From the Guidelines
No, the poliomyelitis (polio) vaccine did not cause more fatalities than poliomyelitis itself.
Key Points
- The risk of vaccine-associated paralysis is extremely small for vaccinees and their susceptible, close, personal contacts 1.
- Administration of OPV can cause vaccine-associated paralytic poliomyelitis (VAPP) that results in death, although this is rare 1.
- The benefits of vaccination in preventing poliomyelitis outweigh the risks of vaccine-associated adverse reactions.
Vaccine-Associated Risks
- The risk of VAPP is minimal, and vaccinees (or their parents) and their susceptible, close, personal contacts should be informed of this risk 1.
- No procedures are available for identifying persons (other than those with immunodeficiency) who are at risk for such adverse reactions 1.
- Very rarely, OPV has caused fatal paralytic poliomyelitis in immunocompromised persons 1.
From the Research
Poliomyelitis Vaccine Fatalities
- The question of whether the poliomyelitis (polio) vaccine caused more fatalities than poliomyelitis itself is complex and requires examination of various studies on the topic 2, 3, 4, 5, 6.
- According to a study published in 2004, the last case of poliomyelitis in the United States due to indigenously acquired wild poliovirus occurred in 1979, and an average of 9 cases of vaccine-associated paralytic poliomyelitis (VAPP) were confirmed each year from 1961 through 1989 3.
- Another study published in 2019 found that the incidence of poliomyelitis caused by wild polio virus (WPV) has declined dramatically since the introduction of OPV and later the inactivated polio vaccine (IPV), however, the cases of paralysis linked to the OPV are currently more frequent than those related to the WPV 4.
- A study from 1990 noted that the few cases of poliomyelitis reported in recent years were largely associated with oral vaccine, despite their small number, and have led to a reconsideration of killed vaccine as a public health measure in the United States 5.
- The risk/benefit factors in immunization against poliomyelitis were examined in a 1979 study, which discussed the relative risk and efficacy of killed and live poliovirus vaccines in the context of poliomyelitis prevalence in developed and developing countries 6.
Vaccine-Associated Paralytic Poliomyelitis (VAPP)
- The 2004 study found that the change in polio vaccination policy from OPV to exclusive use of IPV was successfully implemented, and this change led to the elimination of VAPP in the United States 3.
- The 2019 study found that an IPV followed by OPV schedule may reduce VAPP cases by 54% to 100% compared to OPV alone, although the certainty of this evidence is low 4.
- The study also found that IPV-OPV schedules may increase mean titres of P1 neutralising antibodies compared to OPV alone, but the effect on P2 and P3 titres is not clear 4.
Comparison of Vaccination Schedules
- The 2019 study compared the effectiveness, safety, and immunogenicity of sequential IPV-OPV immunisation schemes with either OPV or IPV alone, and found that IPV-OPV may reduce VAPPs without affecting vaccination coverage, safety or humoral response, except P2 with sequential schemes without P2 components 4.
- The study also found that using three IPV doses as part of a IPV-OPV schedule does not appear to be better than two IPV doses for protective humoral response 4.