more Administer by
date and VVM. Discard 0.5 ml dose. vaccines, make sure intramuscular
the vaccine if it is injections in the same injection (IM). The
expired, the vial is thigh are given at needle must be at a
frozen, or the square least 2.5 cm apart. 90º angle to the
in the VVM is dark. child’s thigh.
3 Give with
other
vaccines
Saves time Improves Healthier

and effort coverage children
Help the children in your community by giving the right vaccines at the right time.
It will save you time, make the health clinic more efficient, and improve coverage.
Most importantly it will protect children from serious and sometimes deadly diseases.
2 October 2014
43
IPV: Inactivated Polio Vaccine
3 things parents and caregivers need to know
1
Vaccines like IPV protect
IPV is babies when they need it most.
very safe It is safe for your child to get 3 or more injections
at one visit.
IPV is needed to protect every child and is safe to

give at 14 weeks even for babies born too early or
who get sick often.
2
Hold your baby on your lap.
You can Baby’s feet should be between your thighs to help
keep baby still. Hold arms still. You can breastfeed
lessen pain while baby is getting vaccinated.
Get all recommended shots on time.

It is better for your child to experience discomfort
during one visit, rather than discomfort during two
separate visits.
Be gentle around baby’s injection sites.

Injection sites may have some redness and feel sore.
3
Polio can paralyze your children – but vaccines can
Baby’s protect them from polio.
vaccines are
important In addition to polio, vaccines can protect your
children from other very serious and sometimes
deadly diseases.
Healthier children Vaccinations give kids a healthy future, so they can

go to school, grow up and have families of their own.
25 September 2014

A Guide To Introducing: Inactivated Polio Vaccine

Uploaded by

Copyright:

Available Formats

A Guide To Introducing: Inactivated Polio Vaccine

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

A Guide To Introducing: Inactivated Polio Vaccine

Uploaded by

Copyright:

Available Formats

A Guide to

ISBN 978 92 4 151141 4 (NLM classification: WC 556)

© World Health Organization 2016

Printed by the WHO Document Production Services, Geneva, Switzerland

1.1 Background ......................................................................................................... 5

2 Decision-making at country level 17

2.1 What is the process?........................................................................................... 17

3 Planning and managing IPV introduction 25

3.1 Planning for a successful introduction ........................................................ 25

2 a guide to introducing inactivated polio vaccine

The specific objectives of this guide are to:

The four objectives of the Strategic Plan are to:

1.2 Polio epidemiology

6 a guide to introducing inactivated polio vaccine

Pol i o Er a d i cat i o n as of J un e 2 016

Reg ula r up d a tes avai l ab l e o n : w w w.p o l i o e rad i c ati o n .o r g

Vaccine-associated paralytic polio (VAPP):

Vaccine-derived polioviruses (VDPDs):

Circ ul atin g vac c in e -

8 a guide to introducing inactivated polio vaccine

Easy, oral administration through drops

Extremely effective in protecting

In extremely rare cases, can cause cVDPV

10 a guide to introducing inactivated polio vaccine

The Strategic Advisory Group of Experts on Immunization (SAGE)

WHO Position Paper on polio is published, confirming that WHO no longer

March 2016: An updated WHO Position Paper on polio is published

1.5 The switch from tOPV to bOPV

Why was it necessary for the switch to be implemented in a

12 a guide to introducing inactivated polio vaccine

What happens if an outbreak of type 2 polio occurs

Invest in a capable and sufficiently resourced national programme management team in

Invest in sharing responsibility on immunization with the community to help reach

How to strengthen immunization programmes and health systems

9 Available on the WHO web site: http://www.who.int/immunization/programmes_systems/policies_strategies/GRISP/en/

14 a guide to introducing inactivated polio vaccine

System Overall goals /

I n f o r mat i o n Soc ial an d

2.1 What is the process?

At 4 months, with the second dose of pentavalent/OPV: OPV1, OPV2+IPV, OPV3

18 a guide to introducing inactivated polio vaccine

Available at: http://www.who.int/wer/2015/wer9022.pdf

Available here: http://www.who.int/immunization/diseases/poliomyelitis/endgame_objective2/inactivated_polio_vaccine/fractional_dose/en/

20 a guide to introducing inactivated polio vaccine

A dva n tag e s o f g i v i n g a c hil d

2015). Available at: http://www.who.int/wer/2015/wer9022.pdf

Countries should not make modifications to recommended

To support health worker training on multiple injections

Health worker training should therefore include:

22 a guide to introducing inactivated polio vaccine

3.1 Planning for a successful introduction

and implementation process immunization programme

as for other new vaccine

Available at: http://www.who.int/immunization/programmes_systems/policies_strategies/vaccine_intro_resources/nvi_guidelines/en/

Managing the impact on other immunization programme plans

26 a guide to introducing inactivated polio vaccine

table Ch a r act e r i st ic s of I P V an d te c hn ic al asp e c ts

C h a r act e r i st i c D e s c rip tion

Target age group Infants under 12 months of age