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June 5, 1996, Vol 275, No. 21 >
ARTICLE | June 5, 1996

Seroprevalence of Antibody Against Poliovirus in Inner-city Preschool Children: Title and subTitle BreakImplications for Vaccination Policy in the United States FREE

Robert T. Chen, MD; Sheryl Hausinger, MD; Adnan S. Dajani, MD; Marcus Hanfling, MD; Andrew L. Baughman, MPH; Mark A. Pallansch, PhD; Peter A. Patriarca, MD
[+] Author Affiliations

Presented in part at the 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy, October 13-14, 1992, Anaheim, Calif.

Reprints: Robert T. Chen, MD, National Immunization Program (E61), Centers for Disease Control and Prevention, Atlanta, GA 30333.


JAMA. 1996;275(21):1639-1645. doi:10.1001/jama.1996.03530450029028
Text Size: A A A
Published online
Article
References

Objective.  —To assess susceptibility to poliomyelitis in selected inner-city preschool children in the United States and to estimate the contribution of secondary spread of live attenuated oral poliovirus vaccine virus to type-specific immunity.

Design.  —Cross-sectional seroprevalence study.

Methods.  —Serum neutralizing antibody levels against poliovirus types 1,2, and 3 were analyzed according to vaccination status, age, and other sociodemographic variables.

Setting.  —Hospital and satellite clinics serving inner-city populations in Houston, Tex, and Detroit, Mich, 1990 to 1991.

Participants.  —A total of 526 children aged 12 to 47 months seeking medical care were enrolled in the seroprevalence study; 144 children aged 12 to 35 months without a history of previous oral poliovirus vaccination were enrolled in the secondary spread study.

Results.  —Seropositive rates were similar in children in both cities, ranging from about 80% for types 1 and 3 in 12- to 23-month-old children to more than 90% in those aged 36 to 47 months. The most important predictor of seropositivity was the number of doses of oral poliovirus vaccine received (P<.01), with levels approximately 90% for all 3 serotypes among children who had received 3 or more doses. In children likely to have been unvaccinated, seropositive rates ranged from 9% to 18% for poliovirus types 1 and 3 and from 29% to 42% for type 2; secondary spread of vaccine virus appeared to have occurred among children who had previously received 1 dose or less but not those with 2 or more doses.

Conclusions.  —Levels of immunity to poliovirus among inner-city preschoolers are high and may be predicted by the number of doses of oral poliovirus vaccine received. Secondary spread of the vaccine virus plays a modest role in increasing polio immunity in inner-city populations, especially against types 1 and 3. This role will decrease in importance if the recently attained high levels of immunization coverage in the United States are sustained and if the risk of importation of wild poliovirus continues to diminish.(JAMA. 1996;276:1639-1645)

