Intramuscular injections within 30 days of immunization with oral poliovirus vaccine--a risk factor for vaccine-associated paralytic poliomyelitis. 1995, Strebel, N Engl J Med

Between 1970 and 1984, Romania participated in the safety trials of an oral vaccine sponsored by the WHO. It turned out, that, for unexplained reasons, the incidence of the vaccine-associated paralytic poliomyelitis (VAPP) is 5-17 higher in Romania than in other countries. It was first believed that the vaccine in Romania was too virulent, but replacing it with a different vaccine did not change the VAPP incidence. It turned out that 87% of paralyzed children received intramuscular injections 30 days before the onset of paralysis (17 injections on average), as compared to 51% of non-paralyzed children (3 injections on average). Each injection increased the risk of paralysis by 13%. Paralysis was observed 8 times more often in those who received one injection, and 182 times more often in those who received over 10 injections. Overall, 86% of VAPP cases were caused by injections.

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