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Am Fam Physician. 1998;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)

AttributeOral poliovirus vaccine (OPV)Inactivated poliovirus vaccine (IPV)IPV/OPV
Occurrence of vaccine-associated paralytic polio8 to 9 cases per yearNoneEstimated: 2 to 5 per year
Other serious adverse eventsNone knownNone knownNone known
Systemic immunityHighHighHigh
Immunity of gastrointestinal mucosaHighLowHigh
Secondary transmission of vaccine virusYesNoSome
Extra injections or visits neededNoYesYes
Compliance with immunization scheduleHighPossibly reducedPossibly reduced
Future combination vaccinesUnlikelyLikelyLikely (IPV)
Current costLowHigherIntermediate

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Copyright © 1998 by the American Academy of Family Physicians.

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