Vaccine-associated paralytic poliomyelitis in a patient with MHC class II deficiency

Parvaneh, Nima; Shahmahmoudi, Shohreh; Tabatabai, Hamideh; Zahraei, Seyed Mohsen; Mousavi, Taha; Esteghamati, A.; Gooya, Mohammad Mehdi; Mamishi, Setareh; Nategh, R; Kew, Olen M.

doi:10.1016/j.jcv.2007.04.002

Cited by 26 publications

(18 citation statements)

References 10 publications

(14 reference statements)

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“…This combined immunodeficiency is also diagnosed in a majority (6 out of 11) of the enterovirus-positive patients identified in this series, corresponding to 54% of cases. Three out of the six patients were poliovirus infected; this finding is particularly important since vaccine-associated paralytic poliomyelitis (VAPP) has been found in MHC class II-deficient patients (24). MHC class II deficiency is characterized by the absence of antigen presentation to T cells by MHC class II-negative antigen-presenting cells (APCs) and, as a consequence, an absence of T cell responses and help to B cells with low antibody production.…”

Section: Discussionmentioning

confidence: 99%

High Susceptibility for Enterovirus Infection and Virus Excretion Features in Tunisian Patients with Primary Immunodeficiencies

Driss

Ben‐Mustapha

Mellouli

et al. 2012

Clin. Vaccine Immunol.

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To estimate the susceptibility to enterovirus infection and the frequency of long-term poliovirus excreters in Tunisian patients with primary immunodeficiencies (PIDs), enteroviruses were assessed in stool specimens of 82 patients with humoral, combined, and other PIDs. Isolated viruses were typed and intratyped by standard molecular techniques, and the whole VP1 region of poliovirus isolates was sequenced. Polioviruses were detected in 6 patients; all isolates were vaccine related. Five patients rapidly stopped excretion; one excreted a poliovirus type 1 isolate for several months, and the isolate accumulated up to 14 mutations in the VP1 region. Nonpolio enteroviruses were identified in 6 patients; 4 of them kept excreting the same strain for more than 6 months. The rate of enterovirus infection was 13.4% of the PID patients and 20.7% of those with an IgG defect; it greatly exceeded the rates generally found in Tunisian supposed-immunocompetent individuals (4.1% during the study period; P ‫؍‬ 0.001 and P < 0.0001, respectively). Interestingly, patients with combined immunodeficiencies were at a higher risk for enterovirus infection than those with an exclusively B cell defect. A major histocompatibility complex (MHC) class II antigen expression defect was found in 54% of enterovirus-positive patients and in the unique long-term poliovirus excreter. The study results also suggest that substitutive immunoglobulin therapy may help clearance of a poliovirus infection and that most PID patients have the ability to stop poliovirus excretion within a limited period. However, the high susceptibility of these patients to enterovirus infection reinforces the need for enhanced surveillance of these patients until the use of oral poliovirus vaccine (OPV) is stopped.

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Section: Discussionmentioning

confidence: 99%

High Susceptibility for Enterovirus Infection and Virus Excretion Features in Tunisian Patients with Primary Immunodeficiencies

Driss

Ben‐Mustapha

Mellouli

et al. 2012

Clin. Vaccine Immunol.

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“…Covering 100% of infants younger than 1 year of age by OPV, viral-induced poliomyelitis is close to eradication in Iran. Reports of VAPP cases in immunodeficient patients bring about concern regarding the endgame strategies of polio eradication in Iran [7]. As OPV is administered at birth when most primary immunodeficien- Immunodeficient recipients of OPV are potentially predisposed to become long-term excretors of poliovirus vaccine strains (immunodeficiency-associated vaccinederived polioviruses [iVDPV]), with the possible risk of both developing paralysis and reintroducing reverted virulent poliovirus into the population after polio vaccination is stopped [5].…”

