Abstract
Prolonged excretion of poliovirus can occur in immunodeficient patients who receive oral polio vaccine, which may lead to propagation of highly divergent vaccine-derived polioviruses (VDPVs), posing a concern for global polio eradication. This study aimed to estimate the proportion of primary immunodeficient children with enterovirus infection and to identify the long-term polio/nonpolio enterovirus excreters in a tertiary care unit in Mumbai, India. During September 2014–April 2017, 151 patients received diagnoses of primary immunodeficiency (PID). We isolated 8 enteroviruses (3 polioviruses and 5 nonpolio enteroviruses) in cell culture of 105 fecal samples collected from 42 patients. Only 1 patient with severe combined immunodeficiency was identified as a long-term VDPV3 excreter (for 2 years after identification of infection). Our results show that the risk of enterovirus excretion among children in India with PID is low; however, systematic screening is necessary to identify long-term poliovirus excreters until the use of oral polio vaccine is stopped.
Highlights
Prolonged excretion of poliovirus can occur in immunodeficient patients who receive oral polio vaccine, which may lead to propagation of highly divergent vaccine-derived polioviruses (VDPVs), posing a concern for global polio eradication
Children with primary immunodeficiency (PID) are at risk for prolonged infection with enteroviruses and may excrete immunodeficiency-related VDPV (iVDPV) after receiving Oral polio vaccine (OPV) or after being exposed to contacts excreting poliovirus
Such patients are at risk for developing paralytic poliomyelitis and must be identified, as they may pose a risk of reintroduction of the virus into the population after global eradication of poliovirus
Summary
Prolonged excretion of poliovirus can occur in immunodeficient patients who receive oral polio vaccine, which may lead to propagation of highly divergent vaccine-derived polioviruses (VDPVs), posing a concern for global polio eradication. This study aimed to estimate the proportion of primary immunodeficient children with enterovirus infection and to identify the long-term polio/nonpolio enterovirus excreters in a tertiary care unit in Mumbai, India. Our results show that the risk of enterovirus excretion among children in India with PID is low; systematic screening is necessary to identify long-term poliovirus excreters until the use of oral polio vaccine is stopped. To establish screening facilities for children with PID in India, we collaborated with the National Institute of Immunohaematology (NIIH, the referral laboratory for PID in India) and Bai Jerbai Wadia Children’s Hospital (a tertiary care unit) in Mumbai, India, which has established facilities for diagnosis of PIDs. The study aimed to identify the proportion of children with PID who have enterovirus infection and to identify long-term polio/nonpolio enterovirus excreters among them
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