Vaccine-Derived Poliomyelitis 12 Years after Infection in Minnesota

Abstract

A 44-year-old woman with long-standing common variable immunodeficiency who was receiving intravenous immune globulin suddenly had paralysis of all four limbs and the respiratory muscles, resulting in death. Type 2 vaccine-derived poliovirus was isolated from stool. The viral capsid protein VP1 region had diverged from the vaccine strain at 12.3% of nucleotide positions, and the two attenuating substitutions had reverted to the wild-type sequence. Infection probably occurred 11.9 years earlier (95% confidence interval [CI], 10.9 to 13.2), when her child received the oral poliovirus vaccine. No secondary cases were identified among close contacts or 2038 screened health care workers. Patients with common variable immunodeficiency can be chronically infected with poliovirus, and poliomyelitis can develop despite treatment with intravenous immune globulin.

Polio Today: State of the Global Eradication Program and Modern Strategy of WHO on Immunization

“…Даже если таких больных не вакцинируют ОПВ, сохраняется опасность их инфицирования в ре-зультате контакта с реципиентом вакцины. Описан случай возникновения паралитического полиоми-елита у 44-летней жительницы США, вызванный ВРПВ типа 2, которым она была инфицирована почти 12 лет назад, когда ее сын был привит ОПВ [35]. С момента внедрения ОПВ в 1961 году в мире установлено более 70 больных первичными имму-нодефицитами (ПИД), выделяющих полиовирус в течение длительного времени [28].…”

Highly Divergent Type 2 and 3 Vaccine-Derived Polioviruses Isolated from Sewage in Tallinn, Estonia

“…This definition follows from the high rate of nucleotide sequence evolution in poliovirus (ϳ1% per year) (9) and the normal period of poliovirus excretion of Ͻ3 months (10). VDPVs are distributed into three categories: (i) circulating VDPVs (cVDPVs) associated with outbreaks in settings of low OPV coverage (8,11,12), (ii) immunodeficiency-associated VDPVs (iVDPVs) from prolonged infections of persons with primary immunodeficiencies (8,11,(13)(14)(15)(16), and (iii) ambiguous VDPVs (aVDPVs) isolated from immunocompetent persons or the environment (8,11,12). Environmental aVDPVs in countries with high poliovirus vaccine coverage may signal latent chronic infections, but none of the infected persons have been identified so far (3,8,(17)(18)(19)(20).…”

“…Most cVDPVs are vaccine/nonvaccine recombinants with limited substitution in the neutralizing antigenic (NAg) sites (8,12,21). In contrast, most iVDPV isolates have nonrecombinant or vaccine/ vaccine recombinant genomes, multiple substitutions in the NAg sites (8,13,14,16), and numerous mixed-base positions (reflecting divergence into separate lineages during prolonged infections) (13,14,(22)(23)(24).…”

“…The Tallinn sewage isolates had properties typical of iVDPVs excreted by a chronically infected individual with a primary immunodeficiency, most likely common variable immunodeficiency (CVID) (3,32). Unlike most individuals with iVDPV infections who either clear their infections or die within a year from complications of their immunodeficiency (8,33), infected individuals with CVID may excrete iVDPVs for Ͼ5 years (13,15,16,22). Some become paralyzed many years after the initial exposure to OPV (13,16,22), but others have remained asymptomatic (15).…”

“…Unlike most individuals with iVDPV infections who either clear their infections or die within a year from complications of their immunodeficiency (8,33), infected individuals with CVID may excrete iVDPVs for Ͼ5 years (13,15,16,22). Some become paralyzed many years after the initial exposure to OPV (13,16,22), but others have remained asymptomatic (15). Consequently, environmental surveillance becomes a powerful tool for the detection of chronic, asymptomatic iVDPV infections (4).…”