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Vaccine. 2019 Jan 29;37(5):751-754. doi: 10.1016/j.vaccine.2018.12.022. Epub 2019 Jan 7.

First case in China of vaccine-associated poliomyelitis after sequential Inactivated and bivalent oral polio vaccination.

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Shanghai University of Medicine and Health Sciences, China; Beijing Yi'an Research Center for Health and Immunization, China.
School of Social Development and Public Policy, Beijing Normal University, China.
School of Social Development and Public Policy, Beijing Normal University, China. Electronic address:


A 16 week newborn vaccinated with bOPV 4 weeks after his first routine IPV vaccination. Nineteen days later, asymmetrical paralysis was developed on his legs, and it was diagnosed to be VAPP. Perianal abscess is suspected to be a risk factor based on some limited results of retrospective studies in China. This is a risk factor similar to the multiple intramuscular injections found by researchers in last century. The two risk factors remind us that, apart from the routine infection route of the fecal to mouth and intestinal tract, skin injury (ulceration) exposure pathway should not be ignored as another possible way of causing polio, for the local injury and lesions of the skin may increase the possibility of oral poliovirus vaccine's entry into the body. As a result, to further reduce the incidence of VAPP, bOPV should be avoided for perianal abscess. If there is perianal abscess, skin injury, or if injection is unavoidable after bOPV vaccination of an infant, much attention should be paid to the treatment and cleaning of infant feces.


IPV-bOPV sequential vaccination; Perianal abscess; Vaccine associated poliomyelitis (VAPP)

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