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International Journal of Epidemiology 2000;29:757-763
© International Epidemiological Association 2000

Vaccine-associated paralytic poliomyelitis: a retrospective cohort study of acute flaccid paralyses in Brazil

Lúcia Helena de Oliveiraa and Claudio José Struchinerb

a Reference Center Hélio Frega, National Health Foundation, Ministry of Health, Brazil.
b National School of Public Health, Oswaldo Cruz Foundation (IMS/UERJ), Ministry of Health, Brazil and IMS/VERJ.

Reprint requests to: Claudio J Struchiner, av. Brasil 4365, Residencia Oficial 21045.900, Rio de Janeiro, RJ Brazil. E-mail: stru{at}procc.fiocruz.br

Background At the present time, in Brazil and other countries in the Americas, the only cases of paralytic poliomyelitis due to poliovirus are caused by vaccine strains. The recognition of possible determinants of vaccine-associated paralytic poliomyelitis (VAPP) by public health surveillance and immunization programmes is relevant to inform the debate on criteria for case definition and vaccination strategies.

Methods A retrospective cohort study based on the cases of acute flaccid paralysis (AFP) reported to the Ministry of Health (MoH) was designed, with the objective of studying cases of VAPP in Brazil between 1989 and 1995. Clinical, laboratory and epidemiological data from 3656 acute flaccid paralysis (AFP) cases, 30 of them diagnosed as VAPP, were analysed.

Results An 8.88 risk ratio of VAPP (95% CI : 4.37–18.03) was found when comparing individuals who received oral poliovirus vaccine (OPV) between 4 and 40 days before the onset of paralysis and individuals who did not receive the vaccine within this period. A risk of 1 case/2.39 million first doses and 1 case/13.03 million OPV doses administered was estimated for the general population.

Conclusions Cases of AFP who received OPV between 4 and 40 days before the onset of paralysis and had fever, a prodrome of gastrointestinal symptoms, history of first dose of OPV, isolation of vaccine poliovirus type 2, and young age deserve careful investigation, since they are at increased risk for the condition studied.

Keywords Vaccine, poliomyelitis, oral poliomyelitis vaccine, adverse effect

Accepted 2 February 2000


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