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Changes in the 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
· 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