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Changes in the 2006 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.
· 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
1. 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