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7 Polio Vaccines
Pages 187-210

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From page 187...
... Antibodies appear within 1 week to 10 days after the initial infection, and viremia then ceases, probably as a consequence of neutralization by the antibodies. Only 1 to 2 percent of infected individuals develop disease in the central nervous system, and fewer still have residual paralysis.
From page 188...
... , which is administered by the parenteral route, and the live attenuated vaccine, which is administered orally and hence is known as the oral polio vaccine (OPV)
From page 189...
... POLIOMYELITIS Clinical Description Infection with poliovirus can take several forms: inapparent infection, mild illness, aseptic meningitis (nonparalytic poliomyelitis) , and paralytic poliomyelitis.
From page 190...
... described nine cases of poliomyelitis that occurred following vaccination with the Kolmer vaccine and that seemed to be caused by the vaccine. The concept that live attenuated polio vaccine causes a small number of poliomyelitis cases thus has a history of at least six decades.
From page 191...
... ; a case of vaccine-associated paralytic poliomyelitis is said to occur in recipients if the onset of the disease begins 7-30 days postvaccination and is said to occur in contacts of vaccine recipients if the onset of the disease begins 7-60 days after a recipient's vaccination. Laboratory tests can identify the strain of the infecting virus as a wild-type or vaccine strain of poliovirus.
From page 192...
... 192 o ._ o o Cal ·_4 V, Cal ._ a, ;> V)
From page 193...
... Occurred in an unvaccinated contact of a recently vaccinated eight-month old." The data regarding OPV-related nonparalytic polio are more scarce than those for paralytic disease. A report of poliomyelitis surveillance in England and Wales from 1969 to 1975 documented 44 cases of nonparalytic poliomyelitis (Smith and Wherry, 19781.
From page 194...
... Infection in the intestinal tract with the vaccine strain of poliovirus results in virus shedding in the feces and the risk that the contacts of a recipient might become infected. The vaccine virus can revert to a virulent form, and this lends demonstrated biologic plausibility to the finding that occasional contacts of vaccine recipients contract polio.
From page 195...
... Conclusion The evidence establishes a causal relation between OPV and paralytic and nonparalytic polio. The incidence of paralytic polio in OPV recipients has been well documented and is greater with the first dose of vaccine.
From page 196...
... Chapter 3 contains a more complete discussion of transverse myelitis. History of Suspected Association There is no particular history of an association between transverse myelitis and polio vaccines.
From page 197...
... POLIO VACCINES TABLE 7-4 Cases of Polio Among Nonimmune Contacts of Polio Recipients Reference 197 Relationship to Recipient Immune Deficiency or History of Polio Immunization in Contact Derenne et al., 1989 Wiechers, 1988 Arlazoroff et al., 1987 Bateman et al., 1987 Canadian Medical Association Journal, 1987 Gross et al., 1987 Maass and Quast, 1987 Bell et al., 1986 Bergeisen et al., 1986 British Medical Journal, 1986 Daneault et al., 1986 26-yr-old mother of infant 19-yr-old mother of infant 34-yr-old father of infant and 10-yr-old relative of infant 16-yr-old uncle of infant, 23-yr-old father of infant 25-yr-old father of infant 19-yr-old mother of infant 40-yr-old father of infant 26-yr-old father of infant 32-yr-old father of infant/ husband of recipients 31-yr-old mother of infant 48-yr-old grandmother of infant 6-wk-old sibling/son of recipients 21-yr-old male in contact with immunized infant 19-yr-old male contact not known 39-yr-old man-contact not known 24-yr-old woman, neighbor of children 20-day-old contact of baby-sitter and sitter's infant 23-yr-old father of infant 25-yr-old father of infant Ishizaki and Noda, 1986 No information Kruppenbacher et al., 1983 Mother of infant Openshaw and Lieberman, 43-yr-old grandfather of infant 1983 Basillico and Bernat, 1978 30 yr-old father of infant Collingham et al., 1978 5-yr-old sibling of recipient Young adult father of infant Remembered receiving polio vaccine as a child No information No information Unimmunized Unclear Unclear Patient on long-term steroid therapy for Netherton's syndrome Previous vaccination against type 1 and type 3 poliov~ruses Unknown Previous vaccination against type 1 poliovirus Unknown Unknown Unknown Received one dose of OPV as a child Received one dose of vaccine as a child Unvaccinated Unimmunized No information Received Salk vaccine as a child No information No information Unimmunized No information Unimmunized Unknown continued
From page 198...
... The committee is aware of a case of transverse myelitis in a child with severe combined immunodeficiency syndrome (Richard B Johnston, Yale University, New Haven, personal communication, 1993~.
From page 199...
... At least five of the cases occurred following multiple immunizations, which complicates an assessment of a causal relation between OPV and transverse myelitis. No cases of transverse myelitis following receipt of IPV have been reported.
From page 200...
... Evidence for Association Biologic Plausibility Chapter 3 contains a detailed discussion of the arguments that vaccines can cause demyelination, including GBS. There are no additional data demonstrating the biologic plausibility of a specific relation between polio vaccines and GBS.
From page 201...
... following administration of OPV in combination with DPT and either MMR or Hib vaccine. Controlled Observational Studies Two controlled studies examined the association between GBS and polio vaccine (Table 7-61.
From page 202...
... The data showed an increase in the number of cases of GBS temporally associated with the immunization program, and the increase was statistically significant. The diagnosis of GBS was made by using consistent criteria throughout the observation period because of the prospective study on GBS that was in place well before the polio epidemic and immunization against polio occurred.
From page 203...
... The consistency of diagnostic criteria and statistically significant differences in the incidence of GBS suggest that the increase was not due to chance variation or biased case reporting. The committee estimated relative risks and risk differences for GBS following OPV based on the studies of Kinnunen et al.
From page 204...
... Conclusion The evidence favors acceptance of a causal relation between OPV and GBS. The relative risk on the basis of studies done in Finland is on the order of 3.5 for adults, and the risk difference is approximately 2.5 per 100,000 people.
From page 205...
... is greater than that for these adverse events associated with any other cause. The possible causal relation between polio vaccines and sudden infant
From page 206...
... The evidence is inadequate to accept or reject a causal relation between polio vaccines and SIDS. Conclusion The evidence establishes a causal relation between OPV and death from vaccine-strain poliovirus infection, including infection that results in paralytic poliomyelitis.
From page 207...
... D'Costa DF, Cooper A, Pye IF. Transverse myelitis following cholera, typhoid and polio vaccination.
From page 208...
... Henderson DA, Witte JJ, Morris L, Langmuir AD. Paralytic disease associated with oral polio vaccines.
From page 209...
... Onorato IM, Modlin JF, McBean AM, Thoms ML, Losonsky GA, Bernier RH. Mucosal immunity induced by enhanced-potency inactivated and oral polio vaccines.
From page 210...
... The relation between acute persisting spinal paralysis and poliomyelitis vaccine: results of a ten-year enquiry. Bulletin of the World Health Organization 1982;60:231-242.


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