REFERENCES

1 +
Strebel PM, Sutter RW, Cochi SL, et al.  Epidemiology of poliomyelitis in the Unites States one decade after the last reported case of indigenous wild virus-associated disease. Clin Infect Dis . 1992;; 14:568-579.
2 +
Centers for Disease Control and Prevention.  Certification of poliomyelitis eradication—the Americas, 1994. MMWR Morb Mortal Wkly Rep . 1994;; 43:720-722.
3 +
National Immunization Program. Biologics Surveillance Summary . Atlanta, Ga: CDC Information System; 1994;.
4 +
Wright PF, Kim-Farley RJ, de Quadros CA, et al.  Strategies for the global eradication of poliomyelitis by the year 2000. N Engl J Med . 1991;; 325:1774-1779.
5 +
Ogra PL.  Mucosal immune response to poliovirus vaccines in childhood. Rev Infect Dis . 1984;; 6( (suppl) ):S361-S368.
6 +
Centers for Disease Control and Prevention.  Progress toward global poliomyelitis eradication, 1985-1994. MMWR Morb Mortal Wkly Rep . 1995;; 44:273-281.
7 +
Nightingale EO.  Recommendations for a national policy on poliomyelitis vaccination. N Engl J Med . 1977;;297:249-253.
8 +
Institute of Medicine. An Evaluation of Poliomyelitis Vaccine Policy Options . Washington, DC: National Academy of Sciences; 1988;. Publication IOM 88-04.
9 +
National Vaccine Advisory Committee.  The measles epidemic: the problems, barriers, recommendations. JAMA . 1991;;266:1547-1552.
10 +
Zell ER, Dietz V, Stevenson J, Cochi S, Bruce RH.  Low vaccination levels of US preschool and school-age children: retrospective assessments of vaccination coverage, 1991-1992. JAMA . 1994;;271: 833-839.
11 +
US Bureau of the Census. County and City Data Book: 1994 . Washington, DC: US Bureau of the Census; 1994;.
12 +
World Health Organization Collaborative Study Group on Oral Poliovirus Vaccine.  Factors affecting the immunogenicity of oral poliovirus vaccine: a prospective evaluation in Brazil and The Gambia. J Infect Dis . 1995;;171:1097-1106.
13 +
Finney DJ. Statistical Methods in Biological Assays . 2nd ed. New York, NY: Hafner Publishing; 1964;:524-530.
14 +
Hardegree MC, Barile MF, Pittman M, Maloney CJ, Schofield F, Maclennaea R.  Immunization against neonatal tetanus in New Guinea, IV: comparison of tetanus antitoxin titres obtained by hemagglutination and toxin neutralization in mice. Bull World Health Organ . 1970;;43:461-468.
15 +
Sprent P. Applied Nonparametric Statistical Methods . 2nd ed. London, England: Chapman & Hall; 1993;:28-37, 141-143.
16 +
Fleiss JL. Statistical Methods for Rates and Proportions . 2nd ed. New York, NY: John Wiley & Sons Inc; 1981;.
17 +
Francis TM. Evaluation of the 1954 Field Trial of Poliomyelitis Vaccine: Final Report . Ann Arbor: University of Michigan; 1957;.
18 +
Patriarca PA, Laender F, Palmeira G, et al.  Randomised trial of alternative formulations of oral poliovaccine in Brazil. Lancet . 1988;;1:429-433.
19 +
Deming MS, Jaiteh KO, Otten MW, et al.  Epidemic poliomyelitis in a well-vaccinated population, The Gambia, 1986, II: the clinical efficacy of trivalent oral polio vaccine. Am J Epidemiol . 1992;;135: 393-408.
20 +
Sutter RW, Patriarca PA, Brogan S, et al.  Outbreak of paralytic poliomyelitis in Oman: evidence for widespread transmission among fully vaccinated children. Lancet . 1991;;338:715-720.
21 +
Patriarca PA, Wright PF, John TJ.  Factors affecting the immunogenicity of oral poliovirus vaccine in developing countries: review. Rev Infect Dis . 1991;;13:926-939.
22 +
Centers for Disease Control and Prevention.  Isolation of wild poliovirus type 3 among members of a religious community objecting to vaccination— Alberta, Canada, 1993. MMWR Morb Mortal Wkly Rep . 1993;;42:337-339.
23 +
Hovi T, Cantell K, Huovilainen A, et al.  Outbreak of paralytic poliomyelitis in Finland. Lancet . 1986;;1:1427-1432.
24 +
