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EMBARGO: MAY 5, 1998 MAJORITY OF PEDIATRICIANS USE COMBINATION OF POLIO VACCINES
Despite a continuing controversy over the most appropriate schedule for immunization against polio, a majority of pediatricians surveyed in a recent study have adopted the Centers for Disease Control Advisory Committee on Immunization Practices' (ACIP) most recent recommendation to administer doses of both the oral and inactive polio vaccines.
Paul Darden, M.D., associate professor of pediatrics at the Medical University of South Carolina in Charleston, will present the results of a collaborative study between the American Academy of Pediatrics' (AAP) practice-based research network, Pediatric Research in Office Settings (PROS) and the Pediatric Section of the National Medical Association (NMA), a medical organization that is largely composed of African American who traditionally provide care to a large proportion of underserved children. He and his colleagues investigated the use of poliovirus vaccines by practicing physicians. The presentation will be made on May 5 at the 1998 Pediatric Academic Societies' annual meeting in New Orleans.
Before the introduction of vaccines in the 1950s and 1960s, thousands of children were left with permanent paralysis as a result of infection with the poliovirus. Widespread immunization with the oral polio vaccine (OPV), has virtually eliminated naturally acquired (wild) polio in the Western Hemisphere; the last reported case in the United States was in 1979.
Although the oral polio vaccine is considered safe, a handful of vaccine-associated paralytic poliomyelitis (VAPP) cases, are diagnosed each year in the United States. About half of these eight or nine cases occur in recipients of the oral polio vaccine. The other half occur in persons who have contact with children who received polio vaccine. More Because of rapid progress in global polio eradication efforts and the availability of the inactivated polio vaccine, which allows doctors to provide high levels of protection without risk for paralytic disease, the ACIP now feels that the risk for VAPP, although low, is less acceptable.
In January 1997, the ACIP issued revised recommendations that include three options for poliovirus vaccination, all of which meet acceptable standards of care: OPV alone, IPV alone, or a sequential schedule, IPV followed by OPV. For the greatest public health benefit, the ACIP now recommends the sequential vaccination schedule, which is expected to reduce cases of VAPP by half and facilitate a transition to exclusive use of IPV following further progress in global polio eradication.
The American Academy of Pediatrics however, has recommended the sequential schedule as one of three equally effective choices, leaving the decision to use the oral or inactivated vaccine alone or the sequential schedule up to the individual physicians. "Because the sequential schedule or the all IPV schedule results in more injections, some feel that those who are already unlikely to have their children immunized will be even less likely to do so when faced with the possibility of additional shots," said Darden. The limited availability of combination vaccine products containing IPV also affected the AAP's decision.
To determine the use of poliovirus vaccines in the face of differing recommendations among practicing pediatricians, Darden, James Taylor, M.D., University of Washington, Seattle, WA, Dennis Brooks, M.D., Johns Hopkins, Baltimore, M.D., and Jessie Sherrod, M.D., M.P.H., Charles R. Drew Medical School, Los Angles, CA, surveyed the members of the AAP's Pediatric Research in Office Settings (PROS) Network, and members of the Pediatric Section of the National Medical Association (NMA) and ascertained their current and planned use of IPV-containing schedules.
Despite the AAP's recommendation giving equal weight to the three vaccine schedules, 56 percent of the 1,317 respondents indicated they are using the sequential poliovaccine schedule for their patients.
"The adoption of ACIP's recommendation has been much quicker than we expected considering the controversy around the issue," Darden said.
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