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Patients With Primary Immunodeficiencies Are a Reservoir of Poliovirus and a Risk to Polio Eradication Publisher



Aghamohammadi A1 ; Abolhassani H1 ; Kutukculer N2 ; Wassilak SG3 ; Pallansch MA4 ; Kluglein S5 ; Quinn J6 ; Sutter RW7 ; Wang X8, 39 ; Sanal O9 ; Latysheva T10 ; Ikinciogullari A11, 35 ; Bernatowska E12 ; Tuzankina IA13 Show All Authors
Authors
  1. Aghamohammadi A1
  2. Abolhassani H1
  3. Kutukculer N2
  4. Wassilak SG3
  5. Pallansch MA4
  6. Kluglein S5
  7. Quinn J6
  8. Sutter RW7
  9. Wang X8, 39
  10. Sanal O9
  11. Latysheva T10
  12. Ikinciogullari A11, 35
  13. Bernatowska E12
  14. Tuzankina IA13
  15. Costacarvalho BT14
  16. Franco JL15
  17. Somech R16
  18. Karakocaydiner E17
  19. Singh S18
  20. Bezrodnik L19
  21. Espinosarosales FJ20
  22. Shcherbina A21, 33
  23. Lau YL22, 23
  24. Nonoyama S24
  25. Modell F6
  26. Modell V6
  27. Ozen A17
  28. Berlin A26
  29. Chouikha A27
  30. Partidagaytan A28
  31. Kiykim A17
  32. Prakash C29
  33. Suri D30
  34. Ayvaz DC9
  35. Pelaez D31
  36. Da Silva EE32
  37. Deordieva E21, 33
  38. Perezsanchez EE34
  39. Ulusoy E2
  40. Dogu F11, 35
  41. Seminario G36
  42. Cuzcanci H9
  43. Triki H27
  44. Shimizu H37
  45. Tezcan I9
  46. Benmustapha I25, 38
  47. Sun J8, 39
  48. Mazzucchelli JTL14
  49. Orrego JC40
  50. Pac M12
  51. Bolkov M13
  52. Giraldo M40
  53. Belhajhmida N25, 38
  54. Mekki N25, 38
  55. Kuzmenko N21, 33
  56. Karaca NE2
  57. Rezaei N1
  58. Diop OM41
  59. Baris S17
  60. Chan SM42
  61. Shahmahmoodi S43
  62. Haskologlu S11, 35
  63. Ying W8, 39
  64. Wang Y8, 39
  65. Barbouche MR25, 38
  66. Mckinlay MA5
Show Affiliations
Authors Affiliations
  1. 1. Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
  2. 2. Faculty of Medicine, Department of Pediatric Immunology, Ege University, Izmir, Turkey
  3. 3. Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
  4. 4. Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
  5. 5. Center for Vaccine Equity, Task Force for Global Health, Atlanta, GA, United States
  6. 6. Jeffrey Modell Foundation, New York, NY, United States
  7. 7. Research and Product Development, World Health Organization, Geneva, Switzerland
  8. 8. Department of Clinical Immunology, Children's Hospital of Fudan University, Shanghai, China
  9. 9. Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
  10. 10. Department of Allergology and Immunotherapy, Institute of Immunology, Moscow, Russian Federation
  11. 11. Department of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
  12. 12. Department of Clinical Immunology, The Children's Memorial Health Institute, Warsaw, Poland
  13. 13. Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russian Federation
  14. 14. Department of Pediatrics, Federal University of Sao Paulo, Sao Paulo, Brazil
  15. 15. Grupo de Inmunodeficiencias Primarias, Facultad de Medicina, Universidad de Antioquia, Departamento de Microbiologia y Parasitologia, Medellin, Colombia
  16. 16. Pediatric Department A and the Immunology Service, Sheba Medical Center, Tel Hashomer, Jeffrey Modell Foundation Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  17. 17. Division of Pediatric Allergy and Immunology, Marmara Medical Faculty, Istanbul, Turkey
  18. 18. Pediatric Allergy and Immunology Unit, Advanced Pediatrics Centre, PGIMER, Chandigarh, India
  19. 19. Dr. Ricardo Gutierrez Hospital de Ninos, Buenos Aires, Argentina
  20. 20. Clinical Immunology and Allergy Unit, Instituto Nacional de Pediatria, Ciudad de Mexico, Mexico
  21. 21. Department of Clinical Immunology, Dmitry Rogachev Federal Research, Clinical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
  22. 22. Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
  23. 23. Shenzhen Primary Immunodeficiency Diagnostic and Therapeutic Laboratory, Hong Kong University-Shenzhen Hospital, Shenzhen, China
  24. 24. Department of Pediatrics, National Defense Medical College, Saitama, Japan
  25. 25. Department of Immunology, Institut Pasteur de Tunis, University Tunis El-Manar, Tunis, Tunisia
  26. 26. Center for Vaccine Equity, The Task Force for Global Health, Decatur, GA, United States
  27. 27. Department of Virology, Institut Pasteur de Tunis and University Tunis El-Manar, Tunis, Tunisia
  28. 28. Immunodeficiency Research Unit, Instituto Nacional de Pediatria, Ciudad de Mexico, Mexico
  29. 29. Division of Microbiology, National Centre for Disease Control, New Delhi, India
  30. 30. Allergy Immunology Unit, Advanced Pediatrics Centre, PGIMER, Chandigarh, India
  31. 31. Grupo de Virologia, Instituto Nacional de Salud, Bogota, Colombia
  32. 32. Enterovirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
  33. 33. Department of Clinical Immunology, Dmitry Rogachev Federal Research, Clinical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
  34. 34. Poliovirus Lab - Instituto de Diagnostico y Referencia Epidemiologicos, Secretaria de Salud, Ciudad de Mexico, Mexico
  35. 35. Department of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
  36. 36. Hospital de Ninos Dr. Ricardo Gutierrez, Buenos Aires, Argentina
  37. 37. National Institute of Infectious Diseases, Tokyo, Japan
  38. 38. Department of Immunology, Institut Pasteur de Tunis, University Tunis El-Manar, Tunis, Tunisia
  39. 39. Department of Clinical Immunology, Children's Hospital of Fudan University, Shanghai, China
  40. 40. Grupo de Inmunodeficiencias Primarias, Departamento de Microbiologia y Parasitologia, Facultad de Medicina, Universidad de Antioquia UdeA, Medellin, Colombia
  41. 41. Global Laboratory Network Coordinator, World Health Organization, Geneva, Switzerland
  42. 42. Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong
  43. 43. Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

