>---------- >> From: Michael Sachs <> >> The question to ask, is what are your reasons for using IPV at 2 and 4 >> months? If it's only to prevent VAPP in infants who might have an >> as-yet-to-be-diagnosed immune deficiency (or 1/1,000,000 bad luck), then >> the sequential schedule and a change to OPV makes sense. But if you're >> also hoping to prevent VAPP in adult contacts, then you'd want to >continue >> with IPV since the previous IPV doses won't prevent shedding of the OPV >in >> the feces or saliva. So if you switch to OPV you'll need to remember to >> ask about possible immunodeficient or unimmunized contacts. >> At 11:12 PM 6/30/98 -0500, Dogwood Ridge wrote: >Mike- Correct me if I'm wrong but the chances of getting polio from an OPV >is 1 out of a million in previously unvaccinated individuals (4-6 babies a >year) and one out of 30 million in immune competent individuals who have >been previously vaccinated with 2 IPVs. Many immunocompromised babies >might not be identified during their first months of life but would >probably be diagnosed by 12 months of age. So, if no live virus vaccines >were given during the first 12 months of life fewer babies would run the >albeit small risk of getting infected with the diseases we're trying to >protect them against. As far as immunocompromised caregivers, if I can >identify their existence at the time of the vaccination I stick to the full >IPV schedule. Regards- Kim Burlingham MD The 1/1,000,000 with the first dose is what I've heard. I've also heard 1/5,000,000 if the all OPV is continued for subsequent doses, but I've not heard statistics for OPV following IPV (1/30,000,000 sounds like it would be about right). One question about diagnosing immunocompromised children: I've also heard that they "should" be diagnosed by 12 months, but we know this is not always the case. It's dependent upon the presentation and the practitioner. You described yourself as "anal and a perfectionist" in a post to Eve, and these qualities will make it much more likely you'd not miss the diagnosis. But we all know there are providers out there who can better be described as "lazy and lousy" and if they miss the diagnosis in the child or fail to ask about immunocompromised contacts, they haven't accomplished as much by switching to the sequential schedule from all-OPV. Another concern: I believe that at least some of the powers-that-be that recommend vaccine scheduling are about to (or might already have) stated that any of the polio sequences can be given 2/4/6 months then 4 years. So those who use the sequential schedule but arbitrarily move the third dose from 18 months to 6 months (because an official body says it's O.K.) will defeat part of the purpose of switching in the first place. The purpose of my initial post which you responded to was that we should all be thinking about the reasoning behind the decisions we make, and those of us on the list can see from your posts that you certainly do. It's more concerning when providers just blindly make decisions which don't necessarily make the best medical sense but can be somewhat justified based on their own interpretation of an AAP statement. Michael Sachs, M.D. General Pediatrician