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Poliovirus vaccine options

R K Zimmerman¹, S J Spann

¹Department of Family Medicine, University of Pittsburgh (Pa.) School of Medicine, USA.

American Family Physician

|January 26, 1999

Summary

Vaccine-associated paralytic poliomyelitis (VAPP) is a risk with oral poliovirus vaccine (OPV). The inactivated poliovirus vaccine (IPV) is recommended for initial doses to prevent VAPP and achieve high immunization rates.

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Area of Science:

Immunology
Vaccinology
Public Health

Background:

Indigenous wild poliovirus has been eradicated in the United States due to successful immunization efforts.
However, vaccine-associated paralytic poliomyelitis (VAPP) remains a concern, with 134 out of 142 reported cases between 1980-1996 classified as VAPP.
The risk of VAPP is approximately 1 in 750,000 first doses and 1 in 2.4 million overall doses of oral poliovirus vaccine (OPV).

Purpose of the Study:

To evaluate the safety and efficacy of different poliovirus vaccine schedules.
To address parental concerns regarding VAPP and vaccine acceptance.
To determine optimal vaccination strategies for achieving high immunization rates, particularly in disadvantaged populations.

Main Methods:

Review of reported paralytic poliomyelitis cases in the United States from 1980 to 1996.
Analysis of VAPP incidence rates associated with oral poliovirus vaccine (OPV) doses.
Examination of studies on immunization rates using schedules starting with inactivated poliovirus vaccine (IPV).

Main Results:

The inactivated poliovirus vaccine (IPV) does not cause VAPP.
Studies indicate that IPV-based schedules can achieve high immunization rates, even in disadvantaged populations.
The American Academy of Family Physicians now recommends IPV for the first two doses of the poliovirus vaccine.

Conclusions:

The inactivated poliovirus vaccine (IPV) is a safer alternative to oral poliovirus vaccine (OPV) for initial doses, as it eliminates the risk of VAPP.
IPV-based or sequential IPV-OPV schedules are recommended to enhance vaccine safety and maintain high immunization coverage.
OPV is reserved for specific circumstances, such as parental refusal of multiple injections.

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