Source: Frontiers in Immunology Published:2017


Abstract

Immunodeficiency-associated vaccine-derived polioviruses (iVDPVs) have been isolated from primary immunodeficiency (PID) patients exposed to oral poliovirus vaccine (OPV). Patients may excrete poliovirus strains for months or years; the excreted viruses are frequently highly divergent from the parental OPV and have been shown to be as neurovirulent as wild virus. Thus, these patients represent a potential reservoir for transmission of neurovirulent polioviruses in the post-eradication era. In support of WHO recommendations to better estimate the prevalence of poliovirus excreters among PIDs and characterize genetic evolution of these strains, 635 patients including 570 with primary antibody deficiencies and 65 combined immunodeficiencies were studied from 13 OPV-using countries. Two stool samples were collected over 4 days, tested for enterovirus, and the poliovirus positive samples were sequenced. Thirteen patients (2%) excreted polioviruses, most for less than 2 months following identification of infection. Five (0.8%) were classified as iVDPVs (only in combined immunodeficiencies and mostly poliovirus serotype 2). Non-polio enteroviruses were detected in 30 patients (4.7%). Patients with combined immunodeficiencies had increased risk of delayed poliovirus clearance compared to primary antibody deficiencies. Usually, iVDPV was detected in subjects with combined immunodeficiencies in a short period of time after OPV exposure, most for less than 6 months. Surveillance for poliovirus excretion among PID patients should be reinforced until polio eradication is certified and the use of OPV is stopped. Survival rates among PID patients are improving in lower and middle income countries, and iVDPV excreters are identified more frequently. Antivirals or enhanced immunotherapies presently in development represent the only potential means to manage the treatment of prolonged excreters and the risk they present to the polio endgame. © 2017 Aghamohammadi, Abolhassani, Kutukculer, Wassilak, Pallansch, Kluglein, Quinn, Sutter, Wang, Sanal, Latysheva, Ikinciogullari, Bernatowska, Tuzankina, Costa-Carvalho, Franco,Somech, Karakoc-Aydiner, Singh, Bezrodnik, Espinosa-Rosales, Shcherbina, Lau, Nonoyama, Modell, Modell, Barbouche and McKinlay.
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