Paralytic poliomyelitis associated with sabin monovalent and bivalent oral polio vaccines in Hungary

Concepción F. Estívariz, Zsuzsanna Molnár, Linda Venczel, Beatrix Kapusinszky, James A. Zingeser, Galina Y. Lipskaya, Olen M. Kew, György Berencsi, Ágnes Csohán

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16 Citations (Scopus)

Abstract

Historical records of patients with vaccine-associated paralytic poliomyelitis (VAPP) in Hungary during 1961-1981 were reviewed to assess the risk of VAPP after oral polio vaccine (OPV) administration. A confirmed VAPP case was defined as a diagnosis of paralytic poliomyelitis and residual paralysis at 60 days in a patient with an epidemiologic link to the vaccine. Archived poliovirus isolates were retested using polymerase chain reaction and sequencing of the viral protein 1 capsid region. This review confirmed 46 of 47 cases previously reported as VAPP. Three cases originally linked to monovalent OPV (mOPV) 3 and one case linked to mOPV1 presented after administration of bivalent OPV 1 + 3 (bOPV). The adjusted VAPP risk per million doses administered was 0.18 for mOPV1 (2 cases/11.13 million doses), 2.96 for mOPV3 (32 cases/10.81 million doses), and 12.82 for bOPV (5 cases/390,000 doses). Absence of protection from immunization with inactivated poliovirus vaccine or exposure to OPV virus from routine immunization and recent injections could explain the higher relative risk of VAPP in Hungarian children. In polio-endemic areas in which mOPV3 and bOPV are needed to achieve eradication, the higher risk of VAPP would be offset by the high risk of paralysis due to wild poliovirus and higher per-dose efficacy of mOPV3 and bOPV compared with trivalent OPV.

Original languageEnglish
Pages (from-to)316-325
Number of pages10
JournalAmerican Journal of Epidemiology
Volume174
Issue number3
DOIs
Publication statusPublished - Aug 1 2011

Keywords

  • adverse effects
  • poliomyelitis
  • poliovirus vaccine, oral

ASJC Scopus subject areas

  • Epidemiology

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    Estívariz, C. F., Molnár, Z., Venczel, L., Kapusinszky, B., Zingeser, J. A., Lipskaya, G. Y., Kew, O. M., Berencsi, G., & Csohán, Á. (2011). Paralytic poliomyelitis associated with sabin monovalent and bivalent oral polio vaccines in Hungary. American Journal of Epidemiology, 174(3), 316-325. https://doi.org/10.1093/aje/kwr070