Return to the PICO Main Page
Though the last reported case of naturally occurring poliomyelitis in the United States was in 1979, the disease still causes significant morbidity and mortality in Africa, Asia, and Eastern Europe. Since travelers could re-introduce the disease at any time, experts continue to recommend vaccination in the U.S.
OPV, which produces both blood-borne and intestinal immunity to the virus, is the principal tool of the worldwide polio eradication campaign, but it has been shown to cause serious side effects in a small number of recipients. IPV, which confers only blood-borne immunity and must be administered by trained medical personnel, is poorly suited to use in lesser-developed countries, but avoids the risk of vaccine-associated paralysis. The combined vaccine schedule, introduced in January 1997, insures that children are immunized against polio with IPV before receiving OPV, thus gaining the advantages of both vaccines while reducing the risk of side effects.
In contrast to the CDC recommendation, the American Academy of Pediatrics recommends that three different vaccine schedules be offered as equally effective choices: the traditional course of four doses of OPV, the CDC-recommended course of IPV and OPV, or a schedule of four doses of IPV only. The rationale of the AAP recommendation is that physicians wary of suggesting additional injections may favor the use of OPV, whereas those concerned about vaccine-associated paralysis might prefer to use IPV only. Giving physicians and patients more options, according to the AAP, should increase vaccine coverage.
According to the study, directed by Dr. Paul Darden, associate professor of pediatrics at the Medical University of South Carolina (Charleston, SC) and presented at a conference on 5 May, 1998, 56% of pediatricians surveyed are employing the sequential IPV/OPV vaccination schedule recommended by the CDC.
Parents who are concerned about their children's polio vaccination should speak with their pediatricians about the risks and benefits of the two vaccines before deciding which schedule to follow.
-Alan Dove, New York