E-drug: Polio vaccine causing Polio (cont'd)
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Vaccine associated paralytic polio VAPP is associated with children who
have received many injections, and who receive an injection within 30
days of having a first dose of OPV. This phenomenon was dramatically
illustrated in Romania some years ago where the rate of VAPP was 5-17
times higher than in other countries (Strebel et al. New England
Journal of Medicine 23/2/95 page 500-506 and editorial 529-530). This
study found that out of 31 children who developed VAPP between 1988
and 1992 27 (87%) had been given a curative injection within 30 days
of receiving a first dose of OPV. The association was especially strong
in children who had received 10 or more injections within the 30 days
after receiving OPV.
However, the situation in Romania was particular. I conducted a study
with the MoH (Battersby and Nedelcu. Injection Frequency Survey in
Romania: Study Findings UNICEF 1996) to establish how many injections
are given to children in the first year of life. We surveyed a total of
1798 children just before their first birthday. Of these 1608 were
family children and 190 were institutionalised children "orphans". We
found that amongst institutionalised children the average number of
injections in the first year of life was 118 (18 per immunisation
injection) and amongst family children the figure was 21 (2.7 per
immunisation injection). It is when such high levels of injecting occur
in the 30 days after first dose OPV that the risk of VAPP rises so
dramatically.
Anthony Battersby
FBA Health Systems Analysts
FBA@compuserve.com
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