Fox JP, LeBlanc DR, Gelfand HM, Clemmer DJ, Potash L.  Spread of a vaccine strain of poliovirus in southern Louisiana communities.  In: Second International Conference on Live Poliovirus Vaccines . Washington, DC: Pan American Sanitary Bureau; 1960;:144-160. Special publication 50.
25 +
Paul JR.  The spread of attenuated polioviruses among household contacts.  In: Fifth International Poliomyelitis Conference . Philadelphia, Pa: JB Lippincott Co; 1960;:359-367.
26 +
Benyesh-Melnick M, Melnick JL, Rawls WE.  Studies of the immunogenicity, communicability and genetic stability of oral polio vaccine administered during winter. Am J Epidemiol . 1976;;86:112-136.
27 +
Gard S, Bottiger M, Lagercrantz R.  Vaccination with attenuated poliovirus type 1, the CHAT strains of the natural spread within families of living vaccine strains of poliovirus.  In: First International Conference on Live Poliovirus Vaccines . Washington, DC: Pan American Sanitary Bureau; 1959;:350-354. Special publication 44.
28 +
Gelfand HM, Potash L, LeBlanc DR, Fox JP.  Revised preliminary report on the Louisiana observations of the natural spread within families of living vaccine strains of poliovirus.  In: First International Conference on Live Poliovirus Vaccines . Washington, DC: Pan American Sanitary Bureau; 1959;:203-217. Special publication 44.
29 +
Horstmann DM, Niederman JC, Paul JR.  Attenuated type 1 poliovirus vaccine: its capacity to infect and to spread from vaccinees within an institutional setting. JAMA . 1959;;170:1-8.
30 +
Kimball AC, Barr RN, Bauer H, Kleinman H, Johnson EA, Cooney M.  Minnesota studies with oral poliomyelitis vaccine: community spread of orally administered attenuated poliovirus vaccine strains.  In: Second International Conference on Live Poliovirus Vaccines . Washington, DC: Pan American Sanitary Bureau; 1960;:161-173. Special publication 50.
31 +
Sabin AB, Michaels RH, Spigland I, et al.  Community-wide use of oral poliovirus vaccine. Am J Dis Child . 1961;;101:546-567.
32 +
Sutter RW, Patriarca PA.  Inactivated and live, attenuated poliovirus vaccines: mucosal immunity.  In: Kurstak E, ed. Measles and Poliomyelitis . Vienna, Austria: Springer-Verlag; 1993;:279-294.
33 +
Onorato IM, Modlin JF, McBean AM, Thorns ML, Losonsky GA, Bernier R.  Mucosal immunity induced by enhanced potency IPV and OPV. J Infect Dis . 1991;;163:1-6.
34 +
Sutter RW, Patriarca PA, Suleiman AJM, et al.  Paralytic poliomyelitis in Oman: association between regional differences in attack rate and variations in antibody responses to oral poliovirus vaccine. Int J Epidemiol . 1993;;22:936-944.
35 +
Moriniere BJ, van Loon FPL, Rhodes PH, et al.  Immunogenicity of a supplemental dose of oral versus inactivated poliovirus vaccine. Lancet . 1993;; 341:1545-1550.
36 +
McBean AM, Thorns ML, Albrecht P, et al.  Serologic response to oral polio vaccine and enhanced-potency inactivated polio vaccines. Am J Epidemiol . 1988;;128:15-28.
37 +
Faden H, Modlin JF, Thorns ML, McBean AM, Ferdon MB, Ogra PL.  Comparative evaluation of immunization with live attenuated and enhanced-potency inactivated trivalent poliovirus vaccines in childhood: systemic and local immune responses. J Infect Dis . 1990;;162:1291-1297.
38 +
Cohen-Abbo A, Culley BS, Reed GW, et al.  Seroresponse to trivalent oral poliovirus vaccine as a function of dosage interval. Pediatr Infect Dis J . 1995;;14:100-106.
39 +
Modlin JF, Halsey NA, Thorns ML, Meschievitz CK, Patriarca PA. Serum neutralizing antibody response to three experimental sequential IPV-OPV immunization schedules. Presented at the 33rd Interscience Conference on Antimicrobial Agents and Chemotherapy, New Orleans, La, October 20,1993.
40 +
Centers for Disease Control and Prevention.  Reported vaccine-preventable diseases—United States, 1993, and the Childhood Immunization Initiative. MMWR Morb Mortal Wkly Rep . 1994;;43:720-722.
41 +
Shalala DE.  Giving pediatric immunizations the priority they deserve. JAMA . 1993;;269:1844-1845.
42 +
