LETTERS * CORRESPONDANCE
We will consider for publication only letters submitted in duplicate, printed in letterquality type without proportional spacing and not exceeding 450 words. All the authors must sign a covering letter transferring copyright. Letters must not duplicate material being submitted elsewhere or already published. We routinely correspond only with authors of accepted letters. Rejected letters are destroyed. Accepted letters are subject to editing and abridgement.
Seules peuvent etre retenues pour publications les lettres recues en double dont la longueur n'exc.de pas 450 mots. Elles doivent etre mecanographiees en qualite "correspondance" sans espacement proportionnel. Tous les auteurs doivent signer une lettre d'accompagnement portant cession du copyright. Les lettres ne doivent rien contenir qui ait ete prdsente ailleurs pour publication ou deija paru. En principe, la redaction correspond uniquement avec les auteurs des lettres retenues pour publication. Les lettres refusees sont detruites. Les lettres retenues peuvent etre abregees ou faire l'objet de modifications d'ordre redactionnel.
Well-baby care and oral polio vaccine T he vaccination schedule recommended for oral polio vaccine (OPV) in the article "Periodic health examination, 1990 update: 4. Well-baby care in the first 2 years of life" (Can Med Assoc J 1990; 143: 867872), by the Canadian Task Force on the Periodic Health Examination, conflicts with the recommen-
dations of the National Advisory Committee on Immunization (NACI),' the Canadian Paediatric Society and all provincial/territorial governments. Remarkably, in this diverse country, all of these groups recommend that if OPV is to be the vaccine used for primary immunization against poliomyelitis three doses of it should be given at ages 2, 4 and 18 months. -
For prescribing information see page 1070
We are pleased that the task force chose to follow conventional wisdom2 and recommend only three doses of OPV in the first 2 years of life. We find it disconcerting, however, that the task force would recommend something other than the immunization schedule used across the entire country without either noting the departure or giving a reference to a recognized scientific study supporting it. Granted, the standard schedule of 2, 4 and 18 months has not been proven to be superior to the one recommended by the task force in any trial reported in the literature. There are, however, good theoretical arguments in its favour. The benefit of deferring the third dose until the immune system matures likely outweighs the minute risk of exposure and disease during the deferral period in Canada, where wild poliovirus is not believed to circulate. (Children who are more likely to be exposed or who may not return for their 18-month visit might benefit from the abbreviated schedule recommended by the task force.) In addition, the standard schedule has the clear advantage of high acceptance in practice across this country. Muddying the water with conflicting recommendations benefits no one. We hope the task force will alter its recommendations to bring them into step with standard Canadian practice. Anne 0. Carter, MD, MHSc, FRCPC
Secretary National Advisory Committee on Immunization Noni E. MacDonald, MD, FRCPC Chairman Infectious Diseases and Immunization Committee Canadian Paediatric Society
References 1. National Advisory Committee on Immunization: Canadian Immunization Guide, 3rd ed (cat no H49-8/1989E), Dept of National Health and Welfare, Ottawa, 1989
2. Givner LB, Anderson DC: Active immunizing agents recommended for routine administration. In Feigin RD, Cherry JD (eds): Textbook of Pediatric Infectious Diseases, 2nd ed, vol II, Saunders, Philadelphia, 1987: 22652275
[The article's principal author and another member of the Canadian Task Force on the Periodic Health Examination respond for the task
force.] The 1979 recommendation of the Canadian Task Force on the Periodic Health Examination to give OPV at 2, 4 and 6 months of age was based on the evidence available at that- time; namely, that OPV given at those ages throughout most of the developed world had virtually eradicated poli-
omyelitis. As Drs. Carter and MacDonald acknowledge, there has been no new evidence to support the change to immunizing at 2, 4 and 18 months. Nevertheless, since these ages have been recommended and since there is no evidence that the new schedule produces less acceptable immunity than the original one we see no reason not to support the change. William Feldman, MD, FRCPC Professor of pediatrics and of epidemiology and community medicine University of Ottawa Ottawa, Ont. Elaine Wang, MD, FRCPC Assistant professor of pediatrics University of Toronto Toronto, Ont. CAN MED ASSOCJ 1991; 144(8)
953
We will consider for publication only letters submitted in duplicate, printed in letterquality type without proportional spacing and not exceeding 450 words. All the authors must sign a covering letter transferring copyright. Letters must not duplicate material being submitted elsewhere or already published. We routinely correspond only with authors of accepted letters. Rejected letters are destroyed. Accepted letters are subject to editing and abridgement.
