title: Nucleotide variation in Sabin type 2 poliovirus from an immunodeficient patient with poliomyelitis.
abstract: The molecular and antigenic properties of a Sabin-like type 2 poliovirus, isolated from the stool samples of a 2-year-old agammaglobulinaemic child who developed paralysis 1 year after receiving the third dose of oral poliovirus vaccine, were analysed. The virus revealed 0.88 % genome variation in the VP1 region compared with the standard reference strain, compatible with replication of the virus in the intestine over approximately 1 year. The typical mutations in the 5'NCR and VP1 associated with reversion to neurovirulence for Sabin type 2 poliovirus were found. Despite this, the virus was characterized by both PCR and ELISA tests as Sabin-like and showed temperature sensitivity and neurovirulence in transgenic mice typical of the Sabin type 2 vaccine strain. Gammaglobulin replacement therapy led rapidly to virus clearance, which, when combined with treatment with the antiviral drug pleconaril, stopped virus excretion; no further virus shedding occurred. This is the first case of poliomyelitis and long-term excretion from an immunodeficient patient to be reported in Italy through the active 'Acute Flaccid Paralysis' surveillance system.
authors.affiliation: Laboratory of Virology, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Buttinelli
authors.affiliation: Laboratory of Virology, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Donati
authors.affiliation: Laboratory of Virology, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Fiore
authors.affiliation: Laboratory of Virology, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
authors.forename: Jill
authors.initials: J
authors.lastname: Marturano
authors.affiliation: Department of Pediatrics, University of Brescia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Plebani
authors.affiliation: Pediatrics Unit, University of Siena, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Balestri
authors.affiliation: Department of Pediatrics, University of Brescia, Italy.
authors.forename: Anna Rosa
authors.initials: AR
authors.lastname: Soresina
authors.affiliation: Pediatrics Unit, University of Siena, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Vivarelli
authors.affiliation: Epidemiologie Moleculaire des Enterovirus, Institut Pasteur, Paris, France.
authors.forename: Francis
authors.initials: F
authors.lastname: Delpeyroux
authors.affiliation: NIBSC, Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN6 3QG, UK.
authors.forename: Javier
authors.initials: J
authors.lastname: Martin
authors.affiliation: Laboratory of Virology, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Fiore
mesh_terms: D020121:5' Untranslated Regions / Q000235:genetics; D000361:Agammaglobulinemia / Q000821:virology*; D019943:Amino Acid Substitution; D000818:Animals; D036022:Capsid Proteins / Q000235:genetics; D002675:Child, Preschool; D005243:Feces / Q000821:virology; D014644:Genetic Variation; D006801:Humans; D051379:Mice; D008969:Molecular Sequence Data; D011051:Poliomyelitis / Q000821:virology*; D017955:Poliovirus / Q000145:classification / Q000235:genetics / Q000472:pathogenicity*; D011055:Poliovirus Vaccine, Oral / Q000235:genetics*; D017422:Sequence Analysis, DNA; D014613:Vaccines, Attenuated / Q000235:genetics; D014774:Virulence
chemical_list: D020121:5' Untranslated Regions; D036022:Capsid Proteins; D011055:Poliovirus Vaccine, Oral; C442540:VP1 protein, Poliovirus; D014613:Vaccines, Attenuated