To the Editor.
—In the design of their model evaluating cost vs benefit of the inactivated poliovirus vaccine (IPV) and oral poliovirus vaccine (OPV) schedule, Dr Miller and colleagues1 state that the Delphi panel assumed that no immunodeficient persons receiving a vaccination will avoid vaccine-associated paralytic poliomyelitis (VAPP) by receiving 2 doses of IPV before OPV. Yet, in their review of 105 cases of VAPP, Nkowane et al2 noted that, of the 11 immunodeficient recipients with VAPP, 3 contracted it on the third or fourth OPV dose. These data suggest a reduction of VAPP by 27% among immunodeficient recipients if the schedule of 2 IPV doses and 2 OPV doses is adopted. Were these data considered by the Delphi panel prior to design of the model?
Brown B. Inactivated Poliovirus Vaccine and Vaccine-Associated Paralytic Poliomyelitis. JAMA. 1997;277(4):295. doi:10.1001/jama.1997.03540280033018