First case of vaccine derived poliovirus isolated from a patient with a primary immune deficiency in Sri Lanka

Abstract

Persons with primary immune deficiency disorders (PIDD) exposed to oral polio vaccine (OPV)) are at increased risk of vaccine-associated paralytic poliomyelitis (VAPP) 1, 2 and prolonged excretion of vaccine-derived polioviruses (VDPVs). 3 VDPV types 1 and 3 are identified by a genetic divergence of at least 1% in the VP 1 region from the corresponding parent Sabin strains. 4 With VDPV type 2, divergence is at least 0.6%. Circulating VDPV (cVDPV) develop in under immunized populations by chains of virus infections initiated from OPV vaccinated individuals to unimmunized children. Outbreaks of cVDPV have been reported in a few countries. 5 Another potential source of VDPV is a person with PID who excretes vaccine-derived polioviruses (iVDPVs). These viruses may occasionally cause paralytic disease in the patient with PID, but have not been reported to cause outbreaks of paralysis in immunologically normal people. 6 We report the first isolate of iVDPV in Sri Lanka from a child with severe combined immune deficiency (SCID).