Prevalence of prolonged and chronic poliovirus excretion among persons with primary immune deficiency disorders in Sri Lanka

Silva, Rajiva de; Gunasena, Sunethra; Ratnayake, D; Wickremesinghe, G; Kumarasiri, C D; Pushpakumara, B.A.W.; Deshpande, Jagadish M.; Kahn, Anna-Léa; Sutter, Roland W.

doi:10.1016/j.vaccine.2012.10.035

Cited by 31 publications

(29 citation statements)

References 20 publications

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“…However, this reflects the source of our data (published literature) as many iVDPV shed OPV asymptomatically [32,33,35]. The majority of our cases occurred in patients with immunodeficiencies classified as predominantly antibody deficiencies, which is likely due in part to the differential prevalence of combined immunodeficiencies and predominantly antibody deficiencies.…”

Section: Discussionmentioning

confidence: 80%

“…Implementation of intensified surveillance for VDPVs and special studies of iVDPV excretion among patients with PIDs in developing and middle-income countries began in the mid-2000s, and the results of these efforts as presented in this study are apparent [12,32,34,35]. In other words, countries that have the means to perform VDPV sequencing—either through their own resources or from support provided by others—and the healthcare services to properly diagnosis immune disorders are overrepresented.…”

Section: Discussionmentioning

confidence: 97%

“…Hence, strengthening polio surveillance programs to identify iVDPVs is critical in the post-eradication era, particularly given the suspected iVDPV cases identified in some studies [68–71]. Previous studies launched to identify iVDPVs have demonstrated the practicality of these surveillance programs [34,35,72], and a multinational surveillance study led by the Jeffrey Modell Foundation is currently underway [73]. …”

Section: Discussionmentioning

confidence: 99%

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Immunodeficiency-related vaccine-derived poliovirus (iVDPV) cases: A systematic review and implications for polio eradication

Guo

Bolivar-Wagers

Srinivas

et al. 2015

Vaccine

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Background Vaccine-derived polioviruses (VDPVs), strains of poliovirus mutated from the oral polio vaccine, pose a challenge to global polio eradication. Immunodeficiency-related vaccine-derived polioviruses (iVDPVs) are a type of VDPV which may serve as sources of poliovirus reintroduction after the eradication of wild-type poliovirus. This review is a comprehensive update of confirmed iVDPV cases published in the scientific literature from 1962 to 2012, and describes clinically relevant trends in reported iVDPV cases worldwide. Methods We conducted a systematic review of published iVDPV case reports from January 1960 to November 2012 from four databases. We included cases in which the patient had a primary immunodeficiency, and the vaccine virus isolated from the patient either met the sequencing definition of VDPV (>1% divergence for serotypes 1 and 3 and >0.6% for serotype 2) and/or was previously reported as an iVDPV by the World Health Organization. Results We identified 68 iVDPV cases in 49 manuscripts reported from 25 countries and the Palestinian territories. 62% of case patients were male, 78% presented clinically with acute flaccid paralysis, and 65% were iVDPV2. 57% of cases occurred in patients with predominantly antibody immunodeficiencies, and the overall all-cause mortality rate was greater than 60%. The median age at case detection was 1.4 years [IQR: 0.8, 4.5] and the median duration of shedding was 1.3 years [IQR: 0.7, 2.2]. We identified a poliovirus genome VP1 region mutation rate of 0.72% per year and a higher median percent divergence for iVDPV1 cases. More cases were reported from high income countries, which also had a larger age variation and different distribution of immunodeficiencies compared to upper and lower middle-income countries. Conclusion Our study describes the incidence and characteristics of global iVDPV cases reported in the literature in the past five decades. It also highlights the regional and economic disparities of reported iVDPV cases.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Immunodeficiency-related vaccine-derived poliovirus (iVDPV) cases: A systematic review and implications for polio eradication

Guo

Bolivar-Wagers

Srinivas

et al. 2015

Vaccine

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“…However, patients with common variable immune deficiency may excrete a mutated, potentially dangerous vaccine derived polio virus (iVDPV) for long periods, as was seen with one patient with CVID within the present cohort. This mutated virus may pose a threat to the community as well [39]. …”

