July 1997
DETROIT — Providers and parents have generally accepted the change in the polio vaccine schedule, and IPV use continues to increase, said the Centers for Disease Control and Prevention (CDC).
After the schedule change last October, the CDC launched a campaign to educate the public about the new polio vaccination schedule and the polio eradication plan. This campaign proved useful and will continue to increase the adherence to the new sequential schedule, based on preliminary surveillance data presented at the 31st Annual National Immunization Conference held here.
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North Carolina immediately began implementing the new schedule, said Barbara Laymon, assistant section chief of immunization and child health, North Carolina Department of Health, Environment and Natural Resources.
"We gave them a simple approach and told them their options. I feel they embraced the whole idea of two and two," said Laymon, who manages state vaccine purchases, handling and distribution. "In the end, our physician groups felt very positive about it. I felt like it was because we didn't force them to. We gave them the option."
However, North Carolina had fewer options than most states because it is illegal there to administer four doses of IPV unless under unusual circumstances.
The increase in amount of IPV ordered by physicians is an indicator that the provider community and parental community have accepted the use of the sequential schedule, Laymon said. Ordering patterns for IPV experienced a seventeenfold increase between September 1996 and April 1997.
California also had success implementing the new schedule, according to James Watt, MD, MPH, California Department of Health Services immunization branch.
The Department of Health Services provided information to other health departments and the private sector Vaccines for Children (VFC) providers about the new recommended schedule, then conducted a survey of 61 local health jurisdictions in California; 54 responded. The majority of jurisdictions (33) chose to use a combination of schedules while 20 chose the sequential schedule; there has been a public sector increase in use of IPV, Watt said.
"The majority decided they would use a combination of schedules depending on parental choice," Watt said. "After talking with a number of local health departments ... They haven't made up their minds yet."
Despite concern over additional injections associated with the sequential schedule, an inner-city study conducted in a Philadelphia pediatric clinic shows parents are comfortable with the extra shots because of the smaller risk of Vaccine Associated Paralytic Polio (VAPP), according to Shoshana Melman, MD, director ambulatory medicine, St. Christopher's Hospital, Philadelphia.
The study sought to determine the willingness of parents and caretakers to allow multiple simultaneous immunization injections for their children, said Melman, regional education coordinator for immunizations.
Of the 876 patients enrolled, 855 (97.6%) received all injectable immunizations due. Of the 372 due for two injections, 98.7% received both; of 332 due for three injections, 98.2% received all three; of the 149 children due for four injections, 95.3% received all four; and of the 23 due for five injections, 87% received all five shots.
Preliminary results from a study conducted in eight public health clinics in two counties in Georgia produced similar results, according to Shalini Desai, MD, epidemiologist with the clinic analysis group, currently assigned to the CDC to work on the implementation and analysis of the Georgia Demonstration Project. The three-component study included provider focus groups, parental surveys and a cohort analysis study.
Most members of provider groups had difficulty identifying body sites for additional injection and prefer to give shots rather than risk VAPP from OPV. Desai also said most pediatricians preferred OPV over not vaccinating and risking disease.
The cohort analysis showed extra injections were not a barrier to high rates of IPV as first dose; nearly two-third of enrolled infants received IPV as the first dose. Acceptance of IPV as the first dose did not vary by race/ethnic groups, Desai said.
Although the new schedule has been generally accepted, vaccine ordering data from the CDC shows variance in the degree of acceptance between the states, said John Stevenson, MA, mathematical statistician with National Immunization Program. The VACMAN ordering system handles orders only for the VFC program, but Stevenson said it is a good representation of statewide ordering patterns.
The conclusion of the VACMAN data shows the new recommendation is being accepted, but there is considerable variation between the states. This variation, he said, can be used to help the program.
"We can use that variation to adapt the program," Stevenson said.
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