POLIO VACCINES

"Salk" = I(nactivated) PV : Now (not before) is as immunogenic as the OPV)

"Sabin" = O(ral live attenuated) PV

  1. 80 cases of vaccine-strain polio in OPV vaccine recipients between '69 & '83 (amounts to 1 case per 3.2-8 million doses of vaccine dist'd for recipients, less for their household contacts)--mostly adults; 10-15% of cases immunodeficient; since 1980, avg. of 8-9 cases a year reported of vaccine-associated paralytic polio. Risk is about 1 case per 750,000 children receiving their first dose of OPV. In immunocompromised persons can be fatal
  2. IOM review found "evidence favored acceptance of a causal relationship" between OPV and Guillain-Barre sd. But has been superceded? Unclear from MMWR 45:RR-2, 1996.
  3. So DON'T give OPV to immunodeficient kids or immunodeficient adults; use IPV instead. Also condider IPV instead of OPV for immunocompetent adults. Use IPV for kids who live with an immunodeficient person (congenital immunodeficiency, HIV, leukemia, lymphoma, generalized malignancy). If a household contact of an immunodeficient person is inadvertently given OPV, avoid close contact for 4-6wks; if can't avoid, at least do good handwashing after contact with feces or saliva.
  4. In kids with immunodeficient or unimmunized household contacts, consider giving IPV to these contacts. They must have all 3 IPV's before give 1st OPV to kid. Can give as little as 4 wks apart. No serious side effects of IPV reported. (MMWR 45:8, 1996)
  5. In 1996, ACIP, AAP, and AAFP recommended 3 options for polio vaccination: all IPV, all OPV, or IPV x 2 then OPV x 2 (preferred per ACIP). This will "facilitate a transition to exclusive use of IPV following further progress toward global polio eradication" (JAMA 277:371, 1997). Timing is same for all 3 regimens except that 3rd dose can be given 6-18mos for all-OPV; for the sequential or all-IPV regimen, the 3rd dose should be at 12-18mos.
  6. In pregnancy: "Although no conclusive evidence documents the adverse effects of OPV or IPV in pregnant women and their developing fetuses, vaccination of pregnant women should be avoided. However, if immediate protection against poliomyelitis is necessary, OPV or IPV can be given" (MMWR 45:8, 1996)