Pharmacy Pearl 26 january 2000

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A new parent brings her 4 month old to the clinic for a well baby check and scheduled immunizations. Mom asks you about the oral polio vaccine vs. the injectable polio vaccine. She wants to know if one is safer than the other and which one you recommend?

What do you tell her? Oral or injectable?

SELECT  here for discussion  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DISCUSSION 26 JANUARY 2000

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The CDC's Advisory Committee on Immunization Practices (ACIP) has recently made recommendations for the childhood immunization schedule for 2000. See the following website http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4902a4.htm for all recommended changes in the immunizations schedule.  One of these new recommendations is an all inactivated polio vaccine (IPV) schedule for all 4 doses. The worldwide incidence of poliomyelitis is very low. There are still areas in the world where polio is a problem. Imported cases could still pose an outbreak in the US. For all practical purposes, polio has been eradicated in the US. There have been no reports of 'wild type' polio since 1982 in the US. Most cases of paralytic polio are related to the use of the oral, live attenuated polio vaccine (OPV or Sabin vaccine). The injectable polio vaccine (IPV or Salk vaccine) is a killed virus vaccine. Children should use the IPV for all 4 doses at age 2 months, 4 months, between 6 and 18 months, and at 4-6 years. OPV may be used only when: 

1. Mass vaccination campaigns to control outbreaks of paralytic polio 

2. Unvaccinated children who will be traveling within 4 eeks to areas where polio is endemic or epidemic 

3. Children of parents who do not accept the recommended number of vaccine injections; these children may receive OPV only for the 3rd and/or 4th dose(s). In this situation, health-care providers should administer OPV only after discussing the risk for vaccine-related paralytic poliomyelitis (VAPP) with parents and caregivers. 

Originally, the oral vaccine (OPV) was given to prevent another injection in an already "injection intensive" schedule, to provide additional (humoral, IgA) gastrointestinal protection since this is the site of infection/entry for the polio vaccine, and the potential for greater immunogenicity of an attenuated vaccine vs a killed vaccine.

This Pearl is meant for academic and educational purposes only. This Pearl is meant to raise important points regarding the safe and cost-effective pharmacotherapy of patients. It is not meant to be the definitive reference for the treatment or prophylaxis of various diseases. Although every effort is taken to ensure this Pearl is correct and factual, errors may occur. The Pharmacoeconomic Center assumes no liability for incorrect information or harm that may occur from the use of the information included in this Pearl.

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