AFROCENTRIC NEWS Network -- New Polio Vaccine guidelines issued

New Polio Vaccine guidelines issued

UPI Science News

CHICAGO, (UPI) _ Pediatricians are changing recommendations on the use of polio vaccines to prevent a rare form of polio associated with an oral form of the vaccine.

The American Academy of Pediatrics announced the new guidelines today, recommending most children receive the "inactivated poliovirus vaccine" (IPV), which is administered as an injection at two to four months of age.

After the first two, pediatricians should give either the IPV or an oral poliovirus vaccine (OPV) for the third dose at six months to 18 months, and the fourth dose at four to six years, the AAP said.

It said pediatricians can now also choose to give IPV for the entire four-dose regimen. It said the new recommendations are aimed at reducing the rare instance of vaccine-associated paralytic poliomyelitis, which is associated with the live virus within the oral vaccine.

Last year, the AAP recommended that the nation's 55,000 pediatricians choose either an IPV-only, OPV-only or a schedule utilizing both vaccines sequentially for the complete four dose regimen against polio. But the AAP said that since the 1997 guidelines were issued, "substantial progress in global eradication of poliomyelitis has occurred and the use of inactivated poliovirus vaccine has increased considerably in the United States, with a corresponding decrease in the use of oral poliovirus vaccine (OPV)."

The majority of physicians routinely immunize children with the sequential IPV-OPV schedule or the IPV-only regimen.

The Washington-based group called Parents Against Vaccine-Associated Paralytic Polio said it welcomed the new guidelines, but its spokesman said they were overdue. Since 1979, when the last case of "wild" _ or non-drug-related _ polio was reported in America, cases caused exclusively by the live virus have become the remaining form of polio, said John Salamone, president of the advocacy group.

He said the new AAP position now makes an all-OPV schedule acceptable only in very special circumstances.

About eight to 10 cases of vaccine-associated paralytic polio (VAPP) have been documented annually for the past 19 years, all a direct result of the oral polio vaccine, Salamone said.

"Many more probably have occurred, but were misdiagnosed," he told United Press International. He said the "equally effective indictable polio vaccine (IPV) contains killed virus and cannot transmit polio."

The U.S. Centers for Disease Control and Prevention in Atlanta issued the first set of recommendations for the mixed IPV-OPV regimen in 1996, and previous AAP guidelines did not indicate a schedule recommendation. The CDC said the mixed schedule is intended to reduce, not eliminate, future VAPP cases. The AAP said in its new recommendations that an all- IPV schedule will be recommended by 2001.

Salamone, whose 8-year-old son David contracted polio by taking the live virus, said it should not be used at all in the United States. He said all pediatricians are supposed to hand out information about polio vaccines, and it's clearly stated in that literature that some vaccines contain live virus.

"We are pretty happy with the new guidelines," he said, "but not totally. You learn to be happy with half a loaf, but it's going to help. Two years ago the CDC made this same recommendation but the AAP did not concur at that time."

He said Lt. Gov. John Hager of Virginia contracted polio by changing the diaper of one of his children who had contracted the disease by taking a live vaccine.

The parents group said "we hope the Academy's decision will mean that physicians will begin to increase their use of the inactivated polio vaccine and even choose the all-IPV option to completely avoid the risk of VAPP."

He said studies have shown that when given a choice, parents usually opt for the safer, indictable vaccine, but only if they are made aware of the rare but real risk of vaccine-associated polio caused by the oral vaccine.

Polio is a devastating virus that attacks the nervous system. It reached epidemic proportions in the United States in the 1950s, but "wild" cases have been virtually eradicated by effective vaccination efforts.

The AAP published news of the change in guidelines in its December issue of the journal Pediatrics.

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