Oral Polio Vaccine Immunization Research Articles

Infectious Diseases-Related Hospitalizations During Oral Polio Vaccine (OPV) and Non-OPV Immunization Periods: An Empirical Evaluation of all Hospital Discharges in California (1985-2010).

Live attenuated vaccines such as oral polio vaccine (OPV) can stimulate innate immunity and may have off-target protective effects on other pathogens. We aimed to address this hypothesis by examining changes in infectious diseases (ID)-related hospitalizations in all hospital discharges in California during OPV (1985-1996) and non-OPV immunization periods (2000-2010). We searched the Office of Statewide Health Planning and Development database for all hospital discharges with any ID-related discharge diagnosis code during 1985-2010. We compared the proportion of ID-related hospitalizations (with at least 1 ID-related discharge diagnosis) among total hospitalizations during OPV immunization (1985-1996) versus non-OPV immunization (2000-2010) periods. There were 19 281 039 ID-related hospitalizations (8 464 037 with an ID-related discharge diagnosis as the principal discharge diagnosis for the hospitalization) among 98 117 475 hospitalizations in 1985-2010; 9 520 810 ID hospitalizations/43 456 484 total hospitalizations in 2000-2010 versus 7 526 957/43 472 796 in 1985-1996. The risk ratio for ID-related hospitalizations in 2000-2010 versus 1985-1996 was 1.27 (95% confidence interval [CI], 1.26-1.27) for all diagnoses and 1.15 (95% CI: 1.15-1.16) for principal diagnoses. Increases also existed in the proportion of lower respiratory and gastrointestinal infections. The proportion of ID-related hospitalizations was lower in the OPV immunization period compared to the period after OPV was discontinued. When focused only on hospitalizations with ID as the principal discharge diagnosis, the signal remained significant but was smaller. These findings require replication in additional studies.

Lessons learnt from implementing community engagement interventions in mobile hard-to-reach (HTR) projects in Nigeria, 2014\u20132015

BackgroundThe year 2014 was a turning point for polio eradication in Nigeria. Confronted with the challenges of increased numbers of polio cases detected in rural, hard-to-reach (HTR), and security-compromised areas of northern Nigeria, the Nigeria polio program introduced the HTR project in four northern states to provide immunization and maternal and child health services in these communities. The project was set up to improve population immunity, increase oral polio vaccine (OPV) and other immunization uptake, and to support Nigeria’s efforts to interrupt polio transmission by 2015. Furthermore, the project also aimed to create demand for these services which were often unavailable in the HTR areas. To this end, the program developed a community engagement (CE) strategy to create awareness about the services being provided by the project. The term HTR is operationally defined as geographically difficult terrain, with any of the following criteria: having inter-ward/inter-Local Government Area/interstate borders, scattered households, nomadic population, or waterlogged/riverine area, with no easy to access to healthcare facilities and insecurity.MethodsWe evaluated the outcome of CE activities in Kano, Bauchi, Borno, and Yobe states to examine the methods and processes that helped to increase OPV and third pentavalent (penta3) immunization coverage in areas of implementation. We also assessed the number of community engagers who mobilized caregivers to vaccination posts and the service satisfaction for the performance of the community engagers.ResultsPenta3 coverage was at 22% in the first quarter of project implementation and increased to 62% by the fourth quarter of project implementation. OPV coverage also increased from 54% in the first quarter to 76% in the last quarter of the 1-year project implementation.ConclusionsThe systematic implementation of a CE strategy that focused on planning and working with community structures and community engagers in immunization activities assisted in increasing OPV and penta3 immunization coverage.

