Poliomyelitis prevention in the United States: introduction of a sequential vaccination schedule of inactivated poliovirus vaccine followed by oral poliovirus vaccine. Recommendations of the Advisory Committee on Immunization Practices (ACIP)

These revised recommendations of the Advisory Committee on Immunization Practices (ACIP) replace recommendations on poliomyelitis issued in 1982 and 1987, and present a new ACIP poliovirus vaccination policy that increases reliance on inactivated poliovirus vaccine (IPV). This change in policy is the most substantive since the introduction of oral poliovirus vaccine (OPV) in 1961. ACIP has determined that the risk-benefit ratio associated with the exclusive use of OPV for routine immunization has changed because of rapid progress in global polio eradication efforts. In particular, the relative benefits of OPV to the U.S. population have diminished because of the elimination of wild-virus-associated poliomyelitis in the Western Hemisphere and the reduced threat of poliovirus importation into the United States. The risk for vaccine-associated poliomyelitis caused by OPV is now judged less acceptable because of the diminished risk for wild-virus-associated disease (indigenous or imported). Consequently, ACIP recommends a transition policy that will increase use of IPV and decrease use of OPV during the next 3-5 years. The revised recommendations include three options for poliovirus vaccination, all of which meet acceptable standards of care: sequential vaccination with IPV followed by OPV, OPV alone, or IPV alone. For overall public health benefit, ACIP recommends a sequential vaccination schedule of two doses of IPV followed by two doses of OPV for routine childhood vaccination. Vaccination schedules that include OPV alone or IPV alone are also acceptable and are preferred in some situations (e.g., IPV alone is recommended for children who are immunosuppressed; OPV alone is preferred for children who begin the primary vaccination schedule after 6 months of age). Implementation of these recommendations should reduce the risk for vaccine-associated paralytic poliomyelitis and facilitate a transition to exclusive use of IPV following further progress in global polio eradication.