ACIP Vote Regarding Routine Childhood Polio Vaccination Recommendations
On June 17, 1999, the Advisory Committee for Immunization Practices (ACIP) voted to change the recommendation for routine childhood polio vaccination beginning in 2000 to a schedule using only the inactivated poliovirus vaccine (IPV) to eliminate the occurrence of vaccine-associated paralytic poliomyelitis (VAPP) in the United States. The committee vote was 8 in favor of a change to four doses of IPV, with 1 abstaining and 3 absent. The vote does not become a final recommendation until it is accepted by CDC through publication in its "Morbidity and Mortality Weekly Report" (MMWR) series. If the recommendation is accepted by CDC, to be protected against polio, all children will need to get 4 doses of IPV at 2, 4, 6-18mo, and 4-6 yrs beginning in January 2000. The committee voted that oral polio vaccine will be acceptable only in special circumstances.
Since 1979, the only polio disease in the United States has been caused by the oral poliovirus vaccine (OPV) vaccine, which had been used routinely for childhood vaccination since 1965. Until recently, because of the risk of polio epidemics in the United States, the risk from the vaccine, about 1 case for every 2.4 million doses, was outweighed by the benefit from the vaccine in protecting against epidemics. Although both vaccines protect children against polio, OPV provides better protection against epidemics. IPV is not known to cause VAPP.
Because of the success of the global polio eradication campaign using OPV, by the mid 1990's, the risk of polio epidemics in the U.S. was much less, and the risk of polio from the OPV became greater than the risk from the disease in the U.S. For these reasons, in Jan. 1997, the polio vaccination schedule was changed to a sequential schedule of two doses of the IPV followed by two doses of OPV. In 1997, CDC confirmed 4 cases of VAPP in the United States. In 1998, one case of VAPP was confirmed. Prior to the change to a sequential schedule, there were 8-10 cases of paralytic polio caused by OPV each year.
In the past two years, the sequential schedule has been well accepted. No declines in childhood immunization coverage were observed despite the need for additional injections. Because of this, and the fact that the polio eradication campaign has led to continued declines in polio cases outside the United States., the ACIP determined that the recommended childhood polio vaccination schedule should be changed to an exclusive IPV schedule to completely eliminate the risk of VAPP while still providing protection to children and adults. Until polio is eradicated, all children still need to be vaccinated for polio.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES