Vaccine-associated paralytic poliomyelitis: a review of the epidemiology and estimation of the global burden

J Infect Dis. 2014 Nov 1;210 Suppl 1(Suppl 1):S380-9. doi: 10.1093/infdis/jiu184.


Background: Vaccine-associated paralytic poliomyelitis (VAPP) is a rare adverse event associated with oral poliovirus vaccine (OPV). This review summarizes the epidemiology and provides a global burden estimate.

Methods: A literature review was conducted to abstract the epidemiology and calculate the risk of VAPP. A bootstrap method was applied to calculate global VAPP burden estimates.

Results: Trends in VAPP epidemiology varied by country income level. In the low-income country, the majority of cases occurred in individuals who had received >3 doses of OPV (63%), whereas in middle and high-income countries, most cases occurred in recipients after their first OPV dose or unvaccinated contacts (81%). Using all risk estimates, VAPP risk was 4.7 cases per million births (range, 2.4-9.7), leading to a global annual burden estimate of 498 cases (range, 255-1018). If the analysis is limited to estimates from countries that currently use OPV, the VAPP risk is 3.8 cases per million births (range, 2.9-4.7) and a burden of 399 cases (range, 306-490).

Conclusions: Because many high-income countries have replaced OPV with inactivated poliovirus vaccine, the VAPP burden is concentrated in lower-income countries. The planned universal introduction of inactivated poliovirus vaccine is likely to substantially decrease the global VAPP burden by 80%-90%.

Keywords: OPV cessation; OPV withdrawal; inactivated poliovirus vaccine (IPV); oral poliovirus vaccine (OPV); polio endgame; polio eradication; poliomyelitis; vaccine-associated paralytic poliomyelitis (VAPP).

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Developed Countries
  • Developing Countries
  • Female
  • Global Health
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Poliomyelitis / epidemiology*
  • Poliovirus Vaccines / administration & dosage*
  • Poliovirus Vaccines / adverse effects*
  • Prevalence
  • Risk Assessment
  • Young Adult


  • Poliovirus Vaccines