Use Of OPV Research Articles

Assessment of Enterovirus Excretion and Identification of VDPVs in Patients with Primary Immunodeficiency in India: Outcome of ICMR-WHO Collaborative Study Phase-I.

The emergence of vaccine-derived polioviruses (VDPVs) in patients with Primary Immunodeficiency (PID) is a threat to the polio-eradication program. In a first of its kind pilot study for successful screening and identification of VDPV excretion among patients with PID in India, enteroviruses were assessed in stool specimens of 154 PID patients across India in a period of two years. A total of 21.42% of patients were tested positive for enteroviruses, 2.59% tested positive for polioviruses (PV), whereas 18.83% of patients were positive for non-polio enteroviruses (NPEV). A male child of 3 years and 6 months of age diagnosed with Hyper IgM syndrome was detected positive for type1 VDPV (iVDPV1) with 1.6% nucleotide divergence from the parent Sabin strain. E21 (19.4%), E14 (9%), E11 (9%), E16 (7.5%), and CVA2 (7.5%) were the five most frequently observed NPEV types in PID patients. Patients with combined immunodeficiency were at a higher risk for enterovirus infection as compared to antibody deficiency. The high susceptibility of PID patients to enterovirus infection emphasizes the need for enhanced surveillance of these patients until the use of OPV is stopped. The expansion of PID surveillance and integration with a national program will facilitate early detection and follow-up of iVDPV excretion to mitigate the risk for iVDPV spread.

Poliomyelitis in modern conditions: achievements and prospects

The creation in the middle of the 20th century vaccines against poliomyelitis (PM) – inactivated vaccine (IPV) and live oral vaccine from Sabin strains (OPV) with various properties, advantages and disadvantages, but highly effective, made it possible to implement the idea of elimination of PM. Since 1988, the WHO Global Program of PM eradication has achieved remarkable success: the incidence of PM caused by wild poliovirus (PV) has been reduced by 10 thousand times, the number of endemic countries has been reduced to 3, the circulation of wild PV has been discontinued in 4 regions of the world the wild type 2 of PV has been eradicated, and wild type 3 of PV has not been detected for almost 5 years. Under conditions of a decrease in the incidence of PM caused by wild PV, the known negative properties of trivalent OPV made its further use problematic. These negative properties are: 1) the ability to cause post-vaccination complications and 2) the genetic instability of Sabin strains, especially PV of type 2, and their ability under certain conditions (primarily in conditions of low collective immunity to PV) to quickly restore neurovirulence, transforming into circulating vaccinederived PV (VDPV), capable of causing incidents and outbreaks of PM. In order to reduce the risk associated primarily with type 2 PV, WHO proposed a global switch to the use of bivalent OPV from types 1 and 3, completed in 2016. In 2019, WHO plans to complete eradication of type 1 and 3 PVs, and in 2022 completely abandon the OPV. The precondition for the safety of such tactics is the maintenance of high collective immunity to PM. There are several threats to the security of this strategy. PVs can “silently” circulate in the human population for a long time without clinical manifestations of PM, which, with inadequate epidemiological surveillance can lead to the return of PM. The reintroduction of both wild PV and Sabin strains can occur from institutions that preserve / work with PV. The source of VDPV can be people with primary immunodeficiencies, which continuously excrete PV. It is necessary to maintain surveillance over the PM, expand additional types of surveillance for the PV, strict containment of all PVs. The only way to maintain collective immunity is immunization with trivalent IPV. The current global shortage of IPV poses a significant threat to the world’s epidemiological well-being. The solution to the problem is the development of a new generation of safe and effective vaccines, improving the ways of introducing IPV, developing antiviral drugs.

Gambaran Cakupan Imunisasi Inactivated Polio Vaccine (IPV) Berdasarkan Faktor Indeks Dan Kipi Bagi Bayi Dan Balita Di Upt Puskesmas Pagarsih Kota Bandung

Immunization is the immune system that can prevent the disease one of them polio. Polio is a disease caused by a virus that can cause paralysis. Polio eradication is a change in the use of OPV to lPV because OPV is a virus that is attenuated by way of oral whereas IPV virus is switched off by injection. The official incidence of polio cases in the world is 350,000 cases. The coverage of Inactivated Polio Vaccine (IPV) PIN in 2017 in Indonesia should reach 75%, unfortunately this coverage still has not met the target due to many factors that affect the index and KIPI factors. The aim of this research is to find out IPV Immunization Coverage Scenario based on Index Factor and KIPI for Infants and Toddlers at UPT Puskesmas Pagarsih Bandung period January-April 2017. Type of descriptive research, univariate analysis, population 67 people, sample 67 respondents, and determined by total sampling. Results of coverage of 26.5% IPV immunization, 1.9 vial usage index, and KIPI have 5 (7.5%) infants and toddlers with local reactions. Suggestion for service institution as health worker is expected to do management in effort of prevention of polio disease for infant and toddler using immunization socialization.