Oral polio vaccine response in the MAL-ED birth cohort study: Considerations for polio eradication strategies

BackgroundImmunization programs have leveraged decades of research to maximize oral polio vaccine (OPV) response. Moving toward global poliovirus eradication, the WHO recommended phased OPV-to-IPV replacement on schedules in 2012. Using the MAL-ED prospective birth cohort data, we evaluated the influence of early life exposures impacting OPV immunization by measuring OPV response for serotypes 1 and 3. MethodsPolio neutralizing antibody assays were conducted at 7 and 15 months of age for serotypes 1 and 3. Analyses were conducted on children receiving ≥3 OPV doses (n = 1449). History of vaccination, feeding patterns, physical growth, home environment, diarrhea, enteropathogen detection, and gut inflammation were examined as risk factors for non-response [Log2(titer) < 3] and Log2(titer) by serotype using multivariate regression. FindingsSerotype 1 seroconversion was significantly higher than serotype 3 (96.6% vs. 89.6%, 15 months). Model results indicate serotypes 1 and 3 failure was minimized following four and six OPV doses, respectively; however, enteropathogen detection and poor socioeconomic conditions attenuated response in both serotypes. At three months of age, bacterial detection in stool reduced serotype 1 and 3 Log2 titers by 0.34 (95% CI 0.14–0.54) and 0.53 (95% CI 0.29–0.77), respectively, and increased odds of serotype 3 failure by 3.0 (95% CI 1.6–5.8). Our socioeconomic index, consisting of Water, Assets, Maternal education, and Income (WAMI), was associated with a 0.79 (95% CI 0.15–1.43) and 1.23 (95% CI 0.34–2.12) higher serotype 1 and 3 Log2 titer, respectively, and a 0.04 (95% CI 0.002–0.40) lower odds of serotype 3 failure. Introduction of solids, transferrin receptor, and underweight were differentially associated with serotype response. Other factors, including diarrheal frequency and breastfeeding practices, were not associated with OPV response. InterpretationUnder real-world conditions, improved vaccination coverage and socio-environmental conditions, and reducing early life bacterial exposures are key to improving OPV response and should inform polio eradication strategies.

Acute flaccid paralysis surveillance, Kano State, Nigeria: 2009 - 2015

Introduction: the gold standard for detecting Poliomyelitis cases is by acute flaccid paralysis (AFP) surveillance. In August and October, 2016 Wild polio virus (WPV) type 1 and cVDPV2 were detected in Northern Nigeria. Hence there is need to close any gaps in the surveillance process. This study describes the epidemiology and trend of AFP/WPV, it also evaluates the AFP surveillance performance indicators in Kano State. Methods: secondary data analysis of Kano State AFP surveillance data from January 2009 to December 2015 was carried out. Data were obtained from Kano State Ministry of Health-WHO database. Ethical clearance was obtained from Kano State Ministry of Health. Data was analyzed using Epi-info version 7.2.0.1. Results: overall, 4644 AFP cases were reported over the study period. After stool analysis, 1058 cases were confirmed to be true AFP cases. Fifty six percent of the AFP cases were males and 83% were less than five years of age. Most (69%) of the cases received <3 doses of Oral polio vaccine (OPV), while 30% were zero dose. There was reduction in the number of AFP cases across the years from 321 cases in 2009 to 0 in 2015. WPV cases were 145 or 14%. There was increase in the prevalence of WPV in March, May and July throughout the study period. More cases (%) were reported from Ungogo local government area. Evaluation of the performance indicators showed that the AFP surveillance system was not timely, complete and Core IDSR indicators were unmet over the study period. Conclusion: AFP/WPV was prevalent among male children less than 5 years, who had received < 3 doses of OPV. Kano State AFP surveillance system did not meet the target for some of its performance indicators. We recommended improvement on OPV immunization and the AFP surveillance system in the state.

