Optimal schedule for the administration of oral poliovirus vaccine

  • P. A. Patriarca
  • R. W. Linkins
  • R. W. Sutter
  • W. A. Orenstein


The optimal schedule for the administration of oral poliovirus vaccine (OPV) can be based on a simple paradigm in which the period of maximum risk from natural infection is balanced by the influence of factors which may affect the immune response to vaccination. Surveillance of paralytic poliomyelitis and seroprevalence data indicate that the maximum risk of wild poliovirus infection in most developing countries occurs between 6 and 24 months of age, suggesting that the primary vaccination series for OPV should be completed as early in life as possible. Although scientific evidence and programmatic considerations provide strong support for the currently recommended schedule of OPV at birth, 6, 10, and 14 weeks of age, as many as 30–40% of recipients may still remain susceptible to poliovirus types 1 and 3 after the fourth dose. Because age-specific gaps in immunity have often been associated with epidemic disease, additional strategies to increase population levels of immunity should be considered as progress continues towards the goal of global eradication of poliomyelitis by the year 2000. Administration of OPV in mass vaccination campaigns has been shown to be highly successful in the virtual elimination of wild poliovirus infections in the Americas, and has been adopted as the strategy of choice for the global initiative. Further studies of other supplemental approaches that may hasten eradication should also be pursued, such as expansion of the routine schedule for OPV to five or more doses, and the combined use of both oral and inactivated poliovirus vaccines.


