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AAP restates need for polio vaccination in US, lifts Tdap cautions

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – In two Policy Statements published in the October issue of Pediatrics, the American Academy of Pediatrics reiterates the need for all children in the US to be fully immunized against poliovirus, and amends cautions regarding Tdap vaccination.

The AAP Committee on Infectious Disease explains that previous recommendations cautioned against the use of tetanus toxoid, reduced-content diphtheria toxoid, and acellular pertussis vaccine (Tdap) within a short interval of administration of other tetanus- or diphtheria-containing toxoid products, because of concern about excess reactogenicity.

However, current evidence indicates that there is no safety issue in this regard, so the cautions have been lifted.

The statement also makes new recommendations for the use of Tdap. A single dose is recommended for children age 7-10 years who may have been underimmunized with the diphtheria-tetanus-acellular pertussis (DTaP) vaccine.

In an emailed comment to Reuters, Dr. Peter Richel, chief of pediatrics at Northern Westchester Hospital, New York, noted that the state of New York has recently added the requirement for a booster shot at age 10-11 prior to entering the 6th grade.

“The reason for this,” he explained, “is that antibodies were seen to lessen, resulting in outbreaks in middle schools and high schools in recent years. Pertussis at this age or older can result in many weeks of coughing, with loss of school days or work days.”

Also, the AAP guidance extends the recommendations for vaccination in adults caring for infants and children. It states that individuals 65 years of age and older may be given Tdap if they are likely to be in contact with infants under 12 months of age.

Regarding the Policy Statement on poliovirus, the report stresses the continuing threat of polio importation into the US despite progress in global eradication. There are a few African and Asian countries where wild poliovirus still persists, and there are pockets of underimmunized children in the US who could sustain polio transmission if the virus is introduced.

“Thus, it is essential to ensure high poliovirus immunity levels in US children to prevent outbreaks should poliovirus be imported into this country,” the authors state.

The schedule for polio immunization is unchanged, the report continues. That is, four doses of inactivated poliovirus vaccine (IPV) should be given at 2, 4, and 6 through 18 months and 4 through 6 years of age.

When the threat of exposure is imminent, dosing at the minimum recommended age and intervals is advised. Specifically, the minimum age for dose 1 is 6 weeks, while the minimum interval between doses 1 and 2 and between doses 2 and 3 is 4 weeks, and the minimum interval between doses 3 and 4 is 6 months.

The statement notes that three combination vaccines containing IPV have been licensed, and it gives guidance on the optimal use of such combinations.

Pediatrics 2011;128:805-812.