Budget impact of polio immunization strategy for India: introduction of one dose of inactivated poliomyelitis vaccine and reductions in supplemental polio immunization

ObjectivesTo conduct a budget impact analysis (BIA) of introducing the immunization recommendations of India Expert Advisory Group (IEAG) for the years 2015–2017. The recommendations include introduction of one inactivated poliomyelitis vaccine (IPV) dose in the regular child immunization programme along with reductions in oral polio vaccine (OPV) doses in supplemental programmes. Study designThis is a national level analysis of budget impact of new polio immunization recommendations. Since the states of India vary widely in terms of size, vaccine coverage and supplemental vaccine needs, the study estimated the budget impact for each of the states of India separately to derive the national level budget impact. MethodsBased on the recommendations of IEAG, the BIA assumes that all children in India will get an IPV dose at 14 weeks of age in addition to the OPV and DPT (or Pentavalent-3) doses. Cost of introducing the IPV dose was estimated by considering vaccine price and vaccine delivery and administration costs. The cost savings associated with the reduction in number of doses of OPV in supplemental immunization were also estimated. The analysis used India-specific or international cost parameters to estimate the budget impact. ResultsIntroduction of one IPV dose will increase the cost of vaccines in the regular immunization programme from $20 million to $47 million. Since IEAG recommends lower intensity of supplemental OPV vaccination, polio vaccine cost of supplemental programme is expected to decline from $72 million to $53 million. Cost of administering polio vaccines will also decline from $124 million to $105 million mainly due to the significantly lower intensity of supplemental polio vaccination. The net effect of adopting IEAG's recommendations on polio immunization turns out to be cost saving for India, reducing total polio immunization cost by $6 million. Additional savings could be achieved if India adopts the new policy regarding the handling of multi-dose vials after opening. Introduction of three doses of IPV with the existing polio immunization schedule will increase the budget requirement by $102 million but replacing OPV doses with IPV will increase the budget by about $59 million. Discontinuation of supplemental OPV immunization with replacement of OPV by IPV will reduce the Government of India's (GOI) polio immunization budget by $99 million. ConclusionAlthough the overall cost of polio programme will decline with the adoption of IEAG's recommendations, state-level costs will vary widely. In states like Kerala, Karnataka, Uttar Pradesh and Andhra Pradesh, cost of polio immunization will increase while in Punjab and Jharkhand the costs will remain more or less constant. Significant cost reductions will happen in states with high intensity of supplemental polio immunizations (Bihar, Haryana and Delhi). The cost of procuring polio vaccines will more than double from $20 million to about $47 million requiring allocation of additional foreign exchanges. In some states (like Bihar), the decline in polio-related employment will be very high requiring reallocation of personnel from polio to other programmes.

Review of the Oral Polio Vaccineimmunization Coverage with Regard to Polio Eradication in Zambia: 2000-2009

Objectives: To review the Oral Polio Vaccine (OPV) immunization coverage (routine and supplemental) in Zambia from 2000 to 2009, with the view of identifying opportunities for system strengthening, given that routine immunization is the “bed rock” for polio eradication. Design: A retrospective descriptive analysis design was conducted on secondary routine and supplemental immunization data for Zambia for the period 2000-2009, consisting of all children aged<5years who had received OPV country wide. Immunization performance was evaluated using the WHO-specified 90% target Results: The target of 90% for Routine Immunization (RI)could not be reached in most provinces. Only Central province attained the target throughout the stated period. In 2004 and 2008, all provinces apart from Copperbelt attained the target. The 90%target for supplemental immunization activities were reached during all rounds of National Immunization Days (NIDs) apart from the first two (2) rounds in1996. The two rounds of Mopping –up immunization in 2002 attained the90% target Conclusion: Routine immunization for the oral polio vaccine has been an integral part of immunization activities in Zambia. The WHO target for OPV immunization was not attained in most districts and provinces in the period under review. This situation needs to be addressed through partner collaboration to raise herd immunity in case of imported polio viruses. While RI alone cannot eradicate the disease, good routine OPV coverage reduces the incidence of polio and makes eradication feasible. It also prevents the re-establishment of poliovirus if it is re-introduced from other countries, through international travelers and migrant populations from conflict areas

