Vaccine-Associated Paralytic Poliomyelitis: A Review of the Epidemiology and Estimation of the Global Burden

• Published in: The Journal of infectious diseases Vol. 210; no. suppl 1; pp. S380 - S389
• Main Authors: Platt, Lauren R., Estívariz, Concepción F., Sutter, Roland W.
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01-11-2014
• Subjects: Adolescent; Adult; Age distribution; Child; Child, Preschool; Developed Countries; Developing Countries; Dosage; Epidemiology; Female; Global Health; Health surveillance; Humans; Inactivated poliovirus vaccines; Infant; Infant, Newborn; Male; Oral poliovirus vaccines; Paralysis; Poliomyelitis; Poliomyelitis - epidemiology; Poliovirus; Poliovirus vaccines; Poliovirus Vaccines - administration & dosage; Poliovirus Vaccines - adverse effects; Prevalence; Risk Assessment; RISK ASSESSMENT, MITIGATION, AND PREVENTION; Young Adult; oral poliovirus vaccine (OPV); OPV cessation; polio endgame; poliomyelitis; vaccine-associated paralytic poliomyelitis (VAPP); OPV withdrawal; polio eradication; inactivated poliovirus vaccine (IPV)
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/jiu184

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%.