title: Vaccine-associated paralytic poliomyelitis in the postelimination era in Latin America and the Caribbean, 1992-2011.
abstract: The Americas interrupted the transmission of poliovirus in 1991; most Latin American and Caribbean (LAC) countries rely on the oral polio vaccine (OPV) to maintain elimination. We estimated the risk of vaccine-associated paralytic polio (VAPP) in LAC for 1992-2011. VAPP cases were identified using LAC's acute flaccid paralysis (AFP) surveillance system. VAPP was defined as any AFP case with residual paralysis 60 days following onset that did not have a clear alternative etiology and with isolation of vaccine-strain poliovirus. Recipient VAPP cases were defined as those with paralysis onset 4-40 days following OPV; cases meeting these criteria but with unknown residual paralysis were added. Nonrecipient VAPP cases were defined as those in individuals with an unknown vaccination status, those in individuals who received 0 doses, or those with paralysis onset outside the 4-40-day interval. Of 40 926 AFP cases reported in LAC from 1992-2011, we identified 72 recipient and 119 nonrecipient VAPP cases. The estimated risk of recipient VAPP was 1 case per 3.15 million newborns (95% confidence interval [CI], 1 case per 2.56-4.10 million newborns), and the estimated overall risk was 1 case per 1.19 million newborns (95% CI, 1 case per 1.04-1.39 million newborns). In this multicountry VAPP analysis in a postelimination period, we found that the risk of VAPP in LAC was lower than previously estimated.
authors: Comprehensive Family Immunization Unit, Pan American Health Organization/World Health Organization, Washington, D. C.
authors: J Mauricio
authors: JM
authors: Landaverde
authors: Silas Pierson
authors: SP
authors: Trumbo
authors: M Carolina
authors: MC
authors: Danovaro-Holliday
authors: Shea E
authors: SE
authors: Cochi
authors: Raghunathan
authors: R
authors: Gandhi
authors: Cuauhtémoc
authors: C
authors: Ruiz-Matus
mesh_terms: D017691:Caribbean Region / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007843:Latin America / Q000453:epidemiology; D008297:Male; D011051:Poliomyelitis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D011055:Poliovirus Vaccine, Oral / Q000008:administration & dosage / Q000009:adverse effects*; D062486:Public Health Surveillance; D018570:Risk Assessment
chemical_list: D011055:Poliovirus Vaccine, Oral
keywords: VAPP; global polio eradication; poliovirus; vaccine-associated paralytic polio