Vaccine-Associated Paralytic Polio (VAPP) and Vaccine-Derived Poliovirus (VDPV)
Vaccine-Associated Paralytic Polio (VAPP) and Vaccine-Derived Poliovirus (VDPV)
Vaccine-Associated Paralytic Polio (VAPP) and Vaccine-Derived Poliovirus (VDPV)
The oral polio vaccine (OPV) is an extremely safe and effective tool for immunizing children against polio.
Over the past 10 years, more than 10 billion doses of OPV have been administered to over 2.5 billion
children worldwide, preventing more than 10 million polio cases during that period.
On very rare occasions, OPV can lead to vaccine-associated paralytic polio or vaccine-derived poliovirus.
These are similar but different phenomena.
OPV is made with live attenuated (weakened) polioviruses that can result in a case of vaccine-associated
paralytic polio (VAPP) in approximately 1 in 2.7 million doses of OPV.
VAPP is caused by a strain of poliovirus that has genetically changed in the intestine from the original
attenuated vaccine strain contained in OPV.
It is associated with a single dose of OPV administered in a child or can occur in a close unvaccinated or
non-immune contact of the vaccine recipient who is excreting the mutated virus.
A VDPV is a very rare strain of poliovirus, genetically changed from the original strain contained in OPV.
On very rare occasions, under certain conditions, a strain of poliovirus in OPV may change and revert to
a form that may be able to cause paralysis (VDPV) in humans and develop the capacity for sustained
circulation. The latter is known as a circulating VPDV (cVDPV).
A cVDPV is associated with sustained person-to-person transmission and is circulating in the environment.
Persistent cVDPVs refer to cVDPVs known to have circulated for more than six months.
Due to the risk of cVDPVs, OPV must be phased out to secure a lasting polio-free world.
As wild polioviruses become eliminated, OPV will need to be phased out, starting with the removal of
type 2-containing OPV (the trivalent OPV to bivalent OPV switch).
Currently, the type 2 component contained in trivalent OPV accounts for more than 90% of all cVDPV
cases (bivalent OPV does not contain type 2).
Wild poliovirus type 2 has been eradicated since 1999.