Hinman AR.  What will it take to fully protect all American children with vaccines? an update. Am J Dis Child . 1993;;147:536-537.
43 +
Centers for Disease Control and Prevention.  State and national vaccination coverage levels among children aged 19-35 months—United States, April-December 1994. MMWR Morb Mortal Wkly Rep . 1995;;44:613-623.
44 +
Koprowski H, Plotkin SA, Pagano J, et al.  Behavior of attenuated strain of poliomyelitis in relation to age, familial spread, and duration of immunity.  In: First International Conference on Live Poliovirus Vaccines . Washington, DC: Pan American Sanitary Bureau; 1960;:159-171. Special publication 44.
45 +
Kucharska Z, Sramova H, Zdrazilek J.  Excretion of attenuated poliovirus in children vaccinated with live oral poliovirus vaccine. J Hyg Epidemiol Microbiol Immunol . 1982;;1:74-82.
46 +
Bottiger M.  Long-term immunity following vaccination with killed poliovirus vaccine in Sweden, a country with no circulating poliovirus. Rev Infect Dis . 1984;;6( (suppl) ):S548-S551.
47 +
Oostvogel PM, van Wijngaarden JK, van der Avoort HGAM, et al.  Poliomyelitis outbreak in an unvaccinated community in the Netherlands, 1992-93. Lancet . 1994;;344:665-670.
48 +
Hinman AR, Koplan JP, Orenstein WA, Brink EW, Nkowane BM.  Live or inactivated poliomyelitis vaccine: an analysis of benefits and risks. Am J Public Health . 1988;;78:291-295.
49 +
Howe CJ, Johnston RB, eds. Options for Poliomyelitis Vaccination: Summary of a Workshop . Washington, DC: Institute of Medicine Vaccine Safety Forum; 1995;.
50 +
Marwick C.  ACIP delays changing polio vaccine advice. JAMA . 1995;;274:203.
51 +
Peter G, Halsey NA.  Poliomyelitis immunization— consideration of change in the current AAP recommendation. Am Acad Pediatr News . 1995;;11:13.
52 +
Plotkin SA.  Inactivated polio vaccine for the United States: a missed vaccination opportunity. Pediatr Infect Dis J . 1995;;14:835-839.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Strebel PM, Sutter RW, Cochi SL, et al.  Epidemiology of poliomyelitis in the Unites States one decade after the last reported case of indigenous wild virus-associated disease. Clin Infect Dis . 1992;; 14:568-579.
2 +
Centers for Disease Control and Prevention.  Certification of poliomyelitis eradication—the Americas, 1994. MMWR Morb Mortal Wkly Rep . 1994;; 43:720-722.
3 +
National Immunization Program. Biologics Surveillance Summary . Atlanta, Ga: CDC Information System; 1994;.
4 +
Wright PF, Kim-Farley RJ, de Quadros CA, et al.  Strategies for the global eradication of poliomyelitis by the year 2000. N Engl J Med . 1991;; 325:1774-1779.
5 +
Ogra PL.  Mucosal immune response to poliovirus vaccines in childhood. Rev Infect Dis . 1984;; 6( (suppl) ):S361-S368.
6 +
Centers for Disease Control and Prevention.  Progress toward global poliomyelitis eradication, 1985-1994. MMWR Morb Mortal Wkly Rep . 1995;; 44:273-281.
7 +
Nightingale EO.  Recommendations for a national policy on poliomyelitis vaccination. N Engl J Med . 1977;;297:249-253.
8 +
Institute of Medicine. An Evaluation of Poliomyelitis Vaccine Policy Options . Washington, DC: National Academy of Sciences; 1988;. Publication IOM 88-04.
9 +
National Vaccine Advisory Committee.  The measles epidemic: the problems, barriers, recommendations. JAMA . 1991;;266:1547-1552.
10 +
Zell ER, Dietz V, Stevenson J, Cochi S, Bruce RH.  Low vaccination levels of US preschool and school-age children: retrospective assessments of vaccination coverage, 1991-1992. JAMA . 1994;;271: 833-839.
11 +
US Bureau of the Census. County and City Data Book: 1994 . Washington, DC: US Bureau of the Census; 1994;.
12 +
World Health Organization Collaborative Study Group on Oral Poliovirus Vaccine.  Factors affecting the immunogenicity of oral poliovirus vaccine: a prospective evaluation in Brazil and The Gambia. J Infect Dis . 1995;;171:1097-1106.
13 +
