Polio Prevention - Practice and Politics

SAN FRANCISCO, December 7, 1999 -- The oral polio vaccine, a fixture of childhood immunizations since the 60's, is on its way out. Future practice will rely on plain polio shots.

This change in practice was set forth in a policy statement issued yesterday by the American Academy of Pediatrics and published in full in the December, 1999 issue of Pediatrics, the Academy's journal.

The aims of this article are to give the new policy as the Academy announced it and then to provide perspectives on it.

Press Release by American Academy of Pediatrics

The press release issued by the American Academy of Pediatrics reads as follows (verbatim):

"In an updated policy statement, the American Academy of Pediatrics (AAP) recommends that all future use of poliovirus vaccine for routine childhood immunization against poliovirus infection should be in the injected (IPV) form.

In January of 1999, recognizing the potential, albeit minimal, risk of vaccine-associated paralytic poliomyelitis (VAPP), the AAP advocated that children in the United States receive IPV for the first two doses of the polio vaccine series in most circumstances. The previous AAP statement allowed either IPV or oral poliovirus vaccine (OPV), which is given as drops, for the following two doses. However, the new policy recognizes that "VAPP can not be totally eliminated until oral poliovirus vaccine no longer is given."

"Pediatricians need to move to an all IPV schedule in an expeditious manner," said Jon Abramson, MD, FAAP, chair of the AAP Committee on Infectious Diseases. Dr. Abramson went on to say that doctors can continue to use their current supply of OPV, as long as it is administered only as the third and fourth doses. "There has never been a case of VAPP reported when the first two doses are IPV, followed by two doses of OPV," said Dr. Abramson.

Other recommendations in the policy include that, effective in early 2000, IPV is routinely given for all children at 2, 4, 6 to 18 months, and again at 4 to 6 years of age. In addition, the policy indicates that the transition to the all-IPV schedule should be completed as soon as feasible and no later than the first six months of 2000. To effect this change as soon as possible, OPV supplies no longer should be purchased for routine use.

According to the policy, OPV - if available - should be used only in the following circumstances, unless otherwise contraindicated:

  • Mass vaccination campaigns to control outbreaks of paralytic poliomyelitis.
  • Unvaccinated children who will be traveling in less than four weeks to areas where polio is endemic or epidemic, i.e., those for whom time before is insufficient for administration of two doses of IPV.
  • During the transition to an all-IPV schedule in early 2000, remaining supplies of OPV should be preferentially used for 4-to-6- year-old children who have previously received three doses of any poliovirus vaccine to fulfill requirements for school entry. Administration of OPV to children who have previously received two doses of IPV or OPV also is acceptable.
  • Children of parents who do not accept the recommended number of vaccine injections to fulfill the current childhood immunization schedule may receive OPV for the third or fourth dose. However, OPV should not be given for the first or second dose of the schedule.
  • The AAP supports the World Health Organization (WHO) recommendation for use of OPV to achieve global eradication of poliomyelitis, especially in geographic areas with continued or recent circulation of wild-type poliovirus.