Current status of polio immunization, with recent legal implications

The administration of live trivalent oral polio vaccine (TOPV) is a daily occurrence in the average family practice. Although the incidence of paralytic poliomyelitis has sharply decreased following the use of the Salk and Sabin vaccines, serious medical and legal problems remain. Physicians should be aware that even the children who have received three doses of TOPV may not be protected against all three types of polio virus. Certain patients have altered immunity and should not be given a live vaccine. Paralytic poliomyelitis can occur in these individuals if another member of their family is given a TOPV, since the live virus is shed in the stool for weeks. Although the incidence of paralytic poliomyelitis associated with the vaccine is extremely low, health-care providers and vaccine manufacturers are currently liable for such untoward side effects in some states. Improved legislation is clearly necessary.