Vaccine-Derived Poliovirus Infection among Patients with Primary Immunodeficiency and Effect of Patient Screening on Disease Outcomes, Iran.

Mohammadreza Shaghaghi,Shohreh Shahmahmoodi,Maryam Yousefi,Seyedeh Panid Madani,Mohammad Mehdi Gouya,Yaghoob M Kandelousi,Gholamreza Azizi,Seyed Mohsen Zahraei,Sussan Mahmoudi,Ahmad Nejati,Asghar Aghamohammadi,Ali Nili,Hassan Abolhassani,Nima Parvaneh,Reza Yazdani,Shiva Shaghaghi,Mona Irannejad

doi:10.3201/eid2511.190540

Mohammadreza Shaghaghi, Shohreh Shahmahmoodi + Show 15 more

Open Access

https://doi.org/10.3201/eid2511.190540

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Journal: Emerging infectious diseases	Publication Date: Nov 1, 2019
Citations: 10	License type: cc-by

Abstract

Patients with immunodeficiency-associated vaccine-derived poliovirus (iVDPV) are potential poliovirus reservoirs in the posteradication era that might reintroduce polioviruses into the community. We update the iVDPV registry in Iran by reporting 9 new patients. In addition to national acute flaccid paralysis surveillance, cases were identified by screening nonparalyzed primary immunodeficiency (PID) patients. Overall, 23 iVDPV patients have been identified since 1995. Seven patients (30%) never had paralysis. Poliovirus screening accelerated the iVDPV detection rate in Iran after 2014.The iVDPV infection rate among nonparalyzed patients with adaptive PID was 3.1% (7/224), several folds higher than previous estimates. Severe combined immunodeficiency patients had the highest risk for asymptomatic infection (28.6%) compared with other PIDs. iVDPV2 emergence has decreased after the switch from trivalent to bivalent oral poliovirus vaccine in 2016. However, emergence of iVDPV1 and iVDPV3 continued. Poliovirus screening in PID patients is an essential step in the endgame of polio eradication.

Highlights

Patients with immunodeficiency-associated vaccine-derived poliovirus are potential poliovirus reservoirs in the posteradication era that might reintroduce polioviruses into the community
We reported the largest series of patients who had paralysis because of immunodeficiency-associated vaccine-derived poliovirus (iVDPV) infection [1]
Symptomatic iVDPV-Excreting Patients We identified 16 patients who had acute flaccid paralysis (AFP) and concurrent iVDPV shedding during 1995–2016 (Appendix Table, https://wwwnc.cdc.gov/EID/article/25/11/19-0540-App1. pdf)

Summary

Introduction

Patients with immunodeficiency-associated vaccine-derived poliovirus (iVDPV) are potential poliovirus reservoirs in the posteradication era that might reintroduce polioviruses into the community. In addition to national acute flaccid paralysis surveillance, cases were identified by screening nonparalyzed primary immunodeficiency (PID) patients. Severe combined immunodeficiency patients had the highest risk for asymptomatic infection (28.6%) compared with other PIDs. iVDPV2 emergence has decreased after the switch from trivalent to bivalent oral poliovirus vaccine in 2016. Patients with primary immunodeficiencies (PIDs) are susceptible to not clearing the vaccine strains after receipt of OPV, which provides an environment for prolonged virus replication and genomic changes. SYNOPSIS patients have an ≈3,000-fold increased risk for onset of prolonged immunodeficiency-associated VDPV (iVDPV) infection and vaccine-associated paralysis [2]. In addition to describing important clinical and virologic properties of newly identified patients, our findings underscore the importance of poliovirus screening programs in increasing the iVDPV detection rate

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