Abstract
BackgroundPoliomyelitis is an acute viral infection caused by poliovirus and transmitted via the fecal–oral route. The causative agent is one of the three serotypes of poliovirus (serotypes 1, 2, 3) that differ slightly in capsid protein. Prolonged vaccine-related poliovirus shedding in human immunodeficiency virus (HIV) positive individuals has been linked to possible reservoir for reintroduction of polioviruses after eradication. The study therefore aimed at estimating the duration for vaccine-related poliovirus shedding among potentially and HIV-infected persons.MethodsPoliovirus excretion was studied following vaccination of children aged ≤ 59 month per human immunodeficiency virus status after national immunization days. Their medical records were reviewed to identify the child’s HIV status, demographic and immunization data. Sequential stool samples were collected at site 2nd, 4th and 8th week after trivalent oral poliovirus vaccine (tOPV) was administered. To isolate suspected polioviruses and non-polio enteroviruses, characterize poliovirus subtypes by intratypic differentiation and Sabin vaccine derived poliovirus, real time polymerase chain reaction was applied. Shedding for ≥ 24 weeks was defined as long-term persistence.ResultsThe mean age of the study population was 28.6 months, while the median age was 24 months. Of the children recruited, majority were in the 25–48 months (n = 12; 46.2%) age category. All the HIV-positive children (n = 10) had mild symptomatic HIV status and did shed vaccine-related polioviruses between weeks 2 and 4 respectively. No participant shed polioviruses for ≥ 6 weeks.ConclusionsIt was evident mildly symptomatic HIV+ children sustain the capacity to clear vaccine-related poliovirus. The oral poliovirus vaccine-2 (Sabin like) that was detected in one HIV-infected child’s stool 6 weeks after the national immunization days was predominantly non revertant. There was no evident prolonged poliovirus shedding among the participants enlisted in the present study. High powered studies are desired to further corroborate these findings.
Highlights
Poliomyelitis is an acute viral infection caused by poliovirus and transmitted via the fecal–oral route
Mutations of oral poliovirus vaccine (OPV) can lead to a form that can achieve neurological infection and cause paralysis [15] this neurological infection include paralysis caused by vaccinederived polioviruses (VDPV) and is indistinct from that caused by wild polioviruses by means of sequencing [16]
The mean of CD4 count among the human immunodeficiency virus (HIV) infected children was 1450/mm3 confirming no child was considered immunodepressed among the enrolled despite having the virus and factoring the age range of those enrolled [37, 38]
Summary
Poliomyelitis is an acute viral infection caused by poliovirus and transmitted via the fecal–oral route. According to World Health Organization (WHO) OPV is considered safe and immunogenic in HIV-infected persons [8, 9] and is widely used as a primary approach for global polio eradication initiative for instance in Africa where about 90% of the two million children with HIV live [10] In this population segment of HIV positive children few cases of vaccine-associated paralytic poliomyelitis (VAPP) have earlier been reported [11, 12]. Mutations of OPV can lead to a form that can achieve neurological infection and cause paralysis [15] this neurological infection include paralysis caused by VDPV and is indistinct from that caused by wild polioviruses by means of sequencing [16] This is a rare occurrence with the rate of vaccine-associated paralytic poliomyelitis (VAPP) varying by region and at about 1 case per 750,000 vaccine recipients [17]. Reported outbreaks of VAPP tend to happen in areas of low OPV coverage and more likely to occur in adults than in children with pre-assumption being OPV is itself protective against the related outbreak strain [4, 18, 19]
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