Randomised trial of alternative formulations of oral poliovaccine in Brazil

In February to July, 1986, an outbreak of type 3 poliomyelitis occurred in north-east Brazil that was linked to type-specific failure of trivalent oral polio vaccine (TOPV). To see if alternative vaccines would improve seroconversion to type 3, 441 children less than 5 years of age who had previously received no or up to four doses of TOPV were randomly assigned to receive one dose of standard TOPV (1,000,000, 100,000, and 300,000 median tissue culture infection doses [TCID50] of types 1, 2, and 3, respectively); a new formulation of TOPV containing twice the dosage of type 3 (600,000 TCID50); or a monovalent vaccine containing 300,000 TCID50 of type 3. While rates of seroconversion to types 1 or 2 were equivalent following vaccination with either formulation of TOPV, children who received the new formulation were 2.7 times more likely to seroconvert to type 3. Similar differences for type 3 were observed when monovalent vaccine was compared with standard TOPV, though both groups had received the same dose of type 3 antigen. The low rate of seroconversion to type 3 in the standard TOPV group was associated with a higher rate of reinfection with type 2, which also appeared to interfere to some extent with seroconversion to type 1. These findings extend earlier observations that interference from Sabin type 2 virus may be an important contributory cause of type-specific TOPV failure, and suggest that interference can be overcome with alterations in the formulation.