Vaccine-associated paralytic poliomyelitis: a review of the epidemiology and estimation of the global burden
Open accessAbstract
BACKGROUND: Vaccine-associated paralytic poliomyelitis (VAPP) is a rare adverse event associated with oral poliovirus vaccine (OPV). This review summarizes the epidemiology and provides a global burden estimate. METHODS: A literature review was conducted to abstract the epidemiology and calculate the risk of VAPP. A bootstrap method was applied to calculate global VAPP burden estimates. RESULTS: Trends in VAPP epidemiology varied by country income level. In the low-income country, the majority of cases occurred in individuals who had received >3 doses of OPV (63%), whereas in middle and high-income countries, most cases occurred in recipients after their first OPV dose or unvaccinated contacts (81%). Using all risk estimates, VAPP risk was 4.7 cases per million births (range, 2.4-9.7), leading to a global annual burden estimate of 498 cases (range, 255-1018). If the analysis is limited to estimates from countries that currently use OPV, the VAPP risk is 3.8 cases per million births (range, 2.9-4.7) and a burden of 399 cases (range, 306-490). CONCLUSIONS: Because many high-income countries have replaced OPV with inactivated poliovirus vaccine, the VAPP burden is concentrated in lower-income countries. The planned universal introduction of inactivated poliovirus vaccine is likely to substantially decrease the global VAPP burden by 80%-90%.
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Shedding was higher in IPV-vaccinated participants, which is expected because, unlike OPV, IPV induces little to no primary intestinal immunity.
“Shedding was higher in IPV-vaccinated participants, which is expected because, unlike OPV, IPV induces little to no primary intestinal immunity.14”
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- Authors
- Platt, L. R., Estivariz, C. F., & Sutter, R. W.
- Affiliations
- World Health Organization (CH)
- ORCID
- Sutter, R. W.
- Venue
- Journal of Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-10-14
- Volume
- 210
- Issue
- suppl 1
- Pages
- S380-S389
- ISSN
- 0022-1899 (ISSN-L)
- 1537-6613
- PMC
- PMC10424844
- OpenAlex
- W2103683759
- Cited by
- 267
- References
- 46
- Citations by year
- 2026: 13 · 2025: 23 · 2024: 22 · 2023: 19 · 2022: 17 · 2021: 20 · 2020: 26 · 2019: 22 · 2018: 31 · 2017: 21 · 2016: 25 · 2015: 24 · 2014: 3
- FWCI
- 3.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- World Health Organization
- National Institutes of Health (CC999999)
- Centers for Disease Control and Prevention
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Viral Infections and Immunology Research
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Health Sciences › Medicine › Epidemiology › Virology and Viral Diseases
- Keywords
- vaccine-associated paralytic poliomyelitis, oral polio vaccine, vaccine adverse events, epidemiology, inactivated poliovirus vaccine, low-income countries, vaccine safety
- MeSH terms
- Adolescent, Adult, Child, Child, Preschool, Developing Countries, Female, Humans, Infant, Infant, Newborn, Male, Poliomyelitis, Global Health, Prevalence, Risk Assessment, Developed Countries, Poliovirus Vaccines, Young Adult
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