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July 17, 1987

Polio Vaccination

Author Affiliations

University of Cologne West Germany

University of Cologne West Germany

JAMA. 1987;258(3):322-323. doi:10.1001/jama.1987.03400030038014

To the Editor.—  We were pleased to see the careful analysis of vaccine-associated paralytic poliomyelitis by Nkowane et al.1One important point concerns the estimate of the true risk of vaccineassociated poliomyelitis in susceptible individuals.2-4 This is of more than theoretical interest: in view of the changing epidemiologic situation in developed and developing countries, one has to assume that more and more children being vaccinated for the first time will be fully susceptible to all three poliovirus types. Thus, the rate of vaccineassociated poliomyelitis may be increasing.Needless to say, this does not call into question the extraordinary blessings of oral poliomyelitis vaccination, particularly in developing countries. But, whenever feasible, consideration should be given to a combined vaccination strategy using inactivated poliomyelitis vaccine for the first polio vaccinations in early infancy, together with diphtheria, tetanus, and pertussis vaccination. This protocol carries the additional advantage of avoiding the possible