I think the legal risk in the all OPV schedule remains really low as long as it's still considered an acceptable option by the AAP and you've explained the different schedules to the family and documented their acceptance of the minuscule OPV risks. Remember, you're talking about risks in the one-out-of-million(s) range, so even a provider who continues all OPV and doesn't ask about household contacts or isn't on the lookout for immune deficiency will still be highly unlikely to encounter VAPP in their career.I'm a little surprised by the minimization of the risk of VAPP. I agree that the risk is quite low, but my question is this: How many patients with Vaccine-Associated Paralytic Polio is too many? One seems like a lot to me when none are necessary.
I personally have another reason -- given my practice -- to go with all IPV. I only take care of hospitalized kids, but I frequently order immunizations on the way out the door if they're due or overdue. Although it's rare, occasionally these kids get rehospitalized within 6 weeks (the typical, tough not maximum, period of OPV shedding in the stool). I'm not jazzed by the idea of these kids possibly returning to the ward and pooping polio anywhere near my immune-deficient and immune-suppressed kids.
I have to say I'm unimpressed by the complaint on the part of many parents about it being an additional shot. #1, the kids are already upset about the other shots they've gotten, and the one more is pretty insignificant. #2, shots may be uncomfortable and inconvenient, but POLIO SUCKS!
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Andrew M. Eisen, MD
Assistant Professor of Pediatrics
Associate Director, Pediatric Residency Program
University of Nevada School of Medicine