Eradication of poliomyelitis in the United States. III. Poliovaccines--practical considerations.

Practical considerations for the choice of poliomyelitis vaccine in the United States are discussed. Both killed and live poliovirus vaccines protect against paralysis. They provide equivalent duration of immunity in individuals, equivalent protection against spread of poliovirus in communities, and equally rapid protection during epidemic outbreaks of poliomyelitis. The principal differences between these vaccines are the transmission of live vaccine viruses from recipieits to their contacts and the occurrence of occasional cases of paralytic poliomyelitis associated with use of live poliovirus vaccine. Risks and benefits of "spreading immunity" by person-to-person transmission of live vaccine viruses are presented. Suggestions for reducing the incidence of live virus vaccine-associated disease are discussed. The level of protection against poliomyelitis that has been achieved in the general population of the United States has resulted in the virtual eradication of disease due to wild polioviruses. Routine use of killed poliovirus vaccine may eradicate all domestically arising poliomyelitis, both vaccine-associated and wild poliovirus disease, and may eliminate poliovirus from the United States.