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Evolving IPV, OPV strategy raises questions: ACIP liaisons offer insights on latest vaccine recommendations

Our practice has decided to initiate the sequential IPV-OPV schedule for infants who are beginning their immunizations. However the recommendations do not address what to give infants who have already received one dose of OPV. Should they receive OPV or, since we are adopting the sequential schedule, IPV for the second dose?

In many circumstances, IPV and OPV are considered interchangeable and, hence either OPV or IPV is acceptable. Because the risk of vaccine-associated paralytic poliomyelitis (VAPP) from OPV is primarily from the first dose, and one dose of OPV already has been given, completion of the schedule with OPV, in this case, is preferred. In addition, a major consideration in the sequential schedule is that at least two doses of OPV are necessary to achieve optimal intestinal immunity.