Isolation of Sabin-like Polioviruses from Sewage in Poland.

As a complement to the active search for cases of acute flaccid paralysis, environmental sampling was conducted from January to December 2011, to test for any putative polio revertants and recombinants in sewage. A total of 165 environmental samples were obtained and analyzed for the presence of polioviruses by use of cell culture (L20B, RD and Caco-2) followed by neutralization and reverse-transcription polymerase chain reaction. Out of the 31 CPE positive samples, 26 contained one and 5 two different serotypes, yielding a total of 36 PVs. The microneutralization test revealed the presence of 7, 10 and 19 strains belonging to poliovirus serotype 1, 2 and 3, respectively. The genomic variability of 36 poliovirus strains was examined by the restriction fragment length polymorphism assay (RFLP). By combined analyses of two distant, polymorphic segments of the viral genome, one situated in the capsid protein VP1 coding region and the other in the 3D-polymerase coding region, we screened for the putative poliovirus revertants and recombinants. All detected PVs were classified as vaccine strains on the basis of RFLP-VP1 test. None of wild-type PVs or vaccine derived polioviruses were detected. RFLP assay also revealed the presence of 11 recombinants in 3D-polymerase coding region. Nine isolates appeared to be S3/S2, one S3/S1 and S1/S2 recombinant in analyzed 3Dpol region. This study revealed, through environmental monitoring, the introduction of SL PVs into the population associated with the routine use of OPV in Poland before the April 2016. Our findings demonstrate the usefulness of environmental surveillance in the overall polio eradication program.

Vaccine-associated paralytic poliomyelitis in Russian Federation during the period of changes in vaccination schedule (2006-2013 y.y.)

The results of virologic testing of clinical materials and epidemiological analysis of vaccine-associated paralytic poliomyelitis (VAPP) cases obtained in 2006-2013 during AFP surveillance are presented. Among the 2976 cases of AFP 30 cases were vapp. 15 cases were observed in OPV recipients, whereas 15 cases were observed in non-vaccinated contacts. The age of the patients varied from 4 months to 5.5 years (13.6 ± 12.4 months old). Children younger than 1 year constituted 63.3% of the group; boys were dominant (73.3%); 53.3% of children were vaccinated with OPV; the time period between receipt of OPV and onset of palsy was from 2 to 32 days (18.7 ± 8.2). Lower paraparesis was documented in 48.3% of patients; lower monoparesis, in 37.9%; upper monoparesis, in 6.9%; tetraparesis with bulbar syndrome, in 6%. the majority of the patients (85.7%) had an unfavorable premorbid status. The violations of the humoral immunity were found in 73.9% cases: CVID (52.9%), hypogammaglobulinemia (41.2%), selective IgA deficiency (5.9%). In 70.6% cases damage to humoral immunity was combined with poor premorbid status. The most frequently observed (76%, p 0.05) represented the single type of poliovirus – type 2 (44%) and type 3 (32%). All strains were of the vaccine origin, the divergence from the homotypic Sabin strains fell within the region of the gene encoding VP1 protein, which did not exceed 0.5% of nucleotide substitutions except vaccine derived poliovirus type 2 – multiple recombinant (type 2 / type 3 / type 2 / type 1) with the degree of the divergence of 1.44% isolated from 6-month old unvaccinated child (RUS-08063034001). The frequency of the VAPP cases was a total of 1 case per 3.4 million doses of distributed OPV in 2006-2013; 2.2 cases per 1 million of newborns were observed. This frequency decreased after the introduction of the sequential scheme of vaccination (ipv, Opv) in 2008-2013 as compared with the period of exclusive use of OPV in 2006-2007: 1 case per 4.9 million doses, 1.4 cases per 1 million newborns and 1 case per 1.9 million doses, 4.9 cases per 1 million newborns, respectively.

Vacunas antipoliomieliticas, erradicación y posterradicación

Vaccination against polio generates herd immunity (both with the attenuated (OPV) and inactivated (IPV) vaccines) and this will allow the eradication of the disease. The OPV vaccine produces 2-4 polio cases per cohort of one million children and therefore IPV is used in countries that can afford its cost (about 15 times more expensive than OPV). In 1988 the World Health Assembly established the polio eradication goal as "interruption of wild poliovirus transmission". If the elimination of wild poliovirus were achieved, the use of OPV will produce annually between 250 and 500 cases of polio in the world. From 1999, it was clear that eradication would require ending of immunization with OPV. On the 25th of January, 2013 it is approved the plan for the eradication and containment of all polioviruses, wild or not, so that no child suffers paralytic poliomyelitis. The most important landmarks include the lack of wild polio cases after 2014, the introduction of at least one dose of IPV in all immunization programs and to cease the type 2 OPV vaccination by the end of 2016 and to stop the use of the oral bivalent vaccine in 2019. To achieve all this, a complex scientific work and economic solidarity will be required.

