Case of Poliomyelitis Caused by Significantly Diverged Derivative of the Poliovirus Type 3 Vaccine Sabin Strain Circulating in the Orphanage.

Ekaterina A Korotkova,Tatiana P Eremeeva,Liubov I Kozlovskaya,Alexandr Y Krasota,Olga E Ivanova,Anatoly P Gmyl,Olga Y Baikova,Nadezhda S Morozova,Maria A Prostova

doi:10.3390/v12090970

Abstract

Significantly divergent polioviruses (VDPV) derived from the oral poliovirus vaccine (OPV) from Sabin strains, like wild polioviruses, are capable of prolonged transmission and neuropathology. This is mainly shown for VDPV type 2. Here we describe a molecular-epidemiological investigation of a case of VDPV type 3 circulation leading to paralytic poliomyelitis in a child in an orphanage, where OPV has not been used. Samples of feces and blood serum from the patient and 52 contacts from the same orphanage were collected twice and investigated. The complete genome sequencing was performed for five polioviruses isolated from the patient and three contact children. The level of divergence of the genomes of the isolates corresponded to approximately 9–10 months of evolution. The presence of 61 common substitutions in all isolates indicated a common intermediate progenitor. The possibility of VDPV3 transmission from the excretor to susceptible recipients (unvaccinated against polio or vaccinated with inactivated poliovirus vaccine, IPV) with subsequent circulation in a closed children’s group was demonstrated. The study of the blood sera of orphanage residents at least twice vaccinated with IPV revealed the absence of neutralizing antibodies against at least two poliovirus serotypes in almost 20% of children. Therefore, a complete rejection of OPV vaccination can lead to a critical decrease in collective immunity level. The development of new poliovirus vaccines that create mucosal immunity for the adequate replacement of OPV from Sabin strains is necessary.

Highlights

The trivalent oral poliovirus vaccine from Sabin strains, which promotes the formation of both humoral and mucosal immunity in vaccine recipients, was considered the most effective tool for fulfilling the objectives of the Global Polio Eradication Initiative (GPEI) [1]
We describe a poliovirus infection that spread in an orphanage, associated with vaccine-derived polioviruses (VDPV) type 3 which could have formed in an immunocompromised child
At the final stage of the Global Polio Eradication Initiative, when the victory over wild polioviruses of types 2 [2] and 3 [3] was announced, and wild poliovirus of type 1 circulated only in two countries (Afghanistan and Pakistan [43]), the problem of the derivatives of Sabin vaccine strains came to the fore

Summary

Introduction

The trivalent oral poliovirus vaccine (tOPV) from Sabin strains, which promotes the formation of both humoral and mucosal immunity in vaccine recipients, was considered the most effective tool for fulfilling the objectives of the Global Polio Eradication Initiative (GPEI) [1]. In polio-free countries, including the Russian Federation [6], OPV remains the main source of poliovirus infection [8]. This situation cannot be corrected by the introduction of immunization schemes that use inactivated poliovirus vaccine (IPV) for primary vaccination [9], as the possibility of the infection of an unvaccinated contact remains.

Methods

Results

Conclusion