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Poliomyelitis  is  a  highly  contagious, seasonal viral disease caused by any of three poliovirus (PV)  serotypes  (types  1,  2,  or  3).  Oral  poliovirus vaccine  (OPV)  on  rare  occasions  causes  vaccineassociated  paralytic  poliomyelitis  (VAPP)  in  recipients of  OPV  and  close  contacts  of  recently  vaccinated individuals.  This  study  describes  the  epidemiology  of VAPP  when  an  all  OPV  schedule  was  used  in  the Expanded Program on Immunization (EPI). Methods:  VAPP  cases  were  identified  using standardized  diagnostic  criteria  from data  reported  by 8  provincial-level  administrative  divisions  (PLADs)  to the National Acute Flaccid Paralysis (AFP) Surveillance System in an 18-month period between October 2012 and March 2014. Results:  During  this  period,  28  VAPP  cases  were reported.  Using  the  number  of  births  as  a denominator,  the  estimated  incidence  of  VAPP  was 2.47  cases  per  million  births.  Using  the  number  of OPV  doses  administered  through  routine immunization, the VAPP incidence was 0.55 cases per million  doses.  Among  vaccine-recipient  VAPP  cases, 22 (85%) were associated with the first dose of OPV; 3 were  associated  with  the  second  OPV  dose.  The relative risk of VAPP following the first dose compared with the second dose was 7.07. Conclusions  and  Implications  for  Public  Health Practice:  The  per-dose  and  per-child  incidences  of VAPP were consistent with incidence estimates by the World  Health  Organization  (WHO).  The  vast majority (85%) of VAPP in China was associated with the first dose of OPV in an all-OPV schedule. Because inactivated  polio  vaccine  (IPV)  is  known  to  prevent VAPP  from  subsequent  doses  of  OPV  in immunocompetent  children,  this  association  provided strong evidence for using an IPV-first, sequential IPVOPV  polio  vaccination  schedule  in  China  during  the globally-synchronized  cessation  of  type  2  OPV  and introduction of IPV in 2016.

Vaccine-Associated Paralytic Poliomyelitis — 8 PLADs, China, October 2012–March 2014