Poliovirus Vaccine Policy

Sir .—I have several comments on the discussion of polio immunization policy for children presented by Marcuse 1 and Katz 2 in the September 1989 issue of AJDC . In the past, the real risk of oral polio virus vaccine (OPV)–related polio has probably been closer to 1 case per 100000 persons immunized. The state of Washington had about 1 case annually for many years. The rate may be lower nationally, but that is most likely a problem of lack of recognition and/or reporting. Additionally, OPV can cause nonparalytic illness, which usually goes unrecognized unless the vaccine virus is picked up inadvertently when spinal fluid is cultured and the patient is then asked about possible OPV exposures (Bruce G. Weniger, MD, MPH; David Remis, MD; Mark Heerema, MD; et al, unpublished case, October 1982). Perhaps the type III component in vaccine is now less apt to revert to neurotoxicity, but can