Section: Discussionmentioning

confidence: 99%

Novel BTK mutation presenting with vaccine-associated paralytic poliomyelitis

et al. 2008

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Oral polio vaccine (OPV) has been used safely and efficiently for more than 40 years in preventive medicine. Vaccine-associated paralytic poliomyelitis (VAPP) is a rare adverse event of OPV due to reversion of the vaccine strain virus to a neurovirulent strain. VAPP can occur in healthy recipients or their close contacts. However, persons with primary humoral immunodeficiencies are at a much higher risk. X-linked agammaglobulinemia (XLA) is a prototypic humoral deficiency caused by mutations in the Bruton's tyrosine kinase (BTK) gene. In addition to susceptibility to bacterial infections, patients with XLA are especially prone to enteroviruses. Here, we describe the occurrence of VAPP in a 15-month old Iranian boy. The child had received four doses of OPV, administered at birth, 2, 4, and 6 months of age. The patient's infectious history was unremarkable. Laboratory evaluation revealed low levels of immunoglobulin G and CD19(+) B cells of less than 1% of the lymphocyte population. A novel insertion (c.685_686insTTAC) in the SH3 domain of the BTK gene was detected as the underlying cause. Immunodeficient recipients of OPV can excrete poliovirus vaccine strains for a long period and are at risk of developing flaccid paralysis. They could also serve as a source of reverted virulent poliovirus to be reintroduced into the general population. This patient presented for the first time with VAPP, without any history of other major infections in 15 months. This suggests that a negative history for recurrent infections does not exclude the presence of a primary defect in the immune system.

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“…And the major part of the OPV used for vaccination in Iran has been provided by the local manufacturer which used MRC-5 cells for vaccine production. Exhaustive national surveillance of all acute flaccid paralysis (AFP) cases in Iran, especially in recent years, revealed that only a few cases (six cases during 10-years of surveillance) had VAPP, mostly in association with immunodeficiency (iVAPP), have been reported as yet [Parvaneh et al, 2007;Rahimi et al, 2007a,b;Davarpanah et al, 2008;Mamishi et al, 2008;Shahmahmoodi et al, 2008Shahmahmoodi et al, , 2009, and no increased level of complications was observed in vaccinees. The risk of VAPP among recipients and/or contacts was 1 case per 745,000 to 7,142,000 used doses of OPV in different parts of the world [WHO, 1982;Nkowane et al, 1987;Joce et al, 1992;Strebel et al, 1992;Prevots et al, 1994;Andrus et al, 1995;Kohler et al, 1999;Zimmerman and Spann, 1999;SamoDlovich et al, 2007].…”

Section: Discussionmentioning

confidence: 99%

Phenotypic and genomic analysis of serotype 3 sabin poliovirus vaccine produced in MRC‐5 Cell substrate

Alirezaie

Taqavian

Aghaiypour

et al. 2011

Journal of Medical Virology

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The cell substrate has a pivotal role in live virus vaccines production. It is necessary to evaluate the effects of the cell substrate on the properties of the propagated viruses, especially in the case of viruses which are unstable genetically such as polioviruses, by monitoring the molecular and phenotypical characteristics of harvested viruses. To investigate the presence/absence of mutation(s), the near full-length genomic sequence of different harvests of the type 3 Sabin strain of poliovirus propagated in MRC-5 cells were determined. The sequences were compared with genomic sequences of different virus seeds, vaccines, and OPV-like isolates. Nearly complete genomic sequencing results, however, revealed no detectable mutations throughout the genome RNA-plaque purified (RSO)-derived monopool of type 3 OPVs manufactured in MRC-5. Thirty-six years of experience in OPV production, trend analysis, and vaccine surveillance also suggest that: (i) different monopools of serotype 3 OPV produced in MRC-5 retained their phenotypic characteristics (temperature sensitivity and neuroattenuation), (ii) MRC-5 cells support the production of acceptable virus yields, (iii) OPV replicated in the MRC-5 cell substrate is a highly efficient and safe vaccine. These results confirm previous reports that MRC-5 is a desirable cell substrate for the production of OPV.

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Vaccine-associated paralytic poliomyelitis in a patient with MHC class II deficiency

Cited by 26 publications

References 10 publications

High Susceptibility for Enterovirus Infection and Virus Excretion Features in Tunisian Patients with Primary Immunodeficiencies

High Susceptibility for Enterovirus Infection and Virus Excretion Features in Tunisian Patients with Primary Immunodeficiencies

Novel BTK mutation presenting with vaccine-associated paralytic poliomyelitis

Phenotypic and genomic analysis of serotype 3 sabin poliovirus vaccine produced in MRC‐5 Cell substrate

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