Seules peuvent etre retenues pour publications les lettres recues en double dont la longueur n'exc.de pas 450 mots. Elles doivent etre mecanographiees en qualite "correspondance" sans espacement proportionnel. Tous les auteurs doivent signer une lettre d'accompagnement portant cession du copyright. Les lettres ne doivent rien contenir qui ait ete prdsente ailleurs pour publication ou deija paru. En principe, la redaction correspond uniquement avec les auteurs des lettres retenues pour publication. Les lettres refusees sont detruites. Les lettres retenues peuvent etre abregees ou faire l'objet de modifications d'ordre redactionnel.
Well-baby care and oral polio vaccine T he vaccination schedule recommended for oral polio vaccine (OPV) in the article "Periodic health examination, 1990 update: 4. Well-baby care in the first 2 years of life" (Can Med Assoc J 1990; 143: 867872), by the Canadian Task Force on the Periodic Health Examination, conflicts with the recommen-
dations of the National Advisory Committee on Immunization (NACI),' the Canadian Paediatric Society and all provincial/territorial governments. Remarkably, in this diverse country, all of these groups recommend that if OPV is to be the vaccine used for primary immunization against poliomyelitis three doses of it should be given at ages 2, 4 and 18 months. -
For prescribing information see page 1070
We are pleased that the task force chose to follow conventional wisdom2 and recommend only three doses of OPV in the first 2 years of life. We find it disconcerting, however, that the task force would recommend something other than the immunization schedule used across the entire country without either noting the departure or giving a reference to a recognized scientific study supporting it. Granted, the standard schedule of 2, 4 and 18 months has not been proven to be superior to the one recommended by the task force in any trial reported in the literature. There are, however, good theoretical arguments in its favour. The benefit of deferring the third dose until the immune system matures likely outweighs the minute risk of exposure and disease during the deferral period in Canada, where wild poliovirus is not believed to circulate. (Children who are more likely to be exposed or who may not return for their 18-month visit might benefit from the abbreviated schedule recommended by the task force.) In addition, the standard schedule has the clear advantage of high acceptance in practice across this country. Muddying the water with conflicting recommendations benefits no one. We hope the task force will alter its recommendations to bring them into step with standard Canadian practice. Anne 0. Carter, MD, MHSc, FRCPC
Secretary National Advisory Committee on Immunization Noni E. MacDonald, MD, FRCPC Chairman Infectious Diseases and Immunization Committee Canadian Paediatric Society
References 1. National Advisory Committee on Immunization: Canadian Immunization Guide, 3rd ed (cat no H49-8/1989E), Dept of National Health and Welfare, Ottawa, 1989
2. Givner LB, Anderson DC: Active immunizing agents recommended for routine administration. In Feigin RD, Cherry JD (eds): Textbook of Pediatric Infectious Diseases, 2nd ed, vol II, Saunders, Philadelphia, 1987: 22652275
[The article's principal author and another member of the Canadian Task Force on the Periodic Health Examination respond for the task
force.] The 1979 recommendation of the Canadian Task Force on the Periodic Health Examination to give OPV at 2, 4 and 6 months of age was based on the evidence available at that- time; namely, that OPV given at those ages throughout most of the developed world had virtually eradicated poli-
omyelitis. As Drs. Carter and MacDonald acknowledge, there has been no new evidence to support the change to immunizing at 2, 4 and 18 months. Nevertheless, since these ages have been recommended and since there is no evidence that the new schedule produces less acceptable immunity than the original one we see no reason not to support the change. William Feldman, MD, FRCPC Professor of pediatrics and of epidemiology and community medicine University of Ottawa Ottawa, Ont. Elaine Wang, MD, FRCPC Assistant professor of pediatrics University of Toronto Toronto, Ont. CAN MED ASSOCJ 1991; 144(8)
953