Optimal Schedule Seroconversion Rate Oral Poliovirus Vaccine Oral Polio Vaccine Poliovirus Type 
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  1. 1.
    Halsey N, Galazka A (1985) The efficacy of DTP and oral poliomyelitis immunization schedules initiated from birth to 12 weeks of age. Bull WHO 63: 1151–1169Google Scholar
  2. 2.
    Henderson RH, Keja J, Hayden G, Galazka A, Clements J, Chan C (1988) Immunizing the children of the world. Progress and prospects. Bull WHO 66: 535–543Google Scholar
  3. 3.
    Sabin AB (1948) Epidemiologic patterns of poliomyelitis in different parts of the world. In: Papers and discussions presented at the First International Poliomyelitis Conference. Lippincott, Philadelphia, pp 24–30Google Scholar
  4. 4.
    Paul JR, Melnick JL, Barnett VH, Goldblum N (1952) A survey of neutralizing antibodies to poliomyelitis virus. Am J Hygiene 55: 402–413Google Scholar
  5. 5.
    Bernier RH (1984) Some observations on poliomyelitis lameness surveys. Rev Infect Dis 6 [Suppl]: 371–375Google Scholar
  6. 6.
    Gelfand HM, Fox JP, LeBlanc DR, Elveback L (1960) Studies on the development of natural immunity to poliomyelitis in Louisiana. V. Passive transfer of polioantibody from the mother to fetus, and natural decline and disappearance of antibody in the infant. Am J Hygiene 85: 46–55Google Scholar
  7. 7.
    World Health Organization (Expanded Programme on Immunization) (1989) Polio myelitis in 1986, 1987, and 1988 (Part I). Wkly Epidemiol Rec 64: 273–279Google Scholar
  8. 8.
    World Health Organization (Expanded Programme on Immunization) (1989) Polio myelitis in 1986, 1987, and 1988 (Part II). Wkly Epidemiol Rec 37: 281–285Google Scholar
  9. 9.
    WilkinsJ, Wehrle PF (1979) Additional evidence against measles vaccine administration to infants less than 12 months of age. Altered immune response following active/passive immunization. J Pediatr 94: 865–869Google Scholar
  10. 10.
    Mendlesohn CL, Wimmer E, Racaniello VR (1989) Cellular receptor for poliovirus. Molecular cloning, nucleotide sequence, and expression of a new member of the immunoglobulin superfamily. Cell 56: 855–865Google Scholar
  11. 11.
    Lepow ML, Warren RJ, Gray N, Ingram VG, Robbins FC (1961) Effect of Sabin type 1 poliomyelitis vaccine administered by mouth to newborn infants. N Engl J Med 264:1071–1078Google Scholar
  12. 12.
    Burstyn DG, Baraff LJ, Peppier MS, Leake RD, St. Geme J, Manclark CR (1983) Serologic response to filamentous hemagglutinin and lymphocytosis-promoting factors of Bordetella pertussis. Infect Immun 41: 1150–1156Google Scholar
  13. 13.
    Pagano JS, Plotkin SA, Koprowski H (1960) Variation of response in early life to vaccination with living attenuated poliovirus and lack of immunologic tolerance. Lancet i: 1224–1226Google Scholar
  14. 14.
    John TJ (1984) Immune response of neonates to oral poliomyelitis vaccine. Br Med J 289: 881Google Scholar
  15. 15.
    Patriarca PA, Wright PF, John TJ (1991) Factors affecting the immunogenicity of oral poliovirus vaccine in developing countries. Rev Infect Dis 13: 926–939Google Scholar
  16. 16.
    McBean AM, Thoms ML, Albrecht P, Cuthrie JC, Bernier R, The Field Staff and Coordinating Committee (1988) Serologic response to oral polio vaccine and enhancedpotency inactivated polio vaccines. Am J Epidemiol 128: 615–628Google Scholar
  17. 17.
    Sutter RW, Patriarca PA, Brogan S, Malankar PG, Pallansch MA, Kew OM, Bass AG, Cochi SL, Alexander JP, Hall DB, Suleiman AJM, Al-Ghassany AAK, El-Bualy MS (1991) Outbreak of paralytic poliomyelitis in Oman. Evidence for widespread transmission among fully vaccinated children. Lancet 338: 715–720Google Scholar
  18. 18.
    Wright PF, Kim-Farley RJ, de Quadros CA, Robertson SE, Scott RM, Ward NA, Henderson RH (1991) Strategies for the global eradication of poliomyelitis by the year 2000. N Engl J Med 325: 1174–1179Google Scholar
  19. 19.
    Benyesh-Melnick M, Melnick JL, Rawls WE (1967) Studies of the immonogenicity, communicability and genetic stability of oral poliovaccine administered during the winter. Am J Epidemiol 86: 112–136Google Scholar
  20. 20.
    Pangi NS, Master JM, Dave KH (1977) Efficacy of oral poliovaccine in infancy. Indian Ped 14: 523–528Google Scholar
  21. 21.
    Swartz TA, Skalska P, Gerichter CG, Cockburn WC (1972) Routine administration of oral polio vaccine in a subtropical area. Factors possibly influencing seroconversion rates. JHygCamb 70: 719–726Google Scholar
  22. 22.
    de Quadros CA, Andrus JK, Olive JM, de Macedo CG, Henderson DA (1992) Polio eradication from the Western Hemisphere. Ann Rev Publ Health 13: 239–252Google Scholar
  23. 23.
    Cutts FT, Zell ER, Mason D, Bernier RH, Dini EF, Orenstein WA (1992) Monitoring progress toward U.S. preschool Immunization goals. JAMA 267: 1952–1955Google Scholar
  24. 24.
    Cutts FT, Glik DC, Gordon A (1990) Application of multiple methods to study the immunization programme in an urban area of Guinea. Bull WHO 68: 769–776Google Scholar
  25. 25.
    Cutts FT, Phillips M, Kortbeek S, Soarea A (1990) Door-to-door canvassing for immunization program acceleration in Mozambique: achievements and costs. Int J Health Serv 20: 717–725Google Scholar
  26. 26.
    Wright PF (1991) Pertussis in developing countries. Definitions of the problem and prospects for control. Rev Infect Dis 13[Suppl]: 528–534Google Scholar
  27. 27.
    Hall AJ, Inskip HM, Loik F, Chotard J, Jawara M, Vall Mayans M, Greenwood BM, Whittle H, Njie ABH, Cham K, Bosch FX, Muir CS (1989) Hepatitis B vaccine in the Expanded Programme of Immunisation. The Gambian experience. Lancet i: 1057–1060Google Scholar
  28. 28.
    WHO Collaborative Study Group on Oral Poliovirus Vaccine (1992) A randomized trial of alternative formulations of oral poliovirus vaccine in Brazil and The Gambia. In: Program and Abstracts of the 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy. American Society for Microbiology, Washington, DC (Abstract #916) page 263Google Scholar
  29. 29.
    Sabin AB, Ramos-Alvarez M, Alvarez-Amezquita J, Pelon W, Michaels RH, Spigland I, Koch MA, Barnes JM, Rhim JS (1960) Live orally given poliovirus vaccine: effects of raid mass immunization on population under conditions of massive enteric infection with other viruses. JAMA 173: 1521–1526Google Scholar
  30. 30.
    Simoes EAF, Padmini B, Steinhoff MC, Jadhav M, John TJ (1985) Antibody responses of infants to two doses of inactivated poliovirus vaccine of enhanced potency. Am J Dis Child 139: 977–980Google Scholar
  31. 31.
    Robertson SE, Traverso HP, Drucker JA, Rovira EZ, Fabre-Teste B, Sow A, N’Diaye M, Sy MTA, Diouf F (1988) Clinical efficacy of a new enhanced-potency, inactivated poliovirus vaccine. Lancet i: 897–899Google Scholar
  32. 32.
    Tulchinsky T, Abed Y, Shaheen S, Toubassi N, Sever Y, Schoenbaum M, Handsher R (1989) A ten-year experience in control of poliomyelitis through a combination of live and killed vaccines in two developing areas. Am J Public Health 79: 1648–1652Google Scholar
  33. 33.
    Patriarca PA, Laender F, Palmeira G, Couto Oliveira MJ, Lima Filho J. de Souza Dantes MC, Tenorio Cordeiro M, RisiJB, Orenstein WA (1988) Randomised trial of alternative formulations of oral poliovaccine in Brazil. Lancet i: 429–433Google Scholar
  34. 34.
    Burke KL, Dunn G, Ferguson M, Minor PD, Almond JW (1988) Antigen chimaeras of poliovirus as potential new vaccines. Nature 322: 81–82Google Scholar
  35. 35.
    Kohara M, Abe S, Komatsu T, Tago K, Arita M, Nomoto A (1988) A recombinant virus between Sabin 1 and Sabin 3 vaccine strains of poliovirus as a possible candidate for a new type 3 poliovirus live vaccine strain. J Virol 62: 2828–2835Google Scholar

Copyright information

© Springer-Verlag/Wien 1993

Authors and Affiliations

  • P. A. Patriarca
    • 1
  • R. W. Linkins
    • 1
  • R. W. Sutter
    • 1
  • W. A. Orenstein
    • 1
  1. 1.Division of ImmunizationCenters for Disease Control and PreventionAtlantaUSA

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