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Changes in the 2002 Immunization Schedule

Incorporation of inactivated polio vaccination, shots vaccination (IPV)

Use of DTaP

Combination vaccines: DTaP/Hib conjugate, HBV/Hib

Initiation of HBV at any age

Second MMR is given at 4-6 yrs

Adolescent visit vaccinations are recommended

Polio: Background

Inapparent infection: paralytic disease 1:100-1000

Case fatality rate in paralytic polio is 2-10%.

Goal of global eradication by year 2000

Last wild-type case occurred in the Americas in 1991; last imported case was detected in 1993 seizures, paralysis, vacination, vacine

Western hemisphere has been free of indigenous polio virus since 1994

Vaccine associated paralytic polio (VAPP) is the only indigenous form of disease in the US since 1979; 8-9 cases per year are detected.

Advantages and Disadvantages of the Three Poliovirus Vaccination Options

Attribute OPV* IPV IPV-OPV in Sequence
Occurrence of VAPP 8-9 cases/yr None 2-5 cases/yr
Other adverse events None known None known None known
Systemic immunity High High High
Immunity of GI 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
Current cost Low Higher Intermediate

Options For Providing Poliovirus Vaccine

Sequential use of IPV and OPV (preferred by ACIP)

Estimated 95% reduction in vaccine associated paralytic polio (VAPP) amongst recipients

Predicted reduction in VAPP amongst household and community contracts

Continued use of OPV induces intestinal immunity and resistance to transmission of wild type virus if