Diphtheria in a 13 year old adolescent girl: Management challenges

Background: Diphtheria is an acute toxic infection which is associated with a high morbidity and mortality and can pose management challenges especially in the absence of proper diagnostic and therapeutic facilities.Case report: A.S. was a 13 year old girl who presented with fever of five days duration, dysphagia and neck swelling of 4 days duration and sore throat and hoarse voice of 3days duration. Her illness started a day after returning from a 4-day holiday youth camp. She received only oral polio vaccine immunization in childhood. Significant physical examinationfindings included a swollen neck, a greyish membrane covering the soft palate and uvula with haemorrhagic spots. The pharynx, anterior nares and the nasal turbinates were inflamed and erythematous. A working diagnosis of respiratory diphtheria was made. Throat swab microscopy showed club shaped Gram positive baccilli. Appropriate culture medium for C. diphtheriawas not available. She received intravenous crystalline penicillin and metronidazole and lateroral erythromycin in an isolated ward. On the 6th day of admission she developed cardiac and neurologic complications–bradycardia (PR=40bpm), hypotension (BP=70/40mmHg), drooling of saliva and paraparesis. Electrocardiography confirmed a complete heart block. She died on the 11th day of admission while efforts were being made to raise funds for a cardiac pace maker. Conclusion: Management of this vaccine preventable disease requires a high index of suspicion and diphtheria antitoxin should be made readily available.

An outbreak of circulating vaccine derived poliovirus in Yemen, 2011-2012

Background: Yemen has been polio free since 2006. However, recently civil unrest and popular uprisings across the country arose with intermittent armed conflicts in the Northern governorates especially Sa’ada led to low routine immunization coverage and suspending supplementary immunization activities (SIAs). Such widening immunity gap known to be predisposing factors for Circulating Vaccine Derived Poliovirus (cVDPV) outbreak. We reviewed acute flaccid paralysis (AFP) cases to identify any emerging cVDPV Methods & Materials: Cases of AFP identified through routine AFP surveillance from April 8,2011,through 24 August 2012 were investigated for any fecal excretion of cVDPV. WHO-recommended virological classification scheme was used. Results: Nine cases of laboratory confirmed type 2 cVDPV and 2 cases type3 cVDPV were identified from six governorates: Sa’ada (1.3/100,000 <15 years children), Amran (0.2/100,000), Hajjah (0.1/100,000), Ibb (0.08/100,000), Sana’a city (0.07/100,000) and Hodeida (0.07/100,000). The corresponding third dose of Oral polio vaccine (OPV) coverage is 49%,78%,89%,87%,83% and 80% respectively. The median age was 22 months with a male to female ratio of 2.7:1. Most reported symptoms were fever (100%), asymmetrical paralysis (73%), and intact sensation (73%). OPV immunization status among cases was: zero dose: 36%, < 3 doses: 36%, and ≥ 3 doses: 27%. Conclusion: The rate of cVDPV is highest in the armed conflict Sa’ada and its neighboring Amran where the lowest vaccination coverage was also achieved. There is an urgent need to maintain high OPV coverage in at-risk populations to prevent the spread of endogenous cVDPV. Sensitive and timely AFP surveillance systems are essential to ensure quick identification of cVDPV and response

Reemergence of Recombinant Vaccine–derived Polioviruses in Healthy Children, Madagascar

Reemergence of Recombinant Vaccine–derived Polioviruses in Healthy Children, Madagascar

Non‐polio enteroviruses in acute flaccid paralysis children of India: Vital assessment before polio eradication

