At 07:52 AM 7/7/98 -0700, Andrew M. Eisen, MD wrote: >My point was not alternatives but the simple fact that we accept the pain, etc. >of other vaccines because we're doing what's best for the population of >children. Although there is an oral option with polio vaccine, it carries a >risk of VAPP which is COMPLETELY avoidable with the use of eIPV. Why subject >even one child to this possibility if we don't need to? > >I'm not aware of the details of the nerve injury incident to which you refer, >but the only nerve of significant size in the thigh, as I recall, is the >sciatic, which is located posterior to the femur. I'm not sure how to hit this >without either using a long needle, or a posterior or lateral approach. >Regardless, the issue would be: how much more often would this occur by adding >an additional injection to the regimen (ignoring the options of combination >vaccines), and does this outweigh the VAPP risk? > >-- >Andrew M. Eisen, MD A question I haven't seen raised with IPV: Is there any risk of anaphylaxis? The package insert states "Although no causal relationship has been established, deaths have occurred in temporal association after vaccination of infants with IPV." We all know that the risks of vaccines have been overblown in the media and the company probably put that statement in for legal reasons. Plus IPV is usually used in conjunction with DTP or DTaP so investigators would not be in a position to say if one or the other of the vaccines could be associated with an adverse event (if the occurrence is even thought to possibly be vaccine related). But any time a foreign substance is put into the body, whether by mouth or parenterally, there's a risk of anaphylaxis. Have there been enough doses of IPV given worldwide to be sure that the remote risk of anaphylaxis following IPV is not equal to or greater than the remote risk of VAPP following OPV? Also, there are other ramifications not vaccine related. If a family decides to return for an extra vaccine-only visit because they don't want their infant to receive four vaccines at once, the return car trip carries it's own risk. Sure, the risk of a serious auto accident is one-in-millions, but so is the risk of VAPP. I'm certainly not saying I totally disagree with the switch to IPV, only that we must factor in more variables than just VAPP when making the switch. The change from OPV to IPV seems to have been presented as a way to avoid VAPP essentially risk-free, but I think there are other ramifications (both individual and global) which have not been presented or are passed over as insignificant. When the problem you're trying to prevent carries a one-in-million(s) risk then other ramifications which also carry one-in-million(s) risks suddenly become significant by comparison. Michael Sachs, M.D. General Pediatrician