title: Evidence for a causal association between oral polio vaccine and transverse myelitis: A case history and review of the Literature.
abstract: A 6-month-old boy developed transverse myelitis 7 days after the receipt of oral polio vaccine (OPV). A paediatric neurologist confirmed the diagnosis when the boy was aged 9 years. The boy had received his first scheduled OPV at the age of 4 months and had developed immunity to serotypes 1 and 2 but not to serotype 3. A poliovirus type 3 was isolated from stool and throat specimens collected from the boy in the first 2 days after symptom onset. This was shown, in a World Health Organization accredited laboratory, to be a vaccine strain by nucleic acid probe hybridiztion and enzyme-linked immunosorbent assay. The boy subsequently developed immunity to poliovirus serotype 3. It is accepted that poliovirus infection can present occasionally as transverse myelitis. This is estimated to occur in 1:125-1:800 cases. It is also accepted that OPV can cause vaccine-associated paralytic polio with a frequency of approximately one case per 2.5 million doses of OPV distributed. It seems feasible therefore that OPV could cause transverse myelitis with a frequency of 1 in 300 million to one in two billion doses distributed. In a 1993 report from the Institute of Medicine of the National Acadamies of the United States pertaining to vaccine safety, theoretical criteria were advanced for the establishment of a causal relationship between a vaccine and a clinical outcome. The clinical history and laboratory results in this case satisfy these criteria, providing plausible evidence for the causal link between OPV and transverse myelitis.
authors.affiliation: Victorian Infectitious Diseases Reference Laboratory, Melbourne, Australia. heath.kelly@mh.org.au
authors.forename: Heath
authors.initials: H
authors.lastname: Kelly
mesh_terms: D015984:Causality; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008297:Male; D009188:Myelitis, Transverse / Q000209:etiology* / Q000534:rehabilitation / Q000821:virology; D011051:Poliomyelitis / Q000517:prevention & control*; D017955:Poliovirus / Q000276:immunology / Q000302:isolation & purification / Q000472:pathogenicity; D011055:Poliovirus Vaccine, Oral / Q000009:adverse effects*; D012703:Serotyping
chemical_list: D011055:Poliovirus Vaccine, Oral