This study is an overview of non-polio enterovirus (NPEV) circulating in North India studied from the perspective of poliomyelitis eradication. Wild polio cases declined because of intensive oral polio vaccine immunization. As we approach global eradication of poliovirus (PV), NPEV causing acute flaccid paralysis (AFP) are equal cause of concern. A total of 46 653 AFP samples (World Health Organization) and apparently 1000 healthy contacts living in the same geographical area were studied (2004-2007). Serological identification of NPEV was done using RIVM-specific pools (The Netherlands). Untyped (UT)-NPEVs were sequenced directly from reverse transcription-polymerase chain reaction using pan-enterovirus (Pan-EV) primer (CDC, Atlanta, GA) targeting highly conserved 5'un-translated regions of the enterovirus. In this study, 12 513 NPEVs were isolated from the collected stool samples. Seroneutralization had identified 67% of NPEV isolates, whereas 32.6% remained as UT- NPEV. Of the typed NPEVs, Coxsackie-B accounted for 32.3%; followed by echoviruses-11, 12, 13, 7 between 8 and 28%. In sequencing few UT-NPEVs, some were identified also as echovirus-30, 11 and 18 which were probably present in mixtures as they remained UT-NPEV in ENT. Newly classified human enterovirus virus-86 (HEV) (EU079026), HEV-97(EU071767) and HEV-B isolate (EU071768) were isolated in AFP samples. This study provided definitive information about circulation, prevalence and new emerging NPEV in the polio-endemic region of India, hence they should be considered in AFP surveillance. This would help in adopting and planning new strategies in post-PV eradication era in the country. This is the right time to prepare for the future tasks while we head towards a polio-free region.

Vaccine-associated Paralytic Poliomyelitis : A Case Report of Flaccid Monoparesis after Oral Polio Vaccine

This report describes a case of acute flaccid paralysis after administration of oral polio vaccine (OPV). A 4 month-old male patient with the decreased movement of left lower extremity for 1 month was transferred to the Department of Pediatrics. He received OPV with DTaP at 2 months of age. Flaccid paralysis was detected 4 weeks after OPV immunization. Attempts to isolate Sabin-like viruses in the two stool and CSF samples failed because those specimens were collected more than 2 month after the onset of paralysis. Hypotonic monoparesis (GIV/V), hypotonia and atrophy on the left lower extremity, and ipsilateral claw foot persisted for more than 18 months, while we followed him with rehabilitation therapy. This is the first case of officially approved, recipient vaccine-associated paralytic poliomyelitis in Korea.

Toscana Virus and Acute Meningitis, France

Toscana Virus and Acute Meningitis, France

Strengthening routine immunization services in the Western Pacific through the eradication of poliomyelitis.

Infant immunization coverage in the Western Pacific Region of the World Health Organization was reviewed to evaluate the impact of polio eradication activities on routine immunization services. The trend in bacille Calmette-Guérin (one dose; BCG), diphtheria-tetanus toxoids-pertussis (three doses; DTP3), and measles (one dose) vaccination rates was analyzed from the beginning of eradication activities in 1990 to 1994 in the five polio-endemic countries that conducted supplementary oral polio vaccine immunization. In China and the Philippines, coverage for each antigen remained at or above 90% and 85%, respectively, while in Vietnam, coverage for all three antigens rose from 85% to 95%. BCG, DTP3, and measles vaccine coverage more than doubled in the People's Democratic Republic of Lao and increased by >30% in the Kingdom of Cambodia during the same period.

RESPONSE TO POLIO VACCINATION IN CHILDREN INFECTED WITH HUMAN IMMUNODEFICIENCY VIRUS

Vaccination strategies in children infected with human immunodeficiency virus (HIV) are controversial; live virus vaccines are generally contraindicated in immunodeficient children. 23 HIV-infected children received at least 2 doses (median = 3) of oral polio vaccine (OPV) before HIV infection was suspected, 3 others received inactivated polio vaccine (IPV). The median interval from OPV immunization to serum sampling was 2.8 years (range 1 mo to 15 yrs), the median interval from IPV immunization to sampling was 1 mo (range 1 to 4 mo). Congenital HIV infection was present in 23 and postnatally acquired infection was present in 3. Antibody to poliovirus 2 was determined by microneutralization. Protective levels of antibody (≥1:4) were found in 21/23 (91%) of persons given OPV (GMT = 22.9), and in 3/3 given IPV (GMT = 25.4). The stage of clinical illness correlated with the antibody titer; patients with AIDS had a GMT = 5.7, patients with ARC had a GMT = 26.9, and HIV infected apparently well children had a GMT = 84.4. Protective levels of antibody occur in the majority of HIV infected children immunized against poliovirus type 2. The potential for rare adverse events and intrafamilial spread suggests that IPV is the preferred vaccine for HIV infected children. Although no adverse events, attributable to polio vaccination, were documented in these children, further study of the effects of vaccination on the manifestations of HIV infection is needed.

