Inactivated Poliovirus Vaccine and Vaccine-Associated Paralytic Poliomyelitis-Reply

Abstract

In Reply. —Two recent reviews 1,2 have updated our understanding of the epidemiology of VAPP in the United States and the relative proportions of recipient, contact, and immunologically abnormal cases. These data as well as a review of immunologically abnormal VAPP cases were considered by the Delphi panel. 3 With respect to immunologically abnormal VAPP cases, the panel noted the following: (1) 95% of such patients were associated with B-cell disorders, and IPV administration would not be expected to induce an effective immune response in these individuals; (2) the median age at onset of paralytic disease among recipients was 11.2 months; and (3) with the exception of 1 contact case, VAPP was the precipitating event that led to the diagnosis of immunodeficiency. In addition, few cases of agammaglobulinemia (the most severe form of B-cell disorders) are diagnosed in the first year of life. In one study the mean age at diagnosis of