National Surveillance of Poliovirus Excretion among Children with Primary Immune Deficiency in Pakistan & Assessment of Sensitivity of JMF Signs for Screening of Suspected PID Children (2018-To Date)

Abstract

Background and objectivesPolio is an infectious viral disease that invades a child’s nervous system. Children with PID disorder exposed to the oral polio vaccine have chronic poliovirus excretion. This project aims to develop a national surveillance system to identify and monitor vaccine-derived poliovirus excretion among children diagnosed with PID. It will also assess whether Jeffery Modell Foundation warning signs are appropriate for screening PIDs in Pakistan. MethodsThe surveillance is currently being undertaken at tertiary healthcare facilities around Pakistan. In the initial stage, mapping was executed to identify hospitals and their consultant pediatricians. Master training workshops were conducted for the pediatricians from the selected hospitals of each province of Pakistan who agreed to participate in iVDPV surveillance. The suspected PID cases were tested for the confirmatory PID status and poliovirus excretion in the fecal specimen. Children who were excreting poliovirus were followed on the monthly basis until the two negative stool samples are obtained. ResultsThe surveillance for poliovirus was initiated in December 2018. Till date, 444 children (17 days-15 years; 264 males and 180 females) have been enrolled in the surveillance. Immunodeficiencies affecting cellular and humoral immunity were the most frequent, accounting for 113/444 cases. The second most prevalent immunodeficiency were antibody deficiencies, which accounted for 75/444 cases. Additionally, congenital disabilities of phagocyte number or function accounted for 18/444 of the cases. The surveillance system also included uncategorized suspected PIDs 114/444 and Children with normal investigations but considered suspected PID 124/444. The serotype of the excreted virus was predominantly SL3 in 10/358 cases, followed by SL1 in 4/358 cases and SL2 in 1/358 patients. During the four-year surveillance period, two AFP cases were tested for PID after isolation of VDPV 1 (1/358) and VDPV 3 (1/358) whom were later confirmed as Primary Immunodeficient. The JMF signs 8, 5 & 3 are the most frequently occurring signs amongst enrolled PIDs. [Display omitted] ConclusionThe poliovirus excretion in PID children should be the programmatic priority for the polio eradication initiative. The JMF proved to be adequate screening tool for the identification of PID individuals.