Finney DJ. Statistical Methods in Biological Assays . 2nd ed. New York, NY: Hafner Publishing; 1964;:524-530.
14 +
Hardegree MC, Barile MF, Pittman M, Maloney CJ, Schofield F, Maclennaea R.  Immunization against neonatal tetanus in New Guinea, IV: comparison of tetanus antitoxin titres obtained by hemagglutination and toxin neutralization in mice. Bull World Health Organ . 1970;;43:461-468.
15 +
Sprent P. Applied Nonparametric Statistical Methods . 2nd ed. London, England: Chapman & Hall; 1993;:28-37, 141-143.
16 +
Fleiss JL. Statistical Methods for Rates and Proportions . 2nd ed. New York, NY: John Wiley & Sons Inc; 1981;.
17 +
Francis TM. Evaluation of the 1954 Field Trial of Poliomyelitis Vaccine: Final Report . Ann Arbor: University of Michigan; 1957;.
18 +
Patriarca PA, Laender F, Palmeira G, et al.  Randomised trial of alternative formulations of oral poliovaccine in Brazil. Lancet . 1988;;1:429-433.
19 +
Deming MS, Jaiteh KO, Otten MW, et al.  Epidemic poliomyelitis in a well-vaccinated population, The Gambia, 1986, II: the clinical efficacy of trivalent oral polio vaccine. Am J Epidemiol . 1992;;135: 393-408.
20 +
Sutter RW, Patriarca PA, Brogan S, et al.  Outbreak of paralytic poliomyelitis in Oman: evidence for widespread transmission among fully vaccinated children. Lancet . 1991;;338:715-720.
21 +
Patriarca PA, Wright PF, John TJ.  Factors affecting the immunogenicity of oral poliovirus vaccine in developing countries: review. Rev Infect Dis . 1991;;13:926-939.
22 +
Centers for Disease Control and Prevention.  Isolation of wild poliovirus type 3 among members of a religious community objecting to vaccination— Alberta, Canada, 1993. MMWR Morb Mortal Wkly Rep . 1993;;42:337-339.
23 +
Hovi T, Cantell K, Huovilainen A, et al.  Outbreak of paralytic poliomyelitis in Finland. Lancet . 1986;;1:1427-1432.
24 +
Fox JP, LeBlanc DR, Gelfand HM, Clemmer DJ, Potash L.  Spread of a vaccine strain of poliovirus in southern Louisiana communities.  In: Second International Conference on Live Poliovirus Vaccines . Washington, DC: Pan American Sanitary Bureau; 1960;:144-160. Special publication 50.
25 +
Paul JR.  The spread of attenuated polioviruses among household contacts.  In: Fifth International Poliomyelitis Conference . Philadelphia, Pa: JB Lippincott Co; 1960;:359-367.
26 +
Benyesh-Melnick M, Melnick JL, Rawls WE.  Studies of the immunogenicity, communicability and genetic stability of oral polio vaccine administered during winter. Am J Epidemiol . 1976;;86:112-136.
27 +
Gard S, Bottiger M, Lagercrantz R.  Vaccination with attenuated poliovirus type 1, the CHAT strains of the natural spread within families of living vaccine strains of poliovirus.  In: First International Conference on Live Poliovirus Vaccines . Washington, DC: Pan American Sanitary Bureau; 1959;:350-354. Special publication 44.
28 +
Gelfand HM, Potash L, LeBlanc DR, Fox JP.  Revised preliminary report on the Louisiana observations of the natural spread within families of living vaccine strains of poliovirus.  In: First International Conference on Live Poliovirus Vaccines . Washington, DC: Pan American Sanitary Bureau; 1959;:203-217. Special publication 44.
29 +
Horstmann DM, Niederman JC, Paul JR.  Attenuated type 1 poliovirus vaccine: its capacity to infect and to spread from vaccinees within an institutional setting. JAMA . 1959;;170:1-8.
30 +
Kimball AC, Barr RN, Bauer H, Kleinman H, Johnson EA, Cooney M.  Minnesota studies with oral poliomyelitis vaccine: community spread of orally administered attenuated poliovirus vaccine strains.  In: Second International Conference on Live Poliovirus Vaccines . Washington, DC: Pan American Sanitary Bureau; 1960;:161-173. Special publication 50.
31 +
Sabin AB, Michaels RH, Spigland I, et al.  Community-wide use of oral poliovirus vaccine. Am J Dis Child . 1961;;101:546-567.
32 +
