Afterword
The CDC-sponsored workshop was held on June 8, 1995. An agenda for that workshop follows the text of this summary. The morning session included presentations on potential schedules for a new polio immunization policy, future prospects for combination vaccines, provider perspectives and parent perspectives, consumer and ethical issues, liability and compensation issues, and a cost-benefit assessment of the options. The afternoon was given over to panel presentations by advocates of the five options and to discussion of the issues raised; excerpts from these presentations appear in the relevant sections of this document. Samuel Katz summarized the presentations and discussion from both days and expressed his opinion that the current circumstances of disease burden and vaccine-induced injury justify an increased reliance on IPV in the U.S. immunization system.
At its meeting on June 29, 1995, the CDC's Advisory Committee on Immunization Practices (ACIP) approved the following statement:
Dramatic progress toward global eradication of poliomyelitis through the use of oral polio vaccine (OPV) has led to the elimination of this disease in the Western Hemisphere and has greatly decreased the incidence of polio worldwide. There has been no circulation of wild-type polio in the United States since 1979. However, OPV rarely can cause paralytic disease; there are 8–10 cases of vaccine-associated poliomyelitis (VAPP) each year in the United States.
To decrease the occurrence of VAPP in the United States, the ACIP is currently developing a new polio vaccination policy that will include a greatly enhanced role for inactivated polio vaccine (IPV). An ACIP working group has been formed to explore policy options and to develop a proposed plan for
implementation, which will be presented to the entire committee at its October meeting. Combination vaccines that include IPV will enhance implementation by minimizing the number of injections needed. Until a new policy is developed and implemented, the ACIP reaffirms its current polio vaccination policy.
After a meeting of the ACIP on June 20, 1996, the CDC released a media advisory that read in part:
CDC's Advisory Committee on Immunization Practices (ACIP) today voted to change the recommendation for routine childhood polio vaccination. To decrease the occurrence of vaccine-associated paralytic polio, the committee's recommendation is that children in the United States receive two doses of inactivated polio vaccine (IPV) followed by two doses of oral polio vaccine (OPV). The ACIP continues to believe that both the four-dose schedule of OPV, currently routinely recommended, and the alternate four-dose schedule of IPV remain acceptable options for childhood immunization.
This recommendation follows a 2-year review by ACIP of the current policy, written in 1982. The CDC will now evaluate the recommendation. Until the CDC decides on the recommendation, CDC reaffirms the ACIP 's current polio vaccination policy that relies primarily on OPV for prevention of polio in the United States. Parents should be made aware of the polio vaccines available and the reasons why these recommendations are made. The benefits and risks of the vaccines for individuals and the community should be stated so that vaccination is carried out among persons who are fully informed.