Polio controling Nigeria and other developing countries: A systematic review/meta-analysi of literature on the use of combined OPV & IPV measure as against OPV only

Polio controling Nigeria and other developing countries: A systematic review/meta-analysi of literature on the use of combined OPV & IPV measure as against OPV only

Poliomyelitis prevention in the United States: new recommendations for routine childhood vaccination place greater reliance on inactivated poliovirus vaccine.

Until worldwide eradication of poliomyelitis is achieved, vaccination with poliovirus vaccines is the only means for providing population and individual immunity to polioviruses. The ACIP, AAP, and AAFP support the global poliomyelitis eradication initiative, and have recommended a transition policy that will increase use of IPV and decrease use of OPV during the next 3 to 5 years.

Vaccination against poliomyelitis: present possibilities and future prospects.

As long as the World Health Organization continues to report that more than 250,000 cases of paralytic poliomyelitis occur annually in developing countries, the United States must be prepared for periodic exposures to wild virus.' Until poliomyelitis is brought under control throughout the world, it behooves us to maintain a high level of vaccine-induced immunity. Hinman and his colleagues from the federal Centers for Disease Control, in the first paper in this series,2 document how well this has been achieved in the nation through the widespread use of OPV. From more than 20,000 cases of paralytic poliomyelitis in 1952, we now have a situation where endogenous wild poliovirus seems to have disappeared from the United States; and when the few imported cases are considered, there is virtually no spread of virus from them. Unfortunately, OPV, like other vaccines, is not perfect, although it is more nearly perfect than most. About five or six vaccine-associated cases now occur per year. Over the past 15 years more cases have occurred in contacts, particularly household contacts, than in the vaccinees. This is not surprising since it was known even before licensing that the virus excreted by vaccinated children was less attenuated than the vaccine itself, having regained some neurovirulence in monkey tests.3 At that time, some recommended that families be vaccinated as units, to avoid exposing susceptibles to mutated virus from the vaccinee. Had that been done, contact cases would have been avoided. The issues raised by the foregoing Hinman/Salk papers2'4 hinge on the possible shift in immunization policy from OPV to IPV. One of the public health axioms on which I was brought up is that if a large-scale program is working wellsuch as reducing the burden of paralytic polio from 20,000 cases per year to less than 10 per year-it should not be tinkered with unless we are certain that the resultant effect will be an improvement. Ifwe had used IPV, it is doubtful that we would have been as successful as the Dutch and the Scandinavians-and even those homogenous populations with their excellent vaccine coverage have had some outbreaks during recent years which, if extrapolated to our large population, would have meant many hundreds of paralytic cases and over a million carriers of wild virus. There is reason to consider a properly timed combination of both IPV and OPV. Such a program would not have any possibility of raising the risk of OPV-associated poliomyelitis and indeed may eliminate cases altogether. Combined IPV/OPV vaccine regimens have proven successful in the tropics where the local population had been subjected to regular and high importation of virus from neighboring countries, resulting in frequent wild virus challenge very early in infancy5'6 In such environments, the killed poliovac-

Rationale for the sequential use of inactivated poliovirus vaccine and live attenuated poliovirus vaccine for routine poliomyelitis immunization in the United States.

Despite the concerns mentioned in the last section, there are many reasons to believe that a polio immunization schedule that incorporates sequential doses of inactivated poliovirus vaccine and live attenuated poliovirus vaccine would provide both humoral and intestinal immunity to the fully immunized person that is at least as good, if not better, than the immunity achieved by the use of IPV or OPV alone. A substantial degree of protection should also extend to partially immunized and unimmunized preschool aged children in the community. Furthermore most of the cases of OPV-associated paralytic poliomyelitis could be prevented. Because the reasons for these beliefs are based on data from small studies and on inferences from related research, specific recommendations for a change from current polio immunization policy must depend on additional clinical research. Well-designed trials comparing several different options for sequencing both inactivated and live vaccines are needed, and these studies should focus carefully on both humoral and intestinal immunity conferred by the various vaccine schedules.

Current poliovirus vaccines.

Most of the poliovirus vaccine distributed in the United States since 1962 has been of the live, oral type ( OPV ). Production problems have not been a major concern for the manufacturer. The statistics compiled by various authorities since the product was introduced relative to paralytic disease following the administration of OPV are discussed and recommendations for the use of OPV are cited.