Vaccine-Derived Poliovirus Infection among Patients with Primary Immunodeficiency and Effect of Patient Screening on Disease Outcomes, Iran

Abstract

Patients with immunodeficiency-associated vaccine-derived poliovirus (iVDPV) are potential poliovirus reservoirs in the posteradication era that might reintroduce polioviruses into the community. We update the iVDPV registry in Iran by reporting 9 new patients. In addition to national acute flaccid paralysis surveillance, cases were identified by screening nonparalyzed primary immunodeficiency (PID) patients. Overall, 23 iVDPV patients have been identified since 1995. Seven patients (30%) never had paralysis. Poliovirus screening accelerated the iVDPV detection rate in Iran after 2014.The iVDPV infection rate among nonparalyzed patients with adaptive PID was 3.1% (7/224), several folds higher than previous estimates. Severe combined immunodeficiency patients had the highest risk for asymptomatic infection (28.6%) compared with other PIDs. iVDPV2 emergence has decreased after the switch from trivalent to bivalent oral poliovirus vaccine in 2016. However, emergence of iVDPV1 and iVDPV3 continued. Poliovirus screening in PID patients is an essential step in the endgame of polio eradication.

Asymptomatic immunodeficiency-associated vaccine-derived poliovirus infections in two UK children

“…Many countries lack PID registries or surveillance programmes in this clinically vulnerable group. In screening studies of non-paralysed PID patients, both Sabin-like PVs and iVDPVs have been detected, though detection rates have varied from country-to-country 9 – 14 . Health systems increasingly support the complex care of PID patients resulting in improved survival.…”

Health Economic Analysis of Antiviral Drugs in the Global Polio Eradication Endgame

“…6 Soon thereafter, reports of vaccine-associated paralytic polio (VAPP) and vaccine-derived polioviruses (VDPVs) began to emerge, preferentially involving individuals with PIDs. [7][8][9][10][11][12][13][14] The pathophysiology of VAPP is somewhat uncertain, with VAPP largely considered an adverse individual reaction. On the other hand, VDPVs are of great public health concern as they represent the ability of OPV to accumulate enough genetic alterations following persistent replication to behave phenotypically like a wild poliovirus (WPV).…”

Genetic characterization and molecular evolution of type 3 vaccine-derived polioviruses from an immunodeficient patient in China

“…Polioviruses (PVs) belong to the Enterovirus genus, Picornaviridae family, and are among the most rapidly evolving viruses known ( Shaghaghi et al., 2019 , Jorba et al., 2008 ). They are known to be the causative agents of poliomyelitis with three different serotypes 1, 2 and 3 ( Zhang et al., 2010 , Minor et al., 1989 ).…”

“…They mainly infect children aged ≤ 5 years and may lead to permanent disability or death in severe cases. Since the implementation of the Global Polio Eradication Initiative launched by the World Health Organization (WHO) in 1988, extensive use of live attenuated oral poliovirus vaccine (OPV) in routine childhood immunization programs and mass campaigns has led to a >99.99% decrease in the incidence of wild-type poliomyelitis ( Shaghaghi et al., 2019 , Morales et al., 2016 , Shaghaghi et al., 2016 , Korotkova et al., 2016 , Macklin et al., 2020 ). Wild poliovirus types 2 and 3 (WPV2 and WPV3) have been eradicated in 2015 and 2019, respectively ( Moffett et al., 2020 ).…”