Recommendations for a national policy on poliomyelitis vaccination.

Declining numbers of adequately vaccinated persons, new data about the comparative safety and effectiveness of live, attenuated and killed poliomyelitis-virus vaccines, increased consumer awareness of adverse reactions and pressure from manufacturers seeking protection from liability were factors leading the Institute of Medicine to re-examine poliomyelitis vaccination programs. The relative merits of live and killed virus vaccines as immunizing agents were reviewed within the context of the 60 to 70 per cent level of poliomyelitis vaccination now reached in the United States. Until about 90 per cent of persons are adequately immunized, the continued use of live-virus vaccines for infants is recommended, with provision that certain categories of persons receive killed-virus vaccine. Vaccination with attenuated live virus of children 11 to 12 years old is suggested to reduce vaccine-associated disease when they become parents of vaccinated infants. Recommendations are made on education, research, liability and informed consent as they pertain to prevention of polyomyelitis.