Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2014 Nov 1;210 Suppl 1(Suppl 1):S380-9.
doi: 10.1093/infdis/jiu184.

Vaccine-associated paralytic poliomyelitis: a review of the epidemiology and estimation of the global burden

Lauren R Platt  1 , Concepción F Estívariz  2 , Roland W Sutter  1
Affiliations
Review

Vaccine-associated paralytic poliomyelitis: a review of the epidemiology and estimation of the global burden

Lauren R Platt et al. J Infect Dis. .

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%.

Keywords: OPV cessation; OPV withdrawal; inactivated poliovirus vaccine (IPV); oral poliovirus vaccine (OPV); polio endgame; polio eradication; poliomyelitis; vaccine-associated paralytic poliomyelitis (VAPP).

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. All authors: No reported conflicts.

All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

References

    1. Minor P Vaccine-derived poliovirus (VDPV): impact on poliomyelitis eradication. Vaccine 2009; 27:2649–52. - PubMed
    1. Dowdle WR, De Gourville E, Kew OM, Pallansch MA, Wood DJ. Polio eradication: the OPV paradox. Rev Med Virol 2003; 13:277–91. - PubMed
    1. Shahmahmoodi S, Mamishi S, Aghamohammadi A, et al. Vaccine-associated paralytic poliomyelitis in immunodeficient children, Iran, 1995–2008. Emerg Infect Dis 2010; 16:1133–6. - PMC - PubMed
    1. Nkowane BM, Wassilak SG, Orenstein WA, et al. Vaccine-associated paralytic poliomyelitis: United States: 1973 through 1984. JAMA 1987; 257:1335–40. - PubMed
    1. Más Lago P, Ferrer H, Goyenechea Á, et al. Casos de poliomielitis paralítica asociada a la vacuna oral antipoliomielítica en Cuba (1963–2006). Rev Cuba Hig Epidemiol 2008; 46:1–14.

Publication types

Substances