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Ensuring Preparedness for Potential Poliomyelitis Outbreaks
Recommendations for the US Poliovirus Vaccine Stockpile From the National Vaccine Advisory Committee (NVAC) and the Advisory Committee on Immunization Practices (ACIP)
NVAC-ACIP Joint Working Group and Centers for Disease Control and Prevention (CDC)*
Arch Pediatr Adolesc Med. 2004;158:1106-1112.
Paralytic poliomyelitis was once endemic in the United States; however, because of high vaccination levels, the last case of wild disease occurred in 1979. Although worldwide polio eradication may be achieved in the near future, the presence of undervaccinated children in urban areas and among groups who refuse vaccination creates an outbreak risk, should importation of wild virus occur. In 1999, the Advisory Committee on Immunization Practices (ACIP) recommended that inactivated poliovirus vaccine (IPV) be used for routine immunization of the US population and that oral poliovirus vaccine (OPV) be reserved for "mass vaccination campaigns to control outbreaks of paralytic polio." Subsequently, the sole US manufacturer of OPV withdrew from the market. In 2003, a joint National Vaccine Advisory Committee (NVAC)/ACIP working group was charged with reporting to its parent bodies concerning the need for a poliovirus vaccine stockpile. Based on that working group’s report, the NVAC and ACIP have concluded that stockpiles of both IPV and OPV should be maintained. In the event of an outbreak in which OPV continues not to be available, IPV should be used for control, and a stockpile of 8 million doses seems to be sufficient. Should IPV be manufactured only in combination with other vaccines, appropriate procurement actions should be taken to ensure that uncombined IPV continues to be stockpiled. Under circumstances of diminished population immunity, OPV may offer outbreak control advantages. The NVAC and ACIP recommend that the United States collaborate with international agencies to provide guaranteed and rapid access to at least 8 million doses of trivalent OPV or 8 million doses of each of the 3 types of monovalent OPV. The regulatory and practical obstacles to implementation of this recommendation will require assertive facilitation at high levels of the federal government and careful planning at the state and local levels.
*Authors: The NVAC-ACIP Joint Working Group Members and CDC Staff who had complete access to the raw data needed for this report and who also bear authorship responsibility for this report are Lorraine Alexander, RN, MPH; Guthrie Birkhead, MD, MPH; Fernando Guerra, MD; Charles Helms, MD, PhD (chair); Alan Hinman, MD, MPH; Samuel Katz, MD; Charles W. LeBaron, MD; John Modlin, MD; and Trudy V. Murphy, MD.
Author Affiliations: National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Ga (Ms Alexander and Drs LeBaron and Murphy); New York State Department of Health, Albany (Dr Birkhead); San Antonio Metropolitan Health District, San Antonio, Tex (Dr Guerra); Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City (Dr Helms); Task Force for Child Survival and Development, Decatur, Ga (Dr Hinman); Department of Pediatrics, Duke University Medical School, Durham, NC (Dr Katz); Department of Pediatrics, and Dartmouth Medical School, Hanover, NH (Dr Modlin).
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