Safety of Sabin-derived inactivated poliovirus vaccine in adult booster recipients: a systematic review and meta-analysis.

BACKGROUND: Poliomyelitis remains a public health concern in select regions. Sabin strain-derived inactivated poliovirus vaccine (sIPV) offers a potentially safer and cost-effective alternative to conventional IPV (cIPV) for adult booster immunization. OBJECTIVE: To systematically review and meta-analyze evidence on the safety of sIPV in adults. METHODS: We searched PubMed, Embase, Cochrane, and Scopus through January 2026 for randomized controlled trials comparing sIPV with cIPV/w-IPV or placebo in adults. Safety outcomes included local and systemic adverse events: pain, erythema, induration, fever, headache, malaise, and allergic reactions. Data extraction and risk of bias assessment were independently performed. Meta-analysis was conducted using random-effects models in RevMan 5.4, reporting risk ratios (RR) with 95% confidence intervals (CI). Evidence certainty was assessed using GRADE. RESULTS: Four trials encompassing 70-340 adults were included. Pooled analyses demonstrated no statistically significant differences in any adverse events between sIPV and cIPV: pain (RR 1.57, 95% CI 0.98-2.50), erythema (RR 1.54, 95% CI 0.64-3.69), induration (RR 0.33, 95% CI 0.04-3.06), fever (RR 0.96, 95% CI 0.39-2.33), headache (RR 0.70, 95% CI 0.21-2.37), and malaise (RR 0.75, 95% CI 0.17-3.27). Heterogeneity was negligible (I 2 = 0%). Overall, adverse events were mild, transient, and comparable across vaccines and most included trials reported no serious adverse events (SAEs), indicating a favorable safety profile. Certainty of evidence was low to very low due to small sample sizes and imprecision. CONCLUSION: sIPV demonstrates a safety profile comparable to conventional IPV in adult booster recipients, supporting its use as a viable alternative in polio eradication strategies. Further large-scale and long-term studies are warranted to confirm these findings. SYSTEMATIC REVIEW REGISTRATION: identifier: CRD420261329648.