http://bmj.com/cgi/content/full/314/7079/461/i
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Deborah Johnson, Connecticut
The United States Centers for Disease Control and Prevention has issued new guidelines for administering the polio vaccine after determining that nearly all cases of paralytic polio contracted recently in the country were caused by the oral polio vaccine.
Two types of polio vaccine are available: the Sabin vaccine consists of live attenuated virus, which is administered orally, and the Salk vaccine consists of inactivated polio virus and therefore cannot cause polio.
The new recommendations call for a sequential vaccination schedule in which the inactivated vaccine is given at ages 2 months and 4 months, followed by the oral vaccine at age 12–18 months and again at age 4–6 years. The aim of the schedule is to reduce the incidence of vaccine associated polio while preserving the benefits of herd and mucosal immunity provided by the Sabin vaccine. Because the Sabin vaccine consists of live virus it more closely mimics wild polio.
Vaccine experts and epidemiologists believe that when a person is given the inactivated virus first, he or she will develop enough immunity to prevent the development of polio from the live version.
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Between 1980 and 1994, 133 people contracted polio in the US, and 125 of these cases, or 94%, were attributed to the oral vaccine. Although the risk of contracting vaccine associated polio is only one in 2.4 million doses, for children receiving their first dose of oral polio vaccine it rises to one in 750 000 doses. The new schedule is expected to cut vaccine associated polio cases to between two and five a year. The plan is to eventually use only inactivated vaccine once polio is eradicated globally.
The decision to revise the polio vaccination programme was controversial and debated for over 10 years. Although public health doctors clearly favour the sequential approach, they have left the final decision to individual families and doctors.
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