Accelerated Immunodeficiency-associated Vaccine-derived Poliovirus Serotype 3 Sequence Evolution Rate in an 11-week-old Boy With X-linked Agammaglobulinemia and Perinatal Human Immunodeficiency Virus Exposure

Abstract

Primary B-cell immunodeficiencies are risk factors for the generation of vaccine-derived polioviruses. We report immunodeficiency-associated vaccine-derived poliovirus serotype 3 in an 11-week-old boy with X-linked agammaglobulinemia. Unique characteristics of this case include early age of presentation, high viral evolutionary rate, and the child’s perinatal exposure to human immunodeficiency virus.

Stem Cell Transplant in Immune-deficiency–associated Vaccine-derived Poliovirus

“…Over the past 15 years, there have been 3 reported cases of iVDPV in South Africa, all of which were attributed to serotype 3. One patient in Johannesburg was diagnosed in 2018 with major histocompatibility complex class 2 deficiency, whereas the other 2 were diagnosed with X-linked agammaglobulinemia syndrome in Johannesburg (2011) and Cape Town (2018) [ 19 , 20 ]. South Africa is 1 of few OPV-using countries with good laboratory facilities to diagnose immune deficiency, at least in urban centers [ 21 ].…”

“…Treatment options for iVDPV patients include increased doses of intravenous immunoglobulin, hematopoietic stem cell transplant, and/or experimental antiviral drugs such as pocapavir. With regard to the South African reported cases, the patients were treated with high-dose intravenous immunoglobulins and pocapavir, respectively [ 19 , 20 ].…”