Developed countries should not use inactivated polio vaccine for the prevention of poliomyelitis.
Taking into account the global status of polio, it seems evident that the continuing use of oral poliovaccine in all countries is the most obvious and prudent public health policy for the foreseeable future. Possible exceptions might include those countries which are not troubled by the added cost of the inactivated vaccine; whose health services are able to guarantee high levels of vaccine coverage; and which can expect to experience comparatively few importations of wild poliovirus. An important question is whether it is warranted at this time to recommend a combined schedule of inactivated vaccine followed by live vaccine. This implies the addition of at least two inoculations of inactivated vaccine to an already complex vaccination schedule. In most countries, this now includes the administration of three inoculations each of DTP and Haemophilus influenzae as well as one of measles-mumps-rubella vaccine by approximately 12 months of age. Some countries also routinely vaccinate young children against hepatitis B (three additional inoculations). Because most physicians and clinics, as a policy, do not give more than two inoculations at one visit, it implies the need for scheduling additional well-child visits. In the United States, this is a principal factor in the greatly increased estimated costs of such a programme. Experience also shows that as the number of routine visits which are required for vaccination increases, overall vaccination coverage diminishes. The schedule recommended in the United States possesses yet a further problem. Children there would not receive the second dose of oral vaccine until five years of age, thus permitting the accumulation of a large number of preschool children with limited intestinal immunity-a potentially explosive problem were wild virus to be introduced. The inactivated polio vaccine is useful and certainly indicated for the small numbers of persons for whom the live, oral vaccine is contraindicated. However, to use it routinely implies accepting the potential of substantial penalties while reducing but not eliminating, an already extremely small risk of vaccine-associated paralytic illness. From the public health perspective, I therefore argue against the proposition. Copyright 1997 John Wiley & Sons, Ltd.
Henderson
DA
The Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205, USA.