Poliovirus vaccine, live, trivalent Disease Interactions

In general, the use of poliovirus vaccine (live oral trivalent) is contraindicated in patients with primary or acquired immunodeficiency or infection with HIV. Since the vaccine contains live attenuated virus, the absence of immune competence may potentiate the replication of vaccine virus, increase adverse host reactions, and compromise serum antibody response. Likewise, the vaccine should not be given to anyone with a family history of congenital or hereditary immunodeficiency until the individual's immune status can be assessed and is determined to be adequate. Finally, poliovirus vaccine (live oral trivalent) should not be administered to any household member of immunodeficient or HIV-infected persons because the recipient can shed vaccine viruses in the feces for up to 6 to 8 weeks after administration, and by the pharyngeal route for 1 to 2 weeks. Polio immunization for all members of the groups described above should utilize enhanced inactivated poliovirus vaccine (eIPV). Incidentally, in an effort to eliminate the risk of vaccine-associated paralytic polio, the Advisory Committee on Immunization Practices now recommends an all-IPV schedule (except under special circumstances) for routine childhood polio vaccination in the United States. As of January 1, 2000, all children should receive four doses of IPV at ages 2 months, 4 months, 6-18 months, and 4-6 years.

Ideally, vaccination should occur when an individual is healthy, thus minimizing the risk of an adverse host reaction and/or vaccine failure. However, a current or recent infection does not necessarily preclude the use of vaccines, depending on the severity of the patient's symptoms and their etiology. Superficial infections and minor acute illnesses such as a mild upper respiratory infection with or without low-grade fever do not contraindicate immunization, particularly if prompt administration of a vaccine is deemed necessary or beneficial. In fact, when vaccines are administered during the course of a minor illness, the risk of adverse events is not increased, and serum antibody response is not often diminished. On the other hand, if fever or symptoms suggest a moderate or severe illness, it is usually appropriate to withhold vaccination until the patient has recovered. In addition to the potential risks already mentioned, evolving signs and symptoms of the illness can sometimes confound the diagnosis of a vaccine reaction if it develops. In the presence of any infection, the decision to administer or withhold/defer immunization should take into consideration the benefits versus the risks to an individual patient.