Polio Vaccine: Time For A Policy Change

by Barbara Loe Fisher

Polio is a contagious disease caused by an intestinal virus that may attack nerve cells of the brain and spinal chord. Symptoms include fever, headache, sore throat, and vomiting. In the 1940’s and 1950’s, when polio was prevalent in the United States, the majority of people who came down with a three or four day bout of polio recovered without permanent damage. However, others developed neurological complications, including stiffness of the neck and back, weak muscles, pain in the joints, and paralysis of one ore more limbs or respiratory muscles that lasted for several weeks before recovery. A fewer number of these were left with permanent paralysis or weakness in one ore two limbs. In rare cases, an attack of polio left the individual totally paralyzed and dependent on a respirator to breathe. Some of the most severe cases ended in death, due to respiratory paralysis.

The first polio vaccine was created in 1955 by Dr. Jonas Salk, an American physician and microbiologist. It is a "killed" or inactivated virus polio vaccine (IPV) and is injected. The Salk vaccine was replaced in 1964 by a live virus oral polio vaccine (OPV) developed by Dr. Albert Sabin, and it is swallowed. OPV has been the vaccine used around the world for the past thirty years in a global effort to eradicate polio.

Polio has been eradicated from the western hemisphere, and there have been no cases of wild polio in the U.S. since 1979. Since then the only cases of polio have been caused by the live oral vaccine. The Centers for Disease Control (CDC) estimates that the risk of a child getting vaccine- associated polio from OPV is 1 in 520,000 first doses and 1 in 12.4 million subsequent doses. The CDC reports that eight to ten American children and adults come down with vaccine-associated polio every year. The National Vaccine Information Center (NVIC) maintains that many more children and adults are neurologically affected by OPV, but are never properly diagnosed. Some parents of children with paralysis of unknown origin only obtain a correct diagnosis of OPV associated paralysis after contacting (NVIC) and getting more information on vaccine associated paralysis to give to their doctor.

Most people are unaware that a major reason why the Sabin vaccine was selected as the primary vaccine to give to all children because it has the ability to passively revaccinate populations every year, when family members and caregivers are exposed to the live virus shed in the body fluid of recently vaccinated babies and young children.

Few people have understood that they are being silently revaccinated. Most are equally oblivious to another side effect of OPV: the baby who has just swallowed it can, on occasion, come down with vaccine-associated polio disease and so can anyone who handles the baby. OPV can paralyze a baby or family member who has changed a diaper, especially if either of them is immune compromised. Vaccine associated polio, unlike milder cases of natural polio, is much more likely to leave a person totally paralyzed and dependent on a respirator.

As a member of the Institute of Medicine’s Vaccine Safety Forum, I assisted with coordination of a public workshop in June, 1995 to explore whether the U.S. should change its polio vaccine policies. The workshop was attended by government vaccine regulators and policymakers, representatives of drug companies, consumer groups and physician organizations, researchers and parents. Five policy change options were discussed:

NVIC publicly supported the last option.

Following that workshop, the CDC’s Advisory Committee on Immunization Practices (ACIP) held several meetings in 1995 and 1996 to discuss options. On June 20, 1996, it voted to recommend that American babies be injected with IPV for the first two doses and given OPV for the subsequent two doses. However, ACIP suggested that parent and physicians together should make informed choices based on each child’s individual needs.

The National Vaccine Information Center maintains that informed consent to vaccination, like informed consent to any medical procedure which carries the risk of injury or death, is a right that should be guaranteed to all Americans. NVIC supports basic research into the latent, long term effects of all vaccinations, including OPV and IPV on the human immune system.

For more information contact NVIC or call 800-909-SHOT.

Barbara Loe Fisher is Co-Founder and President National Vaccine Information Center (NVIC) and Co-author of Dpt: A Shot in the DarkA Shot in the Dark

[Initially published in New Developments: Volume 2, Number 1 - Summer, 1996]

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