A seroepidemiological study of polio in Thailand and investigation of the OPV (oral polio vaccine) immunization

日本医大東南アジア医学研究会第11～16次調査団によって, 1977～1982年にタイ国のBangkokおよびChiang Mai Provinceにおいて0～72歳の被検者から採取された血清試料, 1,523検体についてVero細胞を用いたmicro法により血中ポリオ中和抗体価を測定し, それに基づく血清疫学調査成績を述べ, さらにワクチン接種効果についても言及した. 1) OPVを100%接種されている集団を除いた全検体における抗体陽性率は, 1型86.5%, 2型86.6%, 3型80.5%で, 1型が2型と同率である熱帯地方の特徴を示し, 山間部では3型に対し高い陽性率がみられた. 2) 抗体陽性率は, 全員がポリオワクチン接種を受けているChiang Mai大学小児保健施設1982 CCCCの試料を除いて集計すると, 母児免疫の失われることにより1歳児では1～3型とも0～40%と低いが, その後1型では4歳100%, 2型では8歳90.6%, 3型では5歳66.8%および7歳100%と有意差のみられる上昇を示し, 以後は各型とも75～100%であった. 3) 陽性血清 (≧1: 4) の幾何平均抗体価 (log2GM) は1982 CCCCを除いて集計すると, 2型は1歳未満6.07で, 1型3.78, 3型3.14に比べて高く, 1～5歳では, 1型6.00, 2型5.91, 3型5.35で, 型間に有意差を認めなかった. 6歳以後では, 1, 2型は, ほぼ近似した傾向で, 抗体価の加齢による有意差は両型において認めなかったが, 3型は6～19歳で1, 2型より低く, 20歳以上は加齢とともに上昇した. 4) 抗体保有状況の居住地域による差を, 明白なワクチン接種歴のあるヒトからの試料を除いて検討したところ, Chiang Maiの小児に比較的高い抗体レベルがみられ, それぞれ相互に隔絶した地理的位置にある高地部落の住民については, 抗体レベルの地域差が明らかに認められた. 5) 100%ワクチン接種の記録のあるCCCC管理の小児とワクチン接種歴のない小児集団との比較では, 抗体陽性率においてCCCCが高かったが, 陽性血清の平均抗体価はCCCCが低値を示した. 6) CCCCにおいては2型の抗体陽性率が1, 3型に比べて高く, またポリオの各型すべてに対して抗体を保有するもの (完全防御) の割合も高く, 一般にワクチン接種集団にみられる特徴と一致した. 7) CCCCとその親であるFCCCとの間に血中抗体価の相関は認めなかった. 8) ワクチン接種を受けたことのないチェンマイ市内の小中学校の生徒に対するワクチン接種実験で, 接種後の抗体陽性率は各型とも100%を示し, 陽性血清の平均抗体価は, 各型とも対照群に比べ有意に上昇した. また接種6ヵ月後に接種前の4倍以上の抗体価上昇を示したものは, 2, 3型において対照群より有意に高かった. 9) Chiang Mai市内の実業学校の生徒および教員の抗体陽性率は各型ともやや低値を示したが, これはこの集団の94.4%は女性であったことにより説明される.

Non-polio virus interference with oral polio vaccine immunization: possible influence of physical climate and socio-economic status.

In spite of the widespread use of oral polio vaccine (O.P.V.), vaccination programs in many tropical and subtropical countries have apparently failed to provide the expected results in the control of paralytic poliomyelitis (1). Among several factors considered responsible for these unsatisfactory results, an important role has been attributed to the interferences of naturally occurring enteroviral infections on the “take rate” in the intestine, following O.P.V. administration (2,3).KeywordsOral Polio VaccineSubtropical CountryEnteroviral InfectionParalytic PoliomyelitisLive Virus VaccineThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.