title: Vaccine-associated paralytic poliomyelitis: a review of the epidemiology and estimation of the global burden.
abstract: BACKGROUND
  Vaccine-associated paralytic poliomyelitis (VAPP) is a rare adverse event associated with oral poliovirus vaccine (OPV). This review summarizes the epidemiology and provides a global burden estimate.
  
  
  METHODS
  A literature review was conducted to abstract the epidemiology and calculate the risk of VAPP. A bootstrap method was applied to calculate global VAPP burden estimates.
  
  
  RESULTS
  Trends in VAPP epidemiology varied by country income level. In the low-income country, the majority of cases occurred in individuals who had received >3 doses of OPV (63%), whereas in middle and high-income countries, most cases occurred in recipients after their first OPV dose or unvaccinated contacts (81%). Using all risk estimates, VAPP risk was 4.7 cases per million births (range, 2.4-9.7), leading to a global annual burden estimate of 498 cases (range, 255-1018). If the analysis is limited to estimates from countries that currently use OPV, the VAPP risk is 3.8 cases per million births (range, 2.9-4.7) and a burden of 399 cases (range, 306-490).
  
  
  CONCLUSIONS
  Because many high-income countries have replaced OPV with inactivated poliovirus vaccine, the VAPP burden is concentrated in lower-income countries. The planned universal introduction of inactivated poliovirus vaccine is likely to substantially decrease the global VAPP burden by 80%-90%.
authors.affiliation: Polio Operations and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Lauren R
authors.initials: LR
authors.lastname: Platt
authors.affiliation: Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Concepción F
authors.initials: CF
authors.lastname: Estívariz
authors.affiliation: Polio Operations and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Roland W
authors.initials: RW
authors.lastname: Sutter
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D019049:Developed Countries; D003906:Developing Countries; D005260:Female; D014943:Global Health; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011051:Poliomyelitis / Q000453:epidemiology*; D023321:Poliovirus Vaccines / Q000008:administration & dosage* / Q000009:adverse effects*; D015995:Prevalence; D018570:Risk Assessment; D055815:Young Adult
chemical_list: D023321:Poliovirus Vaccines
keywords: OPV cessation; OPV withdrawal; inactivated poliovirus vaccine (IPV); oral poliovirus vaccine (OPV); polio endgame; polio eradication; poliomyelitis; vaccine-associated paralytic poliomyelitis (VAPP)