Sutter RW, Patriarca PA.  Inactivated and live, attenuated poliovirus vaccines: mucosal immunity.  In: Kurstak E, ed. Measles and Poliomyelitis . Vienna, Austria: Springer-Verlag; 1993;:279-294.
33 +
Onorato IM, Modlin JF, McBean AM, Thorns ML, Losonsky GA, Bernier R.  Mucosal immunity induced by enhanced potency IPV and OPV. J Infect Dis . 1991;;163:1-6.
34 +
Sutter RW, Patriarca PA, Suleiman AJM, et al.  Paralytic poliomyelitis in Oman: association between regional differences in attack rate and variations in antibody responses to oral poliovirus vaccine. Int J Epidemiol . 1993;;22:936-944.
35 +
Moriniere BJ, van Loon FPL, Rhodes PH, et al.  Immunogenicity of a supplemental dose of oral versus inactivated poliovirus vaccine. Lancet . 1993;; 341:1545-1550.
36 +
McBean AM, Thorns ML, Albrecht P, et al.  Serologic response to oral polio vaccine and enhanced-potency inactivated polio vaccines. Am J Epidemiol . 1988;;128:15-28.
37 +
Faden H, Modlin JF, Thorns ML, McBean AM, Ferdon MB, Ogra PL.  Comparative evaluation of immunization with live attenuated and enhanced-potency inactivated trivalent poliovirus vaccines in childhood: systemic and local immune responses. J Infect Dis . 1990;;162:1291-1297.
38 +
Cohen-Abbo A, Culley BS, Reed GW, et al.  Seroresponse to trivalent oral poliovirus vaccine as a function of dosage interval. Pediatr Infect Dis J . 1995;;14:100-106.
39 +
Modlin JF, Halsey NA, Thorns ML, Meschievitz CK, Patriarca PA. Serum neutralizing antibody response to three experimental sequential IPV-OPV immunization schedules. Presented at the 33rd Interscience Conference on Antimicrobial Agents and Chemotherapy, New Orleans, La, October 20,1993.
40 +
Centers for Disease Control and Prevention.  Reported vaccine-preventable diseases—United States, 1993, and the Childhood Immunization Initiative. MMWR Morb Mortal Wkly Rep . 1994;;43:720-722.
41 +
Shalala DE.  Giving pediatric immunizations the priority they deserve. JAMA . 1993;;269:1844-1845.
42 +
Hinman AR.  What will it take to fully protect all American children with vaccines? an update. Am J Dis Child . 1993;;147:536-537.
43 +
Centers for Disease Control and Prevention.  State and national vaccination coverage levels among children aged 19-35 months—United States, April-December 1994. MMWR Morb Mortal Wkly Rep . 1995;;44:613-623.
44 +
Koprowski H, Plotkin SA, Pagano J, et al.  Behavior of attenuated strain of poliomyelitis in relation to age, familial spread, and duration of immunity.  In: First International Conference on Live Poliovirus Vaccines . Washington, DC: Pan American Sanitary Bureau; 1960;:159-171. Special publication 44.
45 +
Kucharska Z, Sramova H, Zdrazilek J.  Excretion of attenuated poliovirus in children vaccinated with live oral poliovirus vaccine. J Hyg Epidemiol Microbiol Immunol . 1982;;1:74-82.
46 +
Bottiger M.  Long-term immunity following vaccination with killed poliovirus vaccine in Sweden, a country with no circulating poliovirus. Rev Infect Dis . 1984;;6( (suppl) ):S548-S551.
47 +
Oostvogel PM, van Wijngaarden JK, van der Avoort HGAM, et al.  Poliomyelitis outbreak in an unvaccinated community in the Netherlands, 1992-93. Lancet . 1994;;344:665-670.
48 +
Hinman AR, Koplan JP, Orenstein WA, Brink EW, Nkowane BM.  Live or inactivated poliomyelitis vaccine: an analysis of benefits and risks. Am J Public Health . 1988;;78:291-295.
49 +
Howe CJ, Johnston RB, eds. Options for Poliomyelitis Vaccination: Summary of a Workshop . Washington, DC: Institute of Medicine Vaccine Safety Forum; 1995;.
50 +
Marwick C.  ACIP delays changing polio vaccine advice. JAMA . 1995;;274:203.
51 +
Peter G, Halsey NA.  Poliomyelitis immunization— consideration of change in the current AAP recommendation. Am Acad Pediatr News . 1995;;11:13.
52 +
Plotkin SA.  Inactivated polio vaccine for the United States: a missed vaccination opportunity. Pediatr Infect Dis J . 1995;;14:835-839.

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