Page (4) For the most recent data concerning children of 2 years of age, the percentage of vaccinated saliva, due to the vaccination campaign followed in the USA, but remained well below 90-95%: in any case, even in years more recent polio outbreaks have not occurred in the US. Basically, despite being (from 1980 to 1985) the vaccination coverage of about 30% lower than the value considered essential to prevent epidemics, these did not occur. Even in the most vulnerable age group (small children) the coverage was about 40% lower than the 95% target. This indicates that in countries similar to ours, at least in recent years the almost disappearance of polio cases is not due to vaccination, but to other causes (of which, strangely, it is never mentioned). Let us now ask ourselves what may have been due to the cases that have occurred in the US in recent years. Taking an average of the 9 surveys mentioned above, 8.22 cases are obtained per year in the USA from 1980 to 1990; Now, in a recent report it states: "since 1980, an average of eight to nine cases of paralytic poliomyelitis associated with OPV has been reported annually in the United States. Vaccine-associated paralytic poliomyelitis (VAPP) has been the only indigenous form of the disease in the United States since 1979. (unreported) cases of VAPP probably occur. "(1) (since 1980, an average of 8 \ 9 cases of paralytic poliomyelitis associated with the OPV The paralytic poliomyelitis associated with the vaccine (VAPP) has been the only type of polio in the USA not imported from abroad since 1979. There are probably other cases of VAPP that are not reported , ndt). So, in recent years, in the US, all cases of indigenous polio (not imported from abroad) were directly caused by the OPV vaccine. But since, as we can deduce from the above data, there is a perfect coincidence between the total data of polio (8.22 the average year) and those caused by the vaccine, we can certainly say that almost all Polio cases in the US since 1980 have been caused by the vaccine. It can therefore be concluded that: A) in the USA, the decline in polio cases was not substantially due to the vaccine B) with regard to the few cases of polio that have occurred, these have been caused almost entirely by the vaccine itself. In Italy, since the vaccination coverage is 98%, it is not possible to know whether the drop in polio cases is due to the vaccine or to extra-vaccinal factors, as the case of the USA suggests; in any case, since the two situations are comparable, it seems at least improbable that the decline was due essentially to the vaccine alone. In the Netherlands, there was a polio epidemic in unvaccinated subjects. In 1992 there were 68 cases in the Netherlands (in unvaccinated subjects) in a religious community of Orthodox Protestants. But in 1988 there were 15 cases in Israel in vaccinated subjects, and in Oman in 1988-89 there were 43 cases in subjects largely already vaccinated completely, or who had started the vaccination cycle, not completed for reasons of age (2). Thus, the fact of being vaccinated or not does not seem to influence the course of limited epidemics. It is interesting to note that both in the epidemics in the Netherlands and in Israel, again from (2), it is clear that both have occurred in communities with close social contacts and with contact with domestic waste water due to the lack of efficient sewers. Since the transmission route of the polio-virus is fecal-gold, this commonality of situation can explain the double epidemic in both unvaccinated and vaccinated subjects. Bibliography: (1) MMWR Recommendations and Reports --- January 24, 1997 / Vol. 46 / No. RR 3 (2) technical office consultancy filed on 11th February 1995 by Dr. Raffaele Barisani, medical examiner, at the Court of Appeal of Trieste-sez. for minors (3) MMWR september 6,1996 / vol. 45 / No. RR- 12 pag. 09 (4) newsgroup: Archive-name: misc-kids / vaccinations / part1; Posting-Frequency: monthly; Last-Modified: February 11, 1996; Collection maintained by Lynn Gazis-Sax