Poliomyelitis: epidemiology and prophylaxis. 5. Results of a two- and three-dose vaccination experiment

In tropical countries, seroconversion rates following oral poliomyelitis vaccination are frequently unsatisfactory. In an area of the Machakos district in Kenya, 4000 children under 5 years of age have been registered and are visited fortnightly by trained field staff as part of a comprehensive, population-based, longitudinal surveillance project. It was considered possible that poliomyelitis vaccine, given orally to children twice or three times at home, would produce satisfactory conversion rates. After collection of blood from a random sample of the children, vaccine was given twice to all children under 5 years of age. Blood was then collected a second time from a different sample of children. After a third dose of vaccine, a third blood collection followed. The percentages of the children that received vaccine each round were calculated and the sera tested for antibodies. It appeared that the mean titre was more strongly related to age than to the number of doses of poliomyelitis vaccine received. Improvement of herd immunity after two vaccine distributions was significant for a few age groups and for two types of vaccine only. In none of the groups was a significant improvement obtained by the third vaccine distribution. The problems associated with vaccination by live poliomyelitis vaccine in tropical countries are discussed in relation to the results.