Do not use oral polio vaccine (OPV) in patients or patients whose contacts have immunosuppression
Do not use oral polio vaccine (OPV) in patients or patients whose contacts have immunosuppression: Excerpt from Avoiding Common Pediatric Errors
Author:
Anjali Subbaswamy, MD
What To Do - Make a Decision, Take Action
Live vaccines are composed of viral or bacterial strains that are deprived
of their pathogenicity but can still replicate in the organism into which it
is injected. These vaccines can provoke a nonpathogenic infection in vaccinated subjects, both inducing an antibody and a cellular immune response.
Live attenuated vaccines, such as measles, mumps, and rubella (MMR) or
yellow fever vaccine, have been widely used with proven efficacy. The oral
poliomyelitis vaccine is composed of three attenuated strains prepared from
the three wild virus types and is efficacious but mutations of the virus (in
particular for type 3) can induce polio-associated paralysis by giving it back
its original neurovirulence (number of cases 2:1,000,000). The emergence of
circulating vaccine-derived poliovirus (cVDPV) strains is a real risk associated with the use of OPV. The cVDPV strains result form point mutations
that occur in the Sabin (developer of oral vaccine) OPV strains. There may
or may not be an exchange of parts of the viral genome with related nonpolio
enteroviruses. This exchange typically occurs in areas where the live OPV
is used and immunization rates are low. The oral polio vaccine is still used
in most parts of the world to prevent transmission (cheaper than injected
form). Since the World Health Assembly launched its polio eradication goal,
outbreaks caused by cVDPV have been seen in the Amish populations in the
United States.
Live bacterial vaccines can be classified as a self-limiting asymptomatic
organism that stimulates an immune response to one or more expressed
antigens. A nonvirulent or attenuated derivative of the pathogen is used to
induce a response to the bacterium itself.
The OPV contains a live virus that is capable of provoking an immune
response but not capable of causing disease. Unfortunately, it very infrequently changes to a more virulent form, and some people may maintain the
living virus in their bodies, excreting it constantly. The injectable vaccine
contains killed virus and is more expensive. The oral vaccine is easier to
administer, but at some point, to eradicate all sources of the live virus, its
use will have to end. Continuing to use OPV while immunization coverage
is not appropriate or optimal and is like playing Russian roulette.
Paralytic poliomyelitis has been a reportable disease since the early part
of the century. Since the advent of immunization, the Centers for Disease
Control and Prevention has issued surveillance reports approximately once
perdecade.Bythe1970s,theprincipalfocusofthesereportsbecamevaccineassociated paralytic poliomyelitis (VAPP), which affected both OPV recipients, mostly young infants receiving their first OPV dose, and close contacts
of OPV recipients, mostly nonimmune adolescents and young adults who
were caregivers to recently immunized infants. Recipients of OPV and contacts of OPV recipients with primary B-cell immunodeficiency had more
than a 3,000-fold increased risk of VAPP compared with those with no
known immune disorders. Over the years, the proportion of contact cases
decreased as polio vaccination rates improved, and the proportion of cases
observed among immunodeficient persons increased; perhaps, because of
increased awareness of their risk. Nonetheless, immunosuppression or contact with immunosuppressed persons remains an absolute contraindication
to the OPV.
Suggested Readings
Gomber S, Agarwal KN. Polio eradication–target 2000. Indian J Pediatr. 1996;63(4):477–483.
Kimman TG, Boot H. The polio eradication effort has been a great success–let's finish it and
replace it with something even better. Lancet Infectious Dis. 2006;6(10):675–678.
Molrine DH, Hibberd PL. Vaccines for transplant recipients. Infect Dis Clin North Am.
2001;15(1):273–305.
Saliou P. [Live vaccines.] [French] Rev Prat. 1995;45(12):1492–1496.
Book Source Details
- Book Title: Avoiding Common Pediatric Errors
- Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
- Year of Publication: 2008
- Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Avoiding Common Pediatric Errors
Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7489-6
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