Tag: oral polio vaccine

What is Eczema Vaccinatum?

Did you know that having eczema is a contraindication to getting a vaccine?

Which vaccine?

The smallpox vaccine!

Yes, smallpox has been eradicated, but the vaccine is sometimes still used in very specific situations, especially in the military.

What is Eczema Vaccinatum?

Not only is eczema a contraindication to getting the smallpox vaccine, you shouldn’t even get it if a household contact has eczema.

Why not?

Shedding.

Yes, although anti-vaccine folks needlessly worry about shedding when kids get routine childhood vaccines and even talk about a shedding season, with the smallpox vaccine, problems with shedding are really a thing.

Since the smallpox vaccine is a live virus vaccine and since it very commonly causes a skin reaction at the injection site, shedding can spread it to others. While that’s a good thing with some vaccines, like the oral polio vaccine, because it increases herd immunity, it isn’t with the smallpox vaccine.

If the weakened smallpox vaccine can cause a skin reaction on your arm where you got the shot, what is it going to do if it gets on a child’s skin that is irritated all over with eczema?

An 8-month-old boy with eczema vaccinatum.
An 8-month-old boy with eczema vaccinatum. Photo by CDC/Arthur E. Kaye

It’s a good thing that we don’t routinely have to use the smallpox vaccine anymore.

“Because persons with eczema are deferred from vaccination, only a single, accidentally transmitted case of EV has been described in the medical literature since military vaccination was resumed in the United States in 2002.”

Reed et al on Eczema vaccinatum.

And that it doesn’t happen with any other vaccines!

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VAPP

VAPP or vaccine-associated paralytic polio are cases of polio that are actually caused by the polio vaccine.

Very rarely, the attenuated (weakened) virus in the oral polio vaccine can revert to a form that can cause the person who was vaccinated or their close contact to actually develop polio.

It should not be confused with cVDPV or circulating vaccine-derived polio virus. With cVDPV, the original strain of attenuated vaccine virus reverts to a form that can not only cause polio, but can also spread from one person to another, causing outbreaks. Fortunately, these outbreaks are very rare.

Vaccine-Associated Paralytic Polio

VAPP only occurs in about 1 in every 1.27 million children receiving their first dose of OPV.

Can’t we just stop using the live, oral polio vaccine?

Although a serious side effect of the vaccine, the vaccine’s benefit clearly outweighs the risk of VAPP while polio is endemic (lots of cases) in a region. After all, without the vaccine, hundreds of thousands of children would get polio and would be paralyzed.

Not getting polio is a good thing. A pediatrician, especially one who wrote a vaccine book should understand the benefits of the polio vaccine.
Not getting polio is a good thing. A pediatrician, especially one who wrote a vaccine book should understand the benefits of the polio vaccine.

Shedding of the OPV vaccine actually helps provide passive immunization to others in the community.

In polio-free countries, the risk of VAPP becomes greater than the risk of polio though, and they move to the inactivated polio vaccine. That helps prevent a situation in which the polio vaccines actually causes more cases of polio than wild type polio viruses.

Eventually, all countries will move to the IPV vaccine as we move closer to polio eradication. We came one step closer to that point in April 2016 when all countries that were still using the oral polio vaccine switched from trivalent OPV to bivalent OPV for their routine immunization programs. This should eliminate up to 38% of cases of VAPP!

What To Know About VAPP

VAPP or vaccine-associated paralytic polio is a rare side effect of the oral polio vaccine.

More Information About VAPP

Albert Sabin

Albert Sabin is well known as the developer of the oral polio vaccine.

In 1961, Sabin’s live, attenuated polio vaccine replaced Jonas Salk’s inactivated polio vaccine that had been in use since 1955.

Sabin's oral polio vaccine helped get us close to eradicating polio.
Sabin’s oral polio vaccine helped get us close to eradicating polio.

Although OPV is very effective and safe, because of the very small risk of vaccine-associated paralytic polio (VAPP), many polio-free, industrialized countries eventually switch back to IPV.

The United States switched back to IPV in 2000.

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