Special Medical Reports

AAFP Childhood Immunization Update



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Am Fam Physician. 1998 Jan 1;57(1):158.

This revised statement provides information from the American Academy of Family Physicians in addition to the Recommended Childhood Immunization Schedule—January 1998 to December 1998. The date that appears at the end of the description is the date on which the revision was approved. The AAFP recommends the following:

Selection of Polio Vaccine for Routine Immunization of Normal Children

The AAFP recommends that physicians and parents jointly decide on the most appropriate vaccine for routine immunization of their normal children against poliomyelitis. This decision should take into account the risks and benefits of each of the three recognized schedules that use oral poliovirus vaccine (OPV), inactivated poliovirus vaccine (IPV) and the combined IPV/OPV schedule.

All three schedules are acceptable options for the prevention of poliomyelitis. The use of an all OPV schedule has the benefits of oral administration rather than an injection, protects 95 percent or more of recipients (probably life long) after the primary series of three doses, and induces intestinal immunity. On the negative side, use of OPV can result in rare cases of vaccine-associated paralytic polio. The overall risk of vaccine-associated paralytic polio is one case per 2.4 million total doses distributed. Among immunocompetent persons, 82 percent of cases among vaccine recipients and 65 percent of cases among contacts occur following administration of the first dose. The most current estimate of the risk for vaccine-associated paralytic polio is one case to 750,000 first doses of OPV distributed.

The use of a sequential IPV/OPV schedule theoretically reduces the risk for vaccine-associated paralytic polio by 50 percent or more. Sequential schedules differing from the one recommended for use in the United States have been used successfully in other countries. The main advantage of the sequential schedule is the reduction but not the elimination of cases of vaccine-associated paralytic polio. The use of a sequential schedule may require additional injections per infant visit depending on the combination vaccines available.

An all IPV schedule eliminates the risk of vaccine-associated paralytic polio. It involves more injections, more cost and provides low mucosal immunity. The table summarizes the advantages and disadvantages of the three polio vaccination options. (Revised July 1997)

Advantages and Disadvantages of Three Poliovirus Vaccination Options

Attribute Oral poliovirus vaccine (OPV) Inactivated poliovirus vaccine (IPV) IPV/OPV

Occurrence of vaccine-associated paralytic polio

8 to 9 cases per year

None

Estimated: 2 to 5 per year

Other serious adverse events

None known

None known

None known

Systemic immunity

High

High

High

Immunity of gastrointestinal mucosa

High

Low

High

Secondary transmission of vaccine virus

Yes

No

Some

Extra injections or visits needed

No

Yes

Yes

Compliance with immunization schedule

High

Possibly reduced

Possibly reduced

Future combination vaccines

Unlikely

Likely

Likely (IPV)

Current cost

Low

Higher

Intermediate


Adapted from Centers for Disease Control and Prevention. Polio-myelitis prevention in the United States: introduction of a sequential schedule of inactivated poliovirus vaccine followed by oral poliovirus vaccine: recommendations of the Advisory Committee on Immunization Practices. MMWR 1997;46(RR-3).

Advantages and Disadvantages of Three Poliovirus Vaccination Options

View Table

Advantages and Disadvantages of Three Poliovirus Vaccination Options

Attribute Oral poliovirus vaccine (OPV) Inactivated poliovirus vaccine (IPV) IPV/OPV

Occurrence of vaccine-associated paralytic polio

8 to 9 cases per year

None

Estimated: 2 to 5 per year

Other serious adverse events

None known

None known

None known

Systemic immunity

High

High

High

Immunity of gastrointestinal mucosa

High

Low

High

Secondary transmission of vaccine virus

Yes

No

Some

Extra injections or visits needed

No

Yes

Yes

Compliance with immunization schedule

High

Possibly reduced

Possibly reduced

Future combination vaccines

Unlikely

Likely

Likely (IPV)

Current cost

Low

Higher

Intermediate


Adapted from Centers for Disease Control and Prevention. Polio-myelitis prevention in the United States: introduction of a sequential schedule of inactivated poliovirus vaccine followed by oral poliovirus vaccine: recommendations of the Advisory Committee on Immunization Practices. MMWR 1997;46(RR-3).


Text adapted from the Centers for Disease Control and Prevention. Poliomyelitis prevention in the United States: introduction of a sequential vaccination schedule of inactivated poliovirus vaccine followed by oral poliovirus vaccine: recommendations of the Advisory Committee on Immunization Practices. MMWR 1997;46(RR-3).

This information is provided by the American Academy of Family Physicians only as an assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute for the individual judgment brought to each clinical situation by the patient's family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations.



Copyright © 1998 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

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