Abstract
ObjectivePrimary immunodeficiency (PID) patients are prone to developing viral infections and should not be vaccinated with live vaccines. In such patients, prolonged excretion and viral divergence may occur and they may subsequently act as reservoirs in the community introducing mutated virus and jeopardizing polio eradication. One hundred and thirty PID cases were included for poliovirus detection in stool with assessment of divergence of detected polioviruses from oral polio vaccine (OPV) virus. Clinical presentations of PID patients with detectable poliovirus in stool specimens are described.ResultsSix PID patients (4.5%) had detectable vaccine-derived poliovirus (VDPV) excretion in stool specimens; of these, five patients had severe combined immunodeficiency (two with acute flaccid paralysis, one with meningoencephalitis and two without neurological manifestations), and one patient had X-linked agammaglobulinemia (paralysis developed shortly after diagnosis of immunodeficiency). All six case-patients received trivalent OPV. Five case-patients had type 2 immunodeficiency-related vaccine-derived polioviruses (iVDPV2) excretion; one had concomitant excretion of Sabin like type 3 virus and one was identified as iVDPV1 excretor. Surveillance for poliovirus excretion among PID patients is critical as these patients represent a potential source to reseed polioviruses into populations.
Highlights
Primary immunodeficiency disorders (PIDs) are a group of diseases that mainly present with recurrent, severe or unusual infections
Surveillance for poliovirus excretion among PID patients is critical as these patients represent a potential source to reseed polioviruses into populations
A study of poliovirus excretion among patients with PIDs from 13 oral polio vaccine (OPV)-using countries reported that patients with combined immunodeficiency (CID) disorders had an increased risk of delayed poliovirus clearance compared to patients with humoral deficiencies [3]
Summary
Primary immunodeficiency disorders (PIDs) are a group of diseases that mainly present with recurrent, severe or unusual infections. PIDs are underreported in developing countries because of lack of awareness. Given high rates of consanguinity in some countries, autosomal recessive disorders form the bulk of PIDs compared to Western populations. A study of poliovirus excretion among patients with PIDs from 13 OPV-using countries reported that patients with combined immunodeficiency (CID) disorders had an increased risk of delayed poliovirus clearance compared to patients with humoral deficiencies [3]. In Egypt, due to the absence of neonatal screening programs for PIDs, such patients often present to medical care after having received repeated OPV doses. Prolonged intestinal replication of OPV virus in PID patients can lead to development of vaccine-derived polioviruses (VDPV), which are referred to as immunodeficiency-related
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