AAFP Childhood Immunization Update

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Jan 1, 1998 Issue

Special Medical Reports

AAFP Childhood Immunization Update

From the AAFP Commission on Clinical Policies and Research

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)

View/Print 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).

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

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.
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