Since 1979, the only indigenous cases of poliomyelitis reported in the United States (n=144) have been associated with use of the live oral poliovirus vaccine (OPV) (an additional six imported cases have been reported since 1979, the last of which occurred in 1993). Until recently, the benefits of OPV use (i.e., intestinal immunity, secondary spread) outweighed the risk for vaccine-associated paralytic polio (VAPP) (one case per 2.4 million doses distributed).1 In 1997, to decrease the risk for VAPP while maintaining the benefits of OPV, the Advisory Committee on Immunization Practices (ACIP) recommended a sequential schedule of inactivated poliovirus vaccine (IPV) followed by OPV.2 Since 1997, the global polio eradication initiative has progressed rapidly, and the likelihood of poliovirus importation into the United States has decreased substantially. In addition, since 1997, the sequential schedule has been well accepted. No declines in childhood vaccination coverage were observed, despite the need for additional injections.3
On the basis of these data, on June 17, 1999, to eliminate the risk for VAPP, the ACIP recommended an all-IPV schedule for routine childhood polio vaccination in the United States. As of January 1, 2000, all children should receive four doses of IPV at ages 2 months, 4 months, 6-18 months, and 4-6 years.
OPV should be used only for the following special circumstances:
Mass vaccination campaigns to control outbreaks of paralytic polio.
Unvaccinated children who will be traveling in less than 4 weeks to areas where polio is endemic.
Children of parents who do not accept the recommended number of vaccine injections. These children may receive OPV only for the third or fourth dose or both; in this situation, health-care providers should administer OPV only after discussing the risk for VAPP with parents or caregivers.
Availability of OPV is expected to be limited in the future in the United States. ACIP reaffirms its support for the global polio eradication initiative and use of OPV as the vaccine of choice to eradicate polio from the remaining countries where polio is endemic.
Revised Recommendations for Routine Poliomyelitis Vaccination. JAMA. 1999;282(6):522. doi:10.1001/jama.282.6.522-JWR0811-2-1