Section: Discussionmentioning

confidence: 99%

Spectrum of primary immunodeficiency disorders in Sri Lanka

Silva

Gunawardena

Rathnayake

et al. 2013

All Asth Clin Immun

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BackgroundWhile primary immunodeficiencies (PID has been recognized in the west for decades, recognition has been delayed in the third world. This study attempts to detail the spectrum of PID, the therapy provided, and constraints in the diagnosis and treatment in a middle income country such as Sri Lanka.MethodsNine hundred and forty two patients with recurrent infections and features suggestive of immune deficiency, referred from the entire country in a 4 year period, to the sole immunology unit in Sri Lanka were included. The following tests were performed. Full blood counts, serum Immunoglobulin and complement C3 and C4 levels, functional antibody levels, enumeration of lymphocyte subsets, in vitro and in vivo T cell functional assays,, nitroblue tetrazolium assay to diagnose chronic granulomatous disease, hair shaft assay to diagnose Griscelli syndrome. Sequencing of the common gamma chain to identify x linked severe combined immune deficiency, and X linked agammaglobulinemia was confirmed by assaying for Btk mutations by single sequence conformation polymorphism. HIV/AIDS was excluded in all patients.ResultsSeventy three patients were diagnosed with a primary immune deficiency. The majority (60.27%) had antibody deficiency. Common variable immune deficiency was the commonest (28.76%), followed by X linked agammaglobulinemia (XLA) (20.54%). Five patients had possible hyper IgM syndrome.Ten patients had severe combined immune deficiency (SCID), including 2 with x linked SCID, in addition to DiGeorge syndrome (2), ataxia telangiectasia (6), autosomal dominant hyper IgE syndrome (2), chronic granulomatous disease (4), leucocyte adhesion deficiency type 1 (2) and Griscelli syndrome (3).Patients with autoinflammatory, innate immune and complement defects could not be identified due to lack of facilities.ConclusionsAntibody deficiency is the commonest PID, as in the west.IgA deficiency is rare. Autoinflammatory diseases, innate immune and complement deficiencies could not be identified due to lack of diagnostic facilities. Lack of awareness of PID among adult physicians result in delay in treatment of adult patients. While treatment of antibody deficiencies provided in state hospitals has extended life expectancy, there is no treatment available for severe T cell defects.

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“…Subsequent introduction of two highly effective vaccines prevented passive immunotherapy from being widely used. Since most known chronic poliovirus carriers have defects in production of antibodies 22, 23 , they are sustained by regular injections of intravenous immunoglobulin (IVIG), which may be insufficient to clear poliovirus infection. Monoclonal antibodies can be produced and administered in significantly higher quantities and increase the neutralizing antibody titer to levels unattainable through vaccination, and which could potentially clear chronic poliovirus infection.…”

Section: Discussionmentioning

confidence: 99%

A single chimpanzee-human neutralizing monoclonal antibody provides post-exposure protection against type 1 and type 2 polioviruses

Kouiavskaia¹,

Chen

Dragunsky³

et al. 2015

Journal of Clinical Virology

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Background Development of anti-poliovirus therapies to complement vaccination is an urgent priority. A number of antiviral drugs are in development. Recently we have developed human monoclonal antibodies that could be used for treatment of chronically infected individuals and emergency response to potential reappearance of polioviruses after eradciation. Objective The aim of this study was to characterize neutralizing activity of anti-poliovirus monoclonal antibody A12 against wild type, vaccine-derived, and drug-resistant poliovirus strains, evaluate in vivo pre-and post-exposure protective properties of the antibody against polioviruses of serotypes 1 and 2, and to determine whether it interferes with response to immunization with poliovirus vaccine. Study Design Immunogenicity studies were performed in CD1 mice. Poliovirus neutralizing titers were determined in poliovirus microneutralization assay. Poliovirus immunization-challenge experiments were performed in poliovirus-susceptible TgPVR21 mice. Results We show that monoclonal antibody A12 effectively neutralizes in vitro a broad range of Type 1 and Type 2 wild and vaccine-derived polioviruses, provides effective pre- and post-exposure protection of TgPVR21 mice from challenge with a lethal dose of poliovirus. Treatment of animals with the antibody concurrent with IPV immunization does not prevent immune response to the vaccine. Conclusions Anti-poliovirus antibody A12 effectively neutralizes a range of wild and VDPV strains and protects transgenic mice susceptible to poliovirus against lethal challenge upon pre- and post-exposure administration. This suggests that the antibodies could be used in combination with drugs and/or vaccine to improve their efficacy and prevent emergence of resistant variants, and provides a justification for initiating their clinical evaluation.

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Prevalence of prolonged and chronic poliovirus excretion among persons with primary immune deficiency disorders in Sri Lanka

Cited by 31 publications

References 20 publications

Immunodeficiency-related vaccine-derived poliovirus (iVDPV) cases: A systematic review and implications for polio eradication

Immunodeficiency-related vaccine-derived poliovirus (iVDPV) cases: A systematic review and implications for polio eradication

Spectrum of primary immunodeficiency disorders in Sri Lanka

A single chimpanzee-human neutralizing monoclonal antibody provides post-exposure protection against type 1 and type 2 polioviruses

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