Tag: John Salamone

Why Are the DPT and OPV Vaccines Still Used in Some Countries?

As most folks know, neither the DPT nor OPV vaccines are used in the United States.

Pope Francis helped launch a polio vaccine campaign when he visited Mexico in 2016.
Pope Francis helped launch a polio vaccine campaign when he visited Mexico in 2016.

That they are still used in other countries likely raises some questions for those folks that get them.

Why Are the DPT and OPV Vaccines Still Used in Some Countries?

As I am sure you have guessed, there is no conspiracy about the continued use of these vaccines in other parts of the world. We aren’t getting rid of old stocks of vaccines or using cheaper vaccines in poorer parts of the world.

So what’s the reason?

To understand why they are still used in other countries, it helps to understand why they aren’t used here.

Remember that the DPT vaccine, which protects folks against diphtheria, pertussis, and tetanus, came under attack in the 1970s and 80s as some folks blamed the vaccine for causing vaccine injuries, including seizures and encephalopathy. It didn’t, but we still got a new vaccine, DTaP, which doesn’t seem to work as well.

“Although concerns about possible adverse events following their administration have led to the adoption of acellular pertussis vaccines in some countries, whole-cell pertussis vaccines are still widely produced and used globally in both developed and developing countries. Whole-cell pertussis vaccines that comply with WHO requirements, administered according to an optimal schedule have a long and successful record in the control of whooping cough. Furthermore, the excellent efficacy of some currently available whole-cell pertussis vaccine has also been shown, not only in recent clinical trials, but also on the basis of the resurgence of disease where vaccination has been interrupted or when coverage has markedly decreased. Therefore, WHO continues to recommend whole-cell pertussis vaccines for use in national immunization programmes.”

WHO on Recommendations for whole-cell pertussis vaccine

The WHO now recommends that if countries do switch to DTaP,  the acellular pertussis vaccine, they should be prepared to add additional periodic booster doses and immunizations during pregnancy, which may still “may not be sufficient to prevent resurgence of pertussis.”

The OPV vaccine, on the other hand, was replaced because it can rarely cause vaccine-associated paralytic polio (VAPP) and circulating vaccine-derived polio virus (cVDPV). Of course, it does it at much lower rates than wild polio virus, so until polio is well controlled, the benefit of using OPV outweighs the risk. In addition to being less expensive and easier to use, OPV has the benefit over IPV of providing better herd immunity.

At some point, as we did in the United States in 2000, countries make a switch to the IPV vaccine.

In 2016, remaining countries that use OPV switched from trivalent OPV to bivalent OPV, because wild polio virus type 2 was eradicated in 1999. Once the remaining two types are eradicated, we can stop using the OPV vaccine altogether.

Until then, countries either use:

  • OPV plus one dose of IPV
  • sequential IPV-OPV schedules – high vaccine coverage and low risk of wild polio importation
  • IPV only schedules – sustained high vaccine coverage and very low risk of wild polio importation

So there is no conspiracy. These vaccines are safe and they work.

Without them, there would be over:

  • 1.3 million pertussis related deaths each year
  • 600,000 cases of paralytic polio each year

With most of these cases affecting young children.

More on the Continued Use of DPT and OPV Vaccines