Poliomyelitis prevention: Revised recommendations for use of inactivated and live oral poliovirus vaccines

Since 1997 when the American Academy of Pediatrics (AAP) issued revised gui delines for the prevention of poliomyelitis, substantial progress in global eradication of poliomyelitis has occurred and the use of inactivated polio virus vaccine (IPV) has increased considerably in the United States with a corresponding decrease in the use of oral poliovirus vaccine (OPV). Surveys indicate that the majority of physicians now routinely immunize chit dren with the sequential IPV-OPV or IPV-only regimens. Nevertheless, vaccine-ass ociated paralytic poliomyelitis (VAPP) continues to occur, albeit infrequen tly, in children who have received the OPV-only regimen and their contacts. To reduce further the risk of VAPP, the AAP now recommends that children i n the United States receive IPV for the first 2 doses of the polio vaccine series in most circrumstances. Exceptions include a parent's refusal to per mit the number of injections necessary to administer the other routinely re commended vaccines at the 2- and 4-month visits. Either IPV or OPV can be a dministered for the third and fourth doses. Assuming continuing progress to ward global eradication, a recommendation of IPV-only immunization for chil dren in the United States is anticipated by 2001.