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Of the 31 children with vaccine-associated disease,27(87 percent)had received one or more intramuscular injections within 30 days before the onset of paralysis,as compared with 77 of the 151 controls(51 percent) (matched odds ratio,31.2;95 percent confidence interval,4.0 to 244.2). Nearly all the intramuscular injections were antibiotics,and the association was strongest for the patients who received 10 or more injections(matched odds ratio for>/=10 injections as compared with no injections,182.1;95 percent confidence interval,15.2 to 2186.4).The risk of paralytic disease was strongly associated with injections given after the oral poliovirus vaccine,but not with injections given before or at the same time as the vaccine(matched odds ratio,56.7;95 percent confidence interval,8.9 to infinity).The attributable risk in the population for intramuscular injections given in the 30 days before the onset of paralysis was 86 percent(95 percent confidence interval,66 to 95 percent); that is,we estimate that 86 percent of the cases of vaccine-associated paralytic poliomyelitis in this population might have been prevented by the elimination of intramuscular injections within 30 days after exposure to oral poliovirus vaccine.Provocation paralysis,previously described only for wild-type poliovirus infection,may rarely occur in a child who receives multiple intramuscular injections shortly after exposure to oral poliovirus vaccine,either as a vaccine recipient or through contact with a recent recipient.This phenomenon may explain the high rate of vaccine- associated paralytic poliomyelitis in Rumania,where the use of intramuscular injections of antibiotics in infants with febrile illness is common. |
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immunization,neurologic complications with
injection,intramuscular
poliomyelitis
poliomyelitis vaccine
poliomyelitis,provocation
risk factors
vaccination,neurologic complications with
vaccine
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