Hs. Izurieta et al., VACCINE-ASSOCIATED PARALYTIC POLIOMYELITIS IN THE UNITED-STATES - NO EVIDENCE OF ELEVATED RISK AFTER SIMULTANEOUS INTRAMUSCULAR INJECTIONS OF VACCINE, The Pediatric infectious disease journal, 14(10), 1995, pp. 840-846
During the past 30 years, Romania reported rates of vaccine-associated
paralytic poliomyelitis (VAPP) approximately 10-fold higher than in t
he United States. The elevated VAPP risk was largely caused by multipl
e intramuscular (im) injections with antibiotics given within 30 days
of onset of paralysis. Because it is not known whether im injections c
ontribute to the VAPP risk in the United States, we examined VAPP case
s reported since 1980. We reviewed injection histories of VAPP cases r
eported to the Centers for Disease Control and Prevention from 1980 to
1993: with vaccines for 1980 to 1987; and for all substances for 1988
to 1993. Bates of VAPP by number of im injections with vaccines were
calculated from 1988 to 1993 with estimated vaccine coverage data from
the National Health Interview Survey, From 1980 to 1993 a total of 11
9 cases of poliomyelitis were reported to the Centers for Disease Cont
rol and Prevention. Of these, 87 (73%) were vaccine-associated and imm
unologically normal: 41 were oral polio vaccine (OPV) recipient cases;
40 were OPV contact cases; and 6 were community-acquired cases. A his
tory of im injections in the 45 days before onset of paralysis was obt
ained from 28 (72%) of 39 recipient cases reported from 1980 to 1993 f
or which dates of paralysis onset could be determined and from 1 (8%)
of 13 contact cases reported from 1988 to 1993. With one exception all
substances administered intramuscularly were routine childhood vaccin
es, No clustering of im injections in the ''high risk'' windows, 0 to
3 and 8 to 21 days before onset of paralysis, was observed. From 1988
to 1993 the rates of recipient vaccine-associated paralytic poliomyeli
tis (VAPP) (per 1 million population) in infants <1 year of age did no
t vary significantly with the number of simultaneous im injections rec
eived, and ecologic analyses did not show increased risk with increasi
ng use of injectable vaccines in children. Intramuscular injections of
antibiotics or childhood vaccines did not appear to contribute to the
risk of recipient VAPP in the United States, The low prevalence of im
injections in contact VAPP cases suggests that the risk is attributab
le to OPV alone. Our study supports the current recommendation for the
simultaneous administration